I have, over the last couple of weeks been giving a little advice to others about Locum work and some of the problems experienced. Learning, generally, is the gaining of knowledge from someone of experience willing to share that experience, whether it be "scientific truths", anecdote, or the admission of mistake in the hope the learner will not be required to make the same mistakes.
Check list :
1) register yourself for an ABN and register for GST. You can register as a sole trader, you do not need an additional company entity, however you must seek financial advice on your options and what best suits your personal situation.
https://abr.gov.au/abrweb/default.aspx?pid=71
2) register for Medicare HPOS and obtain a PKI security dongle. This will allow you to apply for a provider number online and receive it within minutes, as long as you have no provider number restrictions. This is a personal identifier, do not let anyone else use it or access HPOS with your log on.
http://www.medicareaustralia.gov.au/provider/business/online/register/apply.jsp
Update June 2016 : PRODA is now the best way to access HPOS
https://proda.humanservices.gov.au/pia/pages/public/registration/account/createAccount.jsf
3) choose a Locum agency, one with a good reputation and preferably one that comes highly recommended by a colleague you trust. Talk to someone at the agency, don't apply yet, just talk, get information and get a sense whether or not you are happy to work with the agency. Remember you are a valuable commodity to the agency, their survival depends on the commissions generated by the work you do via their referrals. Get on their email list and then sit back and observe two things. The frequency of communications and the quality of placements being offered. Don't be in a rush, sit back and wait ... you will have other things to be doing while you wait. Get yourself on the email list of two other agencies and do the same, wait and observe. Do not be in a rush to commit.
4) While you are waiting, create a Resume/CV ... it needs to be the perfect generic CV that clearly summarizes your training and experience from the moment you entered medical school. It must be clear, succinct and easy to read. First impressions count. Get some professional advice on how to write your CV, the money paid for this will be returned tenfold and more.
http://careers.bmj.com/careers/advice/view-article.html?id=3043
5) Get two references from contemporary professional peers, written by your referees and with those referees willing to be spoken to by both the agency and prospective "employers". Your referees need to be able to confirm intimate knowledge of your professional skills in the area of work you are seeking. Whenever your reference is 12 months old, get new ones, and if possible renew them every 6 months.
6) Gather 100 points of identification documents.
http://www.transport.nsw.gov.au/content/100-point-check-proving-your-identity
7) Gather your original qualification documents - ie. your graduation certificate and your FRACGP or equivalent.
8) find a JP near where you are. Don't stuff around with other people for document certification, some places will only accept a JP certified copy.
http://australia.gov.au/topics/law-and-justice/justices-of-the-peace
... or "google" find a JP and choose the finder site for your state.
9) Make six copies of your 100 points of ID documents and six copies of your qualification documents. Call a JP nearby and ask for an appointment to have documents certified. JPs don't get paid to do this job so be polite and accept the possible inconvenience of the timing of that appointment. Don't take shortcuts and get a non-JP to certify the documents.
10) Get a Federal Police check done .. Yes, at your expense. This will consume your first set of ID documents.
http://www.afp.gov.au/what-we-do/police-checks/national-police-checks.aspx
11) Book yourself in for an advanced life support course.
12) By now you will have received a number of emails from your chosen agencies. Remember you have not committed yet, just receiving email lists of Locums available. Is there a state you would prefer to travel to? Pick one .. best to start with just one. Do you choose based on where you would like to travel? Do you choose based on the type of work available? Do you choose based on the amount paid?
13) Now you have chosen which state you want to do your first Locum, get a state Working With Children Clearance. Go on, "google" it. Yes, this too is at your expense. Each state has their own and will be valid only in that state. The following link is only as an example - it is for the Northern Territory and will only be valid for NT.
http://www.workingwithchildren.nt.gov.au/
14) no, you are not ready yet ... if you has reached frustration point already, leave now ... you are not suited to Locum work.
15) find yourself a simple invoice generator (eg software for PC, app for mobile device) ... ask around to find out what is out there and make sure you know how to use it.
