Dr Adam Brownhill: Good evening everybody and welcome to the first in a series of webinars that the College is having regarding the art of rural locuming.
So the Royal Australian College of General Practitioners would like to acknowledge the traditional owners of the lands on which this webinar is being broadcast and we pay our respects to the elders, past, present, and emerging.
Welcome to the hundred and eighty odd people we've currently got listening for this evening’s webinar. My name is Adam Brownhill. I'm an international medical graduate, originally from the UK. Like a lot of IMGs, I came over to Australia just for six months and roughly six years later I'm still here. I've been a practice owner, an employee, and a locum – so I believe I can see the locum advantages and disadvantages from all sides. I've locumed in the United Kingdom, the Northern Territory, Queensland, Victoria and Tasmania. I currently work as medical director of Urapuntja Aboriginal Medical Service, which is a fairly small community of about five-six hundred people over 16 outstations about 250 kilometres north-east of Alice Springs. I'm also a GP for Equinox, the gender Diverse Health Centre. In fact, I believe it's Australia's largest gender diverse health centre, run by Thorn Harbor Health who people probably originally know as the Victorian AIDS Council. I'm also one of the clinical advisors for the Northern Territory PHN and, as lots of people are aware, the PHN are one of many organisations that help recruit GPs.
My personal love of locuming is the flexibility it gives me to change my work mix depending on the needs of the organisations I work for and also my own personal life. It's also given me the flexibility to study, and a couple of years ago I finished my FARGP.
Kirsty: We'd like to take this opportunity to thank our sponsor Ochre Recruitment. We greatly appreciate their support of this webinar. This webinar is accredited for two Category 2 QI&CPD points. In order to gain these points you need to be present for the duration of the presentation and complete the evaluation at the end of the webinar.
Dr Adam Brownhill: Thank you very much indeed Kirsty. So we're very lucky to have two rather experienced GP locums with us this evening and first I would like to introduce all, wow, nearly 250 odd people to Dr Mark Santini. Over to you Mark.
Dr Mark Santini: Thank you, Adam. I'd like to just go through some of my experiences which I guess I'm not atypical of many of the other doctors that I've spoken to who are doing locums in the locations that I work at. We sort of seem to fall into four broad categories. There are some of us that are doing it as a refresher, almost as a sabbatical, after many years of general practice in the one location. There are others who are using it as an adjunct to suburban general practice, and they are people who keep returning perhaps to the same rural or remote practice to get a different experience but to still maintain continuity. In some cases, it's a lifestyle choice for people with gypsy feet who really don't enjoy the whole idea of settling into one practice. And the fourth group that I've found are the sort of part-time semi-retired doctors who don't want to work a continuous roster and make the commitment in the one practice, and they're still able to maintain their skills by doing locum work.
My experience is actually a combination of all four and it started about 25 years ago. I'd been working in the same practice in outer metropolitan Melbourne and even though it is always a very rewarding experience being a general practitioner, after 15 years in the same place, I did find that the same patients were coming in, the same medicine, the same patient profile kept appearing every day and the learning curve tends to flatten and, to be honest, I started to burn-out and feel a little stale. And I was lucky enough to do what, at the time, seemed like a sabbatical – a six-week rotation in Port Hedland. That opened up a whole bunch of new experiences for me in emergency medicine, I had to relearn my obstetrics, I was involved in Indigenous Health really for the first time in my professional career, as well as just being involved in a rural and remote community. I enjoyed that experience enormously. In fact, I really regretted having to return back to Melbourne and, as a result, when I got around to selling the practice as my children had grown up, I've been locuming ever since. And, as I said earlier, I've used it because I like traveling and it's also given me a wonderful breadth of medical experiences that I doubt I would have had in the same location.
There are many pros to being a GP locum, and obviously there are some cons. The pros that I've found is that it allows me to see some really stunning locations throughout Australia, many of which would be really expensive to do without the advantage of maybe a Health Service flying me there and providing me the car and accommodation. These locations might be a little bit too remote to stay for the long-term, but as a short-term and medium-term solution, they're really excellent.
