*This is the third of a series of reviews that I will be doing as I locum through different hospitals in Australia. I tried to do a simple search online to find locum doctor experiences with different hospitals, and so far, I haven’t found much. I hope this helps other doctors who are thinking of doing locum work in the 700+ hospitals in Australia.

Bathurst Base Hospital – Accident and Emergency Department

Bathurst, NSW

There’s not much official information online for Bathurst Base Hospital, not even their own dedicated website (except for newspaper articles stating problems with the new building and performace targets). So, I searched some more and found this information from the “Bathurst Base Hospital Transition to Practice (RN) Programs 2010” (yes, it was a recruitment file for nurses from http://www.gwahs.nsw.gov.au). Bathurst Base Hospital did not have an orientation manual to it’s emergency department.

“Bathurst Base Hospital is spread across two buildings on the Howick Street site. The new $103 million Bathurst Base Hospital includes 148 beds, a 10 bed mental health unit and a state of the art emergency department. The original heritage listed hospital building is currently being refurbished and is due for completion in 2010. The hospital is fully accredited by the Australian Council on Health Care Standards.

Services

Medical, Surgical, Midwifery, Gynaecology, Paediatrics, Emergency, Operating Theatre, Day Surgery, Rehabilitation, Intensive Care /Coronary Care, Oncology, Ambulatory Care/CAPAC, Pathology, Radiology and Community Health Services.

Bathurst City

Well known for its Mt. Panorama racing circuit, Bathurst has a population of approx. 36,000 and is located approximately 200 km west of Sydney (about 21⁄2 hours drive) and 31⁄2 hours from Canberra. Proclaimed a town in 1815 and then gazetted as a city in 1885, the City of Bathurst is the oldest inland settlement in Australia and has superb examples of early 1800′s architecture with an abundance of heritage buildings. The main streets are a delightful mixture of old and new, with charming cast iron Victorian lamp posts adorning busy shopping centres. Bathurst prides itself on its education facilities, boasting great public and private schools, the Western Institute of TAFE and Charles Sturt University. Education, along with manufacturing industries, Bathurst Gaol, Surveyor General’s Department, and farming provide strong employment and economic growth. Sport, music and entertainment are well catered for with excellent facilities. Bathurst is serviced by cosmopolitan shops, restaurants and cafes.”

- excerpt from “Bathurst Base Hospital Transition to Practice (RN) Programs 2010”

1. Workload / Casemix:

Pros – Apparently, during my stay of 3 nights at Bathurst Accident and Emergency, the staff said it was quiet and strange for a weekend because of the lesser number of patients presenting to the ED and having available beds in the wards (i.e. – no bed block!). It was indeed a bit of the run-of-the-mill cases of gastroenteritis, simple fractures and  older patients requiring TLC, until we got an extraordinary case on my first night, and then a second one on the next night! The senior nurses and doctors there who have worked at least 10 years or more were quite amazed by the presence of these 2 cases one night after another! However, the staff were keen and prepared, hence  both were stabilized while awaiting  retrieval services.

Cons – I was surprised to find out that I would be the lone doctor in the hospital at night.! I was to cover all the specialties in the hospital, including ICU.  I guess, being a rural base hospital, it must be the way it goes. Fortunately, anaesthetic and surgery consultants were quite easy to call in when you need them.

Recommendations:

I would want to have other doctors at night, at least to cover the wards as well. I didn’t mind checking on a few patients in the wards during my time, only because the ED was not too busy (just exciting!), but if I had a full ED, I would probably not be able to respond to ward calls at all.

2. Consultant Support / Colleague Support

Pros – You are your own consultant at night at Bathurst. Other people may not agree – having only yourself to make quick and hard decisions makes you a better emergency physician. I don’t mean that you should not ask for help, but rather you build your own decision-making skills, deciding that you can do something on your own or deciding that you call in the cavalry for help. That’s exactly what I did when I got my 2 exciting patients – call in the anaesthetist and general surgeons. I think I exercised enough prudence and decision-making that I would need help for these patients regardless of my own skill set. The consultants that I called in were quick to respond and were very helpful, eventhough I had to call them 2 nights in a row.

