The Specialty Trainees of New Zealand (SToNZ), which represents about 50 surgical trainees concerned about the impact of new ‘safer hour’ rosters, hopes next month to start negotiating a multi-employer collective agreement (MECA) with all 20 DHBs.

The Royal Australasian College of Surgeons says it shares its trainees concerns that the safer hour rosters currently being implemented at hospitals may significantly impact on training opportunities.

The new safer hours rosters were negotiated early last year by the established junior doctors’ union, the New Zealand Resident Doctors Association (NZRDA), following members taking strike action in 2016 and 2017 in support of safer and shorter working hours to reduce the risk of fatigue from long working weeks. NZRDA, which represents nearly 3500 resident doctors in DHBs and the community, is currently back in MECA negotiations with the DHBs and says it is disappointed at the arrival of the new union “whose primary focus is to avoid working safer hours”.

Heath Lash, chair of SToNZ and a final year orthopaedic surgeon trainee, said he agreed that doctors need safe working hours and a work-life balance but the NZRDA’s new rosters had “unintended consequences” on training and there was no evidence that it was safer for patients and staff than the old roster system.

In particular he was concerned that the rosters’ requirement for junior doctors working weekends have to take two consecutive days off during the conventional working week – when surgical and other specialty trainee registrars gain crucial elective surgery and outpatient clinic experience. For him that would have meant losing about 26 days of elective surgery a year – where he learned the ‘bread and butter’ everyday work like hip and knee surgery.

He was also concerned that taking time off mid-week would lead to more frequent patient handovers, which research showed increased the risk of errors and longer patient stays, and that the new rosters required more junior doctors to be found when there were already international shortages.

“Our main focus is that we want to protect our training,” said Lash. “We want to make sure that at the end of the day that New Zealand has well-trained medical and surgical specialists and to do that you need to be able to be at work Monday to Friday to get the experience to do so.”

Lash has been the trainee representative on the Royal Australasian College of Surgeons Trainees’ Association (RACSTA) since December 2016 for the about 150-160 surgical trainee registrars in DHBs across the country.

He said SToNZ had not been formed to be divisive but members were concerned at international evidence that showed when similar safer working hour rosters were introduced in the UK and the States they had led to a “dramatic dilution” in training opportunities with one Irish study finding that some specialties had a 50 per cent reduction in exposure to elective procedures. “Which is massive.”

Fatigued trainers “do not learn”, says RDA

Dr Courtney Brown, national president of NZRDA, said SToNZ was choosing to ignore the “irrefutable evidence directly linking fatigue with poor performance and error”.

“In stating that their actions are in the interests of training they are also ignoring the fact that fatigued trainees do not learn” she said.

Brown said NZRDA, was committed to excellent training as well as the health and wellbeing of members and quality care for patients.  “”However advancing our own interests, including getting through our training quicker, should never be put ahead of our patients right’s to safe care.”

She said SToNZ members were demonstrating an “outdated attitude” by putting their training ahead of safe patient care with fatigue a recognised risk under the Health and Safety at Work Act 2015.

“It will be a sad day if the safety of patients in surgery comes down to which union your doctor is a member of” said Brown.

Lash said personally he was close to finishing his training and thought it was beholden on people like himself to look after those following behind. “I have this deep need to make sure that I don’t leave the training programme worse than I found it. And I really worry that if I don’t do something we are going to have some big issues.”

He said there was good research evidence supporting the NZRDA’s new limit on consecutive night shifts.

“But everything else they’ve tried to institute – there is no evidence behind it,” he said.  “And until they can show me what we are doing is actually safer – for both patients and the doctors working the roster – then I’m going to use all the evidence I’ve found on safer working hours and try and negotiate rosters that have some evidence behind them and ensure doctors are well-trained”.

College concerned training opportunities may be missed

Richard Lander, the College of Surgeons’ Executive Director for Surgical Affairs in New Zealand, said the College did not get involved with employment issues of its trainees but if the RDA’s new roster was going to interfere with the quality and safety of training it was concerned.  “Some of the trainees that have gone off to form the new union are quite disturbed that it will interfere significantly with their training,” said Lander, himself an orthopaedic surgeon.

“As you can imagine there’s a lot happening during the working week – elective surgery, outpatient clinics and various multi-disclipinary meetings. And if they are excluded from being in the hospital during those time they will miss out on those opportunities that exist.”

He said it would be watching closely the impact of trainees signing up to the new roster to ensure they were not missing out significantly and they were also concerned about the welfare of trainees. “In the end we are training surgeons for the future – we want them to be safe and we want to reassure the public that we’re not compromising on standards for safety by shortening their exposure (to training).”

Lash said SToNZ about 50 members at present but there was a lot of interest from many different areas in medicine and people were waiting to see what the new union managed to negotiate.

Of the current more than 4000 resident medical officers (RMOs), or ‘junior doctors’ about 1500 are house officers (mostly recent medical school graduates) and 2500 are registrars which includes non-trainee registrars and specialty trainee registrars who have been selected for training programmes to become specialist physicians/consultants and surgeons.

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