Jan 112011
 

*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.

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Dec 152010
 
*This is the second 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 locuming to different hospitals.

Calvary Hospital

Bruce, ACT

From the Calvary Hospital ED orientation handbook:

“Calvary Hospital is is situated in the northern suburbs of Canberra. It is one of two public hospitals in the ACT. Calvary Hospital also has a private hospital co-located with the public hospital. Calvary Hospital is the closest hospital to the centre of the city, 2 universities and several high school and colleges. It is also the closest hospital to the population growth centre in Canberra, Gungahlin (see attached map). This has resulted in a steady growth of presentations to the department between 3-4% per annum.”

1. Workload / Casemix:

Pros – Twenty percent of patients are children. Both adult and pediatric presentations are mostly medical (e.g. – cardiac,  infectious) Major trauma patients are brought directly to the referral center which is TCH – The Canberra Hospital. The emergency department is split into  Acute and Subacute areas. Category 1 and 2 patients in Acute, Cat 3, 4, and 5 in subacute. There were 3 doctors assigned to the acute area, 4 in subacute. As a locum doctor, you are usually placed into the subacute area, hence the work is relatively not as stressful. However, with any triage system, a patient may be mistakenly placed into a lower category but actually requires higher acute care. Not exactly a walk in the park, but compared to Tamworth Base Hospital, a much more relaxed atmosphere.

Cons – If you are looking for massive trauma, brains spilling out, doing chest drains left and right and the occasional open cardiac massage, Calvary ED is probably not appropriate for you. Since GP clinics are quite hard to get into (allegedly 2 week waiting period), a large bulk of patients are GP-type presentations (request for repeat scripts, man-flu, D&V’s, etc).

2. Consultant Support / Colleague Support

Pros – I did 2 early weekend shifts (0800 to 1700) during my shifts at Calvary Hospital. Consultants were on the floor most of the time during the day and were just a phone call away at night. The consultants were very approachable and happy to help out with any clinical problems. You will be working with doctors who are seconded from The Canberra Hospital and other Locums as well. Calvary hospital apparently has a chronic shortage of doctors for the ED. The junior doctors and registrar are happy to help and are very welcoming of your presence.

Cons – Nothing much. I’ll probably have to work a night shift to see how things change after dark…

3. Nursing Support

Pros – The nurses were generally nice and very helpful. The lesser acuity of the patients probably didn’t stress them out as much as other places. Most have cannulation / phlebotomy skills but since I was the new person, the nurses would opt to help out the training registrars there because they have to look after the juniors as well. Working in the subacute area, you would usually do most things by yourself like in any other fast-track area.

Cons – Not much.

4. Pathology and Radiology

Pros – All pathology tests that you would reasonably need in the ED are available. Xray, CT and USS are available by request during the day. You only need to call the radiographer. No begging needed! 2 hour-turn around time for results.

Cons – Requests are computerized and take a bit longer than just writing CXR on the form. There’s always a page long questionnaire for each patient. Could possibly take a bit of time for newbies like me. There’s also only 1 viewing computer for radiology images. Irritating to be waiting behind someone at times.

5. Housing and Transportation

Pros – Calvary Hospital will provide for airfare, taxi and hospital accomodation for the weary travelling locum doctor. The room I got had 2 beds, a fridge, a bathroom with towels. There was a common room with a kitchenette where people can cook or reheat food.

Cons – The room was a bit dated, the wiring ran outside the walls which indicated a bit of remodelling / renovation but under a tight budget. The kitchenette was a but unkempt – probably the locum people’s fault!

6. Pay

Pros – They pay 150 per hour for day shifts and 170 per hour for night shifts. You can opt to be paid through your ABN so you can charge tax and get full payment until tax time.

Cons – I would have liked at least a 3 day run of shifts to justify my plane trip, but I guess I was a bit of a last minute addition to the roster.

