10 February 2020

Survey lays bare issues with medical training culture

AHPRA Education Mental Health RACGP

The first national survey of medical trainees has confirmed that bullying, harassment and overwork are still major problems – but that the overall quality of training is high.

In the national survey of around 10,000 doctors in training, 33% reported experiencing or witnessing bullying, harassment or discrimination.

The Medical Training Survey was conducted last year and was developed by the Medical Board of Australia and AHPRA, in partnership with stakeholders such as the RACGP.

Around one in five (21%) junior doctors said they did not have a good work-life balance and half of all doctors in training rated their workload as “heavy” or “very heavy”.

The average working week was 47 hours long. But a small proportion of doctors in training worked extremely long hours; 6% of junior doctors worked 60 to 69 hours per week, and 7% worked more than 70 hours per week.

Around half of doctors in training reported “never” or only “sometimes” being paid for unrostered overtime.

Despite the drawbacks, more than three-quarters of junior doctors said they would recommend their training program to other doctors, and 94% said they planned to continue in their current specialty training program. And nine out of 10 junior doctors said their senior medical staff were supportive.

Of the 18% of the junior doctors surveyed who were currently working in general practice, most said the training program from their college was relevant to their development and they understood what they needed to do to meet training program requirements.

However, some GP registrars seemed unsure about how to access mental health support services from their college.

“When asked whether the RACGP provides access to psychological and mental health support services ,just 38% said that they agree or strongly agreed – we need to significantly improve that figure,” RACGP president Dr Harry Nespolon said.

And much more needed to be done to stamp out bullying and discrimination, Dr Nespolon said.

“The bottom line is that bullying, discrimination and harassment don’t belong in any workplace,” he said.

Dr Tessa Kennedy, the chair of the AMA’s Council of doctors in training, said the issues raised by the survey were unsurprising.

“We have been hoping this survey would happen for a long time so we could get a comprehensive look at the issues,” she said. “The scale of the survey lends credence to the work we are doing around reducing work hours and bulling and harassment.”

Long working hours were known to be correlated with poorer mental health outcomes, she said, and uncertainty around whether trainees would get specialty positions increased their vulnerability to poorer working conditions.

“The fact that the Medical Board has committed to doing the survey every year means there’s a strong mandate to address these issues,” Dr Kennedy said. “We can use it to monitor our success.”

Daniel Zou, the president of the Australian Medical Students Association, said there were some positives in the survey, such as the fact that 47% of doctors in training were interested in rural practice, and 48% were interested in Indigenous healthcare.

But the culture of harassment and bulling was “something that definitely needs to change”, he said.

“Sexual harassment, bullying, and discrimination of any sorts is unacceptable in the workplace,” Dr Zou said. “And there need to be changes. We need to cultivate a culture where there’s respect towards everybody.”

Dr Anne Tonkin, the Medical Board of Australia Chair, said the survey revealed that most doctors in training had a proper curriculum and a proper supervisor and the great majority were very happy with their training.

The issues around workload, and bullying and harassment were concerning but not surprising, she said.

Dr Tonkin said that when she trained as a clinical pharmacologist back in the “bad old days” she experienced the same kinds of issues.

“There is a culture within medicine, or there has been in the past, where some people think that getting cranky with someone is a good way to teach them,” she said.

There was also a culture of pressuring doctors in the junior ranks to not claim overtime by connecting willingness to do unpaid work to dedication and eagerness, she said.

The Medical Board and AHPRA did not provide medical training, and therefore would not step in to regulate training programs, she said.

“We shouldn’t interfere, and we won’t,” Dr Tonkin said.

The Medical Training Survey data could be “sliced and diced” down to the state and college level using an online dashboard, she said.

If the training colleges found a concerning result within the survey data, it was “their responsibility to do what’s necessary to fix it”, Dr Tonkin said.

View the full report here and the dashboard here.