Hospitals’ ‘culture of fear’ exposed as doctors flee public health system
Hospitals are at risk of being drained of the country’s most talented and skilled doctors with swathes of the medical workforce set to abandon the public sector amid what is being described as a widespread culture of cover-up and payback.
Hospitals are at risk of being drained of the most talented and skilled doctors, with swathes of the medical workforce set to abandon the public sector amid what is being described as a widespread culture of cover-up and payback in health systems across the country.
Doctors across the gamut of specialties have described what they say is a profound disconnect between health administrators and clinicians who widely report being reluctant or even terrified to raise issues of patient safety or other threats to good clinical care lest they be subject to retaliatory investigation processes akin to internal star chambers.
Such trends of retribution brought to bear on doctors who seek to raise issues has been revealed as the norm rather than the exception in a national survey of doctors who described having their theatre lists removed, being denied annual leave, and being relentlessly bullied and intimidated after raising issues including lack of critical resourcing or threats to patient safety.
These toxic trends in hospitals are set to be unmasked in in two major reports into the nation’s health systems.
One of the reports, a NSW parliamentary special commission of inquiry, is being handed to the governor on Thursday and will be later publicly released, on a date not yet revealed by the state government. Hearings have unveiled an astonishing level of dysfunction at one of Sydney’s biggest local health districts, where doctors claim to have been punished for speaking out about system failures.
The commission received submissions that also revealed critical care units, including in neurosurgery and children’s intensive care and orthopaedic surgery, were starved of vital resources.
At the same time, a national survey of medicos by the nation’s main doctors union, released on Thursday, finds doctors who reported concerns about safety or adverse workplace issues were routinely subject to retribution by health service managers or administrators.
The national survey carried out by the Australian Salaried Medical Officers Federation of more than 700 frontline doctors in hospitals found about a third of doctors who raised concerns were subsequently accused of misconduct or insubordination. The survey results were analysed and collated by the Australian National University.
The ASMOF survey found only 25 per cent of respondents said they felt they were treated with respect by their hospital administrators and managers.
There were also concerns about a culture of retaliatory behaviour towards doctors who raised issues about workplace health and safety. Just shy of 40 per cent of doctors said they were highly likely to remain in the public health system during the next five years.
Ahead of the upcoming reports, one of the world’s foremost experts in clinical governance, British anaesthetist Stephen Bolsin, a renowned patient safety advocate who exposed incompetent pediatric cardiac surgery at the Bristol Royal Infirmary which led to massive overhauls in hospital management in the UK, has described clinical governance in public health systems in Australia and across similar countries as fundamentally broken.
“There has been an alienation of the professions … clinical governance has actually become a weapon to beat the healthcare professions with, rather than as a constructive tool to make sure we didn’t make mistakes again,” Dr Bolsin said.
His actions as a whistleblower exposing baby deaths in Bristol directly led to a shift from doctor-led management in the British National Health Service towards the rise of an administrative class in public hospitals. Australia followed the trend, but Dr Bolsin, who now lives in Australia, says the rise of managerialism has had perverse results, 25 years on.
“Management has been able to wield power over what had previously been seen as a fairly independent profession, and I think they have really used it almost for personality wars against people who seek to speak out on behalf of patients,” Dr Bolsin said.
“Doctors and other health professionals have been picked on by management through this now burdensome and probably punitive system of clinical governance, and the evidence is that there has been absolutely no decline in patient safety incidents reported.
“I think the primary goal of most organisations now is to balance the budget rather than provide high-quality care.”
The deep sense of malaise felt by many doctors is not confined to NSW. The heads of medical colleges are also concerned about the same corrosive trends in some public hospitals.
One of those medical leaders, Royal Australia and New Zealand College of Obstetricians and Gynaecologists president-elect Nisha Khot, said patient safety was undermined when administrators ignored the advice and feedback of clinicians.
“Whether they be doctors, whether they be nurses, it’s clinicians who are at the front line who are the best to identify any safety concerns, and they should be heard,” Dr Khot said.
“There’s no other way of making hospitals safer.”
The executive summary of the ASMOF survey reflects Dr Bolsin’s independent observations.
“The results of the 2025 ASMOF National Doctors’ Survey present a deeply disturbing picture of dysfunction in the working relationships between administrators of public hospitals and the doctors who work in them,” the executive summary reads.
“The findings of this national survey are deeply concerning and suggest patient risk as well as revealing a picture of workplace dysfunction that threatens our public hospital system at a time when demand for care has never been higher – and will only increase.”
The report found the data suggested “salaried hospital doctors were apprehensive about reporting patient safety or system concerns due to fears of retribution”.
“Unfortunately, this is a common experience for healthcare workers,” it said.
Concerns were also raised that budgets were not managed in line with clinical need.
