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Tough consequences for trainees who fudge work hours

20 July 2020 | Avant Media

Trainees generally work substantially more hours than they record on their timesheets. While long hours are ‘part of the job’, are there any limits on the hours trainees should work?

Hands-on experience is highly coveted by trainees and that experience cannot always be attained during rostered shifts. Many find it is necessary to work outside rostered shifts to participate in education sessions or to attend interesting procedures.

Most trainees regard hard work and long hours as necessary to impress the right people and obtain opportunities. Most hospitals also expect trainees to work the hours that are required to ensure patient care, including covering shifts for other doctors. 

Trainees are often reluctant to complain about their work hours due to fear it may impact their training assessment and career progression.

Risks if working hours are not properly recorded

A 2018 Hospital Health Check survey of 1351 trainees in NSW, found up to one third of trainees said they didn’t claim any of their un-rostered overtime and 24% said they weren’t paid when they did claim it1.

Trainees not recording their hours faithfully may seem innocuous, but a number of issues can arise:

  • A public hospital may decline indemnity for a claim made by a public patient if the hospital records do not show the trainee was working at the relevant time. While a hospital indemnity policy is likely to cover a trainee working overtime hours under the supervision of a consultant or with the knowledge of a consultant, even if overtime hours are not recorded, it may be much simpler to obtain indemnity if the records show the trainee was working at the relevant time.
  • If a trainee is paid for hours they did not actually work, they may face an allegation of fraud. For example, a trainee might work unpaid overtime for three shifts in a row and then ‘finish early’ on the next shift. They could be accused of claiming payment for hours on that final shift they did not work even though they worked hours without payment on the previous days.
  • If a trainee does not record time they have worked in excess of rostered hours, the hospital cannot easily assess whether they are fatigued and whether that fatigue may impact the trainee’s workplace health and safety or the health and safety of others.
  • Many college training programs require trainees to work a minimum number of hours during training. While trainees may maintain a personal record of the hours worked, the college may have more regard for the hospital records of hours worked.

Fatigue management

The impact of fatigue due to long working hours is an ongoing issue for the medical profession.

The Hospital Health Check Survey found that most trainees complained about being overworked and almost two in three trainees said they feared making a clinical error brought on by fatigue2.

Workplace health and safety laws in each state and territory require employers to ensure, as far as reasonably practicable, the health and safety of workers, including hours of work. The employment of most trainees is regulated by awards and enterprise agreements which prescribe working hours. 

Under the Australian Medical Association’s National Code of Practice guidelines working 50 hours a week is considered ‘unsafe’. However, a limit on the maximum number of working hours still doesn’t exist in Australia3.

Most hospitals have fatigue management policies in place, however they unfortunately are often viewed as aspirational and trainees' working hours often exceed the legal requirements. For example, trainees are actively discouraged from claiming overtime or taking prescribed breaks given patient care requirements.

Medico-legal issues due to fatigue

Burnout and exhaustion can potentially cause a range of consequences which include:

  • patient provided with incorrect medication
  • patient injury/death due to clinical error
  • procedure conducted on the incorrect patient.

In these types of scenarios, it’s likely the matter will be referred to Ahpra or the state’s complaints body for assessment. The trainees’ working conditions will be closely reviewed to better understand why their working hours were not correctly logged. In cases of patient death, there may also be a coronial inquest and/or a hospital investigation and the trainee’s employment could be jeopardised.

Useful resources

If you require medico-legal advice on any of these issues, you can contact our medico-legal advisers via email at nca@avant.org.au or if you require immediate advice, call 1800 128 268.

If you would like to access Avant’s Personal Support Program, you are entitled to six sessions of confidential, professional counselling provided by Benestar. Please call 1300 360 364 or visit our key support services page.

Read our article, ‘The heavy load of the doctor in training’ for tips on how to make your health and wellbeing a priority.

References

  1. Junior doctors pressured to fudge work hours prompts push for audit.
  2. 2018 Hospital Health Check results. AMA NSW.
  3. Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey.

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