Membership of a new junior doctors’ union has grown 25 per cent after negotiating a new pay and roster deal that is safe and based on guidelines, argues the union’s chair Heath Lash.

The new Specialty Trainees of New Zealand (SToNZ) union was formed earlier this year by a small group of largely surgical registrars concerned that the new safer working hour rosters negotiated by the established New Zealand Resident Doctors’ Association (NZRDA) in 2017 had had ‘unintended consequences’ on specialist training.

Dr Deborah Powell, National Secretary of NZRDA which represents about 3500 of the country’s 4000 plus resident medical officers (RMOs), described the DHBs offer as a “massive step backwards” for patient safety and doctor wellbeing that would allow fatigued surgeons to operate on patients. NZRDA have been in negotiations with the 20 DHBs since March on the first agreement since striking in 2016-17 to gain the new roster rules that stop a junior doctor being rostered for more than 10 consecutive days or four consecutive nights

SToNZ members are now voting on a new collective agreement negotiated with the 20 district health boards that allows for junior doctors to work for a maximum of up to 12 consecutive days, with the aim of an average maximum working week of 60 hours per week.

Dr Deborah Powell, National Secretary of NZRDA which represents about 3500 of the country’s 4000 plus resident medical officers (RMOs), described the DHBs offer as a “massive step backwards” for patient safety and doctor wellbeing that would allow fatigued surgeons to operate on patients.

Health Lash, chair of SToNZ and a final year orthopaedic surgeon trainee, said the new multi-employer collective agreement (MECA) was safe, more flexible and based on evidence-based guidelines set by the bodies that accredited surgical and other specialty training. “We also have strategies in place to reduce fatigue and we are going to do more research into fatigue – so I think it is a very good contract, it is safe and it means that our junior doctors are well-trained.  And it’s a flexible rostering system which means we can be adaptive.”

Powell said allowing surgical registrars to go back to working 12 consecutive days in a row – including up to three 16-hour days – was going back to the “dark ages”.

In late August the SToNZ union had about 50 members but Lash said membership had now risen to over 100 with about 25 members joining since it released details of the MECA offer last Thursday.  Membership was now also spread over nearly all of the 20 DHBs with the majority being surgical trainees like himself or advanced vocational trainees (registrars) in other specialties.

Balancing training needs and fatigue

SToNZ was largely prompted by concerns that the RDA rosters’ required junior doctors working weekends to take two consecutive days off during the conventional working week when surgical and other specialty trainee registrars gained crucial elective surgery and outpatient clinic experience.

Lash has said while there is good research evidence supporting NZRDA’s roster limits on consecutive night shifts, there was not evidence to back the guidelines on consecutive days.

Powell said the SToNZ the  DHBs were endorsing the SToNZ MECA on the “misguided assumption that an unfounded risk to training trumps the health and safety of doctors”.

She said the DHBS were well aware of NZRDA survey data and concerns expressed by RDA members about missed or delayed diagnoses due to fatigue from working 12 days straight or 72 hours on call.

“Our 2016 survey of resident doctors indicated that more than 91% of us were worried fatigue had led us to make a clinical error,” said Powell. “It is only a matter of time before these fatigue related mistakes made by doctors on the unsafe rosters allowed because of this new agreement, end in serious harm.”

Lash said number one priority for SToNZ was always patients.  “And we think to have good care for patients you need to be well trained.”  He said this led to the second priority which was ensuring specialists continue to be well trained and the contract aimed to do this.

Voting on the new MECA is currently underway and will close at the end of the week.

Dr Peter Bramley, the chief executive of Nelson-Marlborough DHB and the 20 DHBs spokesperson said the proposed SToNZ MECA reinforced the importance of doctor training specified by the relevant medical colleges.

He said SToNZ represented mainly specialist trainees and the new agreement recognised the “need to balance the needs of the doctors who are learning, as well as the patients and the wider medical team”.

Bramley said implementing the new NZRDA roster system over the last year had helped everyone better understand the interplay between training, clinical safety and safe working hours.

“New Zealand has more than 4000 Resident Medical Officers or RMOs – ranging from 1st year graduates to doctors with 8-10 years’ experience about to qualify as specialist – this agreement recognises that variation in training needs,” said Bramley.

“We have been able to agree arrangements with SToNZ that have less impact on training and better outcomes for patients – most importantly, the work arrangements comply with guidelines of the medical colleges and the medical council.

SToNZ MECA

Hours

  • Maximum (max) of 72 hours in 7 days
  • Max of 144 hours in14 days
  • Max of 12 consecutive days worked
  • No more than two long days in seven
  • Working towards an average of 60 hours per week max, averaged over a 4-week period.
  • No more than four consecutive night shifts unless the RMO’s agree and there is regular opportunity for rest / sleep.

Other factors

  • A fatigue management clause and a commitment from both parties to undertake
  • research to provide an evidence-based model for fatigue management.
  • An “inbuilt increase” in salary bands to reflect average hours worked by SToNZ members, flexibility and only being paid for days they work.
  • Plus a 2.5% increase at settlement and a 3% increase in one year
  • A one-off lump sum payment of $2000
  • Ten days sick leave plus 10 extra discretionary sick days

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