Bulletin February '99
Newsletter of the Career Medical Officers Association Inc.
Special Annual General Meeting Edition
(Click on the title to move to that section)
|Why are we proposing changes to NSW CMO Award ?||by David Brock|
|Proposals relating to Grading Criteria|
|Proposals relating to Study Leave|
|Proposals relating to Salaries|
|CMOA Committee 1998|
|Address for Correspondence|
|Submitting Items for CMOA Bulletin|
|Proposed Changes to the Rules of the Association|
|Credits:||Written by: David Brock
Design & Typesetting: Karyn at Flying Colours Printing (02) 4627 6400
Web-page layout: David Brock for the CMOA
|The views expressed within this publication are those of the authors, who enjoy freedom of speech and use it regularly. They are therefore occasionally neither wise nor politically correct. Neither do they necessarily represent the view of the CMOA.|
The current Award has been neglected for a decade. It needs to be re-vitalised or re-invented, before it fades into the background. Many CMOs feel frustrated by an award that hinders their progression, fails to reliably provide for continuing medical education programs, unreasonably limits penalty (and related) loadings when providing their services during unsociable hours.
With an award failing them, many CMOs have moved to private contractual arrangements within their local hospitals or Area Health Services, securing remuneration and conditions well beyond the current award, with 50 to 95% above entry award hourly rates (ie Grade 3 Yr 1). This is approaching or equalling Locum rates. For these CMOs, award conditions have fallenwell behind.
The following proposals are an attempt to renew interest in award conditions. They seek to improve conditions and include the introduction of a Skills-based structure, modelled on the Multi-Skilled Medical Officers Agreement of 1997 currently in place in the Illawarra region.
MuIti-skilling should provide both a focus for staff development, and a navigable career path that would both reward and deliver relevant skills and experience to each area of CMO expertise. This, in turn, may provide significant direct and indirect cost-savings to many areas throughout the health system.
Furthermore, a re-vitalised award may rekindle interest in recruiting experienced CMOs back to Award based conditions. This may renew stability in a workforce that has been prone to fluctuations in supply.
However, it would seem that the overall success or failure of all these proposals depends upon the level of desire amongst Hospital, Area Health Service and Departmental administrators, to renew participation in Award structures rather than continue with current levels of private contractual arrangements.
WHY has the award been allowed to fall so far behind ?
For most of this decade, the PSA has chosen to pursue salary increases subject to "no extra claims" provisions. Consequently there have been few opportunities to update and improve individual awards.
The current "no extra claims" clause affecting the NSW "PUBLIC HOSPITAL (CAREER MEDICAL OFFICERS) (STATE) AWARD" is due to expire on 31 December 1999. With the withdrawal of the PSA from Health, our CMO industrial representatives (ie: ASMOF & HREA) have an opportunity to address specific issues and press for significant changes to both conditions and salaries. We can participate in this process.
Our current Options now include:
1. Do nothing.
The award will continue unchanged beyond 31 Dec 1999, and remain open for future submissions for change, yet continue to fade into the background.
2. Allow our industrial representative organisations,(ASMOF and HREA), to prepare proposals, they believe are in our best interests.
We remain supportive yet peripheral to development of proposals. ASMOF intends to consult the CMOA in Mar 1999, about its proposals to replace the current Award with a PUBLIC HOSPITAL (MULTI-SKILLED MEDICAL OFFICERS) (STATE) AWARD.
[See Peter Sommerville's (ASMOF Solicitor) address to the 1998 CMOA Industrial convention on the CMOA web-site]
3. Act now, and consider possible proposals for change.
Make them available to CMOs across the state, for open discussion, and further refinement.
Offer them to the next CMOA Annual General Meeting on 27th February 1999 for formal debate and/or approval. All agreed proposals will then be forwarded to our industrial representatives: ASMOF [ Australian Salaried Medical Officer's Federation] and HREA [Health and Research Employees' Association of NSW ]
They will be asked to further develop and submit our claim to the Dept of Health and commence the negotiation process as early as May 1999.
Because of the extensive nature of these proposals it may even be reasonable for our industrial representative organisations to "re-invent the award". This current timetable would allow reasonable time for arbitration if negotiation was unsuccessful. Agreed changes could then be implemented as early as 1st January 2000.
Following the recent CMOA Industrial Convention it has become apparent that the existing NSW CMO Award is essentially a modified copy of the RMOs award designed for junior doctors.
- CMOs are not junior doctors.
- Award conditions and rates of pay have fallen behind colleagues on contractual arrangements. Some CMOs have even resigned their award based positions to immediately provide the same services as locums on much higher locum rates.
- CMOs want their Career choice to be "a viable Career Path, worthy of its own qualification, recognition and financial support".
- CMOs want an Award that caters to the needs and aspirations of so-called "Middle Graded" medical officers.
(ie: Doctors, who may lack formal specialist qualifications, yet choose to follow a career path providing specialised skills & expertise from hospital and community based services).
- The current Grading structure fails to acknowledge some CMOs worthy of progression to higher levels.
