Australia’s use of locum GPs investigated

Better remuneration and supportive work conditions could go a long way in attracting locum doctors to permanent roles, according to a report released by the Department of Health and Aged Care (DoHAC).
 
The paper, an Analysis of Locum Use in the Medical Workforce, explored the optimal use of locums and makes recommendations to the Federal Government, as ‘locums can incur higher costs, fragment care, and work outside educational and quality assurance systems’.
 
‘The situation worsened following the COVID-19 pandemic with increased demand for medical staff, increasing costs of locums and anecdotal concerns that more doctors were working as locums,’ the analysis explained.
 
But while costs can be high, the report reenforced the view that locums are essential to Australia’s healthcare system, helping prop up areas of workforce shortage and fill the gaps when existing doctors take leave or education.
 
Recommended by the National Medical Workforce Strategy, the project included a survey of 515 locum doctors and 380 non-locum doctors carried out between May and December 2023. Almost two-thirds of locum respondents were GP and non-GP specialists.
 
Amongst a raft of recommendations in the report to the Commonwealth is the need for greater remuneration for permanent roles to attract locums as well as improved working conditions.
 
‘High remuneration and benefits for permanent staff was the top response, but followed by the combination of flexibility, autonomy and work–life balance,’ the researchers wrote.
 
‘Next cited were career progression, professional development and gaining work at the location and within the specialty of their choice.’
 
Chair of RACGP Rural Associate Professor Michael Clements said locums are an important part of the workforce, with many areas facing workforce stress willing to pay higher remuneration for locums to meet the basic needs of the community.
 
But he said better remuneration and conditions are needed for both permanent and locum doctors.
 
‘We need locums because we just don’t have enough workforce overall. We’re always going to need a workforce that can travel the country and fill the most important and critical gaps,’ Associate Professor Clements told newsGP.
 
‘We know that the ideal community outcome is having a long-term relationship – short-term locums don’t have continuity of care.
 
‘They may not understand the local systems, and it can lead to a mercenary approach, and a situation where locums are being paid far, far more than the person that has lived in the town for 20 years.’
 
In response, the RACGP is calling for funding to support the establishment, implementation and subsequent running of a national ‘Pathways to Rural’ program.
 
It says this will increase exposure to rural general practice for urban GPs by ‘facilitating recurring locum opportunities in underserved rural and remote communities’.
 
‘Improved support for regularly returning locums will enable rural communities to access coordinated and continuous care, from a consistent general practice team,’ the RACGP said.
 
According to the DoHAC report, the most frequent reason given for doctors choosing locum work was the increased remuneration, followed by flexibility and autonomy.
 
‘Flexibility gave doctors better work–life balance and the ability to study, care for family or take holidays without being tied to rosters,’ the paper explained.
 
‘Locums valued the autonomy of being able to choose their work location and not work in units where they found the environment or culture challenging.’
 
Significantly, some 79% of locums surveyed said they would not have accepted a permanent position in their current or most recent roles.
 
Broader survey respondents, such as those who employ locums, said they understood that locum flexibility brought potential disadvantages to continuity of patient care and had potential to impact team cohesion, the report said.
 
However, there was concern that reducing the use of locums could further increase pressure on permanent doctors and wider healthcare teams.
 
The paper also flagged the need for ‘significant national collaboration’ to reach an appropriate balance between locums and permanent doctors across the medical workforce.
 
‘So, if we can fix the workforce; if we can increase the base incentives for everybody that works there, then we might not need locums as much. But in communities where we do need some additional support, there are good models of local solutions, like our Pathways to Rural that can help meet those needs,’ Associate Professor Clements said.
 
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