In 1997, the Dept of Health told the CMOA, that there were approx 450 CMOs in NSW eligible to be paid according to the "PUBLIC HOSPITAL (CAREER MEDICAL OFFICERS) (STATE) AWARD".(="CMO Award").

There are an unknown number of "CMOs" paid by Private Agreements. Estimates vary around the 1000 mark for total CMOs working in private and public sectors within NSW.

Since Awards provide a "floor" rather than "ceiling" to working conditions, improving the CMO Award should benefit all CMOs.

In early 1980's: GP Visiting Medical Officers (VMO's) provided their part-time services for many "non-training" hospital positions. The "Justice Maken Determination" led to a significant pay increase from approx $60 to approx $120 per hr, depending on years of experience. This renewed efforts to recruit: "Non-Specialist, Middle-Graded Hospital-based" doctors to work fulltime in "Non-Training positions in specific service areas such as A & E .. & general positions in hospitals, not covered by RMO secondment networks". (quotes from subsequent Determination)

In 1988, Dept. of Health issued the "Determination in relation to the salaries, terms and conditions of employment for Career Medical Officers". This was agreed to by both ASMOF & PSA. and following ratification by the NSW Industrial Relations Commission, the "PUBLIC HOSPITAL (CAREER MEDICAL OFFICERS) (STATE) AWARD" was implemented in Oct '89 (retrospective to Jan '89).

"Full-time CMOs" rapidly displaced "Part- time GP VMO's" for as little as $ 21 per hr, with considerable cost-savings.

Dept. of Health soon commented:

"Generally, there has been a positive response to the introduction to the Career Medical Officer classification, as this has enabled:

- the development of a new career path in the public hospital system for non-specialist doctors and increased retention rates of hospital medical officers;
- improved middle grade medical staffing in peripheral hospitals not included in the secondment networks;
- improved staffing of some departments where there had previously been deficiencies;
- the service needs of the hospital to be more easily met;
- individuals to undertake more clinical responsibilities and require less supervision.

Not to mention all the money they were saving !   
So, even the Dept of Health officially acknowledged that CMOs had positive benefits to the delivery of Health services well beyond being a cost- effective solution to the Maken Determination.

9 years later, CMOs have continued to be:

"experienced medical staff, providing outstanding and persistent support to the health care of Australians, usually in busy service roles that other medical groups have been unable or unwilling to fill."

(CMO Bulletin, 1997)

CMOs today are largely employed in Emergency Depts. Others are employed in

- Psychiatry,
- Alcohol & Drug Addiction
- Obs & Gynae
- Pathology
- Non-clinical areas,
- Developmental Disability
- Prison Medical Services
- Forensic Medicine, etc.

Many are GP's, some hold Specialist qualifications.

Like most awards its a pretty boring document. It is in 2 Parts with 26 Clauses and 2 Tables:

Notably it doesn't have clauses relating to:

GRADING CRITERIA
PARENTAL LEAVE
RIGHTS TO PRIVATE PRACTICE,
SALARY SACRIFICE OR PACKAGING
TRAINING AND EDUCATION
INDEXING ALLOWANCES to GENERAL SALARY INCREASES
ADOPTION OF SAFE HOURS PRACTICES

Gradings were based on "Higher Medical Qualifns" and experience. (>3 years post-grad, >2 years if approved). They were not well described in original determination and were revised in subsequent Dept of Health Circular" (#. 89/156) .

Study leave provisions were near identical to RMO entitlements, catering to junior doctors wishing to leapfrog to a speciality, rather than maintaining and improving skill levels typical of todays ongoing "Continual Medical Education"

And apparently to appease the Medical Superintendents of the day, all Penalty, Over-time, Call-back & Public Holiday Loadings were limited to the Senior Registrar rate. (apparently Med Supers didn't get more than the Sen reg rate when called back for overtime).

There have been numerous "Decisions", "Encompassing awards" and "Dept Circulars" dealing with Grading Criteria, Salary Increases, Leave entitlements, etc. over the succeeding years. No single document summarises current entitlements.