Having worked in the same practice, and as practice principal at the time, you become fairly set in your ways and you become quite convinced that your way of doing things is probably the best way, and of course you find that by traveling around there are many different alternatives, and that keeps challenging one to improve. I've learnt new procedures and techniques, I've been able to work in emergency medicine, and I've been forced to deliver babies in situations that were really challenging and exciting. I've also formed closer relationships with allied health workers and nurses which perhaps wouldn't have formed in a more conventional general practice. We work very closely with nurses, particularly in rural and remote settings, and we rely on their expertise and their input to look after our patients.
Overall, the paperwork is much less than I found as a practice principle and this is especially so because I've been able to find a very good agency. Finding a good agent is something that I'll perhaps allow Wendy to elaborate on but can make a big difference in enjoying your locum experience.
It can be very difficult to leave a partner in in an urban setting to go and do your exciting rural and remote work for three or four weeks, but you need to know how they feel about it. In some cases you'll be able to convince your partner to come along but where it's really exciting for you, it can be a terribly boring and socially isolating experience for your partner. And the same applies for yourself – some of the health services are very good at making a doctor feel welcome and appreciating the fact that there may not be anyone, there may not even be a pub to go to at night. Other services just expect you to sort it out for yourself. So being resilient psychologically is part of what you learn and being able to develop your own personal skills, or just bringing books and films and DVDs (whatever it is that you will find interesting), will help make your locum experience a so much more rewarding one.
I could go on and on, but I'll hand back to Adam. I'm sure Wendy will have a lot to say and I look forward to answering any of your questions over the course of the webinar. Thank you, Adam.
Dr Adam Brownhill: Thank you very much indeed Mark. That was a lovely summery. It's great to hear that you kind of got to a critical point in your career where your work, your learning curve, had flattened out and you were feeling a bit burnt out, and now that you feel more reinvigorated, that you've developed some close relationships with staff that you're working with and your skills have improved – and I'm sure we all like the idea of far less paperwork.
What I'd like to do now is introduce everybody to Dr Wendy Sexton – so over to you Wendy.
Dr Wendy Sexton: Thank you Adam. Just a little bit about myself. I grew up in rural Western Australia and I now call Perth home. Some of my experience does reflect what Mark has spoken about. I completed my GP training in both urban and regional Western Australia and that included working in general practice and the local Aboriginal Medical Service as well as the local public and private hospitals as a procedural GP obstetrician, delivering quite a lot of babies, and I also worked as a senior medical officer in the emergency department. And, yes, it was really as busy as it sounds and that's kind of how I came to the point to decide to locum. I completed my training and I decided it was time to take a bit of a break. I had always wanted to do that and thought I'll take a year to head out and locum and see what else was out there, and reconsider how I was going to balance all of these roles that I loved in my job, but the workload, particularly with my GP obstetric practice, was very busy.
Anyway, that was more than a year ago. That was actually six years ago. And locuming is the only work that I've been doing for six years now, and it's been a really great experience. I tend to focus much of my time in Western Australia and Queensland and Northern Australia, and I have worked in some particularly stunning locations. One of them, one of my favourites, was the Cocos Islands – for those who have not heard of it, it’s halfway between Perth and Sri Lanka and I believe it has the honour of when you're working there you are the most remote Australian doctor besides the Antarctic posts.
Part of the reason that I have continued to locum six years on is that it allows me some of the time and freedom to pursue my other interests, which is a common theme when you talk to locums who do it for slightly longer. And my interest happened to be in global health and during the last few years I've studied tropical medicine in East Africa and I've spent time (which I do quite regularly) volunteering overseas. So I've spent time in refugee camps in Greece and I fairly recently returned from working in Africa where I was volunteering on Mercy Ships, which is the world's largest NGO hospital ship offering free safe effective surgery to some of the world's poorest people. So, for me, locuming is a really nice mix between my two worlds. It allows me a lot of adventure and an incredibly rewarding and challenging work life here.
Like Mark, I have been to some very off-the-beaten-track and amazing places in Australia's outback. I've really enjoyed experiencing remote Indigenous communities and the colleagues that I've met and the friends that I've made there. I've also seen some patients with fascinating life stories and interesting medical problems and I felt like I was useful and appreciated and welcomed.
