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JMO Charter 2009

4. What Are My Rights? What to do if you have a problem

The groups working for you in WA

Postgraduate Medical Education Council of WA - Junior Medical Officer (JMO) Forum
Australian Medical Association of WA (AMAWA) - Doctors-in-Training (DIT) Committee
Medical Board of Western Australia
Department of Postgraduate Medicine (RPH, FH, SCGH)
RMO Societies (RPH, FH, SCGH)

PMCWA JMO Forum

The JMO Forum reports back to the Postgraduate Medical Council on matters relating to education and training for junior doctors. If you have an issue with your rotation or hospital, let your JMO Hospital representative know, or come along to the meeting yourself. New members are welcome at any time.

Previous issues that have been tackled by the JMO Forum include: inadequate numbers of doctors rostered on for after hours cover; pager-free protected teaching time; and appropriate rotations for junior doctors.

The JMO Committee meets every second month in the Nurses Conference Room at SCGH.

RMO Societies – FH, RPH, SCGH

For a small fortnightly fee that comes out of your pay, the RMO societies do a lot of work on the junior doctor’s behalf. This includes:

Liaising with Hospital Administration regarding issues such as leave, rostering etc. Talk to your RMO Society Representative if you are having problems with work – they may be able to help.
Providing social supports – (Milligans RPH, Blue Room Fremantle, Doctors Common Room SCGH)
Coffee machine, papers, morning tea

AMA DIT Committee

The AMA Doctors-in-Training (DiT) Committee is a group of doctors committed to advocating the professional and industrial aspects of working as a junior doctor in WA.

Who can join?
Membership of the committee is open to all junior doctors that are AMA members, from intern to senior registrar and includes a broad range of subspecialty and prevocational trainees.

What issues are discussed?
The committee has a broad spectrum of issues affecting the education, training, industrial and professional aspects of being a junior doctor. Some are tackled as they arise, such as hospital facilities for junior doctors being withdrawn without notice. Others are prospective initiatives, such as ensuring safe working hours for junior doctors and supporting a healthy work-life balance.

Key issues of 2008:

Finalisation and implementation of the new MHS (Metropolitan Health Services) Agreement for Junior Doctors. In addition to substantial negotiation efforts, the AMA has undertaken a series of hospital visits to ensure knowledge of the provisions of the agreement, the rights of junior doctors as well as generate feedback on working conditions and facilities at each of the hospitals visited.
Payslips – improving accuracy and clarity
On-site parking allocations – at KEMH, PMH and SCGH
Hospital Ratings Survey – comparison of facilities, education, access to medical administration and overall satisfaction of junior doctors at the major hospitals
Support for federal CDT (Council of Doctors in Training) initiatives – the Work-Life Balance survey, Safe Working Hours survey and rostering guidelines, the Junior Doctor Welfare Study (in conjunction with JMO committee)

Pepresentation to organisations:
AMA DiT also provides representation to a number of internal and external committees. DIT members represent the interests of all junior doctors to educational groups (PMCWA Education Committee, the Joint Consultative Committee for Medical Student Training, JMO Committee, UWA and NDU Curriculum Committees), allied PMCWA committees (Executive, Accreditation, Workforce and Education), as well as subspecialty interest bodies. A group of General Practice registrars provide contacts and support to WAGPET as well as the PGPPP and Community Residency Program committees.

The junior doctor movement has really become “aware” in the past few years. The circle of representation is completed by external nominees to the DIT committee. This includes members of the five Resident Medical Officer Societies as well as medical students from both universities (UWA and NDU). Each of these make the DIT committee a vital conduit of information from various groups in all areas, from medical politics to the social scene and upcoming ball dates.

Workshops and courses:
A number of workshops are available to AMA members, initiated by the DIT committee. These include:

Getting Started in Clinical Research – for those interested in getting an edge for their CV by small papers, or for those embarking upon a full Masters or PhD program, potential avenues for funding and mentorship are discussed.
CV and Interview skills workshop for members considering applying for a college program.
Getting Started in Private Practice – for the DIT nearing the end of their training in any subspecialty, the “business of medicine” is rarely discussed but crucially important for survival in the world of private medicine.
Presentation Skills seminar – junior doctors do more presentations than any other professional in their field. Tips on oral presentations, slides and handouts, format and how to make your message clear are covered in this two-day seminar.

