VICDOC Summer 2023 - Magazine - Page 38
In no way can we pretend that a clinician
on a computer screen can replace a clinician
at the bedside. But some rural facilities
have had to do just that.
THE UNFORTUNATE BOOM IN
CASUAL EMPLOYMENT
-
What about locums..or locum agencies?
As hospitals moved away from committing
to providing contracts to specialists,
instead relying on casual workforces, we
have seen a boom in casual employment,
with many clinicians using a burgeoning
locum industry to fill gaps. ‘Fly in fly out’
clinicians, who are earning a significant
amount of money, burn through the
budgets of struggling rural hospitals,
providing episodic care, and not adding
to efforts to improve the ongoing
sustainability of that hospital. On the rare
occasion when a clinician who is looking
to stabilise their career would be prepared
to make a commitment to a facility,
the lucky facility comes up against two
crippling barriers; firstly, a huge ‘finder’s fee’
the hospital must pay, but can’t afford and
secondly, the potential that the hospital is
restricted in being able to offer additional
benefits for that clinician to entice them to
stay. So, the ball remains in the court of the
locum industries, with rural services having
job adds unanswered for staffing positions
they are trying to fill.
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AMA VI C TO RIA
THE PROBLEM WITH PERFORMANCE INDICATORS
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Lastly, lets discuss ‘performance indicators’
and what they mean. I’m ED focused, so
there are a few of these indicators I keep
an eye on which tell me how our health
systems are going. Comparing regional and
urban indicators is interesting. Recent data
released and discussed in media pointed to
the discrepancies between urban and metro
EDs wait time data and the gap between
the time of arrival to the time seen by a
clinician. Questions were raised as to why
there is a big difference. Any commentary
on this needs to be contextualised with an
understanding that the data is incredibly
flawed. To think that the average wait time
to see a clinician in an ED in Melbourne
is accurate is a fallacy. This data does not
account for the time it takes to get triaged
(up to an hour). It then measures the time
to a test (an EC, a CXR or a blood test)
being ordered. This will stop the clock and
clearly leads to over-ordering of tests and
over-investigation of patients. The actual
face to face with a clinician may be, and
often is, many hours later; in many cases,
well over four hours or more. Hiding this
reality benefits no-one. In truth, data
from rural areas may be more accurate,
as ‘strategic reporting tactics’ like these
are not always applied there.