“Budget bottom lines appear to be the main focus. There seems to be limited understanding of how a small expenditure now may result in a large saving,” one of the respondents wrote. “Budgets managed with little consideration for patient safety or service delivery, but to look better than comparator hospitals in the LHD,” wrote another.
Only around 25 per cent of respondents said they felt comfortable reporting concerns about workplace health and safety, the survey found. “I was discouraged from reporting unprofessional behaviour I witnessed … consequently my theatre lists were removed,” said one doctor who responded to the ASMOF survey.
“All I know is that we are so severely under-resourced that I have daily concerns about physician wellbeing and patient care,” said one doctor who responded to the survey.
There were 82,736 full-time-equivalent administrative and clerical staff working in public hospitals nationwide in 2022-23, according to the latest figures from the Australian Institute of Health and Welfare, making up 18 per cent of employees. There were 56,744 salaried medical officers, making up 12 per cent of the workforce. Nurses made up the biggest slice of the clinical workforce.
Most of these doctors employed by public hospitals are unable to speak publicly lest they lose their job. But one retired senior doctor, Anthony Joseph AM, a former senior staff specialist in emergency medicine and Trauma Director at Royal North Shore Hospital in Sydney, said the trends were devastating.
“There’s no doubt that the public health system has become a more difficult place in which to work over the last decade or so,” said Dr Joseph, who chaired the RNSH Medical Staff Council for several years and was also a co-chair of the NSW Medical Executive Staff Council.
“There appears to be a culture of bullying and antagonism towards doctors … in the system.
“We have seen examples when senior doctors have raised issues about clinical care and the local health district refused to investigate and also downgraded the critical incident. Some senior doctors, who raised an issue, were then targeted with threats of code-of-conduct violations and subsequently were forced to leave the hospital, as continuing to work there had become untenable.
“I can only guess as to the reasons for the ‘weaponisation’ of the complaints process against senior doctors which seems to have become more common over the last decade or more. I think a good way to shut down clinicians who are seen as ‘troublesome’ or ‘difficult’ is to subject them to a code-of-conduct investigation.”
The revelation that many doctors may be preparing to abandon public hospitals comes as NSW’s mental health system operates on continuing threadbare staffing, with crucial services shut down, after an unprecedented uprising by staff specialist psychiatrists in the state who recently handed in their resignations en masse after being unable to stand workplace conditions and under resourcing that put patients at risk.
Health administrators in NSW were also hit this month with a highly unusual mass strike by doctors who spoke out about the dire state of hospitals amid a culture of disrespect, overwork and an outdated industrial award that granted managers disproportionate power over working hours and conditions.
Doctor dissent and a growing sense of despair have been playing out through the NSW Special Commission of Inquiry into Healthcare Funding. It has also been examining NSW Health’s governance and accountability structure, the way the department funds health services in public hospitals, and strategies to address escalating costs.
As the special commission was preparing its final report, striking doctors in NSW were sent letters warning they may be reported to health regulators if they didn’t front up during the snap protest earlier this month.
In preparation for the special commission’s final report, an outline of submissions drafted by counsel assisting Ed Muston, SC, was tabled before the inquiry. His 361-page submission made several recommendations, including that the ministry reformulate its approach to funding to create a structure where local health districts and speciality health networks are sufficiently resourced.
“That might include blended, bundled or other funding mechanisms,” he wrote.
He was also critical about the situation at Concord Hospital in Sydney’s inner west- where an extraordinary staff uprising attracted headlines -especially the length of time it took for authorities to become aware of the issues that led to staff voting for a motion of no confidence in the administration.
“It is plainly unsatisfactory for the relationship between the clinicians comprising the Hospital’s Medical Staff Council and Hospital and District executives to have been able to deteriorate to the point that they did,” he wrote.
“It is also unsatisfactory that it took a vote of no confidence in the Chief Executive for the Ministry to become aware of the level of disquiet among a segment of the workforce at that hospital.”
A spokesperson for the Sydney Local Health District, which oversees Concord hospital, said the health and safety of clinicians was of the utmost importance and it was striving to ensure safe workplaces.
“Since September 2024, our chief executive, Deb Willcox AM, has met with hundreds of clinicians across the district and these conversations have shaped how we engage with and support our clinical workforce.
“We also have a number of systems in place to foster relationships between clinicians and administrators, including medical staff councils, consumer councils, clinical councils and regular staff forums.”
The final report of the special commission needs government sign-off before its release.
A spokeswoman for NSW Health Minister Ryan Park said the government intended on making the report public, though it was unclear when that would happen.
“We look forward to the report being published and will carefully consider each of the recommendations the commissioner puts forward and will respond within six months,” the spokeswoman said.
“The NSW government is focused on making decisions to ensure our healthcare system continues to support and retain our essential healthcare workers and deliver world-class care for patients.”
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