Getting home safely after a gruelling night shift is not something Dr Tessa Kennedy takes for granted.
Three of her junior doctor friends have crashed their cars driving home after a night shift, one on her way to pick up her daughter from daycare.
She has caught herself falling sleep behind the wheel at the end of her 16-hour shifts and 90-hour weeks.
The paediatric trainee has battled sleep-deprived panic attacks before medical exams, and cried inconsolably as she sat in her car after a narrowly escaping a crash for which she says she would have been responsible.
She regularly stays back hours after her shift ends only to be told she can't claim overtime. For three months, her only contact with a supervising consultant was through his secretary. He didn't bother to learn her name.
None of this would sound remotely remarkable to any doctor working in NSW, Dr Kennedy said.
Junior doctors are being overworked to the point of exhaustion in an overstretched health system and a bullying culture that puts their lives and the lives of their patients at risk, mounting evidence shows.
A staggering 71 per cent of junior doctors report being concerned about making clinical errors because they are overworked and overtired, found a damning survey of junior doctors by the NSW Australian Medical Association.
"What if you're the patient at the end of a needle being held by a doctor who has been awake for 20 hours, who has just been yelled at and is expected to fix every problem that arises on a night shift with little support?
"I don't want to be that patient and I wouldn't want my child to be that patient," said Dr Kennedy, who is also the chair of the AMA NSW doctor-in-training sub-committee.
The findings come after the recent deaths by suicide of four junior doctors in NSW within six months.
More than two in three junior doctors surveyed said they had been concerned about their own health and safety due to fatigue as a result of their work hours, according to the survey of 1107 doctors in training, an estimated 20 per cent of the current junior doctor workforce in NSW.
Just 3 per cent reported working a 'standard' 38-hour week. Almost half said they worked more than 90 hours in a fortnight.
Almost 90 per cent reported not being paid for all their unrostered overtime, and 46 per cent reported not being paid for any of it.
"This is unhealthy not only for us, but for our patients, who are at increased risk of harm when doctors in training are working in these conditions," Dr Kennedy told the Junior Medical Officer Wellbeing Forum convened by Health Minister Brad Hazzard and mental health minister Tanya Davies in Sydney on Tuesday in response to the spate of suicides.
NSW Health Minister Brad Hazzard speaking at the Junior Medical Officer Wellbeing and Support Forum in Sydney on Tuesday. Photo: Louise Kennerley
"There is enough evidence from those still living that the system is causing harm to a much greater number of doctors-in-training," Dr Kennedy said.
More than two in three of junior doctors said they had felt unsafe at work due to verbal or physical intimidation or threats from patients or staff, the AMA NSW survey found.
Of the 42 per cent who said they had been bullied or harassed, only 25 per cent reported it. Some, 53 per cent reported witnessing a colleague being bullied or harassed at their hospital, yet only 14 per cent reported the matter.
Two thirds were concerned there might be negative consequences in their workplace if they reported inappropriate workplace behaviour.
Mr Hazzard said the health system "is not working as well as it should" to protect doctors in training.
"Junior doctors cannot do their job and be caring and compassionate for patients when they are scared of speaking up about their own problems," Mr Hazzard said.
Mr Hazzard said everything was on the table in an effort to improve the mental health and wellbeing of junior doctors including introducing statewide restrictions on the number of hours doctors are permitted to work.
Professor Samuel Harvey at the Black Dog Institute was one the speakers at the Junior Medical Officer Wellbeing and Support Forum. Photo: Louise Kennerley
A 2013 national mental health survey found one in five doctors reported being diagnosed with depression at some point in their lives. The rates were even higher among junior doctors, well above rates in the general population.
"The most concerning figure [from the report] was that one in ten had thoughts of suicide in the last month," said Associate Professor Sam Harvey, head of the workplace mental health research program at the Black Dog Institute.
"It's a complex problem and changing working conditions will undoubtedly be part of [the solution]," Professor Harvey said.
"We also need to change the way we educate junior doctors and how the health service works to make it easier for junior doctors to ask for help when they need it."