Why should I be an AMA member?
Being an AMA member is a way of supporting the current AMA-MHS Agreement and the significant work by the Association in negotiating this outcome. The AMA represents the medical profession at a state and national level, based around a key ethos of working in the best interests of patient care. The AMA also promotes a number of key public health initiatives against obesity, cannabis and a comprehensive anti-smoking campaign.

Medical Board of Western Australia

The Board is an independent statutory authority responsible for overseeing the Medical Act in Western Australia. It has twelve members. Ten are appointed by the Minister for Health and they include medical experts, two legal practitioners and a community representative. The Director General for Health and the Commissioner for the Department of Consumer and Employment Protection are also represented on the Board.

The Responsibilities of the Medical Board
The Medical Board ensures that medicine is practised in Western Australia according to the requirements of the Medical Act. These responsibilities include:

Ensuring that all doctors registered in Western Australia are suitably qualified.
Ensuring that interns are appropriately trained before they begin to work in the community.
Investigating complaints about doctors and taking appropriate action against those found to be in breach of the Medical Act.
Liaising with national organisations such as the Australian Medical Council to ensure that standards and procedures in Western Australia are generally consistent with those in other States.
Ensuring that people not registered as doctors do not practise medicine or convey to the general public the impression that they are doing so.

In December 2008 a new Medical Act was passed in Western Australia.

As an intern, you hold Conditional Registration with the Medical Board. Upon successful completion of your internship, you will be eligible for General (Unconditional) Registration.

Parental/Extended leave/Part-time and Job-sharing arrangements

The following arrangements are often allowed for through discussion with your employer. Giving adequate notice (10 weeks) to the hospital (usually medical administration/DPGME) prior to leave/part-time work is important in having leave approved.

Parental Leave:
As per the AMA Industrial Agreement (2007), employees are entitled to 52 weeks parental leave in relation to the birth, or adoption of their child. Up to 14 weeks of this may be paid, if the employee is the primary care giver.

Extended Leave:
This leave is organised in consultation with the employer. This is usually not possible during your intern year, due to Medical Board requirements about completing 48 weeks of work, but is more easily arranged from PGY2.

Part time:
According to the AMA Industrial Agreement (2007), a full-time practitioner’s request to work on a part-time basis shall not be unreasonably refused. Hours worked will be determined in discussion with the employer.

Job Sharing:
Most hospitals will allow for job sharing, particularly when part-time work is requested. This needs to be discussed with your hospital.

Supervision requirements

WA teaching hospitals believe strongly in supervision for the junior doctor. As an intern, there should always someone senior on site to refer to if there are difficult or specialist decisions to make. RMOs and registrars also have supervision, however depending on your experience or specialty this may not be onsite supervision. The Postgraduate Medical Council’s Accreditation Committee evaluates each post we do as Junior Doctors to ensure supervision is adequate.

In a situation where you have a patient who is unwell on the ward and are not sure what to do, contacting your registrar is often the first thing to do. However if your patient is acutely unwell and meets MET (Medical Emergency Team) criteria, activate a MET call immediately as they can help you stabilise your patient. Your registrar should also be contacted at this time.

If you find that you are not receiving the support that you require, speak to your consultant or head of department. If this does not improve the support you are receiving or you feel that you cannot discuss this with the department, contact your Department of Postgraduate Medical Education. If need be, this can be further addressed at the Post Graduate Medical Council of WA (PMCWA) and will be assessed during accreditation of that speciality at that site.

Rotations and accreditation

Term Rotations
Interns and Residents generally undertake five rotations throughout each year. Each term is of approximately 10-11 weeks duration. Most hospitals allocate terms based on preferences and are likely to consist of at least one of each of the following; medical, surgical and emergency department. In addition to these, there will be two extra terms which could incorporate any specialty area throughout the hospital (there is variation between hospitals as to the intern jobs available).

Accreditation/Registration
Currently, it is up to the employing hospital to provide satisfactory rotations for each junior doctor to meet accreditation requirements. The medical board will unconditionally register those interns who have completed 48 weeks of work and have met the hospital’s requirements (e.g. end of term assessments).

