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

Attachment 5: NRLP Survey Analysis - Part 3

Page last updated: 04 July 2012

‘I am / have been a locum’

Locum service(s)/ program(s) used

Forty five responses were received to this question.

Just over half (53%) of respondents had used or are using SOLS; and approximately one third (37.8%) had used/were using the RGPLP.

Significantly fewer (13.3%) had used/were using GPALS. A small number (4.4%) were unsure of which program they had used, or could not remember the program name.

A breakdown of these figures by state, role/specialty and remoteness classification appears in Table 14.

Benefits from being a locum

Seventy-five respondents identified a range of benefits attributed to being a locum.

The benefits most commonly identified were as follows (multiple responses were possible):

  • Assisting my colleagues (80% or 60 respondents)
  • Seeing more of Australia (66.7% or 50 respondents)
  • Using more of my skill base (65.3% or 49 respondents).
  • Provides a lifestyle choice (52% or 39 respondents).

Many respondents identified personal benefits related to personal development and lifestyle choices and/or career satisfaction:

  • ‘To work /contribute in Indigenous health.’
  • ‘I can make a difference where the cities are restrictive and protected by specialist groups with little or no understanding of the value of doctors such as myself.’
  • ‘Experiencing other health services also generates new ideas for my usual workplace. I may seek to re-locate to another rural area to work in the future based on locum experiences.’
  • ‘Able to gain a better understanding of the medical politics in the Australian health care problems and issues.’
  • ‘I have an affinity for rural people — they do it tough.’

Many respondents also noted that ‘income supplementation’ was an attraction. This included those who used locum placements to contribute to their retirement income or support more flexible career paths:

  • ‘I am semi-retired and locum work in rural public hospitals suits my financial needs.’
  • ‘I work voluntarily overseas half the year and locums are the best way of gaining employment.’
  • ‘Supplement income in retirement.’
  • ‘I have recently moved to a new country town and they have regular doctors (so don't need me), but I try to locum for them so I can work at home and support them.’

Analysis by state

The data suggests that SOLS and the RGPLP are most commonly used to facilitate locum placements across all states/territories. Respondents had also used multiple agencies, including private agencies such as Wavelength and Ochre.

Qld
NSW
ACT
Vic
Tas
SA
WA
NT
SOLS
20% (2)
66.7% (8)
80% (8)
50% (1)
25% (1)
50% (3)
GPALS
30% (3)
16.7% (2)
16.7% (1)
RGPLP
40% (4)
33.3% (4)
20% (2)
50% (1)
75% (3)
50% (3)
Not sure/don't remember
20% (2)
OtherAusstat (2), Ochre, Wave-length (3), Skilled Medical Pty.Ltd.Last Minute Locums, Ochre, GPNTT (2), Skilled Medical, Wave-length, AusstatSkilled Medical, Ochre, GPNTT, Chandler McLeodOchre, GPNTTWave-length (2)RDWA, CHSA, Bone, Wave-length, Health 24Ochre, WACHS, Rural Health West
No. of responses
(Multiple responses could be provided.)
10
12
2
10
2
4
6
0

Table 14: Locum services used by state/territory

Analysis by role/specialty

While no definitive conclusions can be drawn from these numbers, the data demonstrates that respondents across all roles/specialties are using multiple agencies to facilitate their locum placements.

General practitioners
Anaesthetic specialties
Obstetric specialties
SOLS
92.3% (24)
GPALS
100% (5)
3.8% (1)
RGPLP
100% (12)
60% (3)
7.7% (2)
OtherWavelength (3), Ochre (4), GPNTT (4), Skilled Medical (3), Chandler McLeaod, CHSA, WACHS, Rural Health West, CharterhouseWavelength (2), WA Country Health ServicesOchre, Wave-length (2), Bone, Ausstat (2), Health 24, 24/7
No. of responses
(Multiple responses could be provided.)
12
5
26

Table 15: Locum services used by role/specialty

Analysis by remoteness classification

Again, low numbers prevent definitive conclusions being drawn, but the data below suggests that each of the programs is being used across all remoteness classifications. The exception is RA4 (remote Australia), where all respondents have used private agencies. Further research would be required to determine whether this is a reflection of actual circumstances in remote regions, or simply coincidental given the particularly low number of respondents.