With regards to colleagues, the other locum doctors during the day were nice and helpful enough to give me a few tips and tricks in going about work in Bathurst. I needed help with the electronic medical records because they were very different from the electronic records that the other area health services had (as I soon found out).

Cons – No FACEM consultant to talk to at night.  (I mean a 5 minute walkaround with another locum hardly qualifies as an orientation.) No ED orientation manual. I probably would have been a bit more prepared if there was an orientation manual as clear as the one that Calvary hospital had. In addition, I was a bit not-so-surprised that the person that appeared to manage the ED was the head nurse. I mean, in reality, nurses do run the hospitals and doctors just make suggestions, but the big welcome plaque really underscored the scarcity of doctors in the area.

Recommendations: Don’t forget to do the electronic medical records training module. It will make your life easier! If you are relatively junior in emergency medicine, night shifts in Bathurst will quickly make you a senior!

3. Nursing Support

Pros – There will be at least one senior nurse during the shift so I was very glad to have her during my night shifts. She was very calm during the exciting moments of our nights. The ward nurses were very realistic as well with their patients. They call and ask for help only if essential during the night. They are very relaxed and polite.

Cons –  The hospital is bypassed for trauma cases.

4. Pathology and Radiology

Pros – On-call pathology or radiology after 9pm – meaning you send back the non-urgent patients during office hours.

Cons – No pathology or radiology after 9pm! Very frustrating if you’re trying to fix sick patients! But, they will come in if you ask them nicely.

Recommendations: Try to be considerate that the pathology and radiology people are on-call the whole weekend. Requests that can wait till the morning should be sent home or wait till the morning in ED.

5. Housing and Transportation

Pros – Bathurst Base Hospital provides accommodation to locum doctors. They have at least 2 places where they house locum doctors – both of which are old large houses that have been converted to individual rooms with a built-in kitchenette, portable air conditioner (with the external tubing serving as an odd-looking night-light during the day), tv and ensuite. The rooms have king size beds with electric blankets (for those cold winter nights) but no phone or internet connection. These units are sufficient enough for several days living but is really-tired looking in today’s standards. I have seen other doctors bring their partners and even small children so I guess it’s allowed or tolerated by the hospital administration unlike another hospital that I worked inn before. On the bright-side, Bathurst Base Hospital is building a new doctor’s quarters on the site of the old hospital due for completion at the end of 2011. They have trouble recruiting both temporary and permanent staff so they are hoping that this new accommodation place will be able help entice a few more doctors to work and stay a bit longer in Bathurst. I also hope they have at least Austar in the new place so I can have a bit more entertainment during my stay.

Transportation – Bathurst has its own regional airport. Flights are through Regional Express (REX). They did not have any direct flights from Brisbane or Gold Coast airports so I had to take a connecting flight from Sydney. The small plane going to Bathurst from Sydney and back can be a bit bumpy – not for those who get air sick easily! Other locum doctors fly to Sydney then hire a car to drive 3 hours to Bathurst. If you like a bit of scenery, I guess it should be alright. However, the hospital will only pay for airfares and taxi, not car rental. (but if you bargain hard enough, I guess they will!)

Cons – No phone or internet connection. Rooms are a bit dated, leaking faucets, and musty room!

Recommendations: Wait for the new doctor’s quarters and hopefully, they would include Austar and free internet connection.

6. Food

Pros: There’s a cafeteria in the hospital building open from 0800-2000 weekdays and 0900-1700 weekends. The food in the cafeteria is run-of-the-mill hospital food. You can alternatively drive or walk to the town centre where they have Coles, Mcdonald’s, and other gourmet options. I didn’t have a car and I was doing night shifts so I had Dominos delivery. 3 days on a pizza diet was a bit terrible for my cholesterol level!

Cons: There is a tearoom in the emergency department which has milk, tea and coffee and some day-old sandwiches, however, I would advise you bring your own food to share!

7. Pay

Pros – As doctors are as rare as hens teeth, pay is quite good, 150-170 during day shifts, 170-200 during night shifts / weekends.

Cons – Be ready to handle patients commensurate to the pay! You are the only doctor in the hospital at night.