Our Expert Evidence: 2600 doctors speak out

This week, the Commission heard evidence from Dr Sarah Wise, Senior Lecturer at the UTS School of Public Health, whose report was tendered and examined during proceedings. Members may recall that Dr Wise led the ASMOF Award Arbitration Survey last year examining doctors’ working conditions across NSW Health.

Her evidence focused on the survey findings and what they reveal about workload, working hours, retention pressures, and how the nature and value of doctors’ work in NSW Health have changed.

The survey received more than 2,600 responses, making it the largest survey of ASMOF members ever undertaken and providing one of the most comprehensive snapshots of the current medical workforce in NSW Health.

Read on for a full summary of the evidence presented.

What the Survey Examined

The survey explored how the nature and value of doctors’ work in NSW Health have changed and identified systemic issues impacting retention.

The survey findings were presented in a report produced by Dr Wise, which also examined the causes of doctors’ excessive hours and heavy workloads. In particular:

Increased patient complexity and demand for hospital services

System capacity constraints, reflected in emergency department throughput and average length of stay for admitted patients

Medical workforce pressures, including workforce shortages and the growing reliance on locums and VMOs

Changes to the nature of work, with increasing clinical and technological complexity driving demand for more highly specialised practitioners

Dr Sarah Wise

Senior Lecturer, UTS

Dr Wise’s evidence demonstrated the practical impacts of these pressures on NSW doctors, as reflected in the survey findings.

👉 Read her full report here

Survey Key Findings

Excessive hours are widespread

One-third of full-time doctors were working 55 hours or more per week, exceeding the threshold often identified as harmful to health.

On average, part-time doctors employed at less than 0.5 FTE were working at 1.5 times their contracted hours.

Doctors were often experiencing unpredictable work schedules.

Workloads are unmanageable

Only 16% of survey respondents found their workload manageable.

Doctors reported patient volume and complexity as key drivers of workload.

Almost 90% of respondents reported their administrative workload had increased in the past 2-3 years, with new digital systems and reduced administrative support shifting responsibility onto clinicians.

Doctors in Training cited concerns about clinical supervision, with a mere 18% saying they often or always received good clinical support. After-hours periods were highlighted as particularly unsafe with respect to the level of responsibility required of DiTs.

Three-quarters of DiTs reported that they regularly made decisions or performed tasks beyond their scope of practice.

Impacts of working conditions

Health and wellbeing: Almost two-thirds said their hours negatively affected their health and wellbeing; 69% had worked while sick or injured due to staffing pressures, and one-third had taken sick leave due to stress. Burnout and fatigue were widespread.

Work-life balance: Most respondents reported poor work-life balance, and concerns were raised about the impact of work on family and relationships.

Access to leave: Almost 60% experienced difficulty accessing annual or long service leave, citing refusals, cancellations, or the need to arrange their own cover. Nearly two-thirds faced challenges taking TESL or study leave.

A Growing Retention Risk

The survey indicates that a significant proportion of doctors have contemplated resignation or reducing their hours. Doctors repeatedly stated that their willingness to remain in the NSW public health system was being eroded by poor working conditions, unsafe workloads, and the lack of parity with other states and industries. Many described the situation as unsustainable, with some having already reduced their hours and others seriously considering leaving.

Around 38% of Doctors in Training who responded had considered moving interstate or overseas, while senior doctors were more likely to consider a move to private practice or leaving clinical roles altogether.

Doctors identified several factors that might encourage them to remain in their current roles:

Competitive salary and benefits

Fair compensation for on-call work (senior doctors)

Improved rostering and working hours (Doctors in Training)

Improved staffing and workload management

Summary

Dr Wise’s report concludes that NSW’s medical workforce is under considerable strain due to growing service demand, increased complexity of care, and persistent understaffing, with current systems failing to adequately support staff in these conditions.

To address retention issues, Dr Wise recommends reviewing salary structures to better compensate the intensity, scope, and value of the work being performed by doctors in NSW. Additionally, she recommends rostering, staffing, supervision, and workload management reforms to ensure long-term sustainability.

We’ll provide a full recap of this week’s proceedings next week.

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