16) Now is the time to choose your Locum agency. Choose one and stick with them. Make it clear to them you are committing to just them and you expect a high level of service for that commitment, but don't hesitate to move on if you are not happy. The agent will send you the registration package that will have at least a dozen pages of application paperwork, including declarations and providing proof of immunization status. This is likely to be needed if you are working with or in association with any hospital service, even small regional hospitals that the GP clinic provides medical services to.
17) By this time you will realise you will need access to a fax machine and or scanner. Get one for your home if you don't already have access to one elsewhere. Also find a means of storing copies of all your documents in the "cloud" so you can access them whilst traveling.
18) Once your Locum agent has indicated that all the paperwork is complete including consuming a full set of your certified documents, you are almost ready to choose your first Locum placement.
19) Almost, because you need financial savings to cover at least the period of time you are doing the Locum and then some more. Choose a short Locum for your first one, in your travel comfort zone. Expect to travel initially without your family ... not all places provide suitable family accommodation, and very rarely do they cover family member expenses of any sort. If your first placement is for two weeks, double that for a savings."cushion" to live off. Make sure you have enough to live on for at least the period you are away. Do not expect prompt payment. Many will pay promptly but don't allow yourself to be dependent on prompt payment for your family's financial survival in case a delay in payment does happen.
20) Now wait for that Locum placement that ticks all your boxes in terms of where and when. When it comes, express an interest with your agent but ask details of where, who for and if another Locum has been there and given feedback. Then if it suits, double check the arrangements for travel, accommodation, vehicle if provided, and timing of payment of invoices. Then, if still happy, ask the agent to put forward your details for consideration and patiently wait.
Give very serious consideration to getting legal advice on all the contracts you sign, before you sign and make sure your level of medico legal insurance will cover the type of work expected of you.
Enjoy your foray into Locum work. It provides variety, experience and opportunity to travel like no other. And remember to be joyful for the opportunity you have been given. And please, give consideration to prioritizing your work in rural areas ... rural doctors always need assistants. You never know, you may find a place of heaven you may wish to move to longer term.
Friday, February 22, 2013
Thursday, February 21, 2013
2012
Twelve months go by and it is time to review the year that was. 2012 began with 2011 Christmas and New Year in Julia Creek and then almost three weeks in Normanton, both under the auspices of the Mt Isa health district of Queensland Health.It was also the year I started a little photographic project, taking a photo every day for the year of 2012 and unimaginatively called it "Project 366".
You can find the link to the final product here ... on my Facebook page.
It was a full year. I entered into a challenging financial arrangement by purchasing a high end property in a fast falling market (ie. bought at about about 70% of the building cost) which has now stabilised but has a high mortgage to service for the next 5 years before settling to a basic interest/principle repayment system. I deliberately loaded repayments at the front end to minimise risk if the valuation goes pear shaped. As a result any non-full-time working life has been pushed to about 15 years into the future, which suits a "standard" retirement age rather than "early" retirement and gives me a more focussed approach to work planning.
So yes, 2012 was a full year. Julia Creek, Normanton/Karumba, Gin Gin, Gladstone (Indigenous health), Clifton, Cooktown (incl Wudjal and Hopevale), Orbost, Gladstone (hospital ED), Innisfail (2.5 months), Brisbane Northgate, Yulara (2.5 months) and for the first time in a few years, spent Christmas at home.
The year was professionally and emotionally challenging. Firstly my Queensland Health state-wide credentialling was up for renewal and there was talk about an "unfavourable reference" that, of course, all refused to give me details of what and who for "privacy reasons" and for a period of about ten days I discovered what sleepless nights was all about.
At the same time a locum that was pre-booked and already contracted to the Mt Isa hospital ED was cancelled without explanation other than talk about my credentialling being renewed and the "unfavourable reference".
As it eventuated, my credentialling was renewed and shortly afterwards I was given a Queensland Health job for two weeks in Cooktown.
