Doctors in New South Wales are criticizing a proposed policy that would require them to seek annual approval for secondary employment. The draft rules, which are expected to be finalized before the state election, give the state’s health department broad authority to approve, refuse, or revoke permission for doctors to work outside their primary hospital roles. The Australian Medical Association NSW and the Rural Doctors Association of Australia argue that the policy risks pushing medical professionals away from rural communities just as the state attempts to increase its workforce.
Expanded powers for NSW Health allow the department to manage lawful work done by doctors outside of standard hours. This includes locum work, visiting medical officer (VMO) roles, and other professional or community activities. ASMOF NSW president Dr Nicholas Spooner described the measure as an “attack” on doctors’ industrial rights. He noted that the system depends on doctors working across multiple hospitals and holding fractional appointments, so restricting these activities could undermine the entire public health infrastructure.
Doctors would need to submit applications at least four weeks before starting any secondary employment. The draft permits these arrangements for a maximum of 24 months. The process requires a supervisor to review the request and provide a recommendation within seven business days, followed by a final approval from a relevant authority within another seven days. ASMOF has called on the government to withdraw the draft and instead focus on the fatigue risks caused by unrostered overtime and understaffing.
Clarity and thresholds missing
The Rural Doctors Association of Australia (RDAA) CEO Peta Rutherford said the policy appears to be an overreach. She recommended that the department provide clear guidelines on what constitutes a fatigue-related concern rather than demanding an extensive list of extracurricular roles. The draft uses vague terms like “excessive working hours,” “fatigue,” and “fitness for work” without defining statewide thresholds.
Rural generalists often wear multiple hats, balancing private practice, VMO contracts, emergency care, teaching, and on-call duties. Rutherford argued that these professionals are capable of managing their schedules responsibly. She said the policy fails to understand the context of rural practice and warned that developing rules in a vacuum without consulting the affected professionals would likely lead to service reductions.
Dr Nicholas Spooner said the policy fails to reflect the integral operation of the public health system. He pointed out that the draft even puts longstanding arrangements back up for approval, potentially requiring doctors to cease work they have lawfully performed for years. “NSW Health relies on doctors working across multiple hospitals, fractional appointments, locum roles, teaching and research,” Spooner said. “It cannot build a health system around those arrangements and then subject them all to a sweeping annual permission regime.”
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Bureaucracy and workforce shortages
AMA NSW president Dr Fred Betros said the draft adds another layer of bureaucracy to an already over-burdened workforce. In his August 31 president’s message, he stated that the policy provides no explanation of how it will be funded or administered. Betros warned that if the policy proceeds in its current form, some doctors might reconsider their roles in the public system altogether.
Betros noted that the state’s interests in managing conflicts of interest and fatigue are already covered by national law and industrial instruments. He questioned the government’s ability to deliver on its promises of additional health workers. “Every one of these issues comes back to the same missing piece. The NSW Government has promised 9000 additional health workers – but how many are doctors, where they will work, and will how they will staff the wards, clinics and theatres that keep being announced?”
Dr Nicholas Spooner argued that the policy is unworkable. “Those objectives do not justify giving NSW Health open-ended control over lawful professional activity without clear criteria, proper safeguards or independent review,” he said. Spooner said he had written to the Ministry urging it to abandon the proposal. He argued that if the government genuinely wants to reduce fatigue and improve patient safety, it should address the excessive hours, unsafe rostering, and staffing shortages within its own system.
Fatigue vs. regulation
Betros said he doubted the policy was intended to address fatigue at all. He shared his own experience during registrar training, noting that he once worked 80 to 100 hours a week all within a single hospital. He argued that the issue of fatigue stems from workload, not secondary employment. “During my training as a registrar, I could work 80 to 100 hours a week, and that was all in one hospital. So, it had nothing to do with secondary employment,” Betros said.
The debate over this policy comes at a critical time for rural healthcare. A recent fatal car crash involving a Royal Hobart Hospital cardiothoracic surgery registrar has heightened awareness about doctor fatigue and the pressures of rural rosters. The doctor, Dr Artyom Avetisyan, died on June 12 after leaving an outpatient clinic two hours north of Hobart. The incident highlights the physical demands placed on medical staff, though the draft policy focuses on regulating secondary work rather than the primary hospital roster.
