The health boss in charge of the state's busiest hospital has promised there will be no impact on patient safety as junior doctors are forced to use all their accumulated leave before the end of the financial year.
Westmead Hospital has taken the unprecedented step of giving registrars six weeks to take all their allocated days off (ADOs), which in some cases have been building up for years, to clear a backlog of leave entitlements.
The instruction came down two weeks ago, giving the doctors just six weeks to use up their leave, and leaving their colleagues with the burden of covering the shifts.
Registrars have one day off a month build into their award, but it is common for them not to use these days immediately, either because of work demands or because they want to build a critical mass to take as holidays.
Western Sydney Local Health District chief executive Danny O'Connor said the spike in people taking leave before June 30 was a one-off event prompted by a statewide agreement to ensure people took their ADOs within the industrial period of 12 months.
When doctors accrued their ADOs over long periods, not only did they miss out on the rest that the days were designed to provide, but health districts were faced with extreme wage payments at popular holiday times such as Christmas, he said.
His district faced an additional problem because a disproportionate number of doctors were accruing ADOs in other local health districts and then using them at Westmead.
The current cost of the backlog at Westmead was $1.5 million.
"We've got a problem," Mr O'Connor said.
"The vast majority of people use ADOs - and I understand this - to enrich their personal circumstances around extending the weekend or taking them into holiday periods.
"The situation will improve next year because this year we've cracked really down on it."
No patients would be put at risk because locums would be hired to cover shortages in surgery and the emergency department, he said.
In December, NSW Health gave local health chiefs six months to ensure their registrars either used up their ADOs or had them paid out, as after 1 July they would not be allowed to transfer them between districts.
A NSW Health spokeswoman said health organisations would need to roster regular ADOs for their medical officers and not allow them to accumulate more than three days.
"This rostering assists in managing workloads for medical officers, reduces fatigue and contributes to quality patient care," she said.
The late push at Westmead comes as work stress and exhaustion are being cited as risk factors for suicide among young doctors, and it is understood to have caused anxiety among those who are covering the shifts for their colleagues.
Mr O'Connor said the district had a policy in place to ensure they were not overworked and their mental health was looked after.
"I would take it on the chin that we have an uneven application of the policy across all clinical departments and services and it's my responsibility to be dealing with the heads of department to make sure we're applying it," Mr O'Connor said.
"We're working on it and we're making progress but we're not there yet."