On the other hand, I've often grappled with the logistics of a really unwell patient who needs to go for care to a much bigger centre and there's been bad weather which is threatening to hamper the retrieval efforts, and I felt very challenged and overextended in some ways that I couldn't have imagined before I started locuming. I've also spent a lot of time in planes and airports because Perth is a long way from basically everywhere and I miss a lot of things at home by being away. However, I think overall the balance for me is strongly in favour of locuming and I also believe that the experience has been very rich and varied and made me a very well-rounded doctor.
My current locums are a mix of both general practice and Aboriginal Medical Services as well as some solo roles and hospitalist roles, but I do have a strong focus on rural emergency departments because I want to keep my acute medical skills up. And I do also reduce the cognitive load of this work by having some places, that Mark mentioned I think in one of his categories of locums, of places that I go back to regularly, and I find that quite helpful. I remember when I was starting out thinking ‘oh yes, I'll go on this adventure, it's going to be great’ then realising ‘okay, I’m actually worried about a few things: What if I can't do the job? What if I'm not welcome? What if there's an emergency that I can't deal with and I'm out in the bush on my own or with limited resources? And what about if I went somewhere and I actually hated it?’ Thankfully most of those things have not come to fruition and I have gained a lot of really great skills, and I feel more resilient from all of that.
I've honed my skills and can assess workplace culture and navigate a new system fairly quickly (couple of days). I can pack my bag in under 10 minutes, and I'm very comfortable in the air. I've also been forced to MacGyver some medical equipment in emergency situations, and it always makes for a good story later.
So, for me, from here, I think I'll be locuming for the foreseeable future, but it's certainly not something that I plan to do in this capacity for the rest of my career. But I am enjoying the fact that I can do something that would be really difficult in another role. I can live in the city, which is where I want to be at the moment, but I can do the work that I really love and I trained to do, which is in the bush. I went to medical school (which is quite some time ago now) knowing that I would be a rural doctor and I would work in Africa and other low resource settings, and that's what I'm doing now. So apparently I'm living the dream (according to all my friends at least). Anyway, if any of you want to follow along my blog or contact me on social media, my handle is there @thisgplife.
So the first steps in planning for a locum is to think about why you're doing it and what your goals are and what's going to suit you. A lot of people ask us: Is there enough work out there? Am I going to be able to find work? And the answer is yes, there is plenty of work in rural and regional and remote Australia for the foreseeable future. But your skillset and the style of locum work that you want to do will determine where is a good fit for you. Whether it's that you want to take a bit of time off, you want some variety, you just want to spend the school holidays somewhere warm or out in the bush, or it's always been on your bucket list, you want to travel around the country, or you're looking to try before you buy and see, you know, try a couple of places and see if they're a good fit for you in the longer term, or like me it's a place that you love working but it's not where you want to live or can live at the moment.
And so what is your skillset all about? Are you planning to work primarily in a clinic or would there be a hospital component as well? And by clinic that could be a regular general practice or that could be an Aboriginal medical service. Do you have extended skills in either emergency medicine, obstetrics, anaesthetics, or surgery, or are you planning to think about doing a combination of these? These are all opportunities in rural areas and you will need to up-skill in some of these if they're not what you're doing at the moment.
Then you can look at how long you’re thinking about going too. And my recommendation is if you're thinking about going somewhere, rather than signing up for a three-month locum gig somewhere that you've never been before, sometimes a two-four week period is a good trial to see if it's a good fit. You can always extend but it's much harder to back out gracefully from something that's really not working well for you.
So how do you actually find a job? Well, there are two basic ways to do it. You can go through a locum agency or you can do it yourself – the DIY method. There are a couple of different players in the locum agency world that can be subcategorized into the primary health networks and the local rural workforce agencies that are in each state and are funded separately and are there to provide rural workforce needs. And then there are a lot of commercial locum agencies who basically get a percentage for each locum that they place (and I'll talk a little bit more about that in a second).
If you wanted to go the DIY route, then there's a couple of ways to do that. It might be by word of mouth – you could ask friends who are working in rural areas (for example, if you’re thinking that some work time in Broome might not be bad over the winter), and you can also call directly and find out. Some places, some states, you cannot do that for the local hospitals and health departments, some places you can. I have done a combination of all of the above.
