How to change from being perm doctor to locum in australia
Quitting Permanent Doctor Life to become a Locum Doctor?
Blugibbon works with hundreds of locum doctors directly to help them organise their current locum status; however, it may not be common knowledge that we also specialise in assisting permanent doctors in reimagining their medical careers from complacency to adventure and guiding that transition to locum life.
If you are a doctor in Australia reading this, most doctors in permanent positions in Australia have gotten an appetite for the locum lifestyle by hearing stories about colleagues and their locum work.
If you are a doctor that has been in a permanent position for a while, you may consider a career change to locum work. Here are some things to consider if you are considering the switch:
- Locum work can offer more flexibility and freedom than a traditional permanent position and may be a good option if you are looking for a change of pace.
- Locum work can be a great way to explore different areas of medicine and may be a good fit if you are interested in trying other specialties or working in various settings.
- Locum work can be a great way to earn extra income and if you are looking to supplement your income or save for a specific goal, locum work may be a great option.
First Up, What Are The Basic Requirements For Locuming As A Doctor In Australia?
The essential requirements are that you either have general registration or specialist registration (this includes General Practice).
Or you can find a locum against a vacant hospital role (usually a trainee role) in which you need general registration. By their very nature, locum positions are temporary and, therefore, not open to doctors on other types of registration because they require a level of independent practice.
So, as an absolute minimum, you will need to be in postgraduate year 2 (PGY+2) and have your general registration.
Beyond this essential requirement, you will need to be a citizen or permanent resident, which most locum doctors in Australia are. Or possibly be on a Visa that permits you to work as a locum.
You will likely need to register with at least one medical recruitment or locum agency (we recommend 3 maximum to keep us on our toes!).
You will probably need to either not be currently employed as a doctor or on a break from your role. And you may need to consider setting up a limited company to collect payments that you make as a locum doctor (get yourself a great medical-focussed accountant for this).
Beyond these basic requirements, there are several other considerations for doctors that work as locums, that we will cover for you below (get your cup of tea ready for a productive read!).
Registration Requirements
As we have noted, the nature of locum jobs is that they are temporary and usually time-limited.
Notwithstanding the current reporting on their usage, they are not generally seen as a permanent workforce solution. Locums are often seen as quick and urgent solutions to filling a gap due to unforeseen circumstances.
For these reasons, it is generally not possible to set up a locum appointment for anyone who may need one of the unique types of registrations available under the Medical Board of Australia, where specific supervisory requirements may need to be demonstrated to be in place.
Often a locum is being sought because there is a lack of supervisors available.
So this generally (but not always) means that International Medical Graduates can not obtain a locum position.
However, there have been some limited circumstances where it has been possible. This has generally been around deputising services for a general practice where medical recruitment agencies have set up a service and essentially employ the IMG doctor.
Provider Numbers
Locum positions (even ones for trainee doctors) are often advertised with a request for the locum to have a provider number. This may be just for referral purposes or for billing purposes as well.
Performing locums in private practice, such as general practice, is impossible without a provider number as you will not be able to charge patients Medicare fees for the services you provide and the locum position will, therefore, not be viable.
Provider numbers can be pretty confusing and complex. Part of the problem is that each provider number is generally linked to one medical practitioner and one location. Technically you need a provider number for every site you provide services at or from. This can be hard to predict if you are locumming.
There are some solutions to this issue about general practice but often, you need to fill in a form for another provider number. As it takes time for Medicare to approve this as a locum, you must be on to this issue promptly.
Other Skill And Experience Requirements
Services advertising for Specialist locums are generally happy to accept anyone with the appropriate Fellowship (although there are some exceptions).
For general locums, the amount of experience you have as a doctor will count towards how eligible you are for a locum and how much you will be paid. Having additional skills such as the various advanced life support training certificates or experience in paediatric emergencies for example will also open up the number of locum posts available to you as well as the rates you can earn.
So, whilst you can technically locum as a PGY2, your prospects may be even better if you wait until you are a PGY3 or PGY4 doctor.
