For the sake of the crumbling healthcare system, the Minns government should come to an agreement that considers what will happen if it doubles down on its current refusal.
Last week there occurred something that most of us who’ve been doctors for a while would never have expected to see: doctors from public hospitals across Sydney went on a three-day strike after months of fruitless negotiations with the NSW government around wages, which have been frozen some 12 years.
The doctors were finally advised by their union to strike and are asking for a 30% wage increase. For reference, inflation during that time is 34% so what they’re asking for is still below standard.
Yet the Minns government refused, offering a raise below inflation instead.
The last time doctors went on strike was in 1998. It is all but unheard of.
In all my years as a junior doctor in the public hospital system, I’d never heard of a doctors’ union. Unlike nurses and teachers, who have powerful and outspoken unions, for doctors it was simply not “done”.
Why?
For one thing, the ordeal of getting into medicine often means we don’t want to jeopardise it by appearing to be difficult. Junior doctors seen as difficult are often quietly replaced and miss out on coveted spots in speciality training.
For another, we are regularly given the message to “shut up and put up” and to be grateful to be chosen for a life of sexual harassment and horrible working conditions – like the 36-hour shifts that were the norm not long ago.
My private practice patient list includes 25% doctors and other healthcare professionals, many of whom are NSW public servants, so I’ve had a front-row seat to their ongoing challenges over the past year or so.
Last week, following the strike, I saw several trainees and staff specialists who’d taken part in the strike, and who were hopeful of change and proud of having stood up for themselves, even though there is no resolution forthcoming.
There are many parallels with the feelings in general practice over the past 12 years since patient Medicare rebates were first frozen in 2013, remaining effectively frozen ever since.
As GPs we were expected to simply continue showing up to work with less and less remuneration and recognition and more and more red tape.
My patients who are staff specialists in hospitals are salaried with a base wage irrespective of whether they work their allocated hours or twice as many. If they go in after hours to check on patients, they’re doing that for free. There is no overtime, no Sunday or public holiday leave. Nothing.
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They have told me of an exodus to other states where trainee doctors are earning more money than staff specialists in NSW hospitals.
My daughter is a first-year nursing student, and from week 1, I was hearing from her about the presence of the nurses’ union. They all joined for free on their first week of university. I hear regularly from her about safe nurse:patient ratios and safe working hours.
While nurses may still require more in order to be safe at work and paid adequately, they’re still miles ahead of us doctors who are simply quiet due to the very real risk of being not chosen or replaced if we speak up too much. In general practice we have made do with less and less to continue to provide our patients with good care, until we simply could not.
To this day, it is not that we don’t want to, it is that we face the choice of burnout, leaving the speciality or having our practices close because we are running at a loss on every front, including financially.
It has brought home to me, quite clearly, that humans are, by nature, exploitative.
We are often OK with others suffering as long as we get a good deal, even when we say we aren’t. We can make up stories about how they’re better off than us, or deserve it in some way. By “othering” them we make it easier for us to continue to exploit them without feeling bad for doing so.
It has been this way for a dozen years both with the NSW government and with general practice.
If we don’t say enough, stop, people will continue to expect we will simply say yes.
Many of us do because we are people pleasers who’ve never learnt to say no or been taught effective boundaries.
Others will say yes because we are invested in our image as someone who helps and serves even at cost to ourselves.
It needn’t be this way.
We can say no. We can walk away. Failure of the government to provide adequate and timely care to patients should not be our personal problem.
I was reminded of this when I had a patient ask for a discount who’d referred a relative to see me also. I was caught off guard and said yes. I have since been mulling.
That discounted fee doesn’t meet the ongoing costs of running my business. It doesn’t meet the fixed overheads and expenses. It doesn’t reflect the rising indemnity fees I pay nor the rising cost of consumables.
Obviously, I want my patients to get results and a referral at the end of the day means a happy patient. But that discount fee is no longer a reflection of what my service costs in 2025 and it is important that I don’t say yes and shortchange myself. This is how it begins.
I’m sure the NSW staff, when advised of the wage cap 12 years ago, couldn’t foresee everything that was to come including inflation, covid and rising costs of living.
I’m sure when GPs were bulk billing everyone because the patient rebate was adequate, they didn’t predict the government would simply freeze the rebate and patients who’d been trained to need only their Medicare card would be angry.
Our actions and choices have consequences long after we make them. Unfortunately, we are usually doctors first and business people second and this is how we end up being taken advantage of by others.
It’s OK to want to be remunerated adequately and at least in line with inflation and rising cost of living.
For the sake of the crumbling healthcare system, I hope the Minns government will come to an agreement that considers what will happen if it doubles down on its current refusal.
Our healthcare system is already a mess and only set to get worse with loss of doctors.
Nurses, NPs and pharmacists are also overworked and most of them are not adequate substitutes for the expertise and skills that only medicine and speciality training provide.
Dr Imaan Joshi is a Sydney GP; she tweets @imaanjoshi.