Just to spend a little bit of time on locum agencies. There's a couple of ways to go about it. I would strongly recommend that you ask for recommendations and be really choosy about your agency. As Mark said earlier, they can make or break and really define how good your locum experience. Because they can place you, you basically want to be placed in the right place for you. So, as I said, ask for recommendations and you can essentially call a few different agencies and try and get a feel for them. I would be looking for someone who's got a really great personal approach, they’re happy to get to know you and what you're looking for, and they're very responsive and happy and quick to answer your emails and phone calls and there's no kind of lag and delay time because some of the popular jobs will go quite quickly.
So the other option while you're getting a bit of a feel for it, is to sign up for some email alerts from a couple of agencies just to get a bit of an idea of what's out there and how much is being offered for pay for different types of roles – that just gives you a sense of what's out there. You don't have to do any more than that – you can just watch for a little bit.
I might just at this point mention that if you've got a LinkedIn profile and you're thinking about locuming, it can be a bit of a double-edged sword if you put the word locum in your bio – you will be absolutely inundated by locum recruiters in agencies. So if you want people to find you that's fine, if you want to be a bit more choosy, then I would suggest that might not be the best option for you.
So the next step in the process, once you're kind of thinking about and looking for some work, is to get your paperwork in order. That means updating your CV and thinking primarily about your skillset and highlighting these and not just your work history. Think about some referees – you will need at least two and they need to be people that you have worked with in the last six months or six to 12 months. So have a think about who they might be and then start getting all of these documents in order. It's becoming more and more the standard that you will need to have copies of your qualifications, so both your medical degree and postgraduate qualifications, certified by a JP rather than just a copy, and you will also need to be able to provide a certificate of currency for your medical defence and your CPD statement, vaccine history, driver's license, passport and all of the extended skills courses and things that you have if you're going to be in a hospitalist role – so that includes things like advanced life support and emergency trauma skills, and if you're doing obstetrics or anaesthetics, the paperwork that will be required for scope of practice credentialing for those things. It's basically a pain but you just need to sit down and get it done. And once it's done it's much easier to keep in order, and then for each new location you go to there will generally be a little bit more paperwork but not too much.
I'd also just suggest at this point that if you're eligible to apply for provider numbers online via PRODA that you make sure that you've got PRODA access at this point because that's much quicker turnaround time than having to submit written copies to Medicare.
My other tip in this point is to also keep a list of your locums and the dates that you've been to different places, particularly if you're doing this for any length of time – the reason being is that you will have to justify any gaps of more than three months in your CV more and more and it's a pain in the neck to have to reconstruct several years’ worth of locums if you haven't kept an easy reference at the time.
The next step would be to think about the medicolegal implications of locuming. And this is not something that I had really given much time to prior to starting, but I would suggest that you do call your medical defence organisation and just check with them what their policy is about locuming. Some medical defence organisations are very happy to have a blanket policy if you're in the correct category (and that's the kind of work you're doing) to cover you for wherever you work in Australia. Some agencies do want to be informed prior to every new locum you take on – so if you're going back to one place regularly, that's fine; if you're going to be all over the country, that can be a bit of a problem. So do clarify that.
And I would also suggest having a bit of a think about the other medicolegal points. When I've spoken to advisors, they generally say that locuming is considered slightly higher risk over working in one place because you are not there to follow up your own patients, you are involved in a lot more clinical handover to the next doctor as well as patients being handed over to you without you knowing the whole story, and you also have very little impact on the systems that we rely on in general practice – recalls and reminders and things. So just be aware of those things as you go into practice.
So on to the really important stuff. You've been watching your locum alerts for a while or you’ve spoken to a recruiter or you've been in contact with the PHN or rural workforce agency and there's three or four jobs that you think sound alright, so you get on the phone and these are the questions that I'd be asking (or asking someone like Adam). Number one: Where exactly is it? Google maps can be helpful, but it's also good to get a bit of a context about where this place is, what is the community around it like, what are the demographics there, and what sort of practice is it actually all about – Is it a clinic? Is there a hospital? Are you doing outreach things? And is there any possibility that you can be sent a bit of a practice profile as well as some information about the place?
