Surgeons blame bureaucrats, not just budgets

The public hospital system is buckling under the weight of political neglect and bureaucratic overreach, with patients now waiting nearly twice as long for essential surgeries as they did 20 years ago.

The Royal Australasian College of Surgeons (RACS) has delivered a scathing indictment of the conditions inside NSW Health, demanding that governments stop the spin and start negotiating with frontline clinicians before the system collapses entirely.

“Our surgeons are dedicated to providing the highest standard of care for patients across NSW Health public hospitals, however, they cannot continue to do so under the current conditions,” said outgoing RACS President, Associate Professor Kerin Fielding.

The crisis has been years in the making. The result? A system that no longer works for doctors or patients.

“We are increasingly seeing bureaucratic overreach and planning without senior clinician input, which has escalated over the past year. This has significantly impacted surgeon work practices, workforce wellbeing, surgical training, and most importantly, patient safety,” emphasised Associate Professor Fielding.

Those on the ground are voting with their feet. In NSW and the ACT, surgeons have walked off the job or resigned altogether.

“The industrial action reflects the consequences of chronic understaffing, unmanageable workloads, and poor working conditions. These issues threaten the quality of patient care and jeopardise the sustainability of our healthcare system both in Australia and Aotearoa New Zealand,” Associate Professor Fielding said.

At the College’s Annual Scientific Congress over the weekend, surgeons came together to discuss strategies for working with governments to reduce essential surgery waiting lists.

Their frustration is echoed in a damning national survey from the Australian Salaried Medical Officers’ Federation (ASMOF), which exposes the toxic culture permeating public hospitals. The findings are nothing short of alarming: only 25% of doctors said they are treated with respect by hospital management. For specialty trainees – the future of the system – the disrespect is even more rampant.

The report lays bare what ASMOF calls “a deeply disturbing picture of dysfunction in the working relationships between administrators of Australia’s public hospitals and the doctors who work in them.”

The disconnect is staggering. Over two-thirds of doctors say administrators don’t even understand what they do. Worse – only 5% believe budgets reflect clinical realities.

Doctors say they are being punished for speaking up. Only a quarter felt safe reporting issues related to workplace culture or patient safety. Many who did were met with retribution – bullying, threats, downgraded performance reviews, even accusations of insubordination.

“Without meaningful reform and collaboration, the system is under serious threat, many surgeons will leave the public sector, costing the government millions in training and support. We must work together now to turn this situation around before it’s too late,” warned Associate Professor Fielding.

Unless governments engage in urgent reform, Australia’s surgical care system will continue to unravel – at a devastating cost to patient care.

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