Working As A Locum On A Visa
As mentioned above, there are limited circumstances under which a locum doctor can work under a Visa arrangement. Generally speaking, this would occur when you have general or specialist registration, and the medical recruitment agency can obtain a Visa on your behalf.
In most cases, you are probably better off working under a more secure form of employment until you can apply for permanent residency and then look into locum work. This way, you will not be obligated to one particular locum company.
Working With Medical Recruitment (Locum) Agencies
For the most part, most doctors find working with a locum agent from a medical recruitment agency to be a valued and essential part of the role. Someone who understands their requirements and negotiates on their behalf. But this is not always the experience.
If you are not the sort of person that is confident at negotiating conditions of employment, you may find locum work difficult. Locum agency consultants play a challenging role in simultaneously attempting to keep the employer and doctor happy, Blugibbon likes to think we have the strongest relationships with both doctors and healthcare services across the country #selfplug
Sometimes the conditions of the locum job are not as agreed to initially or you may feel pressured to take on a role that you do not wish to do. So being able to stand up for yourself in this situation is an important consideration.
Can You Work As A Locum Whilst Employed?
If you have a permanent position with an employer, such as a hospital, it may still be possible to do the odd shift or week of locumming. But beyond this and even including this, it can get difficult. Besides, you obviously need to have time off work to do locum shifts. There is also the need to consider that you will probably be working in a situation of conflict of interest but also, that you are not working too many hours and considering burnout.
Most employers have a process whereby full-time employees are obliged under the code of conduct to declare any additional work undertaken with the option for the employer to indicate to the doctor that they cannot undertake that additional employment if it conflicts with them completing their other duties.
Even if you work part-time, it may be difficult to work part-time in a permanent position and locum as most locums are done in blocks of weeks rather than days. So essentially, you may be able to do a small amount of locuming whilst employed. If you plan on doing more than a little, you cannot do this whilst also employed.
Getting Paid As A Locum
There are two options here; sometimes, it comes down to the employer’s choice. Some employers will opt to pay you through their payroll, in which case they will also pay the ATO the requisite amount of tax on your behalf and should also pay superannuation on your behalf.
Your locum agency (aja Blugibbon Medical Recruitment) then charges them an additional fee for placement. Others will pay you a set amount as part of an invoice you submit for the contract. This is often paid directly to the locum agency, where the agency takes out its commission and then pays you out.
If there is a choice between PAYG and invoicing, you can opt for either option.
As a locum, you will not always be paid a regular fortnightly salary. So this means that you need to be prepared for sometimes being paid late, having to chase up income now and then and having some amount of cash in the bank to keep up all your regular payments (rent, mortgage, food, car, telephone bill etc.) in the interim.
You will also likely need to set aside some of your income for tax purposes. Otherwise, you will get hit with a large bill come tax time and need to take out a loan to pay it.
Some doctors find financial management a hassle. Good locum agencies will generally help you by chasing up payments and providing your reports. But if you like a less complex set of financial circumstances, then locumming is probably not for you.
Running A Company as a Locum In Australia
Eventually, most doctors that locum set up a company to collect their earnings. There are several reasons for this. Part of this is that some health services, like in Queensland Health, will not pay locums as a sole trader. The other main reasons are to reduce tax obligations and protect your assets.
Running a company does not need to be overly complex. Most accountants will gladly help you to set up a simple company for a small fee. You do need to do some regular bookkeeping and complete some additional tax forms quarterly and annually. It makes sense to set up a separate company bank out to make the bookwork easier.
Many doctors find the idea of being the Managing Director of their own company a little bit exciting. You get to pick your company name and get a logo, letterhead and website if you want to. But if you have aspirations to be a Company Director, you might find this aspect of locum work that leads you to question whether you want to be a locum.
Locum Indemnity Considerations
You will probably need to revise your medical indemnity upwards if you engage in locum work. When you work as a locum for a public hospital, you should check that you will be a state government employer indemnified. It is important to check the arrangements every time and contact your medical indemnity company for expert advice.
Quick Recap So Far
•To work as a locum doctor in Australia, you must have general registration or specialist registration.
• You will need to register with at least one medical recruitment or locum agency.
