The anonymous comments from junior doctors were confronting but come as no surprise to Dr Alan Pham. "It's an accurate reflection of our day-to-day lives and the issues we face," said the deputy chair of Alliance NSW's doctors-in-training committee. It was not uncommon to work a normal day shift, then be on call at the hospital through the night, reviewing sick patients and operating until the morning staff relieve them, the burns registrar and paediatric surgical trainee said. "There were times when I had to work over 24 hour shifts. "I have a two-year-old boy and sometimes I would see him for half an hour or 45 minutes a day, and if I'm lucky on the weekend."

NSW public hospitals have been graded by their doctors in training in the Hospital Health Check Survey report published Monday. No NSW hospital scored an "A" mark for their overall performance in the report published Monday by the Alliance NSW (AMA NSW and Australian Salaried Medical Officers Federation). Among greater Sydney's hospitals, the following scored an overall C: Bankstown-Lidcombe, Blacktown, Campbelltown and Camden, Concord and Canterbury, Liverpool and Fairfield, Nepean, RPA, St George and Sutherland, St Vincent's, The Childrens Hospitals, Prince of Wales and Westmead. Only The Royal North Shore, and the North Sydney LHD hospital grouping of Hornsby, Manly and Mona Vale hospitals scored an overall "B" mark. The two measures with the most C and D grades were "rostering and overtime" and "wellbeing", with no NSW hospital scoring A and only a handful scoring B.

RPA, St Vincent's, Bankstown-Lidcombe, Westmead, and St George and Sutherland hospitals each scored two D marks, one for "rostering and overtime", and the other for "wellbeing". The Childrens Hospital Westmead was the only hospital to get a B for wellbeing, and the NSLHD grouping of Hornsby, Manly and Mona Vale hospitals were the only hospitals to score B for rostering and overtime. A spokesperson for NSW Health said the survey "highlighted some areas of concern at individual hospitals and these hospitals will need to review the results and respond to the issues identified". All five D-graded hospitals have implemented a range of measures designed to improve the safety and wellbeing of staff, including RPA's BPTOK program, JOM complaints officers at Western Sydney LHD and South Western Sydney LHD, and mentoring program at St Vincent's hospital. While there was some variation between individual hospitals, the report showed the issues hampering junior doctors were evident across the network and demanded a system-wide response, Dr Pham said.

"These types of problems are deeply etched into the fabric of our profession and there is not easy glue we can use to slip into the cracks," Dr Pham said. "It's going to take a steady, sustained effort from all stakeholders and parties involved." Overall, the survey of 1107 doctors in training found 71 per cent had been concerned they would make clinical errors, and 68 per cent said they were worried about their personal health and safety due to fatigue caused by hours worked. Only 3 per cent of respondents worked a normal 80-hour week and almost 90 per cent were not paid all their unrostered overtime. Almost one third of respondents said they were bullied but did not report the incidents, and 46 per cent said they witnessed bullying but did not report it.

Two thirds said they feared the negative consequences of reporting inappropriate workplace behaviours. "They were things we would only talk about in hushed tones behind closed doors with none of our seniors around," Dr Pham said. "Now we have this data on paper to say this is what we are dealing with means we have a baseline and work to improve and make things better." Health Minister Brad Hazzard at the JMO wellbeing forum in June. Credit:Louise Kennerley The study also found several positives, including 56 per cent of respondents rating their overall experience as a DIT good or excellent, and 80 per cent said they would recommend their hospital to other doctors.

NSW Health Minister Brad Hazzard said he was well aware of the high degree of concern surrounding untenable work conditions and mental health problems through conversations with young doctors and the JMO wellbeing forum in June. "We need to take these issues seriously ... hospital management need to pick up their game in some instances, but part of the fault lies with the colleges and the government and health system generally," Mr Hazzard said. "The challenge now is to get 15 separate local health districts to work with the central ministry of health to try and improve what are long-term systemic issues," Mr Hazzard said. NSW Health was currently finalising a "JMO Wellbeing Support Plan" based on feedback from the forum and expert advice, and has launched a review of hospitals roster patterns. "The new rostering system that is being rolled out across NSW Health provides support to those developing rosters and managers to ensure rostering meets best practice," a NSW Health spokesperson said.

A JMO Support Line has also been set up in response to evidence of junior medical staff experiencing difficult and unacceptable behaviours, and in some instances, bullying and harassment, during training.