Letters
Health services administration
Volume 198 - Issue 1

“Don’t tell them that you’re working when you are”: safe hours and underreporting

Author:  Rosalind J McDougall

Med J Aust 2013; 198 (1): 20. || doi: 10.5694/mja12.11116
Published online: 21 January 2013
Never let the truth get in the way of a tidy timesheet.
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To the Editor: The aim of the Australian Medical Association’s recent hours audit1 is presumably to encourage hospital administrators to ensure that doctors work safe hours. An unintended consequence is likely to be continued pressure on doctors to underreport their working hours. Too often, it seems that somewhere between the policy and the practice, the focus changes from working hours that comply with safety guidelines to working hours that appear to comply.

When I interviewed interns and residents for a research project about the ethical challenges that junior doctors face,2 a number of them spoke of pressure to underreport the hours that they had worked. For example:

When I began this job I wrote down all my hours on my timesheet. And then I got paid for 38 and a half. So I was like, “what’s the deal?” I spoke to medical admin, and they said to me, “the problem is that something is wrong within your unit if you’re not leaving at four”... I did talk to my registrar about it ... He’s like, “oh look, get used to it. You’ll forever not get paid the hours you actually work.” And I said, “when we write down our hours they crack it, like we’re [doing something wrong]”, and he’s like, “well don’t tell them that you’re working when you are”... It’s not even the money, it’s the fact that I’m being recognised as working safe hours.

This intern’s description illustrates some of the implicit and explicit pressures on doctors, particularly junior doctors, to report their hours inaccurately. First, she highlights a pervasive culture of underreporting. It is seen as easier to just lie on your timesheet than to battle with the bureaucracy, and this is the message clearly communicated to junior staff. Second, she highlights unwillingness by some administrators to acknowledge that sometimes high-quality care simply cannot be delivered in the time allocated.

Administrators ought to be open to information about how long it takes doctors to do their work. Without accurate data, they cannot resource units appropriately nor manage the risks that unsafe work patterns create for patients and staff. There needs to be a willingness on both sides to move beyond the current status quo of administrators making unrealistic demands and doctors feeling that they need to pretend that they have achieved them.

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