- CMOs training and educational entitlements are focussed upon the pursuit of specialist qualifications, rather than training relevant to the individual CMO including Continuing Medical Education. => CMOs can be denied leave and funding to stay up to date in their areas of expertise
- Grade II and III CMOs performing normal rostered duties during "unsociable hours" have their penalty loadings unfairly limited.
- The general neglect of the award has also left several curiosities and some inequities.
These proposals have arisen from comments received from a variety of CMOs, many involved with the CMOA. They have also arisen from presentations and discussions made at the recent Industrial Convention convened in Sydney in November 1998 by the CMOA.
These proposals have been prepared in good faith, without the necessary legal advice for proper implementation. The CMOA plans to forward all agreed proposals to our industrial representatives for further refinement before submission to the Department of Health for discussion and negotiation on our behalf. At this stage we need to acknowledge the support we have already received from our industrial representative organisations, particularly the Australian Salaried Medical Officers Federation (ASMOF).
This issue affects us all. Please participate in the debate, details about how to do this are on the back page
Proposals relating to Grading Criteria.
a) Insertion of the following table, introducing optional "Skills based grading criteria" to exist in parallel with existing Grading criteria for appointment as a CAREER MEDICAL OFFICER
The following criteria is to be met to qualify an individual for appointment as a CAREER MEDICAL OFFICER:
* in the relevant area for the CMO position as determined by the relevant Credentialling Committee.
Whilst it is important that criteria are set for determining grading for CMO positions and the requirements for individuals to be appointed to CMO positions within any department, it is stressed that from time to time exceptional clinical or logistic circumstances may require some flexibilityin the application of these criteria.
b) Skills based criteria be adopted for each area of CMO expertise.
i) Accident & Emergency grading criteria to be adopted as described by the Multi Skilled Medical Officers (MMOs) Agreement of 1997, and be defined within the Award.
ii) Leave reserved for interested parties to develop and include skills based grading criteria suitable for other areas of CMO expertise.
c) Joint Consulative Committee and Credentialling Committee be defined in like manner to those described in Multi Skilled Medical Officers (MMOs) Agreement of 1997.
d) include the following statements regarding Multi-skilling:
i) The Parties agree that multi-skilling is a core element of this award. Multi-skilling can occur within a discipline or across disciplines. CMO's shall strive to attain such multi-skilling and management shall provide appropriate and reasonable training opportunities for the CMO to attain multi-skilling in order to progress on their career path.
ii) The Area shall, as far as possible, provide a CMO with opportunities for training both inter and intra discipline which will lead towards credentialling at a higher level. Appropriate training shall be as designated by the Credentialling Committee. Training can occur either as part of agreed rostered duty, or as part of agreed Training, Education and Study Leave.
When a CMO is undertaking training as part of agreed rostered duty, he/she shall be paid for the agreed training hours at not less than his/her normal CMO level, and subject to the appropriate overtime or penalty rates.
e) Upgrading of CMOs:
i) CMOs appointed at a level in the CMO salary scale, shall be eligible to progress to the next higher step in such scale on the anniversary of the date on which they were appointed.
ii) for appointment to Grade 2 or Grade 3 Career Medical Officer, approval of the CMO's supervising Medical Officer OR relevant Credentialling Committee is required.
a) within 3 mths of the 1st and subsequent anniversaries of payment as CMO Grade I Year 4, or Grade 2 Year 4, the Credentialling Committee is to meet and discuss re-grading the CMO
b) if the Credentialling Committee should decide that a CMO will not be upgraded then the Credentialling Committee must:
i) provide written reasons to the CMO,
ii) formulate and provide strategies to assist AND/OR provide the CMO with reasonable training opportunities to better enable him/her to achieve upgrading the following year.
c) Any resultant disputes to be dealt with in similar fashion to those outlined in Dispute Resolution Procedure described in Multi Skilled Medical Officers (MMOs) Agreement of 1997. (Dispute procedures will need to be formalised by ASMOF & HREA and agreed to by Dept of Health)
iv) The Credentialling Committee shall be constituted to consider and make recommendations to the employer in relation to any request or proposal to alter the grading of a CMO, provided that:
(a) the Committee shall meet within 3 months of such request.
(b) the Committee shall not, without sufficient reason, recommend the retrospective operation of any grading or remuneration; and
(c) where a retrospective date of effect is recommended, such date shall not be earlier than a date six months prior to the date on which the matter was referred to the Committee.
f) Grading levels to be portable between CMO positions throughout NSW
g) Additional percentage loadings applied to ordinary hourly rate for CMOs with extensive relevant post-graduate experience.
i) 5 per cent loading for 10 years
but less than 15 years relevant post-graduate experience
ii) 10 per cent loading for 15 years or more relevant post-graduate experience
NB: Adjustments to the "criteria for determining grading for CMO positions" can also be considered. At this stage we would refer this to ASMOF for their advice and consideration.
|Arguments supporting Alterations
and Additions to Grading criteria.
The current award has no description of the various criteria to determine Grading of CMOs and CMO positions. That is provided in a subsequent Department of Health "Circular". (Circular No: 89/156)
The following criteria is to be used when determining grading for CMO positions:
* Reference: Guide to the Delineation of Roles of Area Health Services and Hospitals ISBN 07305 3216X. June, 1986.
