Potential Unintended Consequences of Inadequate Remuneration for NSW Health Doctors

Workforce Impacts

1. Talent Exodus

• Migration to private practice
• Relocation to other states/territories with better compensation
• International migration
• Early retirement of experienced practitioners

1. Recruitment Challenges

• Difficulty attracting high-caliber specialists
• Reduced competitiveness for top medical graduates
• Unfilled positions, particularly in regional/rural areas
• Increased reliance on locum physicians at premium costs

1. Workforce Composition Changes

• Concentration of early-career doctors with less experience
• Reduced retention of mid-career specialists
• Imbalanced specialty distribution Quality of Care Implications

1. Burnout and Wellbeing Issues

• Increased physician burnout and mental health challenges
• Compassion fatigue and reduced empathy
• Higher rates of medical errors and near-misses
• Increased sick leave and absenteeism

1. Service Delivery Impacts

• Longer wait times for procedures and consultations
• Reduced time spent with individual patients
• Decreased continuity of care
• Potential compromises in service quality

1. System-Level Effects

• Reduced capacity for teaching and mentoring
• Diminished research output and innovation
• Less participation in quality improvement initiatives
• Decreased institutional knowledge retention Economic Consequences

1. Hidden Costs

• Higher recruitment and onboarding expenses due to turnover
• Increased spending on locums and agency staff
• Potential litigation costs from adverse events
• Administrative burden of constant workforce management

1. Systemic Inefficiencies

• Loss of productivity during transition periods
• Reduced system capacity leading to bottlenecks
• Increased emergency department utilization for routine care
• Higher costs for treating complications from delayed care Broader Social Impacts

1. Public Perception

• Eroded trust in the public health system
• Perception of two-tiered healthcare quality
• Reduced public support for healthcare funding
• Potential political consequences from dissatisfied constituents

1. Health Equity Concerns

• Disproportionate impact on disadvantaged communities
• Widening healthcare disparities between metropolitan and rural areas
• Reduced access to specialized care for complex conditions
• Increased financial burden on patients seeking private alternatives Long-Term Structural Concerns

1. Training Pipeline Disruption

• Reduced interest in public health careers among medical students
• Compromised quality of clinical training environments
• Decreased mentorship opportunities for junior doctors
• Potential shifts in specialty choices based on compensation rather than interest

1. System Resilience

• Reduced capacity to respond to public health emergencies
• Weakened ability to implement healthcare reforms
• Diminished institutional memory and leadership continuity
• Potential for systemic instability during crisis situations