As the year progressed it became more obvious that I had been "banned" from working in the Mt Isa district, without explanation, without formal notification and without recourse. In a petty sort of way, I got enjoyment from the fact that the $1300 airfare that Mt Isa paid in advance for my locum that was cancelled was actually not recovered by the Mt Isa district but lost because no one cared to follow up the cancelled locum's expenses. We hear about financial mismanagement within Queensland Health, this was just a small example of financial carelessness.
The medical director of Mt Isa hospital rang and welcomed me to the district during my Julia Creek placement but did not show any sort of professional courtesy in letting me know why he refused to allow me back into the district after my Normanton placement.
To the best of my knowledge there has been no formal complaint to the Medical Board about my professional competence, there has been no formal complaint to the Health Services commissioner, there has been no formal complaint to the Queensland Health Director General. Simply a "you cannot work in the Mt Isa district".
I have pondered for almost the whole year how to address this issue. I have come to the conclusion it was a reaction to my harsh and quite verbal criticism of the standard of care being provided to the community of Normanton and Karumba. A standard of care that was in my less than humble opinion, substandard, unsupervised and delivered by someone who showed disrespect for other people around them. The staff of the clinic and local hospital feared to speak up, and the community (85% indigenous) did not like him and dreaded his return each time a locum who covered his leave left.
I drafted on more than one occasion a letter of concern to be addressed to the area Medical Director (Mt Isa), to the Queensland Health Director General and to the Australian "medical board" AHPRA.
I ended up leaving it as a detailed and harsh appraisal through the locum agency.
I feel sad for the community of Normanton, but the standard of health care in the world is not my personal responsibility - I simply provide the best I can where-ever I am at the time.
During the year of 2012 I had the good fortune to meet someone who knew the circumstances in Normanton personally and her experience was not too dissimilar to mine and from that time I felt a little more comfortable that my assessment of the standard of service provided in Normanton was pretty close to the mark, not purely personal bias.
About mid-year, I went back to Gladstone Hospital ED to revisit a place I had become fond of years earlier. It was an experience that left a bitter taste in my mouth.
Most of the good nursing staff had left (and continued to leave later in the year), all the good doctors had left, as had the personal assistant to the Medical Superintendent and the hospital was still managed by a "locum" Medical Superintendent who I found hard to be convinced was actually serving the hospital's best interests. The welcome to me from the Med. Super. was to pass on a petty, unfinished business from two years earlier where I was accused (inappropriately) of leaving my accommodation in a mess and he instructed me that this must not happen this placement. He in fact interrupted my attempt at explanation and with that I knew this whole experience was not going to go well.
A "primary care clinic" was set up as a trial alternative for lower acuity emergency department patients in preparation to create a Medicare scam to have patients who otherwise should have had their care funded by the hospital (state funded) to be funded at least in part by Medicare billing (federal funds). The state vs federal war has been going on for decades, but I was not happy being placed in an, in my view, immoral setup that was incompetently managed with dysfunctional workflow. I made my views clear, including to a unit manager who had the audacity to complain to me that the wait time was too long when 8 patients who all turned up to ED at about 8:30am were all triaged to my "primary clinic" queue (single doctor) whilst the ED was empty of patients and two doctors were sitting on their arse doing nothing.
I was also, under duress, required to complete a purely theoretical training package to "accredit" me to perform procedural sedation. I pointed out that a theoretical training package without any practical component was in fact potentially dangerous ... and not surprising, something that again they did not want to hear. I answered the "test essays" truthfully and listed the minimalist approach I would take based on my lack of anaesthetic training and skills and received absolutely no feedback despite assurances by the "medical trainer" that I would.
My second week was, without prior notification, a week of night shift, solo senior doctor not only in the emergency department, but for the whole hospital. Could I keep my mouth shut ? No, of course, and it came to a crisis point that despite the hospital knowing well in advance I was flying out on the Friday morning they had rostered me on the overnight Thursday night shift. I refused to work the shift.
The reference I received, not surprisingly suggested that I was "unsuitable for emergency department work". Yes, I am old and grumpy enough to not tolerate substandard and under-resourced health care systems. Once again, not a formal complaint to the Medical Board or the Health Services Commissioner about my competence as a doctor, just simply a closure of another door because I was outspoken enough about perceived competency and service level deficiencies at such a level to be potentially dangerous for patient care.