The following criteria is to be met to qualify an individual for appointment as CMO:
It is important to remember that whilst the criteria outlined above in respect to determining grading for positions and the requirements for individuals to be appointed should be adhered to, the Corporation is cognizant that there may be instances where this is not possible. In these cases to the Human Resources Division for individual consideration and continue to refer all requests for the establishment of Career Medical Officer positions and regrading to the Human Resources Division.
The Australian Salaried Medical Officers Federation (ASMOF) advises us that both sets of existing criteria for CMO appointments and CMO positions are open to alteration and inclusion in any revised CMO award.
The CMOA Grading proposals are directed primarily at altering the latter criteria for "appointment as CMOs". The CMOA would seek advice from ASMOF & HREA about alterations to the former criteria for grading "CMO positions".
Many CMOs want their Career choice to be "a viable Career Path, worthy of its own qualification, recognition and financial support". We want Grading structures capable of recognising the varied skills, qualifications & experience relevant to CMO positions, including non-specialist qualifications & certifications.
We need an Award that caters to the needs and aspirations of so-called "Middle Graded" medical officers. (ie: Doctors, who may lack formal specialist qualifications, yet choose to follow a career path providing specialised skills & expertise from hospital and community based services).
CMOs want Gradings that formally recognise their skill levels and allow "portablility" between hospitals and Area Health Services.
The Health Dept should recognise that agreeing to a Grading structure which acknowledges and rewards skill levels would foster development of expertise relevant to individual practice areas. This would lend itself to overall cost containment.
Indeed educating and employing skilled CMOs may save money. Their experience and skills may reduce attendances by specialist VMOs, minimise unnecessary investigations and unnecessary hospital admissions. Furthermore, they may identify illnesses and initiate definitive treatments at an earlier stage, thereby shortening overall hospital stays. For example employing experienced CMOs in an Accident & Emergency Department could be a hospital's first line of cost-saving measures. Providing funds for their education and training should add another "cost-saving" benefit for both the local hospital and the State Government.
The existing NSW CMO Award is essentially a modified copy of the RMOs award designed for Junior doctors. The current Grading Structure fails to recognise the varied skills, qualifications & experience. It prefers to recognise traditional "higher medical qualifications", often irrelevant to the majority of CMOs and CMO positions.
It provides artificial ceilings that limit or prevent promotion, holding back experienced CMOs, worthy of progression, and stifles their moral. The current criteria even provide "Catch 22" type situations, where it implies promotion can only be gained by leaving your current CMO position.
Introduction of optional "Skills based Grading criteria"
A skills based approach can provide a career path that caters to the multi-skilled nature of CMOs' employment. It provides a focus for professional development, and removes the current ceiling on professional progression.
Many hospitals have difficult retaining experienced middle graded medical staff. With the current CMO award failing to adequately remunerate experienced staff, many hospitals are forced to step way from the award and pay higher hourly rates (approaching "locum" rates) on short-term contracts.
A Skills based award would foster staff development, providing a focus for training that could lead to longterm employment of experienced staff with significant levels of expertise.
The proposed addition of skills based criteria, is modelled on the Multi-Skilled Medical Officers Agreement 1997 currently in place in the Illawarra Area Health Service.Their approach includes additional allowances (in the forming of a percentage loading) for each specialty skill area accomplished.
Skills based criteria need to be developed for each area of expertise. The Multi Skilled Medical Officers (MMOs) Determination includes a set of criteria for the three levels of Accident & Emergency classification. It is suggested that these be adopted for the CMO award.
CMOs are largely employed in Accident and Emergency Departments. But they are also employed in other areas/disciplines. Notably Psychiatry, Obstetrics & Gynaecology, Alcohol & Drug Addiction, Pathology, Non-clinical areas, Developmental Disability, Prison Medical Services, Forensic Medicine, etc. Therefore "Leave should be reserved" for these CMO areas/disciplines to develop their own Skills based criteria in coming months or years, by relevant interested parties.
Skills based classifications need to be interpreted. Relevant Committees are described in the Multi- Skilled Medical Officers Agreement and it is recommended that we adopt their structures. This would include the "Credentialling Committee" and "Joint Consultative Committee".
A Means for resolving disputes is also outlined within the Multi-Skilled Medical Officers Agreement and it is recommended that this structure be modified for inclusion in the CMO award
ASMOF is currently preparing to revise or even re-invent CMO Award, offering Skills-Based Structure ready for submission to the Department of Health as early as April '99.[click here for ASMOF's presentation to the CMOA Industrial Convention , Nov 1998]
The Addition of CMO Grade 4 has been frustrated in the past. It is currently separate to these proposals. In 1992, the Department of Health's response was that it should be resolved through reform of medical workforce structures
a)"STUDY LEAVE" be renamed to "TRAINING, EDUCATION and STUDY LEAVE" and include the following statements in the award
b) The Parties agree that the Health System has a responsibility to ensure that all Career Medical Officers employed in the Health System have appropriate and equitable access to Training, Education and Study Leave that is relevant to both the Career Medical Officer and the needs of the hospital.
i) Leave Entitlement -
(i) The parties agree that Career Medical Officers are entitled to 14 calendar days of paid Training, Education and Study Leave each year.
