With less than 200 days until the state election, they say the proposed policy risks pushing doctors away from the rural communities that need them most.
A secondary employment policy designed to manage fatigue and conflicts of interest has drawn scrutiny from the AMA NSW and the staff specialist union, which warn it could cause “collateral damage”.
The Australian Salaried Medical Officers Federation of NSW (ASMOF) has called on NSW Health to withdraw its draft secondary employment policy and instead address the fatigue risks created by its rostering, unrostered overtime, on-call demands, and understaffing.
The draft gives NSW Health broad powers, including the power to approve, refuse, impose conditions, and even withdraw permission of doctors to undertake lawful work outside NSW Health hours, such as locum and visiting medical officer (VMO) work, as well as other professional and community activities.
ASMOF NSW president Dr Nicholas Spooner said the policy was an “attack” on doctors’ industrial rights and failed to reflect the public health system’s integral operation.
“NSW Health relies on doctors working across multiple hospitals, fractional appointments, locum roles, teaching and research. It cannot build a health system around those arrangements and then subject them all to a sweeping annual permission regime,” he said.
“The draft even puts longstanding arrangements back up for approval. Doctors could be required to cease work they have lawfully undertaken for years, including arrangements already disclosed to and accepted by NSW Health.”
According to the draft policy, secondary employment arrangements would be approved for up to 24 months.
Applications would have to be submitted at least four weeks prior to commencement.
The applicant’s supervisor would then be required to review the application and provide a recommendation within seven business days, and then submit the application to a relevant approver, who would have to approve it within another seven business days.
The ASMOF called for NSW Health to consult health unions, await the outcome of the Staff Specialist Award proceedings, currently subject to ongoing arbitration, and publish a policy impact assessment on doctor recruitment, retention and patient care.
The union also asked for evidence of a “demonstrated” issue with existing arrangements and for NSW Health to address fatigue risks from its staffing operations.
While he said doctors supported genuine measures to manage fatigue and conflicts of interest, Dr Spooner said he had written to the Ministry urging it to abandon the “unworkable proposal”.
“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.
“If NSW Health genuinely wants to reduce fatigue and improve patient safety, it should start with the excessive hours, unsafe rostering and staffing shortages within its own health system.”
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RDAA CEO Peta Rutherford said the draft policy appeared to be an overreach and recommended that it instead provide clear guidelines on what could cause fatigue-related concerns, rather than requiring doctors to submit an extensive list of extracurricular roles and work.
“It’s really up to the individual doctors to manage their day. Who decides at what point that person is now fatigued or not?” she said.
Ms Rutherford said the draft’s terms, including “excessive working hours”, “fatigue”, “fitness for work”, “performance” and “wellbeing”, provided no clear statewide thresholds.
Rural generalists could work in private practice, have a VMO contract, and be rostered or on call to provide emergency and procedural care, she said. They could also have teaching and supervision responsibilities, she told The Medical Republic.
“For some, it may appear overwhelming, but that rural GP VMO may have been able to manage all of those obligations very well for a long period of time,” she said.
“[NSW Health] need to be clearer in their guidelines of what they want to achieve and recognise that these people are responsible professionals who are able to provide some clear judgment.”
She said NSW Health failed to “understand the context of rural practice and the many hats that these people will wear”.
“When policy is developed in a bubble without good engagement and consultation with the health professionals that this will impact most, what is likely to happen will be service reductions,” Ms Rutherford said.
Before the draft is finalised and implemented, she said the policy required significant work and direct input from peak medical bodies and health professionals.
The AMA NSW also lodged a formal submission on the draft policy in August 2026.
In his 31 August president’s message, AMA NSW president Dr Fred Betros said the draft added “another layer of bureaucracy for an over-burdened workforce” and provided no explanation of how it would be funded or administered.
“If it proceeds in its current form, some doctors will reconsider their roles in the public system altogether. That is not a risk worth taking,” he said.
NSW Health’s interests in managing conflicts of interest, fatigue and proper resource use are already covered by national law, the Medical Board’s code and industrial instruments, Dr Betros said.
He said: “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?”
“The overwhelming feedback from our members is that it’s an ill-thought-out policy,” he told TMR.
Dr Betros said the “overreaching” policy would cause “collateral damage”, and he was also doubtful that it was intended to address fatigue.
“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,” he said.
While he advocated for longer breaks between shifts, he acknowledged current workforce shortages made any gap in service provision unacceptable.
“If we had more doctors working in the public health system, that would reduce the need for people to do the extent of the hours that we have,” he said.
The draft policy follows the death of Dr Artyom Avetisyan, a Royal Hobart Hospital cardiothoracic surgery registrar, who died in a car crash on 12 June after leaving an outpatient clinic two hours north of Hobart, where he had planned to return to work at the hospital.
