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Tag: registration

  • What is Recency of Practice? Huge Implications for Doctors.

    What is Recency of Practice? Huge Implications for Doctors.

    Recency of practice is an important concern for medical practitioners in Australia. It’s something you must address both when you register with the Medical Board of Australia for the first time, as well as each time you apply for re-registration. Most doctors tend to focus on the Medical Board standard in relation to recency of practice. But you will also find that most employers have their own expectations and standards around recency of practice. In this post, I am going to guide you through what you need to know about recency of practice, so that you can be appropriately addressing this issue both with the Medical Board as well as with employers.

    So, firstly let us define what we mean by recency of practice for doctors in Australia. According to the Medical Board of Australia, every registered medical practitioner is required to demonstrate recency of practice, which is defined as working a minimum amount of four weeks full time within your scope of practice in one year (one registration period) or 12 weeks full time within your scope of practice across 3 years (3 registration periods).

    From an employment perspective, whilst employers need to be mindful of the Medical Board standard they will generally apply their own standards. A good rule of thumb is if it has been more than 2 or 3 years since you have done a significant amount of clinical work this may be seen as a negative by a prospective employer.

    So, in the rest of this post, we will discuss some of the finer details of the recency practice standard, what might happen if you are found to not be recent enough in practice as well as the options for addressing recency of practice from both a Medical Board as well as employer perspective.

    Recency of practice for doctors video
    Play

    Why have a recency of practice standard?

    It is important that doctors remain current in the type of clinical medicine that they practice. Most laypeople would consider a situation where a doctor had for example not practiced medicine at all for 5 years and not engaged in any continuing professional development during this time as one where such a doctor may pose a risk to the public if they were to return to clinical medicine with no initial support or oversight.

    The question, therefore, is how much recency of practice is enough? Interestingly the Australian Health Practitioner’s Regulation Agency (AHPRA) which oversights the National Boards, including the Medical Board, has reviewed this question a few times. In their most recent report they comment that:

    Research undertaken for this and previous reviews of the ROP registration standards did not provide a definitive answer to the question of how much recent practice a health practitioner needs to maintain their skills and knowledge, or whether minimum hours to maintain competence vary according to the profession, type and scope of practice. National Boards have drawn on the research that is available as well as their regulatory experience and the experience of other National Boards to set requirements for recent practice.

    AHPRA 2019 Report

    They concluded that the revised registration standards balance public safety versus the regulatory burden of allowing practitioners some level of flexibility in their working arrangements.

    Scope is just as important as recency.

    It is important to note that the Medical Board still expects doctors to recognise their own limitations. Even if they have met the recency of practice requirements they should still consider if what they are doing is within their current scope of practice or whether they should be self-limiting themselves or engaging in further training, assessment, and oversight.

    Scope of practice can be a bit difficult to define at times. The Medical Board of Australia defines it as follows:

    Scope of practice means the professional role and services that an individual health practitioner is trained, qualified and competent to perform.

    Medical Board Australia

    Most specialty colleges, for example, will have a statement on their website in relation to the type of clinical practice that they consider a Fellow of the college can safely engage in as a current Fellow of that college.

    If you are working as an International Medical Graduate in Australia you may have some limits on your (scope of) practice imposed as part of your registration by the Medical Board. Typically these may be about only working in a particular area of medicine or only working in certain locations where supervision has been approved.

    How do you prove recency of practice with the Medical Board of Australia?

    Primarily and initially it’s an honesty system. Whenever you apply for registration or a new form of registration or apply to re-register you must indicate to the Medical Board that you meet the recency of practice standard.

    The Medical Board does, however, expect that you keep a record of evidence to prove your recency of practice. And also indicates that it does from time to time audit for compliance and will look into your recency of practice further if it receives a notification about you.

    What can happen if I give the wrong information to the Medical Board about my recency of practice?

    In confirming your recency of practice you are confirming that you comply with the law. Deliberately lying about your recency of practice therefore can have serious consequences if you are found out. Even if you were not deliberately attempting to lie about your recency of practice if it turns out that you were non-compliant you could be in trouble.

    What happens to my registration if I am not recent enough in my practice?

    If you don’t meet the recency of practice standard then the Board can impose conditions on your registration or refuse your registration.

    It is up to you to provide information to the Medical Board to help it decide whether you can safely continue with your registration.

    Requirements for medical practitioners with non-practising registration or medical practitioners who are not registered and wish to return to practice (includes international medical graduates).