Because the Public Service Association actively pursued "across the board" increases, subject to "no extra claims" clauses, there has been no specific attention to the CMO Award, beyond a minor amendment in '92 adjusting to changes to On-call arrangments for RMO's and adding secondment allowances. The PSA didn't want negotiations stalled by minority groups seeking to alter award conditions. So the longstanding invitation to alter award conditions in Clause # 22 Leave Reserved has been unanswered with:

- No applications to adjust Allowance rates,
- No appln to Remove "Penalty, Overtime, Call-back & Holiday Payment Barrier"
- No Addition of Grade 4

Both the "Crown Employees (Public Sector Salaries June 1997) Award" (currently providing increases up to Jan'99) and the "Public Hospital (Career Medical Officers) (State) Award" expire Dec '99.

Associations such as ASMOF are already preparing applications to revise or even re-invent CMO Award. (ASMOF canvassing idea to deveop Skills-Based Award Struct. ready for submission in April '99.)

We need Assocns such as ASMOF and HREA to industrially represent us.
They rely on input from their members. The CMOA encourages all CMOs to join both the CMOA and one of these associations.

( NB: Nolene Salmon (Senior Employee Relations Officer, NSW Dept. of Health, Previous Industrial Officer for NSW AMA) later reminded us that the Industrial Relations Commission is not legally obiliged to recognise individuals or groups of individuals directly affected by any Industrial Awards. However they are obliged to recognise the Associations that are party to that Award, and for the NSW CMO Award, this is both ASMOF & HREA.)

1. CMO Grading structures:

Current Grading Criteria used to qualify employees are minimal and not defined in Award itself, but subseq. Health Dept Circular.

Criteria to be met to qualify an individual for appointment as CMO:

I    At least 3 years post graduate experience.
II   At least 5 years relevant post graduate experience.
III  At least 7 years relevant post grad exp. Relevant post graduate qualifications.

Because they are so minimal, the Health Dept suggested that we (Tweed Heads) should: "Develop your own", so we did. [see Appendix 1]

The criteria fails to recognise "Non-Spec" skills, & experience relevant to individual CMO positions, creating an artificial "ceiling" between Grades 2 & 3 that can be used to prevent promotion of experienced CMOs with years of dedicated service. There is no current provision for Grade 4.

CMOs feel their "Career Choice" is worthy of its own Qualification and Recognition, with a rewarding and navigable Career Path, that encourages self-development and promotion. Programs such as "CPDP" ("Continual Professional Development Program" .. used by Pathologists) may make this feasible in the long run.

2.  Removal of the "Penalty, Overtime and Public Holiday Payments Barrier". ("Call-backs" are also paid at "Overtime" rates)

"Clause 4. Salaries" of the CMO Award states:

"Medical Officers in receipt of a salary higher than that of Senior Registrar in the Public Hospital (Medical Officers) Award are to have penalty, overtime and public holiday payments calculated on the salary ascribed to Senior Registrar , as varied from time to time".

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 upto 6 levels lower than their own.

This can also be Graphically shown as:

This can lead to some surprising situations. For example:

Unlike every other shift worker rostered to work on Saturdays, CMO 3.3's do not receive 50% loading on their normal hourly rate of $47.79. They 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 potentially "losing" $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 their 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. They now receive 150% of lower Sen Reg rate. (this corresponds to only 13.2% loading on normal hourly rate)

Even "double-time" for a CMO 3.3 is only 52% loading on base hourly rate

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. CMOs can often have > 60% of their normal duty rostered afterhours, and typically work public holidays.

If the award wants to limit overtime, why also limit penalty loadings for rostered after-hours and working public holidays ? No-one (including ASMOF & HREA) have been able to show me another award in NSW with a "penalty barrier" of this kind.

Junior Doctors and 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. They are less willing to accept unreasonable conditions such as limited penalty and overtime loadings.