(ii) The parties agree that Career Medical Officers are entitled to 7 calendar days of paid Training, Education and Study Leave each year, if formal agreement to part (iv) of this Entitlements section is in place.
b) such leave can be cumulative to 2 yrs
c) such leave for Career medical Officers who are part-time employees is pro rata based on the full-time rate.
ii) Funding entitlement -
a) The parties agree that Career Medical Officers are entitled to funding for the purpose of Training, Education and Study Leave.
(i) such entitlement shall be up to $7,000 for related expenses per year
(ii) such entitlement shall be up to $3,500 for related expenses per year if formal agreement to part (iv) of this Entitlements section is in place.
c) Such entitlement shall be indexed to general salary increases,
d) Such entitlement shall accumulate to a maximum of the dollar value of two years of entitlement.
e) Funding for Career Medical Officers who are part-time employees is pro rata based on the full-time rate.
iii) Approval of Training, Education and Study Leave
a)The CMO shall submit to his/her Medical Director a timetable of the proposed course of study and evidence of the CMO's enrolment in the course.
b) Approval shall be granted for leave to attend Continuing Medical Education courses, Medical Conferences, and any such medical courses or programs relevant to both the training and educational needs of individual CMOs and needs of the employing hospital.
c) The grant of Training, Education and Study Leave is subject to the convenience of the hospital and should not interfere with the maintenance of essential services nor with patient care.
d) Approval shall not be unreasonably withheld.
iv) subsections to Entitlements i) a) (ii) and i) b) (ii) will take effect provided a committment to assist the CMO to attain multi-skilling, in order to progress along their career path, has been formally agreed upon by Management to provide:
a) 7 calendar days of ordinary working time allowed for in-house training
b) appropriate and reasonable training opportunities to attain multi-skilling
c) where Multi-skilling to occur either within a discipline AND/OR across disciplines.
|Arguments supporting alterations
to "STUDY LEAVE"
The CMO Bulletin has recorded that "it has become apparent that there is no consistent application of paid study / conference leave across NSW Hospitals".
The existing NSW CMO Award is essentially a modified copy of the RMOs award designed for Junior doctors. The existing Study Leave provisions have been copied directly from the RMO award, and apply largely to Interns, RMOs and Registrars. Consequently CMOs training and educational entitlements are focussed upon the pursuit of specialist qualifications, rather than Continuing Medical Education and Training relevant to the individual CMO and CMO positions that they hold.
The lack of committment to continuing medical education probably stems from our origin as a workforce specifically recruited to occupy "non-training positions" within hospital departments.
CMOs are employed in diverse settings, utilising diverse skills, where traditional "Higher Medical Qualifications" lack relevance. We are experienced skilled practitioners, needing proper access to Training and Continuing Medical Education. We are wanting to develop Self-Directed Learning Programs suitable for Award Recognition (such CPDP used by Pathologists)
In 1999 more is expected of all doctors regarding Continuing Medical Education. Medical Practitioners are expected to stay up to date in their fields of expertise. CMOs can be expected to work as supervisors or unsupervised, often acting alone in difficult and challenging circumstances, yet the award fails to see education and training as an entitlement or a necessity.
The current award has no reference to supporting (through Leave and funding entitlements) Continuing Medical Education programs, let alone support the attendance of CMOs to Medical Conferences relevant to the needs of the hospital and individual CMO.
Consequently, CMOs can be denied study leave and funding for attending conferences and continuing medical education programs that may benefit both the employing hospital and the individual CMO, if they do not directly or indirectly "lead" to "higher medical qualifications".
In fact, restricting Study Leave to courses leading to traditional "Higher Medical Qualifications", may only provide education that is irrelevant to the needs of both the employing hospital and the individual CMO.
The current guide-lines are even too restrictive to include courses that would attract General Practitioner CME points. It would be desirable to allow a much more relaxed access to study leave in order to suit routine continuing medical education and ordinary medical conferences and training, that are relevant to the individual CMO and needs of their employing hospital.
The current award also states that an employer "may" grant .. study leave. The CMO is forced to appeal to their good nature. This reduces "Study Leave" from entitlement status, and allows employers to bestow it at their whim.
Whereas CMOs are entitled to only 7 calendar days "study leave" and receive no financial support for related expenses for Training, Education, the NSW Senior Medical Practitioners Award provides our specialist colleagues with Leave for 25 calendar days of paid Training, Education and Study Leave each year, and considerable funding entitlements for related expenses to the tune of approx $19,000 per year cumulative for 2 years.
This is far beyond the modest $7,000 per year nominated for "related expenses" for CMOs.
[Staff Specialists Training, Education and Study Leave, is largely a re-distribution of sabbatical leave. was 3 months every 5 years, and 1week conference leave per year. Now it is 18 + 7 calendar days, accumulative for 2 years. The Health Dept agrees to this because most staff specialists have a right to private practice and funding coming from the private billing trust fund.]
If we wish to remain relevant to the Health Care system, we have to be cost-effective.
If we can demonstrate to the Department of Health that educating and retaining experienced CMOs reduces overall costs, then we will find our education fully funded.
