Review of the National Rural Locum Program - Final Report - April 2011

Attachment 5: NRLP Survey Analysis - Part 2

Page last updated: 04 July 2012

‘I have used a locum service’

Locum services used by respondents

Forty four responses were received in relation to this statement. Respondents could make multiple selections in their answers.

Many respondents had used more than one locum service. Over half (54.5%) had used SOLS, and 41% had used the RGPLP. Only 9.1% (4 respondents) had used GPALS.

Nine respondents had also used private locums, identified through local contacts, a ‘freelance’ locum and private agencies. Other sources included Health Workforce Queensland, Rural Health West, North East Victorian Division of General Practice, Rural Doctors Workforce Agency, Rural Doctors’ Association and New South Wales Rural Doctors Network.

Analysis of locum program use by state/territory

A state-by-state breakdown is provided below. Numbers are too low to draw any rigorous conclusions about the difference in usage between the various states and territories.

Qld
NSW
ACT
Vic
Tas
SA
WA
NT
SOLS
57.1% (4)
30% (3)
72.7% (8)
33% (2)
62.5% (5)
100% (2)
GPALS
14.3% (1)
10% (1)
25% (2)
RGPLP
14.3% (1)
70% (7)
18.2% (2)
67% (4)
50% (4)
Not sure/don’t remember
14.3%
(1)
9.1%
(1)
Others
include:
Health Workforce Qld, private agencies, skilled medical, AMPRDN NSW, RDA, private agenciesRural Doctors Workforce Agency, RHWRural Health West, private agencies, global medical, AMA
No. of respondents
(Multiple responses could be provided.)
7
10
0
11
0
6
8
2

Table 8: Locum program use by state/territory

Analysis of locum program use by role/specialty

A further breakdown of the data by role/specialty is provided below.

The data implies that those respondents with obstetric specialties are more likely to use locum services in general. Some respondents also appear to use/have used multiple locum programs.

General practitioners
Anaesthetic specialties
Obstetric specialties
Health service manager
Practice manager
SOLS
64% (16)
100% (3)
50% (3)
GPALS
8% (2)
33.3% (1)
16.7% (1)
RGPLP
100% (6)
100% (3)
24% (6)
66.7% (4)
Not sure/don’t remember
8% (2)
No. of respondents
(Multiple responses could be provided.)
6
3
25
3
6

Table 9: Locum program use by role/specialty

Analysis of locum program use by RA classification

The data could suggest most active use of locum programs in outer regional areas, with some respondents also appearing to use/have used multiple locum programs.

RA1
RA2
RA3
RA4
RA5
SOLS
1
1
8
3
5
GPALS
2
1
1
RGPLP
2
9
3
3
Not sure/don’t remember
1
No. of respondents
1
4
17
6
8

Table 10: Locum program use by RA classification

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Factors considered to be important in choosing a locum service

A broad combination of factors were considered by respondents in choosing a locum service. Over 90% of respondents identified the following factors as ‘important’ or ‘very important’:

  • a short time lag between initial enquiry and getting a locum
  • the travel allowance
  • ease of communication with the locum agency.

The following cluster of factors were also identified as ‘important’ or ‘very important’ by over 75% of respondents:

  • the subsidy available through the locum service
  • support from the locum agency
  • a proven track record in providing locums
  • no administrative fee
  • minimal amount of paperwork required
  • information about, and assistance with, insurance, registration and other professional / credentialing issues
  • a previous relationship with the agency
  • backing of a professional college / association
  • practical assistance with travel and accommodation
  • a structured clinical handover

Benefits for the clinician

Respondents identified a range of personal benefits from using a locum service. Of most significance was the opportunity to obtain a break from work — to prevent burnout, spend time with family, and have a holiday:

  • ‘Finally able to get a holiday with the family, would not have lasted much longer without.’
  • ‘Ability to get away with family and have a break.’
  • ‘Provided much needed relief.’

