The Doctors’ Striking Symptom

By McCRONE John

Strong personalities advocating tough medicine are emerging as negotiators attempt to resolve the junior doctors’ dispute. JOHN McCRONE reports.

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Greedy and irresponsible? Sure no-one died during the two- day strikes by New Zealand’s junior doctors, but plenty of people were inconvenienced.

If you had finally got to the top of the waiting list for that cancer biopsy or hip replacement; booked the time off work, the child care; gone through the worry and fuss involved in even a minor stay in hospital; you might be wondering if these young medics were right to be exercising the nuclear option quite so quickly. Especially if you had been listening to what the other side has been saying.

Their union, the Resident Doctors’ Association (RDA), is demanding a 10 per cent pay rise for the next three years in a row – - twice what anyone else in the health service is getting. Then rather than drop the figure by even a fraction, they have jumped straight into their two-day strikes.

Health bosses say these guys are basically apprentices, just learning their trade, yet they want to hold the system to ransom.

David Meates, Wairarapa District Health Board (DHB) chief executive and lead negotiator for the country’s 21 DHBs, says junior doctors have already won better conditions and shorter working hours than found overseas. The average first-year house surgeon is taking home about $88,000 for a 60-hour week — less than Australia obviously, but a fair Kiwi wage. Yet they keep coming back to ask “more please”.

Government ministers and even trade- union leaders have been still more pointed. Please note, they say, the RDA is not a proper union – and the junior doctors have a hired-gun negotiator.

In Parliament last month, Health Minister David Cunliffe was asked who was responsible for the disruption to 8000 patients such as the woman who had waited months for vital brain surgery and had now been put off for another couple of months.

Cunliffe replied he had two words: “Deborah Powell”.

Powell has been a thorn in the side of health managers for near 20 years. She runs an Auckland industrial-relations consultancy, Contract Negotiation Services, which has represented physiotherapists, medical technicians, radiation therapists and others in fractious disputes. Powell led the junior doctors in a dogged 14-year fight over lost meal allowances and through a five- day strike in 2006.

Even her friends call her a tough nut in negotiations (although a sweetie in private). Her opponents call her confrontational, unreasonable, tantrum- prone and worse.

Cunliffe says Powell represents 7% of the health sector’s workforce yet her members have been responsible for nearly 90% of all the strikes which have plagued the hospitals for the past few years.

Cunliffe paints a clear picture. While the main players, like the nurses and senior doctors, have been able to settle their pay claims — although it was a near thing with the senior doctors’ union threatening its own strike — Powell is leading the whole system a merry dance.

The junior doctors have been emboldened by some past victories and are really pushing it now. Cunliffe says enough is enough. They can strike for two days or two months but the Government is not about to fold to such unrealistic demands.

Council of Trade Unions president Helen Kelly echoed the Government’s stance, saying there must be better ways than the RDA’s jump straight into strike action.

And DHB managers may feel they have Powell finally backed into a corner. This could be their chance to finish her, and her style of negotiation, off.

Many junior doctors worked through the two-day strikes in April and May, so there is a question of how much support there will be if the RDA calls a third stoppage in a couple of weeks.

Then there is the knowledge that the junior doctors’ multi- employer collective agreement (Meca), the contract on which the RDA must negotiate, expires at the end of June. Stall on any settlement, let the Meca lapse, and future hires would become local deals on local terms.

What the DHBs and the Government need — especially in an election year — is for public opinion to swing decisively against the junior doctors’ cause. Then they can hang tough and watch the RDA implode.

So whose side are the public going to be on? Right now, many are probably unsure.

Eleanor Carter, a campaigner for Health Cuts Hurt recently elected to the Canterbury District Health Board, says there is still an instinctive sympathy for young hospital doctors. We all know how hard they work, how long they study, how much they care.

And yet industrial action is industrial action. Some are surprised doctors even can strike. Other critical services such as police and fire can’t.

“Personally, I’m not happy with the strikes. There are people’s lives being affected here. There should be arbitration like there is with the police,” says Carter.

“People don’t like to criticise doctors, but I think there is probably a lot more mixed opinion about their actions than has been reported.”

There is much that does not add up.

Junior doctors are by definition smart, not the sort to be led around by the nose by some rogue negotiator. And in the modern world of skill shortages — even the DHBs admit hundreds of junior hospital positions cannot be filled — bosses simply have to pay people what they are worth. However, insiders say that to understand why this dispute appears to have got so out of hand, you have to step back to the bigger picture of the health reforms which have been convulsing the sector ever since the Rogernomics era. All the current bitterness stems from putting professional managers in over the heads of the doctors.

Governments don’t like to be seen making health cuts. However, with an ageing population and costly new medical treatments, the cost of running a national health service has been galloping away.

So the politically convenient solution has been to create the hands-off management structure of the DHBs. Appoint your managers, set their budgets, then let them handle the fallout.

Robin Gauld, of Victoria University’s Institute of Policy Studies, says the DHB system has its good points. For a start, the elected boards give the public a greater say in health provision. But it has led to a toxic relationship between doctors and managers.

