Taking time out to practise medicine in a different location is a rite of passage for many, but recent regulation and workforce changes are altering the locum landscape
It was late at night on Groote Eylandt in the remote Gulf of Carpentaria. General practitioner Dr Nigel Bacon was settling himself in his accommodation when the call came in. A woman had been stabbed in the neck during a domestic dispute.
He quickly headed down towards the remote mining island’s clinic, thinking to himself with some panic: “What can I do?”
The nearest hospital was 700 kilometres away.
“Fortunately it was nothing”, he tells the MJA. “The anticipation is always worse than the reality.”
But the incident was a sharp reminder that he was a long way from the family practice he had operated for most of his working life in regional New South Wales.
Dr Bacon is semiretired and is one of the thousands of doctors, from general practice to emergency medicine, who make up Australia’s valuable locum workforce.
Locums often make good fodder for headlines in the mainstream press: they are too many or too few, too expensive or too risky. But as a group, they play a vital, sometimes underrated, role in the medical system, from respite for GPs in remote solo practices to emergency relief at all levels of the hospital system.
Few do locum work for the long term, but many choose to do it at some point in their career for at least a short period. For some, it is a lucrative way to spend annual leave, or a way to keep skills up while on maternity leave; for others, it can be a chance to experience medicine in a completely different environment. Travel opportunities and the idea of giving something back are also important motivators.
But the industry is now in the process of change say long-time observers, pointing to the influence of regulation and workforce changes.
When it comes to regulation, the notorious few being paid more than $200 per hour are even fewer thanks to state health department locum payment caps introduced over the past decade. It is still possible to make $6000, all expenses paid, by stepping in to cover a weekend in a remote hospital but regulation has brought some control of locum providers, with the number of agencies in NSW plummeting from a massive 200 prior to accreditation being introduced in 2008, to just 41 today.
Workforce changes created by the rapidly growing graduate numbers are also beginning to affect parts of the industry. It is now much rarer for training hospitals to have to fill short-term vacancies with locums compared with the situation five years ago. Nevertheless, there is still demand from regional and remote hospitals and general practice.
Dr Joseph Sgroi established Medic Oncall with his business partner Melissa Bennett in 2001, inspired by a particularly frightening experience as an intern.
“When I was working as an intern at Alfred Hospital, I was the medical resident for the weekend when the surgical resident went off”, Dr Sgroi says.
The vacancy was unexpected and the hospital told Dr Sgroi that there was no one to fill it at such short notice. During the evening, he had a medical patient who became acutely ill and went into the intensive care unit (ICU). Within 10 minutes of sorting out that problem, a surgical patient also required ICU services. Luckily, by then Dr Sgroi was available.
“Fortune favoured both those patients, but it could have been a situation where both patients became sick at the same time and we would have been short of staff”, he says.
Medic Oncall became the first agency to be established in Victoria and it now operates around the country with between 5000 and 6000 doctors on the books. As with many agencies, they have a broad clientele including public and private hospitals as well as general practices and even horseracing clubs. Dr Sgroi himself has taken locum placements.
“Over and above everything, the whole idea of setting up the company was not only to protect the doctor but to protect the patient as well, because I didn’t want to see the situation that befell me when I was an intern.”
A former chair of the Australian Medical Association Council of Doctors-in-Training, Dr Sgroi says that as competition for full-time graduate jobs intensifies and as pressure to use the current generic postgraduate year 3 and postgraduate year 4 hospital positions for specialist training intensifies, locum work may become an unexpectedly important avenue for valuable work experience.
“The impediment now to getting a job is experience and if you can’t get a full-time job, the less experience you have and the less ability you have to progress through the system”, Dr Sgroi says.
But the itinerant life may not suit everyone and there is the need to be able to quickly adapt to new work environments and to integrate quickly with different teams — whether in a hospital system or in a private practice.
To guard against rude shocks, Dr Bacon recommends that those new to locum work choose short-term positions, two weeks or less to begin with, and get to know what staff will be available at each destination.
“Nursing staff are the backbone to the whole system and they are so competent. They triage very well and they guide you. Working well with a good nursing team is absolutely essential, so you have to be a team player.”
And given his Groote Eylandt experience, he says of course it is vital to be up to date on emergency skills.
Dr Bacon now does a lot of his locum work close to where he once practised on the NSW north coast. But over the summer period he says he is not doing very much at all.
“That’s the other great thing about locum work — I’ve just taken my name off every roster until February!”
General practitioner Dr Alain Mackie had been practising for 20 years when he decided it was time to do something a little different and introduce some more variety into his work life.
“My children had grown up and left school and I thought it would be a good opportunity to explore a bit”, Dr Mackie Says.
He left his partnership in Byron Bay, New South Wales, in 2010 and began working as a locum for six months of each year.
Since then he has travelled the length and breadth of the country, from Townsville, Queensland, to the Western Australian wheat belt and Tasmania. He goes away for a month or three weeks at a time, returning to his family between each placement.
While some of the accommodation has been a little basic — in one instance a nicely converted caravan — and the entertainment options have not always been great — there was plenty of time for reading while working in the WA wheat belt in particular — Dr Mackie says he would not dream of complaining.
“It’s an interesting way to make a change in your career and it’s a little bit altruistic”, he says. “You’re doing some good deeds for smaller communities, if you’re happy to go out and endure some isolation.”
Travel and accommodation are always provided and most of the placements have been made through the Wavelength medical recruitment agency which, like the vast majority of Australian locum agencies, charges around 10–15 per cent on top of the doctor’s fee.
“They’re in business and they’re making some money and employing staff so they have to charge fees.”
The one thing he misses about practising in this way, Dr Mackie says, is the patient follow-up.
“You think you’re doing good deeds but you actually don’t find out about them unless you go back. There’s a lack of continuity.”
In a few cases over the three years, he has been able to return to the same practices multiple times and so has been able to establish relationships with patients and staff.
But ultimately, like so many, he says he couldn’t do it permanently and will probably settle down in a practice again sometime over the next year.
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