Other benefits identified by respondents included:

  • subsidised costs making a break more affordable
    • ‘A break without huge financial cost.’
    • ‘Access to the rebate to assist with expenses.’
  • ability to reduce pressures of workload on themselves or colleagues
    • ‘Sharing of workload.’
    • ‘Helps colleagues cope in my absence.’
    • ‘Don’t have a mountain of work on my return.’
  • peace of mind while away
    • ‘Ability to be able to leave town and not worry about practice and hospital.’
    • ‘Peace of mind while on maternity leave.’
  • the opportunity for education or professional development
    • ‘Chance to get refreshed in education …’
    • ‘Allowed me to travel to go to an overseas meeting.’
  • continuity of service to patients
    • ‘Ability to keep practice running while away.’
    • ‘I didn't have to shut up shop.’

Respondents also noted the advantages of obtaining a good quality locum, and the broader benefits of being ‘able to keep GP numbers up’ in rural areas.

Benefits for patients

Respondents also identified benefits to their patients through their use of a locum service. Overwhelmingly this related to the ability to provide continuity of service in their community:

  • ‘Not having to travel to another town to obtain service.’
  • ‘To be able to keep providing the same level of service.’
  • ‘Can still deliver locally, instead of going 50km to next town.’
  • ‘Continuity of medical acre in my absence. Due to relative isolation no alternatives for many.’
Other identified benefits for patients included:
  • the advantages of seeing ‘fresh’ personnel:
    • ‘Get different opinion and compare with their own doctor.’
    • having a ‘rested and relaxed doctor’ to provide service on his/her return
    • the contribution made by locum services in ‘ensuring [an] ongoing viable medical workforce in the area.’

Benefits for the community

Similar themes emerged in the benefits for their community identified by respondents. Continuity of service was again a major factor:

  • ‘Provision of ongoing care and no delays in obtaining consultations, also new techniques shown.’
  • ‘Service provided locally, no need to transfer patients.’
  • ‘Ability to continue providing a service while current staff are on leave.’

Other factors identified included:

  • ability to reduce pressures of workload on colleagues
    • ‘My colleagues don’t have to take up the slack.’
    • ‘Less impact on my obstetric colleagues.’
  • contribution to attraction and retention of medical personnel:
    • ‘Chance [that] locum doctor [might] relocate to country area.’
    • ‘Avoiding GP burnout and doctors leaving because of overwork.’
    • ‘Helps in ensuring ongoing viable medical workforce in the area.’
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Benefits for the locums

Respondents also saw significant benefits for the locums themselves. These almost without exception related to the opportunity for new and diverse experiences, well paid, in a supportive environment:

  • ‘An interesting and varied workplace and community.’
  • ‘Enjoyable experience with good appreciation and remuneration.’
  • Opportunity to work in a supportive practice/community, travel.’
  • ‘Working in a pleasant community for grateful patients with a varied interesting workload.’
  • ‘Hopefully enjoys the experience of county remote experience seeing other services, how things can be done differently.’
  • ‘See a different community with more challenging medicine.’
  • Negative consequences of using a locum

    Approximately one third of respondents (11/34) had had no negative experiences with locums.

    Approximately another third (12/34), however, noted issues with the quality of locums they had used in relation to their interest in the work, currency of practice and knowledge of current Medicare item numbers.

    In some cases, difficulties were related to the expectations of the locums or willingness to work under the same conditions as the permanent clinician, such as after hours work, ‘on call’ requirements and VMO responsibilities.

    Respondents also noted that some patients had difficulty accepting locums:

    • ‘Patients still wait to see me rather than see locum.’
    • ‘Some patients find it difficult to relate to the locum, particularly the elderly and children.’

    ‘Red tape’ and financial considerations were also highlighted by a small number of respondents.

    Plans for using locum services in the next 12 months

    Fifty respondents identified their plans for using particular locum services in the next 12 months. Multiple responses were possible.

    Of the fifty respondents, 44% (22) planned to use SOLS, with nearly as many (38% or 19 respondents) planning to use RGPLP or other locum services (36.0%or 18). As can be seen in Figure 1 below, fewer respondents aimed to use GPALS, or were not planning to use a locum.


    Figure 1: Plans to use locum services in next 12 monthsD

    Figure 1: Plans to use locum services in next 12 months

    Many respondents provided brief comment in relation to why they would be seeking the services of a locum in the next twelve months. Many of the reasons have been highlighted above, including the need for a break from the pressures of work; for continuing education and attendance at conferences; and confidence in the provision of a good quality service.

