Whose Job Is It Anyway?

Abstract

This account focuses on a time of conflict and change within my workplace environment over the course of a year. My workplace is a clinical department within a tertiary referral hospital. The change occurred with the movement of the department away from one largely run by long-standing visiting medical officers (VMOs) to a modern one with a completely new leadership structure. It is necessary to describe the department structure before the details of the conflict can be discussed. The department’s business is the provision of public medical services to patients as well as the training of residents. Traditionally one or two full-time staff (director and staff specialists) ran departments. The bulk of the work was performed by VMOs. A junior consultant usually held a staff position for a few years prior to commencing his or her private practice. There was some stigma associated with retaining such a position beyond a few years, as it was often considered that the individual was unable to establish his or her own practice. Clinicians who spent the majority of their time in private practice and often regarded their public appointments as something akin to charity, held VMO positions. Indeed, in the past they were not even paid but were called “honoraries.” Over the past 10 to 15 years there has been a “sea change” in the structure of many departments. Fewer newly qualified consultants have sought to go out into private practice and have instead opted to remain in public or staff appointments. This has happened for a combination of reasons—improved lifestyle, academic interest, improved remuneration, and the decrease in private health insurance associated with the introduction of Medicare. The pendulum has now swung back. Most newly qualified consultants prefer to remain within staff positions, and there is a slight stigma associated with those who go out into private practice straightaway. Within my own workplace, staff and VMO positions have not been as sought after as positions at other tertiary referral academic departments. This may be because the hospital does not offer all specialties. It is also associated with a fair number of night calls (frequent callouts at 2 a.m.). As a consequence, the department was largely run with a small number of full-time staff and a larger number of VMOs. The department has had a checkered history in the recent past. It was one of the first academic departments within its field in the country. Over decades it established an enviable reputation and was responsible for training generations of doctors. After the retirement of a long-serving department head, the next three directors were all longstanding members of the department who had trained under this man. They were thus