In the context of consistently positive references for the previous four years, and the rest of my 2012 references of a similar high standard, I was confident that it was my lack of "keeping my mouth shut" that resulted in a process where the assailed became turtles and sought to deny me further access to the ability to observe system and possible personal failings.
Yes I am arrogant ... my role as patient advocate drives me to speak out against injustice.
So, with needing two emergency department references to work in emergency departments and without two references I could not work in emergency departments to actually obtain the necessary two references, it was clearly time to move on.
2012 and the early part of 2013 has reinforced my desire to continue to work supporting communities in rural and remote Australia that lack good quality health care services and confirmed that doing locum work is still a privileged way to see Australia, especially when I am paid to do it and when Lesley, my wife, has the opportunity to travel with me any time she chooses.
I make a final note of my 2012 experiences that I am greatly honoured to have spent 10 weeks in the country around Uluru and Kata Tjuta, central Australia. I acknowledge with heart felt thanks the traditional owners of the land and the elders of the Anangu people.
You can find the link to the final product here ... on my Facebook page.
It was a full year. I entered into a challenging financial arrangement by purchasing a high end property in a fast falling market (ie. bought at about about 70% of the building cost) which has now stabilised but has a high mortgage to service for the next 5 years before settling to a basic interest/principle repayment system. I deliberately loaded repayments at the front end to minimise risk if the valuation goes pear shaped. As a result any non-full-time working life has been pushed to about 15 years into the future, which suits a "standard" retirement age rather than "early" retirement and gives me a more focussed approach to work planning.
So yes, 2012 was a full year. Julia Creek, Normanton/Karumba, Gin Gin, Gladstone (Indigenous health), Clifton, Cooktown (incl Wudjal and Hopevale), Orbost, Gladstone (hospital ED), Innisfail (2.5 months), Brisbane Northgate, Yulara (2.5 months) and for the first time in a few years, spent Christmas at home.
The year was professionally and emotionally challenging. Firstly my Queensland Health state-wide credentialling was up for renewal and there was talk about an "unfavourable reference" that, of course, all refused to give me details of what and who for "privacy reasons" and for a period of about ten days I discovered what sleepless nights was all about.
At the same time a locum that was pre-booked and already contracted to the Mt Isa hospital ED was cancelled without explanation other than talk about my credentialling being renewed and the "unfavourable reference".
As it eventuated, my credentialling was renewed and shortly afterwards I was given a Queensland Health job for two weeks in Cooktown.
As the year progressed it became more obvious that I had been "banned" from working in the Mt Isa district, without explanation, without formal notification and without recourse. In a petty sort of way, I got enjoyment from the fact that the $1300 airfare that Mt Isa paid in advance for my locum that was cancelled was actually not recovered by the Mt Isa district but lost because no one cared to follow up the cancelled locum's expenses. We hear about financial mismanagement within Queensland Health, this was just a small example of financial carelessness.
The medical director of Mt Isa hospital rang and welcomed me to the district during my Julia Creek placement but did not show any sort of professional courtesy in letting me know why he refused to allow me back into the district after my Normanton placement.
To the best of my knowledge there has been no formal complaint to the Medical Board about my professional competence, there has been no formal complaint to the Health Services commissioner, there has been no formal complaint to the Queensland Health Director General. Simply a "you cannot work in the Mt Isa district".
I have pondered for almost the whole year how to address this issue. I have come to the conclusion it was a reaction to my harsh and quite verbal criticism of the standard of care being provided to the community of Normanton and Karumba. A standard of care that was in my less than humble opinion, substandard, unsupervised and delivered by someone who showed disrespect for other people around them. The staff of the clinic and local hospital feared to speak up, and the community (85% indigenous) did not like him and dreaded his return each time a locum who covered his leave left.
I drafted on more than one occasion a letter of concern to be addressed to the area Medical Director (Mt Isa), to the Queensland Health Director General and to the Australian "medical board" AHPRA.