Then on to the nitty-gritty – What are the hours? What is the on-call arrangements? And be clear about that – you don't want to arrive and find that you're on call when you weren't expecting to be and having to cover a whole bunch of things that you weren't planning on (that's not much fun). You want to know how many patients you’re going to see in a day, and also clarify the pay at this point – is it a daily rate, an hourly rate, percentages, do you get paid on call, how does that all work? I then ask: How am I going to get there? Particularly if I'm not just driving from my place to a rural coastal town that's two hours away to provide cover for a solo GP for a couple of weeks. Am I going to have to fly? Am I going to have to travel before? And how does that all work? If you're thinking about bringing a partner or family because it's school holidays and you're going to provide cover in a coastal town for a few weeks then clarify that because accommodation can sometimes being a bit of an issue there.
As Mark alluded to before, accommodation can vary quite a lot. So I usually ask about that and I ask about transport while you're there too. I've had some jobs where I have walked between places but mostly you have a car. I've caught planes out to a remote clinics, and I've also got a ferry to work but, so far, I've not yet had to cycle or kayak (but maybe that should be my locum goals).
A few more questions here. I usually ask about the software and then a few points that local agencies aren't always expecting and don't always have the answer to but they usually get back to you on. One is, is there an orientation provided (we can talk about that a bit more) and, if not, what are their policies on opioids and drugs of addiction and what back-up and supports are you going to have, especially if you're going to do on-call for emergency. Is there an emergency telehealth service? Will you be calling RFDS for backup? Is there a regional hospital nearby that provides that support? And sometimes at this point if I'm worried about being a solo doctor and on-call for a prolonged period of time (24/7 for a week or more) then I do ask what their fatigue policy is so that I have some sort of sense of how I'm going to manage things if it's ridiculously busy. And then my last question if I'm still not sure is: Can I talk to someone who's recently worked here? So I feel like that gives me a pretty good sense of what my options are and where to go from here. These tips are fairly straightforward.
So you've decided on a short list – you've decided that you're going to go and work for Adam up in the Northern Territory. So you'll need to sign your contract to make sure the payment agreements are clear and then you need to apply for your provider numbers so that you can work there. As a general rule, the majority of jobs start on a Monday, but that's not always true. Sometimes it'll be a Friday, but regardless of when it starts, I usually have a bit of a look the week prior to my locum to make sure that I've got all the nuts and bolts information available – where I'm going, how I'm getting there, what are my transfers, what's the accommodation, what time do I start, who do I report to do, do I need to bring anything in particular? So I have an email folder with all my upcoming locum email information there that I can refer to but you could easily use something like Evernote or something else.
Then the thing that I do that a lot of locums probably don't, is a few days before, I actually give the place a call just to touch base and make sure that everything's in order and to finalise any arrival details and confirm what time I start. The other reason I do this is if I'm starting on a Monday morning, I would really like to make sure that if they're not going to provide an orientation, I don't arrive to the busiest day of the week, a fully booked out clinic, expected to hit the ground running, and it's all a bit nuts. So I make arrangements for a slightly lighter booking if it's a booked GP clinic on Monday morning so that I can get some orientation and get into the flow and all goes well. And then a day or two before I usually get on Google and just check out the weather, and what to do, and where to find good coffee, and things to explore nearby.
Just a note on remote clinics – if you're going to these areas you do need to be really clear about baggage restrictions and what fresh food and supermarket facilities are available in these places (sometimes you have to take it). And there maybe alcohol restrictions so you need to know about those.
And then it's basically pack and go. I have a bit of a grab bag with my medical gear in it that’s got, you know, stethoscope and name tags and some pens and my scrubs and all of those bits and pieces. And I generally make sure I take something good to read and any entertainment, and I usually set myself a small project for while I'm away – whether it's to catch up on a few of those medical magazines while I'm there or to do some other educational activity while I'm away – I try and get through those as well.
As kind of mentioned before, there's a bit of mental preparation to do too. You kind of need to go in with a can-do attitude and an open mind and just go with the flow. You are not there to change the system on day one – that will not go well. I often find in the few days before I go somewhere brand new that I start to feel a little anxious – imposter syndrome really rears its head – and you need to develop some strategies to deal with that.
I have a couple of rules while I'm away, and one is to say yes to everything that I feel happy and comfortable and safe to go to, which gives you a really great opportunity to be shown by some locals some of the places and events and things that are on. So try and engage in the community while you're there.
