Got your fellowship? Consolidated your skills and feeling confident in independent practice? Looking for some adventure while still helping rural communities?
You may have found yourself thinking about the locum lifestyle. Rural Generalist, Dr Rae Madison, shares her experience of the realities of locuming, as well as a few tips for new players.
“And when you’re in a Slump you’re not in for much fun. Un-slumping yourself is not easily done.”
(Oh, the Places You’ll Go! Dr Seuss)
A few years ago, I found myself in a slump laced with workplace issues, self-doubt and regret. I was seriously considering quitting medicine. After years of official hoop-jumping, I had my FACRRM in the bag, a scholarship return-of-service looming and cravings for a more flexible lifestyle solution that would support my travel obsession and still pay the mortgage. I’ve been exclusively doing rural and remote locum work ever since.
My un-slumping began with a month-long journey through Bhutan and Tibet. The literal high point of the trip was above 5800m on Mt Kailash in Tibet. The figurative one was meeting the King of Bhutan with his KTM dirt bike on a remote mountain trail. My hiking buddy unwittingly joked that he was the ice-cream delivery boy. We clearly made an impression! He sent us two tubs of that hard-to-find dessert to the hotel that night. True story! One for another time perhaps…
“Whether this one was that one… or that one was this one or which one was what one… or what one was who.”
(The Sneetches and Other Stories)
After locuming for a while, people, places, practices and printer settings begin to jumble and blur. Starting a new job every few weeks can be rather daunting. Often, the person who may best answer your questions is the absent doctor you are filling in for!
It’s rather taxing wrapping your brain around the different clinical software, hunting for forms and templates and navigating State regulations. Every little glitch or nuance eats precious time.
I now take a USB loaded with my favourite resources, as well as Russian language lessons for a solo expedition in Siberia I’ve got up my sleeve.
“It is fun to have fun but you have to know how.”
(The Cat in the Hat)
The flexibility of locuming opens up a world of travel opportunity. Thinking of hiking the Annapurna Circuit? Combine it with a Mountain Medic course enroute and volunteer at a local clinic in the Kathmandu Valley. Satisfy your inner Space Nerd on the Aerospace Medicine course at the Mars Desert Research Station in Utah. Tax-deductible geeky goodness! What type of doctor will go to Mars? A Rural Generalist of course!
While I’m in the UK teaching ATLS, I’ll squeeze in multi-day hikes like Hadrian’s Wall in England, West Highland Way in Scotland or a quick 100km section of the Pennine Way. The former Zoologist in me couldn’t resist stints on Christmas Island to experience the mass migrations of Red Crabs. Nothing quite like having crustaceans spawning on your reef sandals at three in the morning.
Doing some research in advance can uncover some real gems. Sometimes literally. I’ve found Boulder Opal outside Longreach, rare Atlantisite near Zeehan and Black Tourmaline crystals in Meekatharra. Ask the locals about their favourite spots nearby, like the special snorkelling bays around Norfolk Island and the gorgeous pink salt-pan just outside Sