Proposed changes to the NSW CMO Award
prepared by David Brock on behalf of the CMOA, 26th January 1999
access this information from the CMOA Web-site

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PREAMBLE and our Current OPTIONS
   Current CMO Award
   Other Awards Specialists, Nurses, RMO's
   Presentations from Industrial Convention,

PROPOSALS themselves
ARGUMENTS supporting Proposals
CMOs' COMMENTS about proposals

How to contribute to the debate
Other remaining issues

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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 fallen well 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.

    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.

So, if we follow the 3rd option, what do we want ?

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.

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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).

Copies are also available in full on the CMOA web-site.
Arguments supporting these proposals are also provided on the CMOA Web-site

(Accessing the CMOA Web-site maybe the fastest & simplest method to obtain copies. Locate a computer literate friend or colleague with internet access, and get him or her to download and print them for you).

It is proposed that the NSW "PUBLIC HOSPITAL (CAREER MEDICAL OFFICERS) (STATE) AWARD" be retained and updated to include the following modifications.

1. Proposals affecting changes 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:




at least three (3) years post-graduate experience
The applicant is credentialled at Grade 1 Skill Level *


at least five (5) years relevant post graduate experience
The applicant is credentialled at Grade 2 Skill Level *


at least seven (7) years relevant post graduate experience
The applicant is credentialled at Grade 3 Skill Level *

      * 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.

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.

2. Proposals affecting changes to "STUDY LEAVE"

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.

c) Entitlements

    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.

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.

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.

5. Proposals affecting changes to PENALTY RATES

6. Proposals affecting the inclusion of Clause relating to MEAL BREAKS

7. Proposals affecting the Insertion of additional paragraph to CLAUSE 12. ANNUAL LEAVE

8. Proposals affecting the addition of CLAUSES providing for  ALL FORMS OF LEAVE currently absent from the Award

9. Proposals affecting the addition of CLAUSES providing access to SALARY SACRIFICE & SALARY PACKAGING arrangements

10. Proposals affecting addition to provisions for "LEAVE WITHOUT PAY"

11. Proposals affecting Adoption of AMA's "SAFE HOURS" NATIONAL CODE OF PRACTICE

12. Proposals affecting additions to LEAVE RESERVED Clause

13. Proposals affecting RIGHT TO PRIVATE PRACTICE

14. Proposals affecting remaining issues

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PART D: CMOs Comments about PROPOSALS

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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

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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.

CMOs should continue to be the cost-effective solution we were originally designed to be, providing support to the Healthcare of Australians, in busy service roles that other medical groups have traditionally been unable or unwilling to fill.

PART F: How to contribute to the debate

Join in by sending a request to David Brock
putting "Join CMO
Email Discussion Group"


Lastly, why not JOIN the CMOA,
the ONLY
Association run by CMOs for CMOs

Click here to return to Main CMOA Page
for General Information and Application forms

Other issues not included in above proposals, but worthy of noting at this time:

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.

This page is designed for the sole use of medical practitioners
The information contained within has been provided in good faith.
However, as it may contain opinions and errors in fact, all information is not to be relied upon by any party.

It is presented to stimulate debate amongst the medical profession only

Consult your industrial adviser for further clarification.

page maintained by David Brock for the CMOA