Doctor's decisions a question of life and debt

By MARTIN JOHNSTON

Dr Jason Horsley was under such pressure at work that a colleague at his flat-out Auckland hospital sent him a coded stress-relief package containing two chocolate bars.

One was a TimeOut, the other a Dream. "Read the labels and follow the instructions," read the message, signed "Mother Hen Julie, in Gastro."

"You sounded so stressed yesterday when I rang re the consent forms. I thought a little frivolity ... could help...," she wrote to Dr Horsley, a junior doctor and union delegate at North Shore Hospital.

Pressure is nothing new for junior doctors, nor long hours nor overseas work experience.

But now, bowed beneath big student loans, they are flocking to Australia, lured by reports of higher wage rates, shorter hours, more training and longer holidays. Their union, the Resident Doctors' Association, says base pay rates are at least 50 per cent higher there.

Public hospital managers, already wrestling with a nursing shortage, say a staffing crisis is looming.

Dr Horsley, a 26-year-old house surgeon who is 18 months out of medical school, is pinning his hopes on big improvements to pay and conditions.

He says that otherwise he will most likely follow the horde to Australia next year where he expects he could make a big dent in his student loan.

Last year he was paid about $50,000. He has managed to reduce his student loan to around $50,000, from a peak of nearly $60,000.

Last week on a medical ward, he worked at least 91/2 hours a day and closer to 16 on the Monday. He receives no overtime nor penal rates. His weekend comprises two days off a fortnight but he sometimes does extra shifts.

On Thursday, when a Herald reporter shadowed Dr Horsley throughout his 8 am to 5.40 pm shift, his team was caring for 18 patients, down from 29 on Monday. The team visited all of them on the morning ward round and some again later.

He says that last winter his team often looked after 50 patients. Then the hospital had eight medical teams, compared with 10 now. It has funding for 15 and has junior doctors for 12 but each team needs a senior consultant physician, of whom the hospital has only 10.

Dr Horsley's 18 patients were suffering from a wide variety of conditions, often in combination. They included leukaemia, skin infections, diabetes, various heart and lung illnesses, depression, kidney failure, stroke, epilepsy, pneumonia and hepatitis B.

On the ward round, led on Thursday by a consultant, Dr Horsley frequently sprinted off to retrieve additional records such X-rays or to attend to patients in distress.

As a junior doctor, he still receives training but he in turn also trains medical students. On Thursday, he let a student try to take a blood sample from a patient but had not perfected the technique and Dr Horsley gently took over.

The consultant had gone ahead to the next patient. When Dr Horsley caught up, he quickly switched to absorbing detailed information from the consultant and a third doctor about the patient.

Dr Horsley's only break of the day, unusually long at 20 minutes, followed the ward round. A beeping pager summoned him to deal with what the nurse told him was the "urgent" need to discharge a patient.

He spent most of his afternoon arranging the discharge and referral of patients, each task creating a fresh round of paperwork.

Dr Horsley says the costs of the pressure mount up. Personally, it has contributed to a bout of depression and a broken relationship. Professionally, high patient loads force doctors into short-term, crisis management of their patients.