3. Proposals affecting changes to SALARIES
a) Removal of the "Penalty, Overtime and Public Holiday Payments Barrier"
That is, removal of paragraph 3 "Medical officers in receipt of ..." in Clause 4. SALARIES Part A.
b) General Salary Increase of between 0 to 20 per cent (value to be debated at AGM)
|Arguments to support
Changes to SALARIES
A. Arguments to supportRemoval of the "Penalty, Overtime, Public Holiday and Call-back Payments Barrier"
There is a perception that similar barriers may exist within the NSW Award structures. They don't. The closest thing is a pure overtime barrier designed for clerical public servants. But the CMO Award doesn't stop there. It also restricts penalty loadings, holiday payments and call-backs. (Call-backs are paid at overtime rates).
No-one (including ASMOF & HREA) has been able to locate another award in NSW with a "Penalty and Public Holiday Payment Barrier".
This "barrier" effectively limits all penalty, overtime, public holiday and call-back payments to be calculated according to the CMO Grade 2 Year 1 rate. (corresponds to the Senior Registrar rate).
A quick look at the table below of CMO "Base Hourly" Rates (1 July 1998) shows that the Senior Registrar rate corresponds to the rate for CMO Grade 2 Year 1.
This means CMOs beyond this level will have all Penalty, Overtime (including "Call-backs") and Public Holiday payments calculated on the Senior Registrar Rate, which can correspond to an hourly rate up to 6 levels lower than their own.
(eg: CMO Grade 3 is denied up to $8.80 per hour [Dec 1998 figures] working normal rostered hours on Sundays)
This leads to the remarkable situation where CMOs receive decreased % loadings on their ordinary hourly rate with each successive promotion. Their experience and grading may have proper financial recognition during sociable hours, but not fully financially recognised after hours, often when their presence is most greatly appreciated.
This can lead to some unique & surprising situations.
(figures calculated at Dec 1998)
Unlike every other shift worker rostered to work on Saturdays, CMOs above Grade 2 Yr 1 do not receive 50% loading on their normal hourly rate.
Grade 3 Yr 3 CMOs receive only 38% loading, because their "50% loading" is calculated on the lower Senior Registrar rate ($36.06). This means CMO 3.3's are being denied $5.85 for every rostered hour that they work on Saturdays.
Furthermore, if the phone should ring and ask a CMO 3.3 to extend his/her shift for 2 hours overtime, then they will be accepting a further $11.70 less per hour, because they will no longer be receiving their base hourly rate. Instead they receive 150% of lower Sen Reg rate. (this corresponds to an overall loading of only 13.2% of normal hourly rate)
Even "double-time" for a CMO 3.3 is only 52% loading on his/her base hourly rate
So why penalise experienced CMOs that agree to staff departments on a regular basis during unsociable hours ?
At the CMOA Industrial Convention, Jim Deegan (Manager Industrial Services NSW AMA) pointed out that this barrier resulted from Medical Superintendents not being paid more than senior registrars when performing overtime.
Medical Superintendents typically work 9-5 during weekdays and "never" on public holidays.
Whereas full-time CMOs working in Accident and Emergency Departments are required to work all shifts, including evenings, nights and weekends, often finding that the majority of their normal rostered hours occurs during "unsociable hours" (ie:"after-hours").
If the "unsociable percentage" of ordinary hours
is typically 60%, then once promoted beyond CMO Grade 2 Yr 1 (Note: there
are 6 higher levels) we are being unfairly penalised MOST of the time
If the award originally wanted to limit overtime payments, why also limit penalty loadings for rostered after-hours and working public holidays ?
CMOs in an Accident and Emergency Department are typically rostered to work most public holidays. Whereas most Medical Superintendents, are "never" rostered to work their ordinary hours on public holidays.
[Med Supers. were originally involved in the creation of this barrier]
Why should a "Barrier" be set to the senior registrar rate described in the separate RMOs award ?
Registrars maybe willing to endure minimal pay rates and conditions with the promise of career advancement or specialist qualifications.
CMOs have made their career choice and don't have the prospect of specialist salaries in the near or distant future.
CMOs are less willing to accept unreasonable conditions such as unfair limits to Penalty, Overtime, Public Holiday and Call-back Loadings.
Some CMOs hold the opinion that this barrier is indeed unfair, worthy of a legal challenge, including a claim for restrospective payments.
CLAUSE 22. "LEAVE RESERVED" of the CMO award has been present for 9 years, inviting "the Associations to apply ... for the removal of the overtime barrier" among other things. The PSA's strategy for "across the board" salary increases, meant that invitations like this have been left unanswered
[Still more: the final curiosity is that the award appears to remove this barrier if a CMO is "seconded" to work beyond the Area Health Service.]
B. Arguments to support General Salary Increase between 0 - 20 %
Award conditions and rates of pay have fallen somewhat behind the rates and conditions achieved by colleagues on contractual arrangements. Some CMOs have even resigned their award based positions to immediately provide the same services as locums on much higher locum rates.