• Locum work can offer more flexibility and freedom than a traditional permanent position.
• Locum work can be a great way to explore different areas of medicine.
• Locum work can be a great way to earn extra income
As a Locum, there are some personal considerations
On a personal level, becoming a locum generally means travelling around a lot, spending time on the road in the car or at the airport or living out of a suitcase in a hotel or serviced apartment.
If you have regular activities like sporting, academic or social pursuits, these can be disrupted by locum work.
If you have a family, you may have some options for them to travel with you to locums but this is rare. Depending on how flexible the hospital or employer is, they may even upgrade your accommodation to family accommodation at no extra cost. Again this is rare however.
At the minimum, you will likely have to pay for your family to travel with you. Additional costs such as extra food will probably reduce the financial benefit of doing locums with your family in tow.
Maintaining Registration and Professional Development to grow your Locum Career
Continuing professional development (CPD) for locums is a hot and important topic.
The Medical Board of Australia has signalled that it will take an increasingly active stance in revalidating doctors (confirming their ongoing suitability to practice) to uphold community expectations for quality and safety.
Locum doctors are often left vulnerable regarding continuing professional development and demonstrating their ongoing fitness to practice.
As a locum doctor, you must also consider how you pay for your CPD. Because the hospital does not pay for it.
On the other hand, you could save a sizable amount in college fees.
Specialist locums can generally maintain their continuing professional development through their college’s CPD program.
However, locum doctors without fellowship that rely on their general registration face a more complex set of circumstances as there is generally no professional organisation that can fully support their professional development requirements.
Under its Professional Performance Framework the Medical Board has stated that:
All doctors will:
- Have a CPD home and participate in its CPD program.
- Do CPD that is relevant to their scope of practice.
- Base their CPD on a personal, professional development plan.
- Do at least 50 hours of CPD per year.
- Measure outcomes, and educational activities.
Medical Board of Australia
The current Medical Board requirements for medical practitioners that have general registration only (i.e. do not have specialist registration) indicate that such doctors must:
- Complete a minimum of 50 hours of CPD per year (self-directed program), which must include:
- at least one practice-based reflective element; clinical audit or peer review or performance appraisal, as well as participation in activities, to enhance knowledge such as courses, conferences and online learning, or;
- meet the CPD requirements of a specialist medical college that is relevant to their scope of practice.
Most doctors can make a plan to engage in courses, conferences and online learning. However, the tradition of clinical audit, peer review and performance appraisal is patchy within medicine in general, and locums with general registration may likely struggle to revalidate if they cannot plan for these mandated activities each year and possibly have some support for doing them.
Let’s look at each of the mandated practice-based reflections and consider how it might be implemented for a locum doctor.
Clinical Audit
A clinical audit compares actual clinical practice against established standards. The audit has two main components, an evaluation of the individual practitioner's care and a quality improvement process.
The evidence required by the Medical Board is a certificate confirming completion of the clinical audit or a summary of recommendations and implemented changes or a description of the process that was undertaken, and a reflection on what was learnt.
Practically engaging in a clinical audit may be difficult for locum doctors in Australia because of time constraints for each placement and the ability to access and review clinical records at a later time.
Aussie Locum
Peer Review
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Peer review meetings are undertaken by and with peers to update knowledge and improve practice through the presentation of one’s work to one’s peers with the expectation of a free and frank review.
Evidence of peer review acceptable to the Medical Board includes a documented account of a case review or discussion with a peer or team and a reflection on what was learned or evidence of a log book or diary entry and a reflection on what was learned or a description of peer review activity and a reflection on what was learned.
The practical problem for locum doctors engaging in peer review is coordinating meeting times and locations so peer group members can regularly attend. This might be overcome with the use of technology and holding peer review meetings online. Although it would be important to consider the security implications of online discussions.
An exciting aspect of a locum peer review group would be the potential to incorporate locum doctors working across a range of specialty areas into a group where one could imagine a breadth of generalist knowledge could be imparted throughout the group.
Performance Appraisal
Performance appraisal incorporates activities that allow the practitioner to review their practice / performance.