One of the other things that is worth sitting down and doing is thinking about the usual resources you use in your everyday practice. You need to reduce the cognitive load, particularly in those first few days, and if you get somewhere and you haven't got a billing sheet and you can't access therapeutic guidelines and all of the normal bits and pieces that you have around you to practice aren't there, that just increases your stress. So bookmark some links in Google Chrome, set up a Google Drive, and have all of those documents available in there. If you use a lot of auto fills and shortcuts in your health record, you won't have those so create a document and have it available and ready to go.
If you're going to work in northern Australia where there might be a much higher percentage of Indigenous people than you're used to, then it's worth brushing up your knowledge on cultural awareness as well as some appropriate topics such as ear health, rheumatic fever, rheumatic heart disease, scabies, and syphilis – so just have a think about that and hopefully you've got that information from your questioning earlier.
Another point too, that you don't want to find out the hard way, is if you're going interstate, you do need to familiarise yourself with different legislation that affects your practice and, in particular, the Mental Health Act (particularly if you’re in emergency) and there's also some differences with workers compensation. So do consider that as well.
We'll move on to the next slide. And basically, you're there. So, when you arrive, day one, make sure you're there early and orientation usually involves walking around the building, meet and greet, where your office is, here's the bathroom and the tea room and tea and coffee. Sometimes you get a bit more than that, but often you don't. So the things I like to have available is a list of the names of the staff in the practice because you won’t remember them all as much as you try. It's also great to have a local numbers list of the hospitalists and specialists and radiology and all of those things so you've got it within easy access. Pretty much everywhere I've been there is someone who you can quickly identify as your go-to person. They're the ones who have been there awhile, know how everything works, and when things go wrong you can go to them and ask how do I do X.
And then I usually sit down, if this is not already provided, and ask specific questions about patient flows – is it a walk-in clinic? Booked clinic? How do patients get from walking in the door to seeing me? Are they triaged? What actually happens? And then sort out pathology and radiology and pharmacy and billing, and try and fit in with what happens normally. But if you're in a remote clinic, your turnaround time for pathology might be a couple of days, so you need to have this knowledge before you start. And then I ask specific questions about abnormal results and recalls and reminders and try and figure out how the practice does it and fit in with that. And then check your logins and start work.
Now remember, day one is definitely the hardest and you need to be kind to yourself. The medicine is usually okay, but the staff and systems and resources and things take a while to settle into. Every single patient you see will be a new patient to you, and that means that you don't have all of that background knowledge and things that makes general practice much easier and is really the magic sauce. You'll find that the printer won't work, you’ll have trouble with your logins, you won't be able to find things, and everything just takes a bit more time, and that's why I try to pace myself that first morning. Just take a deep breath and go with it – it will get better – and your first day is about keeping your head above water. You can strive for a higher level of work the following day.
Keep a list of running questions to ask as you go and just try and slot into the team and observe how things are going. Don't try and change everything, you’ll realise that there are some really great systems and approaches and methods and things that you've never thought about before. And there will be things that you wouldn't want necessarily to do that you would like to change or do differently, but just let that sit with you and make sure that you enjoy your time outside of work.
You're almost done and you want to finish well, so make sure you tidy up the results in the paperwork. I would strongly recommend that you create a written handover document for medicolegal reasons (and that you keep a copy of that) to go to the next doctor, and I also discuss any concerns, usually with the nurse, to make sure that the right people are aware that the patient's got an appointment and that everything's going to be okay. I would also suggest you request a copy of your billings to check each day and at the end just to make sure that it's correct because you're responsible for that. And then it's time to go.
Now, getting paid. You've done all this work, you want to be rewarded for it. If you're an employee, it's straightforward. If you're a contractor or percentage of billings, you will need to know what those buildings are. Clarify with your agency whether they do the invoicing or you do and who to send it to and payment terms.
Cash flow can be a bit of an issue, so feel free to discuss with them whether you can invoice in two week blocks if you're there for say six weeks rather than waiting till the end. And also talk to them about payment terms. Often you might do six weeks work, invoice at the end, and then they won't pay you for another 30 days. So if you invoice in two week blocks and you ask them if they will do 14-day terms, you will be bringing some money in rather than waiting and that can be very helpful. Then follow up to make sure that that invoice has actually been received and set a reminder in your calendar to follow up. 99% of the time people pay with no problems, but occasionally you do have to chase them because it's gone missing somewhere.
