Who gets a seat at the table?

I’m watching the three day doctor strike in NSW unfold, like most of us, via the media. I’m tuning in to the demands of the junior and senior medical staff alike, reading the placards, some containing very emotive language about the plight of doctors underpinning this rare and extreme industrial action.

I have had numerous roles in advocacy and doctor’s industrial relations over the years, and aware how much is at stake when doctors strike. I know it should always be an absolute last resort, because of the damage done to our goodwill when we do so, and that the health system relies so heavily on us that any action can have direct consequences of patients health outcomes.

Leading up to and during the COVID-19 pandemic, I ran a private psychiatric clinic exclusively for doctors, and it was at capacity as a result of numerous issues, including the impacts of harsh working conditions, exam stress and burnout on our medical workforce. I left clinical psychiatry after being assaulted by a patient when trying to work on a public psychiatry ward that was barely resourced and overcrowded. When I read the placards and hear the doctors accounts as part of this industrial action it reminds me of my time as a doctor in clinical medicine.

And it really hurts.

Despite this though, I am confused as to the approach taken by ASMOF to run two industrial campaigns at the same time. As a psychiatrist, I am very concerned that the impact of this has been to delay the already protracted campaign commenced by my NSW psychiatry colleagues in 2024. I am not a member of ASMOF and so I can only search articles and media grabs for information, which has been largely repetitive and unhelpful. I have gathered though that talks between the NSW Government and ASMOF in the Industrial Relations Commission were already stalled awaiting further economic information, and then a decision was made to halt talks for my psychiatry colleagues because of further industrial action for all junior and senior doctors employed by NSW Health.

As emotive and as passionate a dispute can be, and this one certainly is that, it is crucial that both sides follow due process and not impact on their efforts for resolution. Unfortunately, this three day strike action has been seen to have occurred in direct disregard for the orders of Acting Justice Peter Kite’s to cease organising and refrain from any industrial action for three months. By choosing to ask all junior and senior doctors employed by NSW Health to strike has been to the detriment of existing proceedings in the IR Commission for NSW Public sector psychiatrists.

What we now have in NSW is two industrial actions, that have blended into each other, diluting the message and impacting on the outcome of each other. ASMOF is fighting for a 30% pay rise in one year for all junior and senior doctors employed by NSW Health at the same time it is fighting for a 25% pay rise over three years for doctors employed by NSW Health in the specialty of psychiatry . This is in the context of already losing valuable psychiatrists who resigned en masse a few months ago.

The actions of ASMOF, from what I can gather, has given the State Government and the Industrial Relations Commission a very legitimate reason to refuse to come back to the table in good faith, and solve both disputes for the benefit of all concerned.

I am aware that the doctors striking are doing this because they believe that this is for the greater good. I’m old enough now to know the issues they are striking for and the messages on their placards are decades old too — some systemic issues no governing body or professional organisation has ever been able to resolve. I’m going to refrain from “in my day” language as it is unhelpful and demeaning, but we have always been a profession that accepts unacceptable working conditions, despite knowing they are unsafe. We have always worked ridiculously long hours despite public awareness campaigns, and we have always propped up health systems, not just in NSW but in every aspect of the health care system in Australia. Governments in all states have abused this, as have hospital boards and executives as they run public health organisations on ever dwindling budgets.

This latest strike has meant we have lost the message of why psychiatrists in particular were taking the actions that they have. I remain especially concerned for the predicament of our trainee psychiatrists in NSW, many who have worked without direct supervision for over two months now. They have absolutely no voice and face having a whole term unaccredited as they cannot satisfy the requirements of the term, through no fault of their own. They have been cajoled along to believe that the dispute between the NSW psychiatrists and the State Government would resolve within weeks of starting the rotation. Some will have already worked on call shifts without adequate support or supervision and are probably wondering about their career next steps.

It’s also disappointing to see this industrial action descend into abuse of NSW Health staff by doctors, regardless of how they are considered. I would be horrified if people published insults about me similar to what I have seen in the media, regardless of how crucial it is to stand up for doctors rights and entitlements. I recognise that the world we live in seems to tolerate abuse of others that we don’t really know, but nevertheless the message could be better displayed than resorting to personal attacks and abusive comments.

I don’t see an end in sight to all of this, the NSW Government seems to be holding out during these three days of industrial action and has said repeatedly they cannot meet the demands for the pay rises that ASMOF are seeking for their members. I feel it is unlikely that talks will begin smoothly again for NSW psychiatrists at the end of this week. I don’t understand the tactics but I am left wondering who will be invited to the table to sort out this mess involving my profession, my psychiatry colleagues and the mental health system we are all in agreement about that desperately needs to be overhauled.