The rules are a'changin !

This document is in the public domain and therefore I will take the liberty of making my own personal opinionated statements.

Click here if you dare to see the document I speak of.

My first impressions are somewhat sceptical ... Queensland Health forcing locum agencies to act as "employers" so Queensland Health can pretend to not be responsible as the employer !!? A few places may well have a better pay rate, but most will have less ... some quite substantially so. Now that aint going to bother the locums - the work is there elsewhere and if this goes badly (ie. lcoums work outside the QHS system) it will be the Queensland health consumer who may well be the loser.

Medical Indemnity no longer Queensland Health's responsibility ?? yeah sure .. betcha "Slater and Gordon" aint going to be suing the locum agency instead of Queensland Health if something goes badly wrong with a locum and the aggrieved wants retribution.

So now the base rate payable for each position now has all costs deducted and issued as a taxed salary if you opt for the employer/employee relationship with your locum agency. The locum agency is required to set up a "third party" to deal with all this ... and with such little notice both the hospital admin staff and locum agencies are in a spin. There is an option to be a "sub contractor" and not have income provided as taxed income - this may be a viable option especially for those who may have issues with deductibility of personal superannuation contributions.

All I can say is that I am glad I am on pre-1st July contracts for another month and should be six weeks before contemplating a position under the new system.

Just a head's up for those contemplating further work with Queensland Health ... "buyer beware" .. check the details of what you actually get in hand for the service you provide, make sure your oncall services are clearly defined and what is being paid for in addition to your "daily" base rate (for hours up to 12 hours per day) - don't get ripped off not clearly defining your payments for oncall/call-back hours, make sure you triple check what your medical indemnity changes will be and finally don't get screwed by being under classified for the job you are expected to do.

Workcover no longer Queensland Health responsibility ? possibly .. that too comes out as costs from your "base rate", along with the actual costs of the infrastructure around paying you (stated to be about 9.75%) AND the commission the locum agency will charge you. Don't think the rates listed in that document anywhere represent the actual payment you receive for your services.

Superannuation ... if you enter an employer/employee relationship the locum agency is going to take 9% and put it into super for you .. that is the law. This has the potential to royally stuff up any personal superannuation contributions you make if you don't get additional financial/taxation advice. Consider "sub contractor" arrangements.

Now let me indulge by making a totally unsubstantiated assertion.

It is my firm belief that the health bureaucrats (or dare I say the health ministers' offices ?? ) have colluded and nominated Queensland Health to be the trial location for a new system that attempts to get away from perceived responsibilities and liabilities as direct "employers" of locums.

Final comment :- this rant is based on first impressions, both from reading the document and from dealing (or at least attempting to) with the people who have to implement this new policy. I reserve the right to change my opinion as things evolve and/or after I do more than just the first "male look" at the document.

Gladstone at sunset

Worked 2 hours overtime last night with a 15 year old who landed face first on the road ... please, please wear helmets when riding a push-bike, the damage that can occur without a helmet is horrific !

.. so I finished a bit earlier today and got out to the marina in time to see the sunset. There was some smoke around due to some distant fuel reduction burning so added to the color.

Feel free to check out a selection of the best here.

Melbourne is cold !

This week I am back in Melbourne after a wonderful week's holiday with the family in Cairns ... photos from this trip are in an album on Lesley's Facebook here - enjoy the best of our over 600 photos taken ! The joys of digital photography.

I will be back in Gladstone next week, have a week off so will "pop back" to Melbourne and then back in Gladstone for another two weeks. Two weeks off in Melbourne after Gladstone then three weeks in Mossman, just north of Cairns, to return to Melbourne in time for the girl's 18th birthday.

I have registered to complete additional training in Advanced General Practice, with the hope that in about 18 months will have enough additional remote rural medicine exposure (probably focusing on indigenous health, emergency medicine and D&A services as sub specialties) to complete this additional qualification.

http://www.racgp.org.au/fargp

Will post again in a week or so .. and keep you up-to-date with the work action.

Today ...

... will be my last shift for this block of four weeks. Heading off to Cairns to meet the family on the weekend. I had been planning a post describing some of my work adventures but I have been somewhat distracted by the fact that I still have not yet been paid a cent for working here and the one month financial cushion that I have routinely in place is now gone.

Not happy Jan!

Edit :

After tracking down a string of delays and errors a direct deposit was paid into my account 1st July 2009. It was a relief especially as we were at that stage half way through our family holiday and "running on empty".

So Yeppoon it was ...

Early rise and off inland to Biloela.   First thing I noticed even as I was leaving Gladstone was that things were a lot drier than in February.  Less green.  Weird approaching winter but up here its coming up to dry season.  The drive into Biloela and then north to Mt Morgan was a long, but interesting drive through inland country, much of it farming land.  Mt Morgan is a town at the peak of a mountain range, quite a nice place.  Apparently it can get really cold there.

 

Then through Rockhampton and to Yeppoon and around to Keppell Bay.  I ended up chosing not to go across to Keppell Island or do a coral cruise.  Just seemed a wierd thing to do by myself, so I wandered along the beach at Yeppoon and around the marina and exotic and no doubt outrageously expensive marina-side units.

 

The first photo is from Yeppoon looking towards Keppell Bay and the other is east out to the reef from the beach near the marina.

 

You can leave now .. just going to talk a about pathology testing.

 

If you are still reading you might want to pop over here to check out the terms specificity and sensitivity.

 

http://en.wikipedia.org/wiki/Sensitivity_and_specificity

 

If one designs the perfect test it is going to give 100% accuracy on determining those with the disease state being tested.  No one with the disease comes up with a "negative test", the false negative, and no one without the disease comes up with a "positive test" - the false positive.

 

I know of no such perfect test.  Some tests are to diagnose the presence of a disease and some tests are to exclude (if one can) the presence of a disease.

 

The "good" exclusion tests are used for screening, eg, faecal occult blood tests for bowel cancer.  See the wiki example for a detailed explanation.

 

Some tests are not good .. but still used.  Why are they not good ?   Because of the high rate of false positives.  And why is this not good ?  Not only is this not good for the mental health of the patient without the disease but an abnormal result but can lead to potentially invasive and harmful investigation to exclude the disease that the first test with its false positive failed to exclude.

 

Why do we do these tests ?   I have a suspicion it is related to lack of clinical confidence and fear of mistakes and subsequent litigation.

 

So who then is to blame for the persistent use of tests that a positive result is more than 50% likely to be a false positive even ... and is the cost of the false positive worth the use of the test simply because it rarely gives a false negative and therefore a negative test result can be reassuring ? .. you try to answer that one if you can.

 

Back again sometime soon.

They say it's cold

Sunset from the unit is beautiful. The weather reports colder than
usual weather for the whole of SE Australia although I note that the
lows here in Gladstone are similar to Melbourne's highs. I plan
travelling inland tomorrow to Biloela and the north via Mt Morgan to
Rockhampton and the out to the coast at Yepoon. I might take a cruise
out to the reef if I have time perhaps stay overnight to catch an
early trip Sunday and back to Gladstone. I will post again after the
weekend - and might have a chat about treating numbers instead of
patients and the specificity and sensitivities of tests.

Catch you then. Meantime greet the sunset of last night looking out
over the hospital.

Found my scrubs !

 

The scrubs I ordered in February were here waiting for me ... yay !  Like the color ?