    Have had 2 or more years of clinical experienceNot practising for up to 12 monthsNo additional requirements to be met
    Have had 2 or more years of clinical experienceNot practising for between 12 months and 3 yearsBefore re-commencing must complete the equivalent of 1 year’s relevant CPD
    Have had 2 or more years of clinical experienceNot practising for more than 3 yearsNeed to provide a plan for professional development and re-entry into practice
    Have had less than 2 years of clinical experienceNot practising for more than 12 monthsRequired to recommence in a supervised training position
    C/- Medical Board of Australia
    REGISTRATION STANDARD:
    Recency of practice
    1 October 2016

    For those doctors who are required to catch up with Continuing Professional Development the easiest path for doing this is via a college CPD program if you are a member of such a college. Many IMGs will register with the RACGP for this purpose, although it should be noted that RACPG CPD is technically only relevant to general practice and not hospital medicine, although clearly there is overlap.

    If you have been out for more than 3 years and are a member of a college then you will normally find that the college provides a re-entry program option that will satisfy the Medical Board requirement. Generally, this will involve working under the oversight of a college fellow for a period of time.

    What if I am changing scope of practice?

    Again according to the Medical Board, if you are changing your field or scope of practice, you may need to undertake further training to ensure your competency.

    If the change is to a subset of your current practice, i.e. you are narrowing your current practice, there are no additional requirements.

    If you are changing your practice in a way that your peers might view as requiring you to undertake more training or you are changing to an entirely different field of practice then you will be required by the Medical Board to consult with the relevant specialist college to develop a professional development plan before entering the new field of practice.

    Why do employers have a different interpretation of recency of practice?

    Employers are of course obliged to take the Medical Board recency of practice standards into account when considering applicants for job positions. However, employers can and often do make their own interpretations around recency of practice.

    Because working supervised is an option for addressing issues around recency of practice employers may consider doctors for posts where the doctors have been out of practice for significant periods.

    However, it is my experience, particularly when it comes to trainee positions and international medical graduates that employers are unlikely to see large gaps in clinical practice favourably. Employers usually have several applications to consider and they will tend to take the easier path of employing a doctor who is either just moving between jobs or has 2 years or less time out of medicine.

    What are the options for addressing recency of medical practice?

    Option 1. Work under supervision to obtain recency of practice

    As the Medical Board itself indicates if you have recency of practice issue then working under supervision is an option for addressing this matter. A key point of this standard is to ensure that doctors who are not recent enough in their practice are given some oversight to return to work.

    So in theory this means that if you are applying for a resident or registrar (trainee) role recency of practice should not really be an issue from a registration standpoint. But as we have highlighted above it may cause a problem in terms of your candidacy versus other candidates who do have recency of practice.

    Option 2. Gain some clinical experience elsewhere to gain recency of practice

    If working under supervision in Australia is not really an option for you then your next option is to regain clinical experience by working in another country. The Medical Board indicates that it considers clinical practice in overseas countries as meeting the standard of recency of practice.

    This is generally an option for most IMGs and something I tend to recommend if they have been more than 2 years away from clinical medicine.

    I will generally advise that you try to work for 3 months back in your own country, or another country where you have a registration, as this will then help you to both meet the Medical Board’s recency of practice standard as well as provide some reassurance to employers.

    Are courses and observerships useful for recency of medical practice?

    In a couple of words not really. Neither really helps that much.

    Certainly, from a Medical Board perspective, observerships do not count as clinical practice towards the recency of practice requirement. Courses may be of assistance if you are required to undertake CPD relevant to your scope of practice.

    From an employer’s perspective, a relevant course might help a fractional amount and an observership may also assist in a small way. The key benefit for an observership may be in being able to nominate a referee who has recent contact with you in the Australian health context. However, the merits of an observership are marginal compared to actual clinical practice.

    Disclaimer. This post was written having researched the current standards for recency of practice. You should always consult an expert to gain individual advice on your circumstances, check out the official advice, and be mindful that guidelines and policies do change over time.

    Related Questions.

    Who Does Recency of Practice Apply to?

    The recency of practice registration standard applies to all registered medical practitioners, except those with non-practising registration and recent graduates applying for provisional registration to undertake an accredited intern position.

    Who Does Recency of Practice Not Apply to?

    Recency of practice does not apply to non-practising clinicians or interns provisionally registered. It also does not apply to registered students.

    Does Recency of Practice Only Affect International Medical Graduates?

    No. The recency of practice standard affects all medical practitioners seeking registration or re-registration in Australia, including locally trained doctors.

    What is Meant by Scope of Practice?

    Scope of practice generally refers to the areas of medicine you are deemed fit to practice within.

    If I Work More Than 38 Hours in a Week. Can I count These Additional Hours Towards Demonstrating Recency of Practice?