    A number of respondents also identified the need to rely on locums while recruiting for new colleagues:

    • ‘Excellent service and the need remains at the present time due to a recruiting period for full time staff member.’
    • ‘My group of doctors are leaving and I need locums until I get permanents.’
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    ‘I have not offered my services as a locum’

    Factors influencing decision not to offer services

    Twenty-eight responses were received to this question.

    The factors that most strongly influenced respondents in choosing not to offer their services as a locum were as follows, in this order (multiple selections could be made):

    • I work fulltime (78.6%)
    • I have family commitments that prevent me being away (17.9%)
    • I am not interested (14.3%)
    • I don’t feel comfortable working in someone else’s practice (3.6%)
    • I don’t feel I have the skills to take on a rural case load (3.6%)
    • I have not really thought about it (3.6%).

    Factors that would influence respondents to consider offering their services as a locum

    Almost all respondents identified a change of work circumstances as the factor most likely to influence them to offer their services as a locum. This included retirement, part time work rather than full time, or a change of employer:

    • ‘Be working part time.’
    • ‘I will consider this in a couple of years when I am semi retired.’
    • ‘I would need a locum myself!’
    • ‘I would need to leave my current employment.’

    Several noted factors related to lifestyle and personal commitments, including work for their partners:

    • ‘Unlikely to happen at the moment, maybe when the children have left home.’
    • ‘GP obs husband would also need to find work at the same time & place.’
    • ‘I would need a suitable practitioner to replace me for the designated period and my practice manager/RN/spouse would also need replacing.’
    • ‘Interesting location my husband felt he could visit.’

    A number of respondents also identified remuneration as a factor:

    • ‘The incentive will have to be better than the highest earning in my practice.’
    • ‘The employer of the locum had to provide indemnity cover.’
    • ‘… probably some financial incentive.’

    Analysis by state

    Respondent numbers to this question are too low to draw reliable conclusions about differences across states, although the data could suggest that working full time is a key factor in why respondents have not offered their services as a locum regardless of the state or territory in which they live.

    Qld
    NSW
    ACT
    Vic
    Tas
    SA
    WA
    NT
    I am not interested
    20% (1)
    25% (2)
    100% (1)
    I work full time
    60% (3)
    75% (6)
    83.3% (5)
    100% (1)
    100% (6)
    100% (1)
    I don’t feel comfortable working in someone else’s practice
    16.7% (1)
    I don’t feel I have the skills to take on a rural case load
    12.5% (1)
    I have not really thought about it
    16.7% (1)
    I have family commitments that prevent me being away
    40% (2)
    25% (2)
    16.7% (1)
    No. of responses
    (Multiple responses could be provided.)
    5
    8
    1
    6
    0
    1
    6
    1

    Table 11: Reasons for not having offered services as a locum by state

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    Analysis by role/specialty

    The data suggests that the two main reasons for not having offered their services as a locum (‘I work fulltime’ and ‘I have family commitments that prevent me being away’) are consistent across all roles/specialties.

    General practitioners
    Anaesthetic specialties
    Obstetric specialties
    I am not interested
    42.9% (3)
    9.1% (1)
    I work full time
    57.1% (4)
    85.7% (6)
    90.9% (10)
    I don’t feel comfortable working in someone else’s practice
    14.3% (1)
    I don’t feel I have the skills to take on a rural case load
    14.3%(1)
    I have not really thought about it
    14.3% (1)
    I have family commitments that prevent me being away
    28.6% (2)
    14.3% (1)
    9.1% (1)
    No. of responses
    (Multiple responses could be provided.)
    7
    7
    11

    Table 12: Reasons for not having offered services as a locum by specialty

    Analysis by RA classification

    The data suggests that working full time is a key factor in why respondents have not offered their services as a locum across all regions, from metropolitan through to very remote regions.

    RA1
    RA2
    RA3
    RA4
    RA5
    I am not interested
    33.3% (1)
    40% (2)
    25% (1)
    I work full time
    66.7% (2)
    85.7% (6)
    60% (3)
    75% (3)
    83.3% (5)
    I don’t feel I have the skills to take on a rural case load
    14.3% (1)
    I haven’t really thought about it
    25% (1)
    I have family commitments that prevent me being away
    100% (3)
    20% (1)
    16.7% (1)
    No. of responses
    (Multiple responses could be provided.)
    3
    7
    5
    4
    6

    Table 13: Reasons for not having offered services as a locum by RA classification

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    ‘I enquired about being a locum but did not proceed’

    Factors influencing decision to proceed with a placement as a locum

    Twenty-two people responded to this question.

