PUBLIC HOSPITAL
(MULTI-SKILLED MEDICAL OFFICERS)
(STATE) AWARD
The Transition from CMO to MMO
Presentation to CMOA Industrial Convention,
14th November '98
by Peter Sommerville
Executive Director,
Australian Salaried Medical Officers Federation (ASMOF), NSW
Solicitor
1999 is an opportune time to press for a comprehensive review of the Career Medical Officers Award ("the CMOs Award"). As part of this comprehensive review, and to take advantage of the special circumstances in the Illawarra that produced the Multi-skilled Medical Officers Agreement, the Federation proposes that the CMOs Award be replaced with a new Award to be called the Public Hospital (Multi-skilled Medical Officers)(State) Award ("the MMOs Award").
2. Background
The parties to the CMOs Award are bound by a no extra claims clause until 31 December 1999. The reason for this is that the various salary agreements that have occurred since the making of the CMOs Award in 1989 have the effect of updating the Award and effectively, precluding the parties from making additional claims.
For most of this decade, the Public Service Association has chosen to pursue salary increases on a public sector-wide basis and, while the results have been good in terms of salary increases, there has been little opportunity to vary the CMO Award to take into account the concerns of individual groups. Now, with the withdrawal of the PSA from Health, CMO industrial representatives have an opportunity to address specific issues and press for significant changes to both conditions and salaries.
3. Remuneration, Progression and Other Issues for Inclusion in MMOs Award Claim
I recommend that remuneration, progression and other issues be pursued as part of the current claim by adoption of one of two strategies, firstly
3.1 "Big bang" approach
The essence of this approach is a review of medical roles in hospitals in their totality. Thus, to meaningfully examine and restructure the role of medical officers will require the consideration of all practitioners from intern through to consultant. Although this is clearly a major exercise, two matters are worth considering, firstly, the exercise has been previously undertaken and secondly, with the AMA’s Safe Hours campaign, a push to re-examine working roles is gaining momentum.
As part of the Structural Efficiency push in the late 1980s and early 1990s, the NSW Health Department (“Health”) commissioned a Medical Services Project Team whose major objective was to
“produce a framework for organising Medical Services within which:
- The focus is the care of
[patients]
- Efficiency and effectiveness of care for [patients] is promoted
- Flexibility for work force, and mobility within the medical service is
enhanced
- Career opportunities and job satisfaction are enhanced”
"Medical services Framework for Re-organising Work" NSW Health Department, 1992, p49
The Team considered such issues as technological developments, increased use of health care services, increasing patient expectations, the relative oversupply but maldistribution of doctors in Australia and the use of Temporary Resident Doctors. Interestingly, they also observed that:
“Work reorganisation should maximise the use of all available staff, both medical and others, by being flexible and utilising people to the full extent of their skills.”
"Medical services Framework for Re-organising Work" NSW Health Department, 1992, p56
[overhead 1]
Subsequently, the Project Team produced a series of work level statements, as an example Level 3 of seven is shown.
[overhead 2]
Level 4 then goes directly to recognition of participation in specialist training as a requirement, largely ignoring the traditional CMO. This, in essence, identifies the major problem with this approach to reform, the focus on large teaching hospitals and their structures. However, as an attempt at producing a generic work statements, it is worth considering.
At the present time, the AMA’s Safe Hours campaign is focussing on regularising and reducing hours of work for hospital employed medical staff. Although the focus has been very much on interns, residents and registrars, a major theme has been the need to review work tasks undertaken by junior doctors and determine whether those tasks are properly undertaken by that group or whether they could be re-allocated to allied health, nursing or other occupational groups. A continuation of this process would inevitably lead to a review of all groups across the medical workforce.
Of course there are also the results of the Hospital Non-specialist pilot projects and the attempt to create viable and enhanced career paths for CMOs.
The difficulty, as ever with the Big Bang approach, is that involves major structural reform across several groups, of which CMOs are but one. The entrenched interests of specialists and occupational trainees make this process quite daunting. In my view, the best hope of achieving change in this area, is through the Safe Hours project and the momentum it has developed on a national basis. For present purposes, however, the timeframe for change is beyond our immediate goal of December 1999.
3.2 Evolutionary approach
This approach primarily relies on adapting the CMOs Award by reviewing, in particular, the gradings, remuneration and after hours arrangements, and moving closer to an objective basis for progression and payment. As many people are aware, in 1997 the NSW Health Dept. entered into an agreement with the Illawarra Casual Medical Officers Association to vary the means by which certain CMO-type medical officers were remunerated.
The Illawarra Multi Skilled Medical Officers Agreement (“the MMO’s Agreement”) contains the following provisions: [overhead 3]
3. Definition
MMO to be at least five years post graduate
[overhead 4]
7. Career Path
Multi-skilling - MMOs to strive to obtain multi-skilling, management will provide training opportunities, multi-skilling can occur within or across disciplines.
