Mercenary Medicine
The MacDoctor was doing locums (aka mercenary medicine) for about five years and only settled in a position this year. Technically, of course, all jobs could be considered mercenary, to some extent, because few of us would work if we didn’t get paid for it. However, there is no doubt that money is the most attractive part of locum medicine. It is partly the expense of locum doctors that that lead a government inquiry panel to the conclusion that DHBs are overly reliant on locum doctors, particularly junior locums. The inquiry also pointed out that using locums allows the DHBs to get doctors to work long, dangerous hours and removes the need to provide these doctors with sick leave, continuing medical education and in-house training.
The reason so many young doctors (and a few of us oldies) are willing to endure such terms in exchange for extra money is because the difference in money is substantial. In case anyone thinks it is not an issue primary of pay, let me point out that Waitakere hospital has all but closed its ED in the evenings because they cannot staff it, yet there is a 24 hour Whitecross A&M just down the road that appears to be managing to staff the place just fine, despite the current shortage of locum doctors. The only difference is about a 60 dollar an hour difference in pay scales.
In addition, there is not much of a disincentive for junior doctors to locum. As the report points out, the junior doctors in hospital positions, work long, dangerous hours, get little continuing medical education and even less in-house training. So, apart from sick leave provision, hardly a big concern for fit, healthy young doctors, the DHBs are offering nothing except markedly lower pay.
And then they wonder why junior doctors leave and become full-time locums.
The report then goes on to suggest a single employment agency for junior doctors, essentially suggesting that the clinical training agency becomes a provider of doctors instead of merely overseeing their on-the-job training. The report goes on to say:
“The commission is critical of health boards for too often giving precedence to work over the training needs of RMOs (house officers and registrars).
““For RMOs to be treated primarily as an in-training workforce requires changes to a system that relies on them as a frontline workforce.””
I’m dubious that this will solve the problem. The main reason why junior doctors don’t get the training they need is that there are not enough of them. You could devolve some of the responsibilities of the junior doctors on to the nursing staff, but there are not enough of them either. A major part of the reason why there are not enough doctors is that their pay scales are inadequate. Having a single employment agency is not going to help. And using the single agency to prevent the use of junior locums will find all those junior locum doctors leaving the country in droves, swiftly followed by the collapse of our health system.
We doctors like to obfuscate about money. We like to suggest that we are motivated by other things. While that is partly true, the reality is that remuneration is by far the most important thing to most of us. If you bumped up the hospital doctor’s salary by 30%, you would solve your doctor shortage within a year or two and the locum industry would mostly evaporate. And with sufficient doctors, revitalising the training scheme would be easy, even for the DHBs. It doesn’t need yet another monolithic bureaucracy for junior doctors, it just needs the application of dollars.
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Aug 8 09 7:21 pm
Agreed that would be to add another layer of parasites into the system with no added value
And therein lies the rub, since, as we all (should) know money does not grow on trees
Nor is it printed by the pixies at the bottom of my garden, drat it.
Aug 9 09 8:16 am
Isn’t this why we need economic growth, so we can afford to pay for health, education and other services we need?
Homepaddock´s last blog ..August 9 in history
Aug 9 09 12:01 pm
HP: Isn’t this why we need economic growth, so we can afford to pay for health, education and other services we need?
Exactly. I am always amazed by the number of people who say that doctors are paid more in Australia, because Australia is bigger; as if size meant anything. Obviously a bigger population requires more doctors so the health budget goes on more doctors rather than bigger salaries.
The only reason why Australian doctor’s salaries are 30% higher than New Zealand doctor’s salaries is because Australia is richer. And that always boils down to productivity.
Aug 9 09 12:39 pm
The current batch of ‘junior doctors’ have the best working conditions ever, far better than currently found in the UK, USA and SA; they are getting paid far more than their seniors ever got paid when they were trainees, in fact they get as much as a newly qualified senior whilst in their last years of training; and are not getting enough experience in their training which is being exposed time and time again. They are not taking responsibility for their own learning and will not turn up to ‘teaching’ if it is not in their rostered working time.
I do not feel sorry for them one bit – they have made their bed and must lie in it. In the mean time the hospitals will continue to go the route of physician assistants, nurses doing junior doctor work, midwives taking control of maternity, etc. In a few more years they will be relegated to the role of lowly paid, poorly skilled technicians, bleating about lost opportunities.
The amount that a doctor can get paid in Oz varies, but it can be a huge amount more than in NZ. I know of newly qualified specialists who have moved to Oz and started off with a salary double that which a top of the scale specialist gets in NZ – and they are not working in some two-horse hick town miles from nowhere.
Aug 9 09 12:57 pm
mawm:
I have to say that I am a little dubious about the validity of the “in my day” argument! I was also treated like a skivvy, paid less than the nurses and generally had to fend for myself when it came to further education. I also had to work 56 hours at a stretch and commonly did 80 hour weeks. Yes, I survived all that, but that does not mean I think that it was right.
The idea that junior doctors should go through that same sort of nonsense just because we did, has more in common with public school-boy initiations than it does with modern medicine.
What we should be asking ourselves is what kind of doctors would we like to create? Do we really want to recreate the almost “master/slave” relationship of yesteryear, or do we want to form mentoring bonds with our junior colleague and help them to become as experienced and as “wise” as ourselves. Perhaps with more of the latter, we will have less young, hot-shot specialists who many times indulge in theoretical and academic medicine at the expense of their patients.
Aug 9 09 7:38 pm
Mac – I’m not condoning the hours we used to work – BTW if you were only doing 80h weeks you must have been a slacker
– and I have not used the ‘in my day’ argument at all. I’m merely stating a fact. The issue here is the junior doctors are digging their own grave – they are coming out of their (longer) training period with fewer skills and less experience, they are pushing health authorities to find cheaper and easier to use staff to do the work, and they are not underpaid – ask any CPA or law clerk. As far as the senior mentoring role is concerned, I see many seniors putting in a lot of effort and personal time to do so and absolutely no engagement from the juniors.
I certainly concede that the training issues are by no means one-sided.
Aug 11 09 12:23 pm
What about the idea that 80 per cent of the work doesn’t require a medical degree. Get the workforce working productively- hire far fewer, pay far more.
That would be my take on it as well, A.T. Nurse practitioners could do a large chunk of the stuff that junior doctors can do, freeing them up for training. Unfortunately, however, you won’t be able to reduce the numbers of junior doctors, because you need them to become senior doctors at some stage, otherwise you will run out of doctors.