    The factors that most strongly influenced respondents in choosing not to proceed with a placement as a locum were as follows (multiple selections could be made):

    • Unable to fit into work schedule (50% or 11 respondents)
    • It was too difficult to arrange registration, credentialing (45.5% or 10 respondents)
    • There is not sufficient financial incentive (27.3% or 6 respondents)
    • The amount of paperwork I had to do to be a locum was too much (27.3% or 6 respondents).

    Several respondents particularly mentioned their discomfort at having to negotiate remuneration themselves, rather than knowing rates in advance to inform their decision:

    • ‘Was looking at SOLS locum — told 'contact practice direct to organise remuneration' — not something I'm comfortable with — better to know rates in advance and let that decide availability.’
    • ‘Too short a lead time, unclear remuneration.’
    • ‘Credentialling needs to be undertaken individually at each individual hospital. Rather than central references held by third party my referees would have been approached by EVERY HOSPITAL for each locum date. This is unacceptable intrusion on my referees. I use a private locum agency for my usual locums and they hold a single copy of my references which are forwarded to any new hospital I work and thus my referees are only approached once when I register with the agency. A central reference scheme is necessary for me to be willing to be involved in program. I work frequently as a locum by stay using commercial locum agencies because of this issue. Also advertisements do not usually give a range for remuneration and I do not wish to have to personally negotiate always directly with the practice without knowing what range of payments they are expecting to pay.’

    What would it take for you to proceed with a placement as a locum?

    Responses to this question had a clear link to the factors identified above.

    Approximately half of the 25 respondents addressed time and availability constraints, including:

    • ‘Fit into my family schedule.’
    • ‘Suitable timing with current work.’
    • ‘Less able to fit in locums than I'd originally thought when signed up.’
    • ‘More notice about when a locum may be required. I know this is hard.’

    Streamlined processes for paperwork and administration were also an incentive for nearly one third of respondents:

    • ‘Help to overcome the above! It was all too hard.’
    • ‘SOMEONE TO DO THE PAPERWORK.’
    • ‘ … Flights/accommodation/travel sorted…’
    • ‘Greater flexibility in scheduling locus times/placements. One body of people managing this initiative.’

    Improved remuneration was also identified as an incentive:

    • ‘Better remuneration.’
    • ‘The few I've enquired about would pay only ~ 60% what I get here doing similar job. I'd expect to be paid at least equal and prob > to go away to a remoter location and have to arrange cover here etc..’
    • ‘Money $2-2.5K per day.’
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    Analysis by state, role/specialty and remoteness classification

    Within the low number of responses to this question, breakdown of data by state, role/specialty and remoteness classification did not reveal any discernable patterns in the factors influencing respondents’ decisions not to proceed with a placement as a locum.

    While the factors identified above - ‘Unable to fit into work schedule’ and ‘too difficult to arrange registration, credentialing’ - were prominent across all groupings, many respondents further identified a scattered range of issues. The following diagrams, for example, depict the diversity of factors identified by New South Wales and Victorian respondents, by those with obstetric specialties, and those in remote regions (RA4). A similarly diverse picture was evident in other states, roles/specialties and remoteness area classifications.

    This suggests that most respondents were influenced by multiple factors in making a decision as to whether to proceed with a locum placement.


    Figure 2: Factors influencing respondents’ decisions not to proceed with a placement as a locum — NSW respondentsD

    Figure 2: Factors influencing respondents’ decisions not to proceed with a placement as a locum — NSW respondents


    Figure 3: Factors influencing respondents’ decisions not to proceed with a placement as a locum — Victorian respondentsD

    Figure 3: Factors influencing respondents’ decisions not to proceed with a placement as a locum — Victorian respondents


    Figure 4: Factors influencing respondents’ decisions not to proceed with a placement as a locum —respondents with an obstetric specialtyD

    Figure 4: Factors influencing respondents’ decisions not to proceed with a placement as a locum —respondents with an obstetric specialty


    Figure 5: Factors influencing respondents’ decisions not to proceed with a placement as a locum —respondents classified RA4D

    Figure 5: Factors influencing respondents’ decisions not to proceed with a placement as a locum —respondents classified RA4