When senior doctors snap

The Association of Salaried Medical Specialists is the union that represents salaried senior doctors (including dentists). It is one of the highest membership density unions in the country.

Overwhelmingly its members are employed by Health New Zealand (Te Whatu Ora) which replaced district health boards in July 2022.

Also overwhelmingly, its Te Whatu Ora members are specialists (vocationally registered with the Medical or Dental Councils).

These members cover the full spectrum of medicine – surgery to anaesthesia to internal medicine to intensive care to emergency departments to diagnostic to public health. Most, but not all, work in our public hospitals.

I was their Executive Director from 1989 to 2019. During much of that time I was interacting on a weekly basis with local delegates in different parts of the country as well as attending numerous membership meetings.

This gave me a unique understanding of what makes senior doctors tick and what makes them snap. Consequently I’m unsurprised with their huge ‘yes’ vote for gradually escalating strike action.

It commenced on 6 September with a limited two-hour strike. A similar second strike was held earlier this week with a third planned for next week.

Now senior doctors have voted “overwhelmingly” to further escalate with a 12-hour strike on 2 October followed by a 24-hour strike on 24 October.

This decision was covered by Stuff health journalist Hannah Martin earlier today: Senior doctor strikes further escalate in October.

A bit of prehistory

The first strike by senior doctors was in 2003. Senior doctors employed by the former South Canterbury District Health Board held three six hour strikes. The strikes were focussed primarily on planned surgery and clinics. Acute cases and emergencies were excluded.

First senior doctors strike was in South Canterbury in 2003

At this time there was no national collective agreement in place. Instead there were single DHB collective agreements. South Canterbury’s conditions compared unfavourably with the other DHBs.

These strikes led to a successful outcome improving their remuneration. Further, it empowered South Canterbury’s senior medical workforce and, interestingly , improved their relationship with senior management.

The latter respected the former’s cohesiveness and determination. This empowerment experience may provide valuable lessons for the current dispute.

2023 is the first time public system senior doctors have taken national strike action. But it is not the first time that they have voted for strike action in a national ballot.

The first time was in 2007. I was the advocate in these negotiations (as I was in South Canterbury four years earlier).

The circumstances between 2007 and 2023 were different. Back then the district health boards (DHBs) were attempting to claw-back on strong consultation rights and recognition of time for non-clinical duties that had been won in the previous negotiation.

The DHBs also ignored the impact on retention and recruitment of the sudden unanticipated widening pay gap with Australia. This arose in 2007. It had begun in Queensland following the tragic avoidable hospital deaths in Bundaberg.

High profile and well-attended national stopwork meetings condemned the employers’ approach and authorised ASMS to conduct a strike ballot if the impasse in negotiations continued.

The impasse did continue, the ballot was conducted, and the result was an over 80% majority for striking based on a high turnout.

As with the earlier South Canterbury strike and the strikes now underway, acute and emergency care would be exempt from the action.

Health Minister David Cunliffe made a brave risky but successful intervention

Partly because of this widening dispute then Prime Minister Helen Clark replaced Pete Hodgson with David Cunliffe as health minister.

Although health ministers had previously been involved in negotiations behind the scenes, Cunliffe was a brave risk-taker who made this involvement overt.

He took the initiative by facilitating a provisional agreement between the parties in an all-night session in his office in early 2008.

The agreement, which involved both withdrawal of clawbacks and useful improvements to existing conditions (including salaries), was subsequently ratified.

There is no doubt that the outcome was the result of the strike ballot and the intervention of a brave health minister that broke the impasse and avoided the need for strike action.

Getting to snap

So why do we have the first national strikes by senior doctors now? In 2003 South Canterbury senior doctors snapped because they were sick of being the lowest paid in the public system.

In 2007 senior doctors nationally snapped because some critical employment rights were under threat and the failure to recognise the threat to both recruitment and retention with a suddenly widening pay gap with Australia.

The snapping of senior doctors employed by Te Whatu Ora has similarities and differences with these earlier cases.

Since coming into office in October 2017, the Labour-led government has refused to address the severe medical workforce shortages that had already existed for some years before.

Jacinda Ardern’s government turned a blind eye to effect of severe shortages and increasing patient demand on health of senior doctors

It turned a Nelson’s blind eye to the effects of the combination of these shortages and increasing patient demand on the health of these senior doctors. This includes mounting evidence of entrenched fatigue and burnout.

Then, in 2020, the government imposed a pay freeze on those working in the public sector (including health) whose annual salary was more than $100,000. This affected all senior doctors.

It amounted to a kick in the teeth for an exhausted workforce that was so critical to the functioning of our health system during the pandemic.

The government’s justification was that it wanted to focus on lower paid staff. It is good that it wanted to address low pay in the public sector. However, this was no excuse for disregarding the dire state of its senior doctor workforce.  

Senior doctors also looked at what was happening to their nursing colleagues. For some time they experienced a similar disregard. Nurses have now made significant advances in salaries through both collective agreement and pay equity negotiations.

But both senior doctors and nurses know full well that this was only achieved through firmness reinforced by strikes. In contrast, the former were only offered a relative pay cut.

It is the protracted impact of all these factors that have led to a workforce that hates the idea of striking to do so. This was the recipe for the 2023 snap.

Adding fuel to the fire

The public response of Te Whatu Ora has been to add more fuel to the fire. It has grossly misrepresented the current remuneration of senior doctors. If they earned what their employer claimed they earned, there would be neither strikes nor dispute.

Chief executive Margie Apa’s Te Whatu Ora’ adding fuel to fire

It embellished its offer to settle the negotiation by including in it what senior doctors were already entitled to. The implication that might be taken is that it was seeking to clawback on an existing entitlement!

To cap it off, Te Whatu Ora downplayed the importance of the huge specialist pay gap with Australia. This is despite BERL economic consultants revealing a pay gap of over 60% in 2019. It tried to argue that there were ‘other factors’ which compensated.

In fact, these ‘other factors’ (like superannuation and paying much less tax through salary sacrifice) were much superior in Australia.

Senior doctors are not fools. They know what the facts are and how much their employer distorts them.

Need for political leadership

The more Te Whatu Ora continues this behaviour, the more difficult it becomes to resolve the impasse. Further, this behaviour embeds for the foreseeable future the lack of credibility and respect its medical workforce has for the new health entity. This is in a sector where success depends on relationships.

In early 2008 a national strike of senior doctors employed by DHBs was averted because of the constructive intervention of then health minister Cunliffe. It was the right thing to do then and it is the right thing to do now.

Ayesha Verrall needs to demonstrate the bravery David Cunliffe did

Current health minister Ayesha Verrall needs to learn from this. To date, she has simply echoed the position of Te Whatu Ora. This only damages her own credibility.

Political intervention works in different ways. It does not have to be in the same that David Cunliffe adopted. But only political leadership will resolve this matter without further worsening relationships.

As things presently stand, one thing at least is certain.

It is going to take many years (perhaps more than one electoral cycle) for senior doctors to have confidence in a Labour-led government to be trusted with the responsibility of leading Aotearoa New Zealand’s health system.