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Dec 072010
 

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

Tamworth Base Hospital

From the www.hnehealth.nsw.gov.au website:

“Tamworth Hospital provides 265 beds with a 24 hour Emergency Department, high level Surgical and Medical services, including a Cardiac Catheterisation laboratory with both diagnostic and low risk interventional procedures, Burns Service, Rehabilitation services (including Brain Injury), a Diabetes Centre, Banksia Mental Health Unit, Renal services, Oncology, Radiology and Pathology.”

1. Workload / Casemix:

Pros – Good amount of pathology going through the doors from kids with bad asthma attacks to a man with complete laceration of all flexor tendons at the wrist with compromised blood flow to the right dominant hand. I don’t think I ever got bored through the night.

Cons – If you are looking for relaxing / easy locum shifts where you would be just treating small cuts and lacerations, this is not the hospital for you. I observed some of the medical staff getting a bit overworked / pressured with the number of patients and the acuity of the cases (myself included!)

2. Consultant Support

Pros -I did 3 nights (2200 to 0830)  during my shifts at Tamworth Base Hospital – consultants were just a phone call away if you need to call them. They were actually nice about being called even during the early hours when you need advice. I even had to call a consultant in at one point because I had 2 ongoing problematic patients. I think they are quite understanding of locum doctors.

Cons – None really, except  that I thought I was going to have a proper introduction to the department (staff and where things are kept) but sadly, nobody came eventhough I was 30 minutes early for my shift. It did say on the acceptance of employment letter that I would have a proper orientation to the place.

3. Nursing Support

Pros – The nurses were generally nice and very helpful. Although with any new encounter of health professionals, you do not know the exact capability of each other. I didn’t really mind when they asked me if I had airway skills and the like because I knew they just wanted to clarify what I am capable of doing.

Cons – I didn’t have a problem much with the nurses in the ED, but some of them can be quite bossy (as with any other place I’ve worked with before). As with the ward nurses that did a “Metcall” for NGT insertion, let me say that I am not fond of being a ward-call slave (I mean ward-call doctor).

4. Pathology and Radiology

Pros – All pathology tests that you would reasonably need in the ED are available. Xray and CT are on-call, and you don’t need to ask permission from the Radiologist before you can get a CT. However, if you need to get the official results of a CT, you better have a rock-solid explanation why you woke him or her up at 2 am!

Cons – Having to defend the need for an official reading of a CT in the wee hours of the morning – I thought getting run over by a car was a pretty good mechanism…

5. Housing and Transportation

Pros – Tamworth Hospital will provide for airfare, taxi and hospital accomodation for the weary travelling locum doctor. The room was spartan.

Cons – You are not allowed to share the room with your wife, so we opted to stay in a motel for the duration of my stay.

6. Pay

Pros – They pay 110 per hour for day shifts and 130 per hour for night shifts.

Cons – 3 weeks have passed and I still haven’t been paid!!! This is an ongoing issue with NSW health I was told. Makes me want to reconsider doing locum shifts in NSW again…

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Oct 142010
 

What is a Locum?

- A locum is a casually-employed doctor who opts to work in a specific area or hospital for a short period – usually less than 2-3 months. Locums are mostly non-specialists, although special skills are needed in specific jobs (ICU, ED, etc)

Who can be a Locum?

- Australian doctors, permanent resident doctors, and doctors from countries who have reciprocal arrangements (UK, Ireland) to allow you to work in Australia. In addition, you need to be at least PGY3 to Locum in NSW.

How much do Locum doctors earn?

- Depends on the area – in NSW, there are 5 categories / Areas with corresponding pay scales. Category 1 – capital cities   -> Category 5 – bush / outback areas. In NSW, Category 1 – no special award rates; Category 5 – not more than 150 dollars per hour. You get an additional 15 per hour if you are already 5 years post-graduation.

For more information regarding Locum work in NSW – http://www.health.nsw.gov.au/aboutus/business/locums/index.asp

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