The current entry point (Jan '99) for an experienced CMO is only $43.56 per hr (CMO Grade 3 Yr 1). Even allowing for a 30% loading to adjust for related benefits, the consequent hourly rate ($ 56.63) still falls well short of the minimal rates some NSW hospitals are forced to pay, (through contractual arrangements) to secure the services of experienced medical staff.
One NSW Emergency Department cannot find CMOs willing to accept award conditions, despite its attractive coastal position.
Hence all its CMOs are employed on a contractual basis with hourly rates ranging from $65 to $85 per hour depending upon years of relevant experience.
These rates approaching "locum" rates, for CMOs with the necessary skills and experience.
Consequently contractual arrangements are extremely common. The award is currently an unattractive option for many.
With the current CMO award failing to adequately remunerate experienced staff, many hospitals are forced to step way from the award and pay higher hourly rates on short-term contracts.
It would seem that the overall success or failure of all these proposals depends upon both local and State Government desires to renew participation in award structures rather than allow increased participation in contractual arrangements.
4. Proposals affecting changes to ALLOWANCES
a) All Allowances INDEXED to general salary increases
(This has not been done since the awards inception 9 years ago)
b) Increases to On-Call allowances
$ 50.00 for rostered day,
$ 100.00 for rostered day off,
$ 350.00 per week.
c) Qualification allowance made equal to "equivalent" RMO Qualification allowance
d) In-Charge Allowance
i) to be paid to all CMOs, regardless of Grading level.
ii) be increased to $ 30.00 for each twelve hours of duty or part thereof of continuous in-charge duty for responsibility for after hours medical services.
e) The inclusion of an "Unpalatability Allowance" in the form of an additional $25 per hour, to be applied in addition to appropriate penalty or overtime rates, to:
i) all hours worked on Saturdays and Sundays greater than (4) four Saturdays or Sundays or any combination of both per calendar month,
ii) all hours worked on Nightshift greater than (3) three per calendar month,
iii) such an allowance to be indexed to general salary increases.
|Arguments to support
alterations to Allowances:
1. Allowances have never been INDEXED to General salary increases.
The Qualification, In-charge, & Uniform allowances have all stood still since 1989 whilst salaries have enjoyed consiberable increases. The On-call allowances have not changed since 1992
These allowances should be corrected for salary increases over recent years
2. The On-Call allowances are generally regarded to be minimal at $10 for rostered day and $20 for rostered day off and $70 per week.
The CMOA consider that reasonable amounts for an On-call Allowance would be:
$ 50 for rostered day,
3. Qualification allowance made equal to "equivalent" RMO Qualification allowance.
It appears that the RMO qualification allowance may have experienced an increase that was not passed onto the CMO award. CMOs allowance appears to be currently $183 lower than RMOs equivalent alowance.
4. In-Charge Allowance to be paid to all CMOs.
Some Area Health Services have denied this to all Grades of CMOs. It is currently the focus of a dispute between ASMOF and one Area Health Service. The Area Health Service is currently arguing that the Grading criteria for CMO 2 and 3 positions include Out of Hours Supervisory Roles.
The Allowance is described within the CMO award (regardless of CMO grading), whilst the Grading criteria are not even within the Award, but confined to a subsequent Department of Health Circular.
We will have to wait for this one to be resolved.
5. Introduction of Unpalatability Allowances.
Financial disincentives in the form of "Unpalatability Allowances" are included to acknowledge and minimise the health risks and disruption to family and social lives inherent in excessive shift work performed during unsociable hours.
With no limit to weekend or night rostering, CMOs are typically "used" to staff depts during "unsociable" hrs .. is this "planned obsolescence" for CMOs ... wait till they have children and then they'll have to leave ?
Such an allowance would follow the AMA's interest in developing the "Safe Hours" National Code of Practice.
Increase the penalty rate to 50 per cent for any ordinary hours worked between midnight and 8.00 am, midnight Sunday to midnight Friday.
(ie: Increasing penalty rate for "weeknight" nightshifts. Weekend nightshifts already receive 50% or 75% penalty loadings)
Meal Breaks are to be defined within the award.
a) In the interests of patient care and the health and welfare of medical staff, officers must have a break from duty for the purpose of taking a meal.
b) There shall be a uniform meal break of 30 minutes except where locally agreed arrangements for a longer period are made (which shall not exceed one hour).
c) If officers are required to work during their meal break they shall be paid for the time worked. Unless the employee is permitted to finish duty early on the same shift then overtime becomes payable once the total ordinary work time of the shift has elapsed.
d) Medical Administrators are to establish simple and effective procedures in consultation with officers to record when staff are required to work through their meal break and to ensure that payment is made.
e) One twenty minute interval (in addition to the meal break) shall be allowed each employee on duty for a tea break during each shift. Such interval shall count as working time. Part time and Casual employees who are engaged for less than a whole shift on any one day shall only be entitled to one tea break of 10 minutes.
the following paragraph be inserted into Clause 12. ANNUAL LEAVE.
Addition of Section ii) "if more than 35 such periods on such days have been worked - leave proportionately calculated on the basis of 38 hours leave for each 35 such periods worked
(to allow pro-rata payments if greater than 35 "such periods" as defined in 12 i & ii)
Include clauses providing for Parental and Adoption Leave, Personal Carers Leave, FACS Leave, etc.