RA1
RA2
RA3
RA4
RA5
SOLS
42.9% (3)
42.9% (3)
60% (3)
12.5% (1)
GPALS
28.6% (2)
28.6% (2)
12.5% (1)
    RGPLP
28.6% (2)
57.1% (4)
40% (2)
62.5% (5)
    Not sure/don't remember
25% (2)
OtherLast Minute Locums, GPNNT, WavelengthOchre, GPNTT, Skilled Medical (2), Wavelength (2), CHSA, BomeWavelength (4), Ochre, Health 24Medical Agency, Ausstat, WACHS, Private agencyOchre (3), Chandler McLeod, GPNTT, Ausstat
No. of responses
(Multiple responses could be provided.)
7
7
5
4
8

Table 16: Locum services used remoteness classification

Locations where locum service has been provided:

Qld

Mornington Island, Mt Isa x3, Beaudesert, South Brisbane, Atherton, Roma x3, Mossman x2, Weipa, Mackay, Glenden, Proserpine, Sarina, Mirani, Moranbah, Airlie Beach, Cannonvale, Walkerston, Cunnamulla, Emerald x3, Blackwater, Thursday Island x2, Biloela x2, Palm Island, Mareeba, Ingham, magnetic island, Mt Morgan, Barcaldine, Blackall, Yarrabah, Clermont, Normanton, Kingaroy, Clermont, Nambour, Hervey Bay, Bundaberg x2, Nambour x3, Goondiwindi, Cairns, Redland Bay, Atherton, Mosman.

NSW

Queanbeyan, Bateman’s Bay, Grafton x3, Murwillumbah x3, Cowra x2 (GP Anaes & ED), Collarenebri, Nyngan, Forbes, Tenterfield, Glenden, La Trobe, Mildura, Gin Gin, Childers, Armidale x2, Tamworth, Grenfell, South West Rocks, Canowindra, Albury, Casino, Gunnedah, Byron Bay, Moree, Hillston, Warren, Trangie, Narromine, Bingara, Molong, Cobram, Robinvale, Condobolin, lake Cargelligo, Nyngan, Cobar, Bega x3, Hay, Griffith x2, Lismore x2, Orange, Gosford x2, Nowra x3, Goulburn x2, Taree x3, Griffith, Broken Hill, Wagga Wagga x3, Kempsey, Bowral x2, Tweed Heads, Coffs Harbour.

ACT

Canberra.

Vic

Yarram (GP & ED), Maldon, Inglewood, Cobden, Penshurst, Timboon, Bentleigh, Dandenong, Wantirna, Gippsland, Mildura x3, Wangaratta, Bendigo x3, Shepparton x5, Sale, Wodonga, Warragul x3, Warrnambool x3.

Tas

Rural areas (GP), St Marys x2, King Island, Launceston x4, Rosebery, Zeehan, Latrobe x2, Burnie, Hobart.

SA

Rural SA (RDWA), Kangaroo Island x3, Coober Pedy x2, Streaky Bay x2, Wudinna x2, Victor Harbour, Jamestown, Tanunda, Ceduna x3, Roxby Downs, Orroroo, Cummins, Pinnaroo, Penola, Quorn, Cowell, Burra, Port Pirie x2, Keith, Mt Gambier, Elliston, Cleve, Port Lincoln, Laura, Maitland, Whyalla, Gumeracha, Boolaroo Centre, Peterborough, Wudinna, Meningee, Robe, Port Broughton, Berri x2, Murray Bridge.

WA

Fitzroy Crossing, Derby x4, Kalgoorlie x3 (GP), Jigalong, Christmas Island x2, Kimberley x2, Wyndham x2, Halls Creek, Kununurra x3 (GP anaesthetist), Northam, Esperance, Broome x4, Karratha x3, Dalwallinu, Gnowangerup, Bunbury, Port Hedland x3, Pilbara, Fremantle, Ravensthorpe, Margaret River, Albany, Lake Grace, Condining Hill.