And then finally, you're done. It's good to sit down, either on your way home or when you do get home, and think about: What did I like about this place? What would I do differently? And how would I approach this locum? If this was my workplace, what would I do? What will I take away from it? And what have I learned about myself? And I often think it's good to just think about three points that when people ask you ‘how was your locum’ that you can just rattle off.
I also like to close the loop, which means that I generally email the clinic, or the manager, or my supervisor, and say thanks for having me, I'm happy to come back, and identify the things that were really good, and if they want to give any feedback, they can contact you and let you know. I also let the recruiter know at your locum agency because they really do appreciate that as well. And then it's time to connect with friends and family at home.
So my top tips, particularly for longevity in the game, is to think about your goals and why you're doing it and what you want to get out of it, be organised with your paperwork, systematise things (what you're going to pack, what you’re going to do on your days off), and have something to look forward to when you get home. Also, don't start tired. If you've got a long way to travel to get to your locum, it's better to do it the day before rather than arriving at a super busy day, on call, and it just snowballs and becomes quite difficult.
And then embrace the opportunity. You need to make some conscious decisions to prioritise your relationships and the things that you find fulfilling outside of work, and you can plan your locum to fit around other things in life, which we've talked about. I like to make my time while I'm away valuable by getting some education or doing some sort of project (you could even learn language in your spare time). And if you’re thinking that things are a bit demanding, you can always pull back. Finally, reflect on your experience – it does make you better.
So if you're thinking about it, I'd suggest do it. If you're going to regret not going then it's time to go. But do have fun. Get some experience, embrace the adventure, see the country and you'll meet some amazing people, but make sure you do enjoy it. And I'm going to hand back for questions.
Dr Adam Brownhill: Thank you very much indeed Wendy. That was a really useful summary. I'm having a conversation in the background with the organisers here to see whether or not there's a way of distributing your top tips on what you've just talked about, your slides, to the 2/3 of people that have never locumed before. And just quickly, Mark, I'm wondering have you got anything to add from there before we go to answer some questions.
Dr Mark Santini: No. I thought it was an excellent summary of what to expect. There is a lot of information that Wendy has provided. And the first few locums that you do, you really do feel like you've been thrown in at the deep end, so that's the only thing I would perhaps emphasise is don't feel badly about yourself. It can be really enjoyable, but of course you're out of your comfort zone in some cases.
Dr Adam Brownhill: Yeah, I think that's a really good point. And I think the thing is that the title of this is ‘Your Skills are Transferable’. There have been some questions coming through that I've tried to answer but I wonder Kirsty whether or not we can go to the first question, please.
Kirsty: Yes, Adam. The first question (and there seems to be a theme), is do you need to be a Fellow of either ACRRM or RACGP to go locuming?
Dr Adam Brownhill: Oh, is that aimed at me as a potential medical director? But why don’t we ask Mark – Mark how many times have you been asked about your qualifications and what you think the minimum standard set is?
Dr Mark Santini: Well, typically, a service will want your CV and will want evidence of your degree and your Fellowship or whatever. More and more, people are expected to have Fellowships, especially to work in rural and remote settings, but I've been involved in health services in North Queensland where I'm the only doctor with a Fellowship and the other doctors are all very experienced and they’re just working through the process of getting the Fellowship. So it's not mandatory, but it is certainly a very good way to demonstrate that you have at least the skills to conduct a consultation and those sorts of things.
Dr Adam Brownhill: And I think you're quite right, Mark – it depends on the location and support services that are there. So for our particular location, a lot of the time you're the sole GP, so our minimum standard set is a Fellowship or just about to Fellow. But everything is done on a case-by-case basis and there are movements in the background towards moving everybody towards Fellowship and we won't get bogged down with access to Medicare, billing rights, and things like that. What about the next question please Kirsty?
Kirsty: How many years’ experience would you recommend for a newbie registrar before they enter into the locuming game?
Dr Adam Brownhill: I think that's a great one for Wendy.