    No. You may only accumulate 38 hours in one week. Additional time will not count towards the standard.

    What If I Work Part-Time?

    Doctors who work part-time must still complete the same minimum number of hours of practice – this can obviously be completed part-time over more weeks, for e.g. working 20 hours per week for 8 weeks of the year would meet the standard.

    Will Doing a Certain Course Help My Recency of Practice?

    From a Medical Board perspective courses and degrees do not assist in any way with the recent of practice standard. From an employer perspective, they might assist in a very marginal way but really nothing beats recent clinical practice.

    Will Doing an Observership Help My Recency of Practice?

    From a Medical Board perspective, observerships do not count as clinical practice towards recent of practice. From an employer perspective, an observership may assist in a small way. The key benefit may be in being able to nominate a referee who has recent contact with you in the Australian health context. However, the merits of an observership are marginal compared to actual clinical practice.

    Does Overseas Experience Count?

    Absolutely. The Medical Board “accepts practice outside Australia for the purposes of meeting the recency of practice registration standard.”
  • Getting Registered In Australia. The Four Options for International Doctors.

    Getting Registered In Australia. The Four Options for International Doctors.

    *The process of getting a job and getting registered as a doctor in Australia is complex, it’s important to understand that you do need to get individual advice on your circumstance. Circumstances do vary for individuals and also things change over time.

    If you are an ad doctor looking for some general information about your options for getting registered in Australia, then this post is for you. I spend a lot of time on Zoom calls these days explaining to doctors from overseas countries (International Medical Graduates or IMGs) what their options are for working as a doctor in Australia. It’s quite a complex process. And inevitably at some point, it makes sense to talk one on one. Particularly if you are starting to get serious about the idea of working as a doctor in Australia. If that’s you I’d recommend booking a strategy call.

    With that being said. Let’s look at the four pathways available for IMG doctors to become registered in Australia from overseas. And let me be quite clear here. These are not the main pathways. They are the only pathways available for getting registered in Australia, at the time of writing this post. If you are a doctor coming from overseas to Australia your pathways to registration are:

    • The Standard Pathway, which is a general registration pathway for doctors from any country who do not have specialist qualifications and are looking to start at junior doctor level in Australia.
    • The Competent Authority Pathway, which is a restricted pathway that enables both specialist and non-specialist doctors from the United Kingdom, United States of America, Republic of Ireland and Canada to commence their work in Australia.
    • The Specialist Pathway, which is a pathway that can ultimately lead to recognition as a specialist in Australia and requires you to be initially assessed by the relevant medical specialty college.
    • The Short Term Training in a Medical Specialty Pathway, which allows for time-limited registration, so that advanced trainees and specialists from other countries can obtain some top-up training in Australia.

    It All Comes Down To the Medical Board of Australia.

    So the first thing to know about getting registered in Australia is that it’s the same final authority wherever you work in the country. No matter what state or territory you are in, it’s all conducted through what’s called the Medical Board of Australia under the overarching umbrella of the Australian Health Practitioners Regulation Agency.

    This is actually a reasonably new thing in Australia. Prior to 2010, the various state and territory medical boards were responsible for registration, which actually made the process even more complex.

    Under the Medical Board of Australia, there are essentially four pathways to becoming registered as a doctor in the country. And if you’re an IMG, you can find some very helpful information about these pathways on the board website.

    There are even handy flow charts that can help you make some decisions about which option might be best for you.

    But It All Starts with the Australian Medical Council.

    Whilst the endpoint for registration for IMGs is the Medical Board the starting point is always the Australian Medical Council. For some IMGs (those attempting the Standard Pathway) you will have a lot to do with the AMC. But for the rest it’s really a very quick but mandatory step where you have to get your medical degrees verified.

    Why Have Pathways to Registration?

    Pathways to registration in this country for international medical graduates are essentially comparisons against the process by which Australian and also New Zealand medical graduates are given registration.

    Australian graduates first become registered in the system upon graduating from medical school as interns and progress through what is called provisional registration to general registration. After this most Australian doctors hope to eventually add what is called specialist registration to their registration status at some point.

    The four pathways to getting registered in Australia are therefore pathways that lead to a form of initial or provisional registration. But which ultimately lead to the IMG being able to gain either general or specialist registration. This is with one notable exception. The Short Term Specialist Training Pathway, which is a time-limited pathway that does not lead to either general or specialist training.

    The Competent Authority Pathway.

    The competent authority (CA) pathway essentially recognises that doctors that come from other healthcare systems, with similar systems, and processes, and standards to the Australian context, have a level of equivalence.