3. CMO "Study Leave" Entitlements

The current entitlements are almost identical to those for RMO's which are designed to allow junior doctors to study & prepare for Specialist Qualification exams. They fail to provide for "middle graded" doctors not wishing to pursue "Higher Med Quals" largely irrelevant to CMO positions.

The Award fails to acknowledge that ongoing CMO Education and Training is important or necessary. (? because CMO positions are, by definition, "non-training" positions).

It completely fails to commit itself to Continuing Medical Education relevant to our practice areas, and even provides opportunities for employer to refuse you.

It only provides 7 calendar days per year for the pursuit of specialist qualifications, plus NO expenses !! (whereas Specialists are entitled to 25 calendar days of "Education, Training and Study Leave per year plus full expenses: total of $19,000 per year cumulative for 2 years, currently seeking to extend this to 3 years)

Yet CMOs are "middle graded" officers needing proper access to "middle graded" CME & Training. They are expected to work unsupervised, often in challenging circumstances. "Study Leave" should be renamed to "Training, Education and Study Leave" [as described in staff specialists award] and include written committments to:

a) encourage & promote ongoing training and education of CMOs.
b) formally ackowledge Training, Education and Study Leave as a necessary entitlement.
c) include routine Continuing Medical Education courses, programs and Ordinary Medical Conferences that are deemed relevant to the training and educational needs of individual CMO, without the need for delivering formal qualfications.
d) provide at least 14 cal days PAID leave plus > $3,500 expenses per year (indexed to salary increases, cumulative to 3 yrs, pro-rata for part-time employees) [This is similar to agreements offered to CMO type positions in NZ]

3. Other issues include:

Adoption of "Safe Hours practices", developed by AMA. with the additional entitlement to sleeping quarters for CMOs completing nightshift or extended periods of duty and feeling unable to safely drive home. (Hospitals are now probably liable for errors cause by overworked doctors)

Introduce "Unpalatability Allowances"(additional $25 per hour) for excessive Weekend (>2 per month) or Nightshift rostering (> 4 per mth). [Indexed to general salary increases]

With no limit to weekend or night rostering, CMOs are typically "used" to staff depts during "unsociable" hours, despite staff specialists having an afterhours element factored into their annual salary .. is this also "planned obsolescence" for CMOs ... wait till they have children and then they'll leave ?

Increase On-Call allowances (widely regarded as minimal at $ 10 per day) to $50 for rostered day .. $70- $100 for rostered day off.

Remedy current imbalance between CMO & RMO Qualification allowances (CMOs is currently $183 less than identical RMO Qualification Allowance)

Clarify In-Charge Allowance clause, as it has been denied to many Grade 2 & 3 CMOs over the past 9 years

Index all allowances to general salary increases. Most allowances are unchanged from 1989, despite significant increases in salaries.

Provide clause specifying Parental Leave provisions. These are implied only as they are not present in CMO award, yet present in both RMO & more recent Staff Specialists award. (NSW Nurses Award has 6 pages of provisions !)

Provide access to Salary Sacrifice & Packaging arrangements currently available to executive staff, and being negotiated on behalf of the Staff Specialists. This relies on public hospitals being fringe benefit exempt. There is some sort of 50% sharing of the fringe benefit saving between employee and employer.

Increasing Penalty Loading for Nightshifts to 30-50% of base hourly rate, to acknowledge their negative social impact and associated disruption to normal sleep patterns and associated ill-health.

Removal of discriminatory sections in Long Service denying benefits to defactos or partners of deceased medical officers.

Clarify part-time employees entitlements to Long Service Leave after 10 yrs part-time employment. (This may be currently available, but it is not stated in current CMO Award => confusions have arisen.)

Ensure portability of Long Service Australia-wide.

and finally

Remove "Preference of Employment" clause for unionists and those who fought in the war.

CMOs are skilled & experienced staff that:

- reduce the cost (& inconvenience) of unnecessary hospital admissions.