Training - the employer will provide, so far as possible, opportunities for training both “inter and intra discipline”, appropriate training will be designated by a credentials committee (two medically qualified representatives from each of the employer and the MMOs and an independent consultant).
A comparison with CMOs Award and Circular 89/156 (which outlines the criteria for grading positions and individuals) is illuminating. Firstly, in regard to individual criteria
[overheads 5 and 6]
CMO grades 1, 2 and 3 require, respectively, 3, 5 and 7 years post-graduate experience, for grades 2 and 3, relevant post graduate experience and grade 3, relevant post-graduate qualifications. Secondly, in regard to grading of positions.
While, I am certain we would all support, both relevant experience and continuing education as important, the MMOs Agreement only explicitly refers to the criteria of relevant experience in relation to an additional allowance of 4%.
Although, I think it is likely that the MMOs credentialling committee, when it is formed, will look at this matter.
[overhead 7]
10. Remuneration
The style of remuneration for MMOs is a "rolled up" rate including payment for all leave entitlements. An allowance of 4% is payable for three or more multi disciplinary areas of expertise, at level 2 or above, and leave has been reserved to develop a 2% allowance. "Unsociable hours" are also recompensed by a loading.
A crude analysis of the remuneration arrangements reveals the following:
[overhead 8]
Any comparison between the two arrangements is highly likely to reveal a similar outcome.
In my view we should adopt, so far as it is relevant, the terminology and concepts of the MMOs Agreement and incorporate it into a new award – the Public Hospitals (Multi-skilled Medical Officers)(State) Award. We should explicitly adopt the Definition, Career Path and Credentialling Committee clauses. Career paths will also need to be considered, in particular for full-time MMOs under the new Award.
In regard to the Salaries clause, I would recommend that we take the MMO remuneration equivalent to a 38 hour week, "unpick" the various paid leave elements and claim this as a salary. My calculations reveal, that for an MMO3 under the new Award this would be approximately $133,000 - equivalent to a Year 4 Level 1 Staff Specialist!
The After Hours issue presents two possibilities, firstly remove the barrier on penalty rates, public holidays and overtime. The public holidays and penalty rates issue should be dealt with as part of this claim; while the overtime issue should also be dealt with in this claim, it does present another option. That option is to incorporate a "rolled up" allowance for After Hours work, such as Staff Specialists currently have. This is set at 17.4% of the base salary and while administratively easier for both employer and employee, does not necessarily reflect the actual work undertaken by individuals. The preferred approach can be determined as the draft claim progresses.
At the present time, our Research Officer, Cynthia Sneddon, is reviewing the file of the 1988/89 Industrial Relations Commission proceedings, which established the CMOs Award, to determine the basis for the barrier.
Thus a skeleton of the MMOs Award would look like:
[overhead 9]
The Federation’s preferred position involves an evolutionary approach (although rapid evolution!) of the type described above.
In the short term, we should also pursue the issue of the current CMO structure and gradings and ensure that positions and individuals are graded correctly. This may involve review of the current CMO Circular and establishment of a grading committee for CMOs.
4. Suggested Process
A suggested process and timeframe is as follows:
Feb 1999 - survey members re issues to be included
in claim
Mar 1999 - discuss with key groups including CMOA
Apr 1999 - finalise and submit claim to Dept of Health
May 1999 - commence negotiation process
=> arbitration if negotiation unsuccessful
5. Other Issues
The role and work of the Medical Training Review Panel (MTRP) and particularly the Hospital Medical Officer Working Group (HMOWG) and Post Graduate Year 3 & beyond (PGY 3+) consultancy and recommendations on continuing learning.
The first report of the Medical Training Review Panel including HMO working groups recommendations on the first two post-graduate years and a structured training environment. In addition, the HMOWG recommended that the structured environment be extended to non-vocationally trained PGY3s and beyond. The key recommendation was:
"The skills and competence acquired by PGY 3s and beyond be adequately documents, and that hospital medical officers be able to choose whether they want to supplement their training portfolio with formal qualifications gained from a range of other providers, such as the Universities and Medical Colleges."
Medical Training Review Panel, First Report, August 1997, p5
This recommendation, endorsed by all the parties represented on the MTRP, fits with an industrial structure which rewards competence, however so described.
7. Conclusion
Finally, you will not be surprised if I say that 1999 will be a crucial year for the current (and future) CMOs. With a major opportunity now available to make significant changes in working conditions it is important that your industrial representatives are well supported. While I, of course, would urge you to join ASMOF, if you are not already a member, the fact of the matter is it is important that you join one of the relevant organisations so that we can approach the Department of Health from a position of maximum strength.
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