    The competent authority pathway is for both non-specialists as well as specialist doctors. It is a streamlined process for becoming granted registration in Australia. The board has approved a number of international authorities as competent in their assessment of doctors for medical registration. The reason that these authorities are deemed competent (and others are not) is unclear but historically well before the advent of the Medical Board of Australia, these jurisdictions were given preferred status by the old State and Territory Medical Boards. Arguably these countries do have medical training systems that are equivalent to Australia.

    The authorities are:

    • the General Medical Council in the UK for local UK graduates as well as international graduates who go through the PLAB pathway.
    • the Medical Council of Canada.
    • the Educational Commission for Foreign Medical Graduates of the United States and the United States Medical Licensing Exam (essentially, anyone who has the USMLE certificate).
    • the Medical Council of Ireland.
    • And the Medical Council of New Zealand*

    *The Medical Council of New Zealand is only listed here for IMG doctors who go through what’s called the NZREX process. Something akin to the AMC Standard Pathway process in Australia. Actual medical graduates of medical schools in New Zealand are considered absolutely equivalent to Australian graduates of Australian medical schools because these schools are actually also accredited by the Australian Medical Council.

    So if you have primary qualifications in medicine awarded by a training institute, which is recognised in the competent authority jurisdictions and also recognised by the Australian Medical Council you will normally be permitted to apply to work as a doctor in Australia under this pathway.

    This is on the proviso that you have completed some clinical training or assessment within that authority. This differs from jurisdiction to jurisdiction but is either a year of training or two. So, for example, in the UK, that would be the first foundation years. Whereas in the US it would mean completing 2 residency years in an ACGME accredited post.

    Why Is The Competent Authority Pathway Attractive?

    If you are eligible for the Competent Authority Pathway in Australia this is generally a good thing as it is considered to be the easiest pathway to getting registered and being able to start working here.

    Often times employers will also prefer say a UK-trained doctor over a doctor from Sri Lanka when there is a need to employ an IMGs.

    If you are eligible for the Competent Authority pathway essentially all you need to do is convince an employer to offer you a suitable position and have the intended supervision for this position assessed by the Medical Board of Australia.

    Once you are approved for registration you work for 12 months under provisional registration and will need to complete satisfactory supervisor reports. If all goes well at the end of this process you are able to apply for general registration. There’s no need for examinations or other forms of assessment (other than supervisor reports).

    (It should be noted that sometimes doctors from CA countries who are applying for specialist registration also work for 12 months under this pathway. In this situation you do not gain general registration at the end of the process you gain specialist registration in your particular specialty.)

    The Standard Pathway.

    The next pathway is the most common pathway that the majority of IMGs attempt in order to work as doctors in Australia.

    The standard pathway applies to IMGs who are not eligible for the competent authority pathway and who do not have specialist qualifications. To come in through this category, you need to have a recognised primary qualification in medicine. But before you can apply to the Medical Board of Australia for registration or approach employers for jobs, you have to go through some additional steps with the Australian Medical Council.

    These steps include the mandatory check of your degree, which all IMGs have to do. But also include sitting for the AMC Certificate examinations, which is a 2 part examination, consisting of a Part 1 MCQ Exam, and then a Part 2 Clinical Examination.

    You can actually begin to apply for jobs once you have successfully passed the AMC Part 1. But you will only be able to gain general registration once you have completed the full certificate.

    We have a guide to the AMC exam here. The AMC Exam, particularly the clinical exam, is generally considered to be a very tough and difficult examination to complete. Despite this, there are quite a few IMG doctors who have obtained their certificate but have been unable to find employment as a doctor in Australia.

    The Specialist Pathway.

    The final main pathway for most IMGs is the specialist pathway. This pathway is for overseas trained specialists so that they can apply to be assessed against the capability of a similar Australian-trained specialist. A process that is called “comparability”.

    This process includes IMGs applying for what is called Area of Need positions, which are extremely rare to find these days. As well as specialist IMGs just going for assessment with the college.

    As with all other pathways, you need to have a recognised primary degree first. But then just to create more confusion IMGs applying for the specialist pathway don’t apply to the AMC or the Medical Board for assessment they apply to the relevant specialist college. Which then performs an assessment.

    So if, for example, you’re a specialist from a competent authority country, it can be very confusing because you can apply to the Medical Board of Australia for provisional registration under the competent authority pathway to work in a supervised position.

    But at the same time, you need to also apply it to the college to assess your specialty training and experience and qualifications in order to get registered as a specialist and come through the specialist pathway.

    Applying for the Specialist Pathway assessment involves quite a bit of time and money. In general, you will need to fill out an extensive application outlining all of your past experiences to date. The more complete and detailed you make this generally the better the outcome. The college may just reject you based on your application. But generally, in the case of most colleges you are then invited to an interview to further explore your credentials.