- identify illnesses and initiate definitive treatments earlier, reducing Morbidity and Mortality and shortening overall hospital stays.

- reduce the cost (& inconvenience) of unnecessary investigations and A/H call-backs for ancillary staff such as radiographers and lab technicians.

- can perform numerous procedures without the need for calling in Specialist staff (such as Paediatric IV cannulation, suprapubic catheterisation, intercostal catherisation, etc.)
[For a full list, CLICK HERE to view the skill levels required of CMO's in the Illawarra Region, known as Multi-Skilled Medical Officers]

- can perform procedures, such as fracture reductions and complicated wound repairs, that might otherwise require Theatre and the expense of calling in Theatre staff, etc.

and ALL of this without compromising patient care.

For example:

In a three month period from June to August 1998, Tweed Heads Emergency Dept (staffed predominantly by CMOs), admitted 56 fewer forearm fractures requiring manipulation, than our regional hospital Lismore, (staffed predominantly by RMO's, where all forearm fractures are routinely admitted).

Because CMOs can perform regional anaesthesia (Bier's blocks), we conservatively estimate that employing CMOs saves the Northern Rivers Area Health Service > $112,000 per year for this one condition..

The world-wide trend of increasing levels of senior staff in Emergency Depts, and reducing junior staff involvement suggests that:

The First line in saving hospital costs:

employ experienced CMOs at the Front Door.

The Second line,

keep them there .. with

- adequate Remuneration
- rewarding and navigable Career Structure
- adequate funds to maintain & update skill levels
               with Continual Medical Education Programs, etc.

- CMO Award's Base Hourly rates range from $28 - $48
- CMOs on "Private Agreements" can achieve $65 (plus 7 wks Paid leave Car and petrol.)
- Replacing CMOs with Locums cost $70 - 100 , depending upon urgency and locality (+ Locum agency fees of $12-14/hr)
- GP VMO's cost $80 - 120 , depending upon years of experience

=> Grade 2 CMO @ $ 36 /hr is looking pretty cheap for a dctor who can independently:

- intubate unconscious patients at 3 in the morning
- resuscitate & stablise multi-trauma patients
- revert life threatening arrhythmias
- stabilise compound fractures
- insert chest drains
- identify bleeding ectopic pregnancies
- take CSF off a child with meningitis who is delusional and unco-operative

Many CMOs have successfully negotiated private agreement packages in excess of award conditions, by threatening to leave the award and offering their same services as Locum practitioners.

We are the "Middle Graded" Medical Officers that permeate the Hospital based Health Care system. We fill positions in busy service roles (often "essential" ), that other medical groups are unable or unwilling to fill. We have the experience & skills to keep the system working. Our presence minimises associated costs. We were once the cost-effective solution to the Goverment, and 9 years on we remain cost-effective.

An award that is historically linked to junior doctors fails to see Training & Education of a middle-graded workforce as necessary. CMOs are not junior doctors. We are employed in diverse settings, utilising diverse skills, where traditional "Higher Med Quals" lack relevance. We work unsupervised, with increased roles & responsibilities. Many of us work the majority of our rostered normal hours during After-Hours without proper penalty loadings. We endure a Grading Structure that doesn't recognise their skills, with artificial ceilings that limit or prevent promotion.

Working in isolation or small groups, we may go un-noticed. We need to remind everyone that CMOs provide:

- outstanding support to the Healthcare of Australians
- in busy service roles (including "essential")
- that other medical groups are unable or unwilling to fill

Our presence:

- raises standard of Health care
- improves provision of services
- reduces overall costs.

We are NOT rejects from "Real" career. We don't wish to be "Lack of a Career" Medical Officers

CMOs are experienced skilled practitioners, needing proper access to Training and Cont. Med. Educn. They want to develop Self-Directed Learning Programs suitable for Award Recognition, such CPDP (Continuing Professional Development Programme) currently used by Pathologists.

Being a CMO is an admirable career choice, worthy of renewed support and recognition.

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