I ended up leaving it as a detailed and harsh appraisal through the locum agency.
I feel sad for the community of Normanton, but the standard of health care in the world is not my personal responsibility - I simply provide the best I can where-ever I am at the time.
During the year of 2012 I had the good fortune to meet someone who knew the circumstances in Normanton personally and her experience was not too dissimilar to mine and from that time I felt a little more comfortable that my assessment of the standard of service provided in Normanton was pretty close to the mark, not purely personal bias.
About mid-year, I went back to Gladstone Hospital ED to revisit a place I had become fond of years earlier. It was an experience that left a bitter taste in my mouth.
Most of the good nursing staff had left (and continued to leave later in the year), all the good doctors had left, as had the personal assistant to the Medical Superintendent and the hospital was still managed by a "locum" Medical Superintendent who I found hard to be convinced was actually serving the hospital's best interests. The welcome to me from the Med. Super. was to pass on a petty, unfinished business from two years earlier where I was accused (inappropriately) of leaving my accommodation in a mess and he instructed me that this must not happen this placement. He in fact interrupted my attempt at explanation and with that I knew this whole experience was not going to go well.
A "primary care clinic" was set up as a trial alternative for lower acuity emergency department patients in preparation to create a Medicare scam to have patients who otherwise should have had their care funded by the hospital (state funded) to be funded at least in part by Medicare billing (federal funds). The state vs federal war has been going on for decades, but I was not happy being placed in an, in my view, immoral setup that was incompetently managed with dysfunctional workflow. I made my views clear, including to a unit manager who had the audacity to complain to me that the wait time was too long when 8 patients who all turned up to ED at about 8:30am were all triaged to my "primary clinic" queue (single doctor) whilst the ED was empty of patients and two doctors were sitting on their arse doing nothing.
I was also, under duress, required to complete a purely theoretical training package to "accredit" me to perform procedural sedation. I pointed out that a theoretical training package without any practical component was in fact potentially dangerous ... and not surprising, something that again they did not want to hear. I answered the "test essays" truthfully and listed the minimalist approach I would take based on my lack of anaesthetic training and skills and received absolutely no feedback despite assurances by the "medical trainer" that I would.
My second week was, without prior notification, a week of night shift, solo senior doctor not only in the emergency department, but for the whole hospital. Could I keep my mouth shut ? No, of course, and it came to a crisis point that despite the hospital knowing well in advance I was flying out on the Friday morning they had rostered me on the overnight Thursday night shift. I refused to work the shift.
The reference I received, not surprisingly suggested that I was "unsuitable for emergency department work". Yes, I am old and grumpy enough to not tolerate substandard and under-resourced health care systems. Once again, not a formal complaint to the Medical Board or the Health Services Commissioner about my competence as a doctor, just simply a closure of another door because I was outspoken enough about perceived competency and service level deficiencies at such a level to be potentially dangerous for patient care.
In the context of consistently positive references for the previous four years, and the rest of my 2012 references of a similar high standard, I was confident that it was my lack of "keeping my mouth shut" that resulted in a process where the assailed became turtles and sought to deny me further access to the ability to observe system and possible personal failings.
Yes I am arrogant ... my role as patient advocate drives me to speak out against injustice.
So, with needing two emergency department references to work in emergency departments and without two references I could not work in emergency departments to actually obtain the necessary two references, it was clearly time to move on.
2012 and the early part of 2013 has reinforced my desire to continue to work supporting communities in rural and remote Australia that lack good quality health care services and confirmed that doing locum work is still a privileged way to see Australia, especially when I am paid to do it and when Lesley, my wife, has the opportunity to travel with me any time she chooses.
I make a final note of my 2012 experiences that I am greatly honoured to have spent 10 weeks in the country around Uluru and Kata Tjuta, central Australia. I acknowledge with heart felt thanks the traditional owners of the land and the elders of the Anangu people.
PS ... as a gentle reminder to younger doctors who's career is dependent on whose arse you lick and turn a blind eye to, seek legal advice if you are ever to "open your mouth" against injustices and medical incompetence. You have a difficult choice to make.
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