    There are only 3 outcomes for this assessment process:

    1. You are deemed not comparable.
    2. You are deemed partially comparable.
    3. You are deemed substantially comparable.

    Being deemed not comparable means you need to think about other pathways.

    Being deemed partially comparable or substantially comparable means that the college views you as either being within 2 years (partially comparable) or 1 year (substantially comparable) of becoming a specialist in Australia.

    If you achieve comparability you will still need to secure an appropriate post where you can receive oversight by other specialists in your field. In the case of partially comparable, it is also likely that you will need to sit further examinations.

    If you gain a post and complete all the requirements you will finally be recommended to the Medical Board for specialist registration.

    We will eventually have a more detailed post about the specialist pathway. But in the meantime the following 2 blog posts are useful:

    As well as our series of videos on the Specialist Pathway on YouTube.

    The Short Term Specialist Training Pathway. The Final Pathway.

    There is actually a fourth pathway option. This option is not as well known to IMGs as the other 3 options. And this is perhaps because it is not a pathway to permanent registration in Australia.

    The final pathway is called the Short Term Training in a Medical Specialty Pathway, or Short Term Specialist Training Pathway. This pathway is limited to IMG doctors who are either already specialists or in the advanced or final phase of their specialty training. Ostensibly the pathway is designed to facilitate additional “top-up” training or experience, i.e. it is designed to give a specialist from another country some additional training and experience to help when they return to their own country.

    The pathway is therefore strictly limited to 2 years and you generally have to complete a form indicating that you are intending to return to your own country at the end of this period of registration.

    To be eligible for this pathway you first need to secure a job offer (usually an Advanced Training post) from an employer. Like all other pathways, you need to verify your degree with the AMC. You also need to apply to the specialist college for assessment of your credentials against the post you have secured.

    Unlike the specialist pathway, the college assessment is only paper-based, requires less information, and generally easier to pass.

    Is Short Term Specialist Training A Pathway to Working Permanently in Australia?

    Even prior to the advent of the one Medical Board there were registration categories in existence that enabled trainee doctors from other countries to come to Australia and work for a limited period of time.

    It was not uncommon for these doctors to take the opportunity whilst working in Australia to pursue other forms of registration and the case is the same still with the Short Term Specialist Training Pathway.

    So, whilst the pathway itself is designed to be time-limited and there is a requirement to state your intention to return at the end of your registration period. There is really no way of enforcing this and there is nothing to say that you might change your mind halfway through the process.

    And I have certainly seen a number of IMG doctors use this particular pathway as a “stepping stone” to a more permanent registration category.

    Whilst, specialist colleges are not permitted to take into account any experience you have gathered under the Short Term Specialist Training Pathway, it is hard for them to ignore the fact that you have already worked successfully in the Australian context and also hard to ignore references from Australian College Fellows attesting to your capability.

    Similarly, if you have proven your work capability in an Australian health service then this tends to dramatically improve your prospects with employers in Australia for other jobs over and above most other things, including things like qualifications and observerships.

    Related Questions.

    I Have More Questions About the Standard Pathway and AMC Exams.

    We recommend you check out this extensive post that we wrote.

    Where Can I Find More Information About the Specialist Colleges?

    We have you covered in this post

    Do I Need to Pass an English Test?

    Unless you have high schooled and trained in English in a small number of countries that the Medical Board recognises it is likely that you will have to pass one of the English competency tests. This is a requirement prior to obtaining registration and may also be required prior to other assessments, such as specialty college assessments. We have a detailed guide about this issue here.

  • Locum Doctors Australia. How To Become One and How to Stay Current.

    Locum Doctors Australia. How To Become One and How to Stay Current.

    A recent series of articles in the Sydney Morning Herald highlighted the rising rate of medical locum doctor usage in Australia. The articles indicated that an average of 16.5% of doctors working in the NSW Health system are locum doctors. So it seems there is a trend towards locumming as either a career or a break in one’s career in Medicine. In this article, I would like to briefly cover how you can become a locum As well as address an important issue for locum doctors which is about staying current and registered as a locum doctor.

    So firstly what are the basic requirements for locumming as a doctor in Australia? The key requirements are that you either have general registration and/or specialist registration. You can either locum as a Specialist (includes General Practice) in which case you need specialist registration. Or you can locum against a vacant hospital role (usually a trainee role) in which case you need general registration. By their very nature locum positions are temporary and therefore not open to doctors on other types of registration because they require a level of independent practice. So this means as a minimum you will need to be at postgraduate year 2 and have your general registration. Beyond this basic requirement, you will need to be a citizen or permanent resident, which is most locum doctors in Australia. Or possibly be on a visa which permits you to work as a locum. You will most likely need to register with at least one medical recruitment or locum agency. You will probably need to either not be currently employed as a doctor or on a break from your role. And you will likely need to consider setting up a limited company to collect payments that you make as a locum doctor.