NT

Central Australia, Oenpelli Gove x2, Alice Springs x6, Miwati, Darwin x2.

What do you believe needs to be done to better support rural medical practitioners take leave?

Summary

This question was answered by 173 respondents, across all state/ territories, roles/specialties, and remoteness classifications.

A number of themes could be identified in the range of responses. In order of importance, these related to:

  • the importance of continuing to fund and/or provide additional funding for locum services and programs
  • the need for an increased number of locums
  • additional incentives for locums
  • the need for improved planning.

The following issues were also identified by approximately 6-8 respondents each:

  • reduced paperwork
  • the need to provide improved information for potential locums
  • the need for additional awareness raising related to the locum programs
  • the value of country service
  • the need to ensure an effective match between the GP and locum.
  • The major themes are discussed in further detail below.

    Continuing/additional funding for locum programs

    Over one third (36%) of respondents noted the importance of continuing to fund and/or provide additional funding for locum services and programs.

    • ‘More vigorous locum services — well funded & professional. Assist some of the better private locum services as well as the government funded eg GPNNT.’
    • ‘Continue to subsidise practice overheads as well as locum’s fees.’
    • ‘Increasing the availability of these programs would be great eg RGPLP is a tiny number of positions for the need.’

    Increased number of locums

    Over one fifth (21%) of respondents highlighted the need for increased numbers of locums in general, and particularly those who know rural practice:

    • ‘Recruit more locums by making the program more attractive.’
    • ‘What about funding permanent locums that go around and provide leave relief where it hasn't been taken in say 2 years?’
    • ‘Improved availability of procedural locums that can work in general practice.’
    • ‘More skilled doctors based in areas so you can get a returning locum that knows your area and services available. Having locums from Brisbane who don't know where to refer or what a PTS form is frustrating, costly & time consuming.’

    Additional incentives

    Over one fifth (21%) of respondents also noted the need for additional incentives to encourage clinicians to offer their services as a locum.

    The issue of private indemnity cover was raised most consistently:

    • ‘Private indemnity is an issue as too expensive for the practice principal to pay in a part or full private practice situation. I as many others will only do public hospital locums [who cover our indemnity] as a consequence.’
    • ‘Private indemnity cover provided for locums doing short term cover for private specialist practitioners.’
    • ‘Evaluate and address the problem of Medical Indemnity Insurance for part-time practitioners who wish to provide locum services to private practitioners.’
    • ‘Semi-retired practitioner will not be able to do locum unless the employer provide full indemnity cover.’

    Improved planning

    Ten percent of respondents identified improved planning processes at a range of levels as a key area of need.

    • ‘There should be long term planning rather than last minute urgent locum calls.’
    • ‘A bit more notice of placement availability dates.’
    • ‘Rural practices/hospitals linked to other urban/regional practices and hospitals to work as one co-ordinated network to share resources and minimise locum use.’
      1. A realistic leave period, eg 3 to 4 weeks, as less than this means that patients will usually defer the consultation until the principal returns;
      2. A capacity to book the locum 12 months or longer into the future;
      3. That a and b are reliable;
      4. The locum is suitably credentialed;
      5. Ensure that handover before and after the service is provided;

    Do you think the government should continue to provide subsidies and programs to assist in providing rural locum medical services? Why or why not?

    Summary

    Nearly 200 respondents answered this question, with overwhelming agreement that subsidies and programs to assist the provision of rural locum services should be continued.

    Respondents particularly noted the role of the programs in supporting rural clinicians to take a break to prevent burnout or enable further study, to address the costs of locum relief, and to aid in retention.

