Overworked and underpaid. Are exhausted junior doctors putting patients at risk, writes JOANNE HUNT
IMAGINE WORKING from 8am until 8am the next morning. Then instead of going home for some shut eye, you are expected to continue on until 6pm. Now imagine not getting paid for it – welcome to life as a junior doctor.
“It’s extremely frustrating and it’s very demoralising,” according to Dermot Bowden, a surgical senior house officer (SHO) at Waterford Regional Hospital.
“You’re giving a considerable commitment to your job but as a group, you are being singled out for cost cutting. I find that hard to swallow.”
Bowden is just one of thousands of junior doctors in hospitals around the State whose free labour cash-strapped hospital management teams rely on to get things done. Payment for their hours seems to be at the whim of management.
“What they say they won’t pay you for is ‘un-rostered overtime’ – that essentially means the hospital picks a set of hours each day that it says are rostered,” he explains.
“In this hospital, they consider 8am to 4pm to be the rostered hours. I can count on zero hands the times I’ve come out of a hospital at 4pm. Regularly, you’re there until 7pm. If you’re an intern, it will be 8pm or 9pm getting blood tests for the next day or getting X-rays organised.”
Then there is the on-call time. “We do what is known as 24-hour call – that means you come in at about 7.30am and you’re working until the following evening, whenever you go home, so in reality, it’s a 30-plus hour call.”
He says, as with many hospitals, getting paid for such overtime in Waterford requires filling in timesheets, then submitting them to the medical manpower department. Bowden’s first day in Waterford was a wake-up call.
“I went down there to get the forms and a lady very politely said, ‘You know they are not paying you guys for any of this stuff?’”
While he loves the work, describing Waterford as an “excellent” training post, he likens payday to “a roulette game”.
“You’ve no idea what they might pay you for. We assume they pay your basic salary but I’ve literally no clue what else they might pay me. I just don’t know.”
He says apart from the “casual disregard” the system has for junior doctors’ rights, the punishing hours are putting patients at risk.
“Somebody is going to get something wrong that they wouldn’t have otherwise because they are exhausted.”
He says while there are senior colleagues to consult with on serious issues while on call, and he praises his consultant boss who tries to minimise overtime, things can and do get muddled.
“You’re just trying to fill out something like a drug card or an X-ray request and everything is much more laborious . . . you fill out a form and it comes back saying you didn’t sign this. If you take it that we have thousands of doctors in the country doing these kind of hours, surely there has to be risk there.”
Tallaght hospital SHO Niall Feeney is on a similar grind. Of his on-call duty last week, working from 8am Monday morning until Tuesday evening, he slept for one hour. He was expected back on the wards again at 8am on Wednesday.
“You’re pretty exhausted . . . sometimes you’re too tired to even get out of your scrubs. I’ve heard of people drifting into the wrong lane while driving home,” says Feeney.
“Sometimes you’re so tired, you can’t concentrate on what you are prescribing or ordering.”
Unlike the time-sheet system in Waterford, a clock-in system in Tallaght should make payment transparent – except it doesn’t.
Feeney himself isn’t entirely sure for which hours he gets paid
“I clock in so they should have a record of everything I’ve done . . . but you don’t get paid all those hours, you have to get them signed off by your consultant . . . I’m not entirely sure, but I don’t think you get paid for the day after your call, I know in the case of interns, they are definitely not paid for the day after call.”
He says while at Tallaght, he probably gets paid for 70-80 per cent of his hours, it’s a battle.
“I think your contract says you’re not allowed to be rostered for anything more than a 24-hour shift but in reality, everyone from intern upwards has to stay the day after [call] so you will always exceed that.
“You will always break your contract.”
Would the hospital be able to function if junior doctors worked only their contracted hours?
“No, it would probably shut down,” says Feeney.
For Damien Ferguson, an SHO at St James’s Hospital, the system is different again.
That hospital pays all rostered overtime: “If I’m rostered to be on call overnight, I’ll get paid for that, but you don’t get paid for un-rostered overtime,” Ferguson says.
Having just finished a surgical rotation in gynaecology, he had a quota of 10 hours un-rostered overtime a week for which he would get paid, on top of his 39-hour working week.
But with a typical day running from 7am-7pm, he was exceeding his quota in just two days.
“You feel like you are being taken for a fool,” he says. “You are getting no thanks for it and you feel like you are being taken for a ride.”
Email queries to hospital management are met with a line on “hospital policy”.
“They say it’s up to you and your team to make sure you’re not exceeding your quota, but that’s impossible . . . someone could be on annual leave or study leave.
“The hospital never provides cover and they don’t see that it’s up to them to provide cover. It’s like it’s our fault for working overtime.”
Does he think hospitals could function if junior doctors worked only the hours for which they are paid?
“The whole system would come to a halt, nothing would happen. Surgery in Ireland and cancer services, they just wouldn’t survive.”
Colm Keane is an anaesthetic SHO at University College Hospital Galway. While he hasn’t started call duty yet, he works up to 15 un-rostered hours a week, payment for which is at the discretion of the medical manpower department.
He talks of one example of tending to two very sick patients until 11pm, well after his shift officially ended.
“I’ve emails back from medical manpower saying, ‘why were you in when you weren’t supposed to be?’”
While he says at the moment he “usually” gets paid for all his hours, payment for overtime lags six weeks behind, making it more difficult for junior doctors to keep on top of their hours or query payments.
He says payment for overtime will become less likely as the year goes on.
“By about October, when they realise they are going to run out of money, they will send an email saying people will only get paid for rostered hours.”
Could the system survive if junior doctors worked only the hours for which they were paid?
“No, definitely not,” says Keane.
“You justify it to yourself saying it’s the patients you are trying to sort out, not the HSE, so you just stay in and do it . . . but if everyone was just to do their hours, the hospitals would fall apart. It’s as simple as that.”
“You justify it to yourself saying it’s the patients you are trying to sort out, not the HSE, so you just stay in and do it . . . but if everyone was just to do their hours, the hospitals would fall apart