    Beyond these basic requirements, there are a number of other considerations for doctors who work as locums, which I will now go into.

    Registration Requirements

    As we have noted the nature of locum jobs is that they are temporary and time-limited and notwithstanding the current reporting on their usage, they are not generally seen as a permanent workforce solution. Locums are also often seen as quick and urgent solutions to filling a gap due to an unforeseen circumstance. For these reasons, it is generally not possible to set up a locum appointment for anyone who may need one of the special types of registrations available under the Medical Board of Australia where certain supervisory requirements may need to be demonstrated to be in place. In fact, often the reason a locum is being sought is that there is a lack of supervisors available. So this generally means that International Medical Graduates can generally not obtain a locum position. Although there have been some limited circumstances where it has been possible. This has generally been around deputizing services for general practice where medical recruitment agencies themselves have set up a service and essentially employ the IMG doctor.

    Locum Doctors

    Provider Numbers

    Locum positions (even ones for trainee doctors) are often advertised with a request for the locum to have a provider number. This may be just for referring purposes or for billing purposes as well. Performing locums in private practice, such as general practice is fairly impossible without a provider number as you will not be able to charge patients Medicare fees for the services you provide and the locum position will therefore not be viable.

    Provider numbers can be quite confusing and complex. Part of the problem is that each provider number is generally linked to one medical practitioner and one location. Technically you need a provider number for each and every location that you provide services at or from. This can obviously be hard to predict if you are locumming. There are some solutions to this issue in relation to general practice but often what needs to occur is to fill in a form for another provider number. As it takes time for Medicare to approve this as a locum you need to be on to this issue promptly.

    Other Skill and Experience Requirements

    Services advertising for Specialist Locums are generally happy to accept anyone with the appropriate Fellowship (although there are some exceptions). For general locums, the amount of experience you have as a doctor will count towards how eligible you are for a locum as well as how much you will be paid. Having additional skills such as the various advanced life support training certificates or experience in paediatric emergencies will also open up the number of posts available to you as well as the rates you can collect. So, whilst you can technically locum as a PGY2 your prospects may be even better if you wait until PGY3 or PGY4.

    Working as a Locum On a Visa

    As mentioned above there are limited circumstances where a locum doctor may be able to work under a visa arrangement. Generally speaking, this would occur when you have general registration or specialist registration and the medical recruitment agency can obtain a visa on your behalf.

    In most cases, you are probably better off working under a more secure form of employment until you are able to apply for permanent residency and then looking into locum work. This way you will not be obligated to one particular locum company.

    Working With Medical Recruitment (Locum) Agencies

    I’ve previously written in more detail about working with medical recruitment agencies. However, a key question about becoming a locum is whether you can work with a locum agency. This is because whilst it is possible to directly contract yourself for locum roles. Most doctors do find it easier and more productive to engage with a locum agency.

    For the most part, most doctors find working with a locum agent to be a valued and essential part of the role. Someone who understands their requirements and negotiates on their behalf. But this is not always the experience. If you are not the sort of person who is good at negotiating conditions of employment you may find locum work difficult. Locum agents play a difficult role in attempting to keep the employer and doctor happy at the same time. Sometimes the conditions of the job are not as agreed to initially or sometimes you may feel pressured to take on a role that you don’t wish to do. So being able to stand up for yourself in this situation is an important consideration.

    Can You Work As a Locum Whilst Employed?

    If you have a permanent position with an employer, such as a hospital, it may still be possible to do the odd shift or week of locumming. But beyond this and even including this it can get difficult. Apart from the fact that you obviously need to have the time off work to do locum shifts. There is also the need to consider that you will probably be working in a situation of conflict of interest. Most employers have a process whereby full-time employees are obliged under the code of conduct to declare any additional work undertaken with the option for the employer to indicate to the doctor that they cannot undertake that additional employment if it conflicts with them completing their other duties.

    Even if you work part-time it may be difficult to work part-time in a permanent position and locum as most locums are done in blocks of weeks rather than days.

    So essentially whilst you may be able to do a small amount of locuming whilst employed. If you are planning on doing more than a little bit you cannot really do this whilst also employed.