    • ‘Yes, locums are an essential part of rural practice, especially as so many rural obstetricians are working excessive hours with little relief.’
    • ‘Certainly. Rural practitioners find it difficult to get away and continue to provide cover. Study leave is usually very expensive as there are costs of travel, accommodation, registration, together with keeping the practice open.’
    • ‘Yes or medical staff in rural areas will continue to leave these practices as they cannot take adequate leave.’
    • ‘Definitely yes. If the rural specialist shortage is to be alleviated and rural communities offered equity of access to care then support is essential.’
    • ‘Yes. Otherwise the program will fall over, rural practice will become even less attractive and health of people in rural and remote areas will suffer.’
      • There are currently a range of locum service providers and programs. Do you believe any one is better placed to provide locum services? If so, why?

        Summary

        There were 167 responses to this question. Nearly half of the respondents expressed no preference or were unsure whether any locum service provider was better placed than any other to provide services.

        Approximately 12% of respondents nominated SOLS. Several respondents identified the program’s link with the Royal Australian and New Zealand College of Obstetrics and Gynaecology as a major benefit.

        • ‘SOLS is best placed to serve our needs as it is run through the Royal Australian and New Zealand College of Obstetrics and Gynaecology. They are the most appropriate body to source and management locums related to Specialist Obstetrics and Gynaecology.’
        • ‘SOLS is the best in my opinion. It does not have a commercial benefit as the core of the operation.’

        Nearly 10% nominated private agencies as their preferred choice for their flexibility and ability to negotiate on behalf of the locum:

        • ‘Private providers have flexibility to negotiate best terms and conditions for the locums and as a locum I find this an advantage.
        • ‘Private sector more responsive to supply and demand.’
        • ‘Requires an experienced private provider for best service.’
        • ‘Commercial locum agencies provide a lot more information about the potential locum, without me having to directly contact the hospital involved. I can then determine if I am interested without directly speaking to the doctor advertising for a locum. I have no idea what they wish to pay me and am a bit
        • reluctant to speak to them directly without more information.’

        The concept of a centralised agency had appeal for a further 5% of respondents:

      • ‘It would be a lot easier for practices if there was one contact that can help with our locum needs rather than having a lot of different options and spending a lot of time dealing with multiple agencies.’
      • ‘They should all be rolled into one service that can be contacted. Why have multiple services? Just duplication again. Very frustrating to get the run around all the time.’

      Some respondents, however, noted the value of local knowledge:

      • ‘Agencies that have good regional knowledge could provide a better service than one nationally based agency.’
      • ‘There is a place for some centralisation, but local knowledge application of locums is essential to ensure a good alignment of locums and locations.’

      State-based locum services were also nominated:

      • ‘State workforce agencies are best placed to ensure scarce allocation of resources goes where most needed.’

      The Rural Doctors Workforce Agency in South Australia, in particular, was nominated five times by respondents:

      • ‘RDWA in SA has a proven track record of excelling in this area.’
      • ‘Much as I hate to say it (because of its obvious deficiencies) the most successful service is the RDWASA, which demonstrably is the most successful, maybe because of the additional funding provided by the state, good management by doctors for doctors.’
      • ‘The RDWA locum program in SA should be a role model for other services. It is an excellent service.’

      Any other comments regarding medical locum services?

      Summary

      Approximately 100 respondents took the opportunity to make a general comment. These contributions covered a broad span of topics. Approximately one fifth of respondents affirmed the value of the National Rural Locum Program:

    • ‘The system works very well, it has been seamless doing my first locum, very warmly received by the docs taking leave and all in the town.’
    • ‘They are a necessity for rural practices. We rely heavily on them so that our doctors can have regular much needed breaks without the community suffering.’
    • ‘Essential to continuing well being and care of doctors and patients alike.’
    • ‘Essential to keep rural practice viable and to provide services to rural communities.’