The Medical Board will accept documentation to show how the practitioner reviewed or improved their practice or performance and a reflection on what was learned or a description of the process undertaken and a reflection of what was learned from the appraisal.
In our opinion, this is probably the simplest of the three options for mandated peer-based reflection to achieve compliance and could be effectively completed with a performance coach.
What The Medical Board Doesn’t Accept As Evidence Of CPD For Locums
The Medical Board is becoming quite circumspect about CPD evidence. Here is a list of things the Board will not accept as evidence of 50 hours of CPD per annum:
- Receipts of Courses
- Course Itineraries
- Course Agendas
- Course Programs
- Conference Itineraries
- Conference Agendas
- Non-planned and non-measured reading online
- Web-surfing
- Statutory declarations stating 50 hours of journal reading were undertaken
- Agendas of journal clubs
Generally speaking, the Medical Board requires more definitive evidence of the 50 hours of CPD, examples of which would include certificates of attendance, certificates of completion, evidence of questions being attempted and log books of readings.
What Areas of Medicine Can I Locum In?
Locums can pretty much find work in any area of medicine these days.
At a Consultant level, hospitals are often looking for locums in all typical specialties, including Physicians, Surgeons, Psychiatrists, and Critical Care Physicians. There are also a surprising number of Medical Administration locums advertised regularly. And, of course, there is General Practice.
At a non-Consultant level, you can also easily find locums in all ranges of specialties. Critical care (mainly emergency) and psychiatry tend to be the most common, along with medical registrar roles.
Below is some of our MANY! Locum location Guides supplied by real doctors, Just like you! A cool perk of working with us a Blugibbon is the more we have doctors helping share their experiences in different locations to help others make the right decision for their locum career we actually give away prizes!
How Long Should I Locum For?
It is difficult to answer this question categorically. Some doctors have turned locoming into a long-term career quite successfully. Some doctors go into locuming planning that it will just be a temporary year or two away from training or permanent work but then find themselves enjoying the work and the lifestyle it provides.
Perhaps the question should be “How long should I Locum for? Before I consider locuming to be a career?”
As we have indicated above, whatever part of medicine you practice in, it is important to maintain your standards and professional development.
We recommend that if you have been locuming for more than two years, then you should review your professional development approach.
Even if you are a Specialist and under a College CPD framework, you probably want to think about how working as a Specialist locum affects you differently than working in a permanent role and a team. Establishing a Peer Review group with other locums in your Specialty may make sense, or perhaps joining an existing Peer Review Group of Specialists who work in your field in permanent roles.
As a non-registered doctor, there will come the point where it is difficult to maintain your professional development through a College. There are a few alternatives, such as enrolling in Masters programs at University but the CPD from these programs only lasts as long as the program lasts.
Again a Peer Review group probably makes sense as well as organising a regular performance assessment. You should also try to develop a CPD plan at the start of each year to address current gaps in skills and knowledge and consider asking your locum employers for feedback on your strengths and weaknesses. A career coach may help guide you through some of these processes.
Is it Possible To Make A Career As A locum?
Yes. One could make a strong argument for obtaining a Fellowship first to support the locum choice. But some doctors have forged a career successfully locuming.
There is high demand for locums, and there has never really been a time when a degree in locum doctors have been necessary to complement doctors working in permanent roles. As we have highlighted above, a key consideration is how you stay current in your practice.
A Quick summary of those two points
- It is difficult to answer how long one should locum for, as it depends on the person. Some doctors make a career out of it, while others only do it temporarily.
- It is important to maintain standards and professional development no matter how long you plan on locuming.
- We recommend that if you have been locuming for more than two years, you review your professional development approach.
- As a non-registered doctor, there will come the point where it is difficult to maintain your professional development through a college. A few alternatives are available but they may not be sustainable in the long term.
- It is possible to make a career as a locum doctor—high demand makes this an viable option for many people
Blugibbon knows that locum work can change lives
From bread & butter locum jobs across emergency medicine, critical care and more, to weird and wonderful opportunities outside the clinic in government, corporate and healthtech.
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