Doctors are seen as the guys with the foot on the accelerator, always wanting to spend more on patients. Managers are there to put a foot on the brake. With both sets of feet jammed to the floor, no wonder we hear awful graunching noises coming from under the bonnet.

Alma Rae, a Christchurch psychiatrist and former president of the RDA, says doctors used to have all the authority. Hospitals were run by superintendents. Consultants were treated as gods. They may have been fearsome masters at times, but at least they understood the service they were running.

Then came the first wave of “managerisation”.

“People were coming from Wattie’s and the like with the view that if you could manage a canning factory, you could manage a hospital. It was grim.”

Rae says health-service management has become a recognised profession. The bosses are better qualified now. Yet there are still many reasons for a continuing clash of cultures. It is even possible to detect an inferiority complex at play.

Doctors may now be reduced to the status of hirelings, but they make intimidatingly clever hirelings.

Remember too, says Rae, many of today’s managers might once have been humble toilers in an administrative department or a ward nurse.

Uncertainty in those now having to wield the power in hospitals could be part of the industrial-relations dynamic. It would explain a condescending attitude, Rae says.

“We’ve got used to them saying rude things about us such as it being like trying to herd cats.”

Rae says they are treated like kids.

“Furthermore, a group of difficult, manipulative, particularly cunning, sort of kids,” she laughs.

So there is a power game going on even years down the line. The Government has put new managers in charge, but they are managing on shaky ground. They face a workforce ready to question them at every turn. And naturally they will want to neutralise that dissent wherever possible.

Ian Powell, of the senior doctors’ union, the Association of Salaried Medical Specialists (ASMS), says this need to maintain the upper hand is what produces the flare-ups when it comes to wage negotiations.

The meetings are never just about a fair pay rate.

Each side is also hoping to nudge the balance of power.

This is the unhappy world our junior doctors have been graduating into for some years. Junior doctors historically have expected a tough initiation. Rae says she was doing 100-hour weeks as soon as she started. But at least young medics were gods-in-training back then. They knew their own rewards in terms of status and job satisfaction would come with time.

Now, of course, it is a completely different equation. For a start, students come out of medical school with staggering debts. About $100,000 is typical.

They also know they can take their skills anywhere in the world. Certainly it is easy to head for Australia where pay rates can be a third higher.

Rae says the older generation of doctors still have a commitment to the public-health system instilled in them. Even if they hate the way service is now going, they feel they have to make the changes work. But junior doctors reckon if they are going to treated as simply contract staff, then that is how they will act.

Timaru Hospital junior doctor and RDA delegate Scott Newburn says this is exactly how he and many of his colleagues feel.

“There is a very unhealthy culture, a very hostile relationship between employers and employees. They’ve made it clear that the only way you’re going to get anything today is if you’re prepared to fight.

“The DHBs are using this huge tactic called guilt. They’re saying we’re being greedy. But all the time they’re just treating us like a number,” says Newburn.

This brings us back to the question of Deborah Powell and whether, as Cunliffe and others suggest, she is the reason why the junior doctors and other health workers are always going on strike, making the health service the “most badly behaved” arena of industrial relations.

Powell would not return The Press’s calls this week. Her staff said she was too busy negotiating on another matter. However, all the RDA members approached said it was ridiculous to think the problem was Powell rather than the intransigence they face from the DHBs.

Stephen Ram, a house surgeon at Blenheim’s Wairau Hospital, says calling Powell a malign influence was typical DHB spin. Ben McConchie, RDA delegate at Rotorua Hospital, says Powell does not order the strikes. RDA members are voting for them from extreme frustration.

They say why not take a look at the DHB’s own negotiators? The management side was initially led by Southland DHB chief executive Nigel Murray. He was a tough nut, too, who once served with the military in Iraq.

Although it all got a little strange last year after it was discovered Murray had been acting as a consultant to a Canadian health authority alongside his duties with both Southland and the national negotiation team.

Murray resigned suddenly in September to become chief executive of that authority, citing unspecified family reasons for the hastiness of his departure. Murray was later cleared of any breaches to his employment contract, however, the episode left a bad taste with many.

Yet ASMS’s Ian Powell says that while the senior doctors were unhappy with Murray’s conduct during their own recent pay negotiations — senior doctors felt they were being so lied to and misrepresented that they reached the verge of striking themselves — things did not get much better when Meates followed as the DHB’s representative. It took the intervention of Cunliffe to eventually broker a settlement with senior doctors.

So Ian Powell says it cannot be just the personalities which are producing the face-offs and strikes. Nigel Murray and Deborah Powell are symptoms rather than causes. Given the riven nature of the health system, each side is simply being forced to select the biggest, baddest, most confrontational characters they can find to represent them.

No-one wants things to be this way. But it is, and so the junior doctors are just reacting to the circumstances they find themselves in.

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(c) 2008 Press, The; Christchurch, New Zealand. Provided by ProQuest Information and Learning. All rights Reserved.