A Sydney hospital could not follow through on a significant expansion of its mental health beds due to shortages of psychiatrists, a court has heard.
Dr Brett Oliver, director of medical services for the South Western Sydney Local Health District, appeared on Wednesday as a witness for NSW Health on day three of its arbitration with the doctors’ union in Sydney’s industrial relations commission (IRC) court.
The Australian Salaried Medical Officers’ Federation (Asmof) is seeking a special levy to increase its psychiatrist members’ pay by 25% to stem the flow of specialist doctors leaving the public system.
In January, 206 psychiatrists in New South Wales threatened to resign: at least 62 have resigned, while others await the IRC outcome.
Under cross-examination by Asmof’s barrister, Thomas Dixon, Oliver confirmed that Campbelltown hospital had a plan to increase its 66 beds for psychiatric patients to over 100.
The expansion was meant to accomodate increased mental health presentations due to the district’s expanded population but could not go ahead due to shortages of psychiatrist staff, Oliver said.
The hospital had also been unable to use extra adolescent mental health beds while an old age mental health unit’s opening was delayed due to staff shortages, he said.
Oliver confirmed the district had been using visiting medical officers (VMO) to cover shortages of permanent staff specialists.
The district’s clinical director for old age psychiatry was previously a staff specialist employed full time, but since transitioning to a VMO contract, had worked 0.8 or 0.6 full-time equivalent (FTE), Oliver said. He agreed that fractional appointment of a VMO was “fairly typical”.
VMOs are senior doctors who provide services on a contractual basis. Asmof’s case has repeatedly emphasised the difference between VMOs’ duties – focused on clinical care – and permanent staff specialists who the union says for a lower hourly rate of pay also contribute to a hospital’s leadership, safety and quality of work, and the education and training of junior doctors.
But Dr Justine Harris, NSW Health’s chief medical workforce advisor, also appearing as a witness for NSW Health on Wednesday, disagreed under cross-examination by Dixon that there were differences in the type and quality of work undertaken by staff specialists compared with locums and VMOs.
Since January, 72 permanent staff specialist psychiatrists had transitioned to VMO roles across NSW. Alfa D’Amato, NSW Health’s chief financial officer, said the government had not yet costed the replacement of permanent staff specialists by VMOs.
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Dixon put to D’Amato that NSW Health spent $97.4m to fund 196.4 FTE VMO positions in 2023-24, working out at close to $500,000 per FTE doctor, as opposed to paying $119m for 300 FTE permanent staff specialists, or $396,000 per doctor.
Asked if VMOs were more expensive, D’Amato said it “seems the case”, but said it was necessary to account for additional costs, such as staff specialists being paid annual leave.
Dixon highlighted that in 2023-24, NSW Health additionally spent $37m on commission fees paid to locum agencies, which a parliamentary inquiry had revealed was a $20m increase on the prior year.
D’Amato said VMOs took on “additional work”, but when pressed by Dixon, agreed he had no knowledge of whether VMOs provided additional work above and beyond that of staff specialists.
Dixon put to another witness for NSW Health, industrial relations director Melissa Collins, that VMO hours logged in the system were overinflated, citing evidence of a VMO being paid for 10 hours when they had only worked eight.
Collins said any uplift in hours could have been to meet a rate set in a verbal agreement between a district and a doctor within an individual contract.
The hearing, which is scheduled to run until Friday, continues.
