Arguments to support Proposed Changes to NSW
PUBLIC HOSPITAL (CAREER MEDICAL OFFICERS)(STATE) AWARD
[Many of these arguments have already been presented to CMOs at the Industrial Convention in Nov '98]
They are now repeated in point fashion and linked to their associated proposals
|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
|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.
|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.
|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.
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.
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