    Getting Paid As a Locum

    There are essentially two options here and sometimes it comes down to the employer’s choice. Some employers will opt to pay you through payroll in which case they will also pay the ATO the requisite amount of tax on your behalf and should also pay superannuation on your behalf. Your Locum Agency then charges them an additional fee for placement. Others will pay you a set amount as part of an invoice you submit for the contract. This is often paid directly to the locum agency where the agency takes out its commission and then pays you out.

    If there is a choice between PAYG and invoicing you can opt for either option.

    As a locum, you are not going to be paid a regular fortnightly salary. So this means that you need to be prepared for being paid late, having to chase up on income every now and then and have some amount of cash in the bank to keep up all your regular payments (rent, mortgage, food, car, telephone bill etc…) in the interim.

    You will also most likely need to set aside some of your income for tax purposes. Otherwise, you will get hit with a large bill come tax time and needing to take out a loan to pay it.

    Some doctors find financial management a hassle. Good locum agencies will generally help you by chasing up on payments and providing your reports. But if you like a less complex set of financial circumstances then locumming is probably not for you.

    Running a Company

    Eventually, most doctors who locum set up a company in which to collect their earnings. There are several reasons for this. Part of which is that some health services like Queensland will not pay locums as what is called a sole trader. The other main reasons are to reduce tax obligations and protect your personal assets.

    Running a company does not need to be overly complex. Most accountants will gladly help you to set up a simple company for a small fee. You do need to do some regular book-keeping and complete some additional tax forms quarterly and annually. It makes sense to set up a separate company bank out to make the book work easier.

    Many doctors actually find the idea of being the Managing Director of their own company a little bit exciting. You get to pick your own company name and you can even get a logo, letterhead and website if you really want to. But if you have aspirations to be a Company Director you might find this aspect of locum work that leads you to question whether you want to be a locum.

    Indemnity Considerations

    You will probably need to revise your medical indemnity upwards if you engage in locum work. When you work as a locum for a public hospital you should probably still be state government employer indemnified. But it is important to check arrangements each and every time.

    Personal Considerations

    On a personal level becoming a locum generally means traveling around a lot. Spending time on the road in the car or at the airport. Living out of a suitcase in a hotel or serviced apartment. If you have regular activities like sporting, academic or social pursuits these can be severely disrupted by locum work.

    If you have a family you may have some options for them to travel with you to locums. Depending on how needy the hospital or employer is they may even upgrade your accommodation to family accommodation at no extra cost. But at the minimum, you will probably have to pay for them to travel with you. Additional costs such as extra food will probably reduce the financial benefit of doing locums with your family in tow.

    Maintaining Registration and Professional Development

    I wanted to spend the remainder of this post discussing the issues around continuing professional development for locums.

    The Medical Board of Australia has signaled that it will take an increasingly active stance in the process of revalidating doctors (confirming their ongoing suitability to practice) in order to uphold community expectations for quality and safety.

    Locum doctors are often left in a vulnerable area when it comes to continuing professional development and demonstrating their ongoing fitness to practice.

    And. By the way. As a locum doctor, you are going to also have to think about how you pay for your CPD. Because the hospital is not going to pay for it.

    On the other hand, you are probably saving heaps in College fees.

    Specialist locums can generally maintain their continuing professional development through their college’s CPD program.

    However, locum doctors without fellowship who are simply relying on their general registration face a more difficult set of circumstances as there is generally no professional organization that can fully support their professional development requirements.

    Under its Professional Performance Framework the Medical Board has stated that:

    All doctors will:

    – have a CPD home and participate in its CPD program 
    – do CPD that is relevant to their scope of practice
    – base their CPD on a personal professional development plan
    – do at least 50 hours of CPD per year, that includes a mix of:reviewing performance
    measuring outcomes, and educational activities.

    Medical Board of Australia

    The current Medical Board requirements for medical practitioners who have general registration only (i.e. do not have specialist registration) indicate that such doctors must

    • complete a minimum of 50 hours of CPD per year (self-directed program), which must include
      • at least one practice-based reflective element; clinical audit or peer review or performance appraisal, as well as participation in activities to enhance knowledge such as courses, conferences and online learning, or
    • meet the CPD requirements of a specialist medical college that is relevant to their scope of practice.

    Most doctors can make a plan to engage in courses, conferences and online learning. However, the tradition of clinical audit, peer review and performance appraisal is patchy within medicine in general and it’s likely that locums with general registration may struggle to revalidate if they are unable to plan for these mandated activities each year and possibly have some support for doing them.

    Let’s look at each of the mandated practice-based reflections in turn and consider how it might be implemented for a locum doctor.

