Psychiatrist James Lawler’s lament: ‘I don’t want to resign’
Psychiatrists say their dispute with the NSW government is about far more than pay. This is why one psychiatrist is walking away from the public system.
Child and adolescent psychiatrist James Lawler always wanted to work in the public health system. But in the 12 months since he finished his training and gained employment as a staff specialist in hospitals in western Sydney, he has watched morale plummet to rock bottom and psychiatrists with decades of experience sadly walked away.
“I thought when I joined the public system that I would be joining for my entire career,” says Dr Lawler, an Australian Medical Association NSW councillor. “I spent 13 years training to be a psychiatrist and met some kids who I really felt were among the most vulnerable in society who really needed the best care.
“For a while, I was always able to leave work and feel like I was helping people who really needed it. But since I’ve joined the system, and in the last 12 months statewide, one in three psychiatrists’ positions are empty.
“It’s surprised me how I’ve seen colleagues who’ve been working for decades start to question whether it’s still a moral or ethical thing to do to work in a system that’s so under-resourced.
“The resigning psychiatrists are not walking away from patients. They’re walking away from the health system that this health minister is responsible for, which is so under-resourced.”
Dr Lawler is among 201 staff specialist psychiatrists to have handed in their resignations in an action that is rocking the NSW mental health system. NSW Health Minister Ryan Park is begging the doctors to withdraw their resignations, as the Health Ministry prepares to move to crisis mode to cope with patient demand amid threadbare staffing levels. Already one-third of positions in NSW are staffed by locums, whose pay is up to three times more than permanent employed psychiatrists, and the bill is set to skyrocket.
Mr Park is casting the situation as an industrial dispute, but psychiatrists say their action is about far more than wage negotiations. They are demanding an immediate 25 per cent rise in staff salaries, which they say is necessary to stem the tide of psychiatrists quitting the system and the inability to retain registrars once they finish training.
At the heart of the retention crisis is a big discrepancy between public and private sector remuneration, and also the fact that NSW salaries for doctors are depressed compared to neighbouring states.
But compounding the despair of staff is the fact that the mental health system is critically under-resourced. Many patients are unable to be admitted because of bed shortages, people are discharged to insecure housing, only to bounce back into the system, and patients are frequently discharged prematurely because the demand for beds is so large.
“I think if this dispute was about pay, there would be no staff specialist psychiatrists in NSW,” Dr Lawler said. “Every staff specialist psychiatrist is working in the public system because they want to help people, and the ones who have resigned, most of them want to remain there. I don’t want to resign.
“But I’m concerned that if I was to stay and we continue with the status quo, my work will be devalued more and more as I’m spread thinner and thinner, and I’ll eventually be propping up a system that doesn’t work and doesn’t help anyone.”
The NSW government says that if it carves out a special deal for psychiatrists, similar pay demands from across the spectrum of medical specialties, and including other parts of the health workforce, would pile in with similar pay demands.
But is hard to see how the preferred solution of propping up the system with locums and attempting to manage demand in an integrated fashion across health districts, and with registrars working to an increased scope of practice, will work. Mental health wards are bursting at the seams everywhere, and a ready alternative workforce is not apparent.
“The ministry is looking at bringing in pandemic-like solutions to manage this but this is a pandemic that the government is bringing on itself,” Dr Lawler said.
“Since the end of Covid, we knew there would be a wave of mental health presentations, there have been more children and adolescents than ever before presenting to emergency departments with mental health problems. We’ve had a wave of school refusal problems that parents and schools are desperate for help to fix. But there hasn’t been any strategic plan for how to deal with this.”
Dr Lawler is not sure exactly what he will do if there is no resolution to this dispute, and his resignation takes effect on January 21 along with 200 of his colleagues.
“I feel sure enough myself that wherever I work, I’ll make sure that I see children and families that need the help most,” he said. “There’s many ways that psychiatrists will keep helping their patients, whatever happens. I feel very confident of that.”