Including statements that part-time career medical officers are entitled to all the benefits enjoyed by fulltime employees on a pro-rata basis,
including access to pro-rata long service to employees completing 10 years service (whether part-time or any mixture of part-time and full-time service).
Full access to all Salary Sacrifice & Salary Packaging arrangements as they become available to any group of public servants within NSW
Leave with out pay shall not be unreasonably withheld for the purposes of gaining relevant post-graduate qualifications
Formal Adoption of AMA's "Safe Hours" National Code of Practice provisions as varied from time to time.
Including the provision of sleeping quarters for CMOs exclusive use when completing nightshift or extended periods of duty
i) Leave reserved for interested parties to develop skills based classifications suitable for assessing Grading of CMOs for areas of CMO expertise other than Accident & Emergency.
Establishment of a clear RIGHT to PRIVATE PRACTICE
A. Deletion of OBSOLETE clauses
such as the Removal of "Preference of Employment" for those "who have been members of the Forces during the war"
B. Correction of all DISCRIMINATORY LANGUAGE or OMMISIONS
Long Service leave entitlements currently appear to be unavailable to defactos or partners of deceased medical officers.
1. ARGUMENTS for increasing Penalty Loading for "Weeknight" nightshifts to 50%
Most shift workers find nightshift onerous
CMOs working nightshift (eg: A & E Departments) are called upon to make clinical decisions and provide optimal care without the level of medical and ancillary supports enjoyed by their daytime colleagues.
Support during nightshifts, if available, is often remote from the hospital.
CMOs report significant physical and social disruption during and following demanding periods of work at night.
For these reasons many CMOs view the current "weeknight"penalty loadings to be inadequate.
CMOs also seek the provision of hospital based sleeping quarters for CMOs exclusive use when completing nightshift or extended periods of duty and feeling unable to safely drive home.
Several CMOs have reported that they prefer to sleep immediately after nightduty. They report feeling better rested and have avoided the danger of falling asleep driving home.
2. ARGUMENT for insertion of additional paragraph to CLAUSE 12. ANNUAL LEAVE
"Section ii) "if more than 35 such periods on such days have been worked - leave proportionately calculated on the basis of 38 hours leave for each 35 such periods worked"
The award provides for for pro rata payments if less than 35 "such periods" are worked, but fails to provide pro-rata payments for more than 35 "such periods" worked.
Many CMOs work 50 or more such periods per year, without pro-rata payments for the last 15 or more periods.
3. Clear statement for Parental and Adoption Leave provisions, & references to Circulars governing other forms of leave, FACS, etc.
Conditions for Maternity, Paternity and/or adoption leave are presently absent from the award, but presumed to be on some circular somewhere. The RMOs & Senior Medical Practitioners have it mentioned in their awards. The NSW Nurses have 6 pages of Provisions outlined in their award.
Perhaps now is the time to incorporate them into our award, even if only described in the form of "Parental and Adoption Leave to be provided as per ruling # ... as varied from time to time", etc
4. Full access to all Salary Sacrifice & Packaging arrangements as they become available to any group of public servants within NSW
Fringe benefits tax is not applied to public hospitals. The benefits from this can be passed onto Employees. If benefits are available to senior executive staff and ASMOF is preparing arrangements for staff specialists, then why isn't it being offered to CMOs as well.
5. Provision for leave without pay to gain relevant post-graduate qualification.
There are CMOs wishing take leave without pay to gain post-graduate qualifications without risking losing their longterm employment.
6. Consider including statement adopting "Safe Hours practices", developed by AMA.
The AMA believes that prevailing medical culture needs to adjust to changing community attitudes. Employing Hospitals will become liable for adverse outcomes attributed to avoidable fatigue in employees.
CMOs should seek an entitlement to sleeping quarters for CMOs completing nightshift or extended periods of duty and feeling unable to safely drive home.
Some CMOs will no doubt lament the passing of 24 hr shifts (or longer), but we may find that we will need to embrace these changes.
7. Deletion of obsolete clauses
such as "Preference of Employment" for those "who have been members of the Forces during the war"
The Award could do with some tidying. It has some dated attitudes and historical associations irrelevant to current medical practice.
All these adjustments have a greater chance of success if we remain relevant to the Health Care system.
We remain relevant when we deliver quality services whilst proving to be cost-effective. We need to remind and repeatedly demonstrate to the Health Dept. that experienced staff, such as CMOs, reduces overall costs.
For example in the Accident & Emegency setting, we need to demonstrate that experienced CMOs decrease the costs associated with:
- unnecessary hospital admissions
- unnecessary and A/H investigations,
- unnecessary VMO attendances.
(eg manipulation of some fractures under regional anaestheseia by CMOs rather than general anaesthesia which would require involvement of VMOs, theatre staff, and general Nursing staff, etc associated with consequent hospital admissions)
whilst possessing the necessary skills and experience to improve the overall quality and standard of medical care.
Furthermore by achieving earlier diagnosis and initiating earlier definitive treatments, experienced CMOs should help reduce morbidity and mortality, whilst reducuing the length of inpatient stays and their associated costsi
The world-wide trend of increasing levels of senior staff in Emergency Depts, and reducing junior staff involvement suggests that:
The First line in reducing hospital costs is:
employ experienced CMOs at the Front Door.
