Locum Life in a Global Pandemic

What a time to choose to hit the road and work as a locum psychiatrist again.

In Australia, our locum medical workforce has been markedly affected as borders between states continually close and open to fend off spread of COVID-19. This is right at a time when Australia’s health system requires locums (emergency, short term contracted staff) more than ever. The demand has increased because of an ongoing inability for overseas trained doctors to enter Australia, even after successfully securing a post here and doctors needing time off to cope with fatigue and burnout, while continuing to fill workforce shortages in most regional and rural areas of our country.

I have enjoyed working as a locum psychiatrist for the past 7 years on and off, as a way to mix up life in private practice and to keep my knowledge and skills of public psychiatry fresh. I love arriving at a regional hospital somewhere in Australia and joining hard working teams of nurses, doctors in training, allied health practitioners and medical students. In essence it soothes my ills when the onerous burden of private practice becomes too much. In 2020, after four solid months in lockdown running a practice via Telehealth saw me fall on my sword, I decided to do more of locum life.

Being a locum doctor affords no job security and posts can be cancelled at the last minute, such as when there are announcements of hard border closures between states. The daily pay rate has not increased for nearly 10 years, and entitlements such as superannuation and sick leave are not paid. Yet the thrill and freedom experienced is worth it, the ability to ‘clock on and clock off’ a real drawcard when compared to private practice.

As I have endeavoured to work as a locum into 2021, I have noticed some real changes in the way doctors who are essentially ‘fly in fly out’ are regarded. Despite the enormous disparity between demand and supply, and doctors being put of from travelling interstate for work, those on the ground can be poorly regarded.

In a situations where federal leadership is lacking and states are left to determine how citizens will move across borders, an insidious culture of discrimination has begun to occur. Several times I have been at the brunt of alleged jokes about ‘grubby Victorians spreading COVID’. The sentiment could appear farcical, except I was on the receiving end of the precedent whereby a locum doctor was removed from their post without any basis, simply because they lived in Victoria. Rather than telling the story again, you can read all about it here.

I know first hand that the medical workforce shortage across Australia is absolutely dire. I know permanent staff were meant to arrive into their new posts months ago, and are still waiting to enter Australia. Our health services simply cannot afford or rely on locum staff for the forseeable future. And at the same time, the services cannot have it both ways. Deciding to cancel a locum contract because the doctor is from an area where there has been cases of COVID and citing safety issues is short sighted and dismissive of the need for good patient care. Developing a national guideline that governs how doctors are screened when arriving at posts would be a much better measure. Ensuring our medical workforce is fully vaccinated is another key priority in all of this.

It is way too recent to forget that in Victoria’s deadly ‘second wave’ of COVID infections in 2020, over thousands of health care workers succumbed to the virus. It is now fact that these workers caught COVID in their workplace. They caught COVID whilst working to help patients, and took it home to their families. For this reason we saw initiatives like the ‘Hotel for Heroes’ in Victoria which allowed doctors and other health care workers to isolate from loved ones until the infectious period was over.

Despite this understanding of the total failure of workplaces in Australia and overseas to keep their staff safe, our locum workforce is now seen as filled with pariahs, spreading COVID and putting patients in danger. Whist there is always risk when workers move across different sites, we must be more sophisticated in our approach. Because, after all, having no doctor in a post carries huge safety issues for the patients and fellow doctors who have to take up the slack too. Filling the posts with fully vaccinated and screened doctors seems much more of a sensible thing to do.

So, I am writing this a week out from my next booked post interstate, where COVID cases have started to appear again. Again, my week is filled with uncertainty as I await the possibility of a call that my post will be cancelled, or indeed that I won’t be able to travel home, as cases grow and border announcements continue. This is indeed a whole new take on job security in a workforce that is essential, decimated and unsustainable.