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HOSPITAL HEALTH CHECK 2026

More than a snapshot,
HHC is a warning

Dr Owen Taylor-Williams

AMA (WA) Doctors in Training Practice Group Co-Chair

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The 2026 AMA (WA) Hospital Health Check (HHC) has again given WA’s doctors in training (DiTs) a collective voice, with more than 1,300 responses across the State. It’s a significant achievement for the HHC committee, whose work in writing, reviewing and analysing the survey has produced one of the AMA (WA)’s most important advocacy tools. More importantly, the results provide a clear picture of what DiTs are experiencing and what the health system must do next.

The headline finding is not simply that DiTs are working hard – but that the longer they stay in the system, the more they are asked to postpone their lives while seeing fewer clear opportunities for career progression in WA. For many, the bargain is becoming harder to justify.

HHC highlights several warning signs:

  • 47% of trainees and 58% of service registrars say the training process or the process of getting into training is affecting their wellbeing;
  • 44% of service registrars do not believe training programs are transparent;
  • As DiTs become more senior, they are more likely to work longer hours and to question whether WA offers them a sustainable future.

The path forward should focus on two linked reforms: secure employment for DiTs and a stronger, more transparent training pipeline.

Employment insecurity is often treated as a normal feature of hospital training. It should not be. Many DiTs spend a decade or more rotating between sites on contracts that last less than a year. That level of transience may be familiar, but it has consequences. When doctors are repeatedly on short-term contracts, they may feel less able to raise concerns about unsafe environments, patient safety risks, bullying or workload. There is good evidence for this in multiple studies.

“ A doctor who is too fearful to call in sick, or who feels unable to claim overtime or raise concerns, is working in a system which has normalised avoidable risk.

HHC shows this reluctance to raise concerns is real – 65% of DiTs report being afraid to call in sick even when unwell; and at many sites, 40% or more of doctors are not claiming the overtime worked.

These are not just industrial problems. They are workforce and patient safety problems. A doctor who is too fearful to call in sick, or who feels unable to claim overtime or raise concerns, is working in a system which has normalised avoidable risk. Secure employment would not solve every issue, but it would reduce the fear that honest reporting and basic entitlements may come at a career cost.

The second priority is training opportunities. The HHC shows that confidence in a future career as a doctor in WA declines with training seniority. While 68% of interns and RMOs believe there is a future for them in training here, that confidence falls to 61% among service registrars. This matters because service registrars have often already invested years in WA hospitals. They have built clinical skills, institutional knowledge and relationships. Losing them at this stage is costly.

At the same time, the expectations placed on DiTs as they become more senior intensifies. They work more hours, carry greater responsibility, and increasingly put major life decisions on hold. For that sacrifice to be sustainable, the pathway ahead must feel fair and attainable. Too often, it does not.

Training places remain limited, the number of service registrars continues to rise, and nearly half of service registrars do not believe training program selection is transparent. This is difficult to reconcile with the emphasis many colleges place on transparency in their own selection principles.

“ The 2026 HHC is more than a snapshot of training conditions. It’s a warning about the future of the WA medical workforce. DiTs are telling us they want to build their careers here, but they need the system to offer a credible path.

Locum work then becomes a rational choice, not merely an individual preference. When DiTs can obtain better pay, greater flexibility, and more control over their lives outside permanent hospital career pathways, WA should not be surprised that they consider leaving. Retention will not be achieved by goodwill alone. It requires a health service structure that rewards commitment with security, fairness and genuine progression.

The 2026 HHC should therefore be read as more than a snapshot of training conditions. It’s a warning about the future of the WA medical workforce. DiTs are telling us they want to build their careers here, but they need the system to offer a credible path.

That path must include more training positions, transparent selection processes and secure employment arrangements that allow DiTs to speak up, take leave when unwell, and claim overtime without fear. These reforms are practical, achievable, and aligned with the broader interests of the health system.

WA cannot afford to train doctors for years only to push them towards locum work, interstate opportunities, or careers outside the system. A stable career pathway for DiTs would strengthen retention, improve morale, and support safer patient care. HHC has again given us the evidence. The next step is to act on it.

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