The Second line,
keep them there with
- adequate remuneration
- rewarding and navigable Career Structure
- adequate opportunities and funding for relevant training and education programs
The State Government will realise that this level of service & expertise costs money.
If we can repeatedly demonstrate that employing experienced CMOs increases the quality of care whilst reducing overall costs our future will be secure.
If we can further demonstrate that educating CMOs enhances further cost containment then we will find our training & education fully funded.
if CMOs can remain the cost-effective solution we were originally designed to be, then we can continue to provide outstanding support to the Healthcare of Australians, in busy service roles that other medical groups have traditionally been unable or unwilling to fill.
clear statement that part-time CMOs are entitled to all the benefits enjoyed by fulltime employees on a pro-rata basis.
statement that guarantees CMOs, moving from full-time to part-time, can return to full-time positions without penalty.
Ensure portability of Long Service Australia-wide, with recognition of time worked in all public hospitals and community based services in all Australian States & Territories..
1. The CMOA Website has a guest book, where you are encouraged to leave your comments for other CMOs to read
2.We also have an informal discussion group communicating via email.
Join in by sending a request to
putting "Join CMO Email Discussion Group"
3. Alternatively you can email your comments to David Brock to include in CMO Comments file
Click here to return to
ASCMO Home Page
for General Information and Application forms
Outgoing CMOA Committee (elected Feb 1998):
|President: John Egan
Vice President: Stephen Delprado
Secretary / Editor: Mary Webber
Ph (H): 02-6361-2018
Ph (W): 02-6360-5227
Ph (M): 015-906-105
Treasurer: Michael King
Public Officer: Jenny Virgona
Education Officer: Peter Love
|Industrial Officer: Rami
Media & Publicity Officer: Kien Coaxuan
National Coordinator: Warwick Barnes
Webmaster: David Brock
CMOA Official Website:
http://www.cmo.asn.au. Now replaced with ASCMO's website www.ascmo.org.au
|Proposed Changes to the Rules
of the Association
Members will have noticed an item on the AGM agenda concerning proposed changes to the rules of the Association. These are the existing rules, with proposed changes in bold italic.
1. Qualification for Membership
A person is qualified to be a member of the association if, and only if:
a) the person is a person referred to in section 15 (1) (a), (b) or (c) of the Act and has not ceased to be a member of the association at any time after incorporation of the association under the Act; or
(b) the person is a natural person:
(i) who has been nominated for membership of the association as provided by rule 3: and
(ii) who has been approved for membership of the association by the committee of the association.
Proposed addition to (b) as follows;
(b) the person is a natural person:
(i) who is a fully qualified medical practitioner of at least one years standing; and
(ii) who has been nominated for membership of the association as provided by rule 3: and
(iii) who has been approved for membership of the association by the committee of the association.
2 Nomination for Membership
(1) A nomination of a person for membership of the associaton :
(a) must be made by a member of the association in writing in the form set out in Appendix 1 of these rules: and
(b) must be lodged with the secretary of the association.
Proposed change to Rule 3 (1) as follows:
A nomination of a person for membership of the associaton :
(a) must be made by the person requesting membership of the association in writing in the modified form set out in Appendix 1 of these rules*: and
(b) must be lodged with the secretary of the association. *
[ie: Nomination form changed to delete requirement to be nominated by an existing member]
3. Fees and Subscriptions
(1) A member of the association must, on admission to membership, pay to the association a fee of $1 or, if some other amount is determined by the committee, that other amount.
(2) In addition to any amount payable by the member under clause (1), a member of the association must pay to the association an annual membership fee of $2 or, if some other amount is determined by the committee, that other amount
(a) except as provided by paragraph (b), before 1 July in each calandar year, or
(b) if the member becomes a member on or after 1 July in any calendar year - on becoming a member and before 1 July in each succeding calandar year.
A member of the association must, on admission to membership, pay to the association an annual membership fee of $100 or, if some other amount is determined by the committee, that other amount
(a) except as provided by paragraph
(b), before 1 July in each calandar year, or
(c) if the member becomes a member on or after 1 July in any calendar year - on becoming a member and before 1 July in each succeeding calendar year.
|Submitting Items For CMOA Bulletin
This is your journal. You are welcome to submit letters, articles, papers, photos, cartoons, quotable quotes, in fact just about anything that its legal to print. CMOA Bulletin will only be as good as your contributions make it, so get to your word processor.
All items submitted should be either sent on disc, or e-mail to the Editor, whose mail and e- mail addresses are on page 2. Just about any PC or Mac Word Processing format is OK. When submitting items on disc, please label your disc, and provide a printed copy if possible.
Please contact the Editor if you wish to submit material generated in other types of software applications. Illustrations should be in black ink, on plain white paper with nothing on the back. Photographs can be either black & white or colour. Typed copy is acceptable if you have no other means available, and we can't seriously expect our publisher to read doctors' handwriting - so don't even think about it.
this site is intended for use by medical professionals only
all information is a guide only and not to be relied upon by any party
site maintained by David Brock for ASCMO