Dr Wendy Sexton: It's a really good question, and I think it depends entirely on where you're going to work and what your previous experience has been. Some of the roles that I have, or currently working, in Northern Western Australia, when they're advertised as permanent positions they want 12 years post medical school experience, which is quite a lot, but that is working as a senior and independent medical practitioner in a hospital emergency department and across a number of areas. If you're going to be working in a clinic and it's similar in style, or if you’ve been working in Aboriginal Medical Service in a larger urban centre and you're going to a remote Centre, then I think those skills are very transferable and you need a lot less experience. So it really depends on what your support and backup is – if you're working solo versus in a much more supportive environment where there might be a surgeon and a paediatrician and a physician to back you up. So it does very quite a lot, which is probably not the most helpful answer.
Dr Adam Brownhill: But I think it's a really useful answer Wendy because people's definition of rural and remote varies greatly. So I don't consider Alice Springs to be real remote or rural and other people would consider Darwin to be incredibly remote. So I think if you're just starting out, there are so many different opportunities and places to work that you can start somewhere and gently ease yourself into it. And I was very, very lucky to have some incredible mentors and supporters along the way. Next question Kirsty.
Kirsty: There are so many courses you can do for an urban GP who would like to go and locumming. What courses would you recommend?
Dr Adam Brownhill: Oh, that's an amazing question. And there's no right or wrong answer to that. I'll pass this one over to Wendy if that's okay with you Wendy.
Dr Wendy Sexton: Yeah, sure. So, as I alluded to before, if you're going to be working primarily in a general practice, then certainly your basic life support is excellent. And then I would probably do one of the broader rural and remote courses – so either REST or CEMP through either of the Colleges. If you're going to be providing emergency care in a hospital setting, then there are a plethora of courses and often there is a requirement from the hospitals for credentialing and they will tell you what is accepted. But basically you need to have your Advanced Life Support (usually level 2) and then you need to have something paediatric and something adult as far as emergency care and something trauma-related. So there's an alphabet soup of courses to choose from but I would try and cover all of those areas so that you're not going to be terrified when you get a neonate come in who is septic and going to stop breathing on you a hospital setting.
Dr Mark Santini: May I add something.
Dr Adam Brownhill: Of course.
Dr Mark Santini: Everything Wendy says is right. The only other thing I found unusual having trained in the southern states is that some of the pathology in the northern states is different. You don't get burkholderia and even there’s STDs in the northern states, particularly in the in the Indigenous communities, that are treated very differently and the pathology presents differently. So there is a manual that the Northern Territory government has produced in the past called CARPA which just sets out that the sort of different pathology, so that when you're confronted, for example, with a child with swollen joints, you're thinking of a streptococcal disease, which is not what you would be thinking about if you saw that child in Melbourne, as an example.
Dr Adam Brownhill: Yeah, it's a really, really good point Mark. And I think the thing that I found even when I've been working a thousand kilometres from the nearest District General Hospital is that I'm never alone – there's always somebody to ring or manuals like CARPA. There are incredibly experienced remote area nurses around as well.
Kirsty: We've had a question from about six different participants along the same lines of: Is it financially viable? Are you taking a pay cut to go from a metro GP to a rural locum?
Dr Mark Santini: Look there is there's a big divergence in pay from state to state and service to service. In rural and remote, the pay will start at $1200 a day and will be as high as $2100 dollars a day (and I've never really understood what the different pays are for because sometimes the work is almost inversely proportional). You can earn more as a locum than you can as a city GP if you're prepared to work continually and in truly difficult situations. You really need to find out what the pay is, what the job description is, and then depending on your aptitude for hard work and remoteness and all those sorts of things you'll have to play it by ear.
Dr Adam Brownhill: I think that's a really good answer but I’d just like to heed everybody that just because someone's paying $2100 a day doesn't necessarily mean you'll have a better experience than somewhere that's paying $1200 or $1300 dollars a day. And if you're regularly locuming in rural and remote locations, don't forget there are rural incentive payments.
I would really like to thank everybody that's dialled in. All of the questions that have been sent in we have captured and that will be informing the webinars that we do further down the line.
I'd like to give a huge, huge thank you to Mark and Wendy. They've brought a huge amount of knowledge to the table. I think between all of us, we've got 30 or 40 years (possibly more) of locum experience (it's making me feel a little bit old). So thank you very much indeed.
Dr Mark Santini: Thank you very much Adam. Thank you Wendy.