Clinical standards and training

As a JMO, there are clinical standards and training which are required.

Your clinical standards will be assessed during and at the end of each term by a senior member of your team (consultant or registrar). During these assessments they are given the opportunity to highlight areas that need improvement and areas that you did well in. As part of orientation week, the hospitals will provide you with an Australian Curriculum Framework for Junior Doctors, which has been brought out by the Confederation of Postgraduate Medical Education Councils (CPMEC). This provides guidelines for clinical standards that should be achieved and outlines the knowledge, skills and behaviours required of prevocational doctors in order to work safely in Australian hospitals and other healthcare settings.

All hospitals provide teaching/training on a regular basis to interns. These are usually once or twice weekly sessions addressing problems that commonly arise on the wards, and opportunities to learn specific skills such as using slit lamps, research skills etc. Teaching and training for RMOs is being started in most of the teaching hospitals and will hopefully be as successful as intern teaching. Once in a registrar training program, most specialties have regular teaching sessions. Some teaching hospitals also provide a ‘skills week,’ in which you will learn to intubate and other skills that you may not learn on the wards. Other hospitals will require you to spend time in theatre learning to intubate.

Pay issues and payslips

How to check your payslip 101 - The Beginners Guide

Before you attempt to understand your payslip there are a few things you should do first;

At the start of each term contact HCN to confirm what your template hours will be. Remember that the template roster for some terms includes after hours work such as evenings and weekends
Record any work you have done outside the template hours in a diary or on a calendar (eg after hours ward cover)
Remember to submit over-time forms promptly after completing a shift. Weekly or fortnightly is best. If the department says they will submit overtime forms make sure it gets done. If in doubt, submit them yourself. The worst that could happen is HCN receives two sets of forms. At least that way you stand a better chance of getting paid!

When you receive your payslip each fortnight take the time to look through it. By following these steps you should have a rough idea of whether you were paid correctly. Please note the following information is a rough guide only as every payslip is different. If in doubt, contact HCN.

Calculate the total number of hours you should have been paid for over the fortnight. Do this by adding your template hours (eg 85hrs) to all the extra hours you have documented in your diary/calendar.
Calculate the total hours you have been paid as indicated on the payslip. Do this by adding up the ‘full’ hours you were paid for (ie add up all the hours where you were paid your hourly rate or above. Ignore anything where you were paid a percentage of your hourly rate eg 75%)
If the numbers in point 1 and 2 are the same you’re doing well! You can now proceed to ensure you were paid the appropriate penalties.
Did you work on a Saturday or were your total hours worked over 76hrs for the fortnight? If so you are entitled to be paid 50% extra for those hours. On your payslip this may either be documented as a 50% payment (ie half your hourly rate) or as a 1.5 times payment (1.5 times the hourly rate).
If you worked between midnight Saturday and 8am Monday those hours attract a 75% penalty. Make sure your payslip includes a 75% payment for the hours worked.
If more than 116hrs are worked in the fortnight all additional hours are paid at double time. This should be on your payslip as 2.0 (double your hourly rate) however they may instead pay you for additional hours at the normal rate. Either way make sure you have somehow been paid double time for the hours worked over 116hrs.
Work on a weekday evening (between 6pm and midnight) attracts a 20% penalty. On a payslip this could either look like a 20% payment or a 1.2 times normal hourly rate payment.
Work on a weeknight (between midnight and 8am) attracts a 25% penalty. On a payslip this could either look like a 25% payment or a 1.25 times normal hourly rate payment.
Public Holidays are paid at a rate of 250% from midnight at the commencement of the public holiday until 8am the following day. On a payslip this is usually reflected as standard hours (1.0) and then an additional payment for the hours worked on the public holiday at 1.5 times the normal rate.

Remember it takes time and practice to be able to decipher your payslip. So do not worry if you are extremely confused at this point.

Other penalties and payment you may wish to check for include on call allowances, call back payments, meal payments and any breach penalties. Information on these and other entitlements can be found in the Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2007.

If you think you may have been paid incorrectly, contact HCN and ask them to take you through the hours worked each day during the pay period. You can then check this against your own records.

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