    Many other respondents highlighted areas of improvement or concern. A number of respondents suggested the introduction or extension of various models of locum service provision:

  • ‘My experience with SOLS suggests that this model (including government subsidies) could be very usefully applied to all rural medical specialties.’
  • ‘Personally I would like to explore the idea of a being a regular locum to the same place ie one week a month with some additional shifts at a local base hospital to keep skills up, but still living where I am settled.’
  • ‘An alternative model is to employ salaried locums rather than contractors.’
  • ‘The RWAV program for training GPs to work in remote communities is absolutely fantastic. There should be more training programs designed to help urban GPs upskill to take on remote work.’
  • ‘Please consider focussing the scheme on sites that require locums services to cover baseline workload and not just leave relief. Any incentive in the market that advantages sites who are better able to recruit permanent staff distorts the market against those sites that require the most locum cover (and not just leave relief).

This included some support for centralisation of administration:

  • ‘A one stop shop would be ideal where practices could find private/public locum agencies and thus be able to find locum services when needed.’
  • ‘A national or federal locum agency managed and administered by a newly structured SOLS administration should be set up to operate a nationwide locum service ...’.
  • Lack of locum availability was of concern for approximately one quarter (8/34) of respondents. Several noted that they had needed to independently locate locums

  • ‘For 2 years we have been unable to get a GP locum. We have ended up finding the locum ourselves and then referring to Health Workforce Qld.’
  • ‘Locums are frequently recruited independently to our service by ourselves and other private sector recruitment agencies, and then referred to the schemes to allow access to the subsidy. Unfortunately this requires a significant duplication of paperwork with minimal added quality to our processes. As our service seems to perpetually operate on locums rather than permanent staff and will do for the foreseeable future, it would be more effective to contribute more than a few weeks per year. Perhaps block funding to the most marginal services would be more appropriate than the current system.’
  • The need for reduction of red tape was a particular concern:

  • ‘Removing red tape. Each out of 6 locum placements I have done in last 12/12 required me to submit 20-40 pages application pack — such a waste!’
  • ‘Give the subsidy direct to the practice.’
  • ‘Streamline the paperwork as well (why does Medicare require the same information on 7 different pieces of paper when a provider number … should ID every doctor, their quals & skills?’
  • About 12% of respondents raised issues related to the cost of locum services:

  • ‘AMA locum and other locum services put % on top of locum earnings which put prices and cost above what a rural practitioner can afford — again just another expense.’
  • ‘Currently it is still hard and expensive —I'd wish for a salaried locum pool that we can access at no cost. The Medicare rebates locums attracted are usually barely enough to pay for the running costs of the practice and the salaries of the clerical staff.’
  • ‘A good initiative that needs development. Key is a lot of availability and reasonable cost. Locums rarely earn the same as the principal they replace.’
  • A further 10% highlighted issues related to the support of or incentives for locums:

  • ‘Subsidies to locums for air fares for accompanying spouses is a valued incentive used by at least one provider. Attention to provision of good standard accommodation is important.’
  • ‘Can't do it on the cheap if you want highly skilled people who maintain their skills travelling to remote areas … Need good family accommodation otherwise spouses and kids will not support GP to go away to do locums. Have to make it worthwhile for whole family. Ultimately its the wife who gives the okay as to whether I supply a locum slot. Certainly can't stay in dodgy accommodation or vehicles. Need family vehicle.’
  • ‘I really appreciate it when I have contact with a locum manager who knows the practice environment I am going to and where I feel supported. Much easier than going in blind.’
  • ‘More creative upskilling & learning incentives to be built into plan.’
  • Other issues raised by small numbers of respondents included the need to address the cost of indemnity cover for locums and concerns about the quality of service provided by private locum agencies.

    Method of analysis

    Because of the volume and qualitative nature of some of the survey responses (particularly the general questions), the data analysis software NVivo was used to facilitate the analysis. Using NVivo enabled the project team to analyse the data with a high level of rigour and reliability in a short time frame. The process included the following steps:

  • Each question was ‘coded’ to identify key themes in the responses (see sample in figure 6 below)
  • A ‘coding profile’ was generated for the set of questions in each section of the survey to determine which themes were raised most consistently by respondents.
  • A ‘coding report’ was generated for the top themes that emerged in responses to each section of the survey. Representative quotes were then selected from the coding reports to demonstrate respondents’ views about each topic.