    Clinical Audit

    A clinical audit compares actual clinical practice against established standards of practice. The audit has two main components: An evaluation of the care that the individual practitioner provides, and a quality improvement process. The evidence required by the Medical Board is a certificate confirming completion of clinical audit or a short summary of recommendations and implemented changes or a description of the process that was undertaken and a reflection on what was learnt.

    Practically engaging in a clinical audit may be difficult for locum doctors because of time constraints for each placement as well as the ability to access and review clinical records at a later point in time.

    Peer Review

    Peer review meetings are undertaken by and with peers with the aim of updating knowledge and improving practice through the presentation of one’s own work to one’s peers with the expectation of a free and frank review. Evidence of peer review acceptable to the Medical Board includes documented account of case review or discussion with peer or team and a reflection on what was learned or evidence of log book or diary entry and a reflection on what was learned or a description of peer review activity and a reflection on what was learned.

    The practical problem for locum doctors engaging in peer review is coordinating meeting times and locations so that peer group members can regularly attend. This might be overcome with the use of technology and holding peer review meetings online. Although it would be important to consider the security implications of online discussions.

    An exciting aspect of a locum peer review group would be the potential to incorporate locum doctors working across a range of specialty areas into a group where one could imagine a breadth of generalist knowledge could be imparted throughout the group.

    Performance Appraisal

    Performance appraisal incorporates activities that allow the practitioner to review their practice /performance. The Medical Board will accept documentation to show how the practitioner reviewed or improved their practice or performance and a reflection on what was learned or a description of the process undertaken and a reflection of what was learned from the appraisal.

    In my opinion, this is probably the simplest of the 3 options for mandated peer-based reflection in order to achieve compliance and could be effectively completed with a performance coach.

    What the Medical Board Doesn’t Accept as Evidence of CPD

    The Medical Board is becoming quite circumspect in relation to CPD evidence. Here is a list of things that the Board will not accept as evidence of 50 hours of CPD per annum.

    Receipts of Courses
    Course Itineraries
    Course Agendas
    Course Programs
    Conference Itineraries
    Conference Agendas
    Non planned and non measured reading online
    Web-surfing
    Statutory declarations stating 50 hours of journal reading was undertaken
    Agendas of journal clubs

    Generally speaking, the Medical Board requires more definitive evidence of the 50 hours of CPD, examples of which would include certificates of attendance, certificates of completion, evidence of questions being attempted and log books of readings.

    Related Questions.

    What Areas of Medicine Can I Locum In?

    Locums can pretty much find work in any area of Medicine these days. At a Consultant level hospitals are often looking for locums in all of the common specialties, including Physicians, Surgeons, Psychiatrists, and Critical Care Physicians. There are also a surprising amount of Medical Administration locums advertised on a regular basis. And of course, there is general practice.

    At a non-Consultant level, you can also easily find locums in all range of specialties but critical care (mainly emergency) and psychiatry tend to be the most common along with medical registrar roles.

    How Do I Choose a Locum Company?

    We have written another post for you on this question. Feel free to have a read of it.

    How Long Should I Locum For?

    It’s difficult to categorically answer this question. Some doctors have turned locumming into a long term career quite successfully. Some doctors go into locumming planning that it will just be a temporary year or two away from training or permanent work but then find themselves enjoying the work and the lifestyle it provides.

    Perhaps the question should be “How Long Should I Locum For. Before I Consider Locumming to Be a Career?” As I have indicated above. Whatever part of Medicine you are in it is important to maintain your standards and professional development.

    I’d recommend that if you have been locumming for more than two years then you should review your professional development approach.

    Even if you are a Specialist and under a College CPD framework you probably want to think about how working as a Specialist Locum affects you differently than working in a permanent role and a team. Establishing a Peer Review group with other Locums in your Specialty may make sense or perhaps joining an existing Peer Review group of Specialists who work in your field in permanent roles.

    As a non-registered doctor, there will come a point where it is difficult to maintain your professional development through a College. There are a few alternatives, such as enrolling in Masters programs at University but the CPD from these programs only lasts as long as the program lasts.

    Again a Peer Review group probably makes sense as well as organizing for a regular performance assessment. You should also try to develop a CPD plan at the start of each year to address current gaps in skills and knowledge and consider asking your locum employers for feedback on your strengths and weaknesses.

    A career coach may be useful in guiding you through some of these processes.

    Is it Possible to Make a Career As a Locum?

    Yes. One could make a strong argument for obtaining a Fellowship first to support the locum choice. But there are doctors who have forged a career successfully locumming. At the present time, there is high demand for locums and there has never really been a time when a degree of locum doctors have been necessary to compliment doctors working in permanent roles. As we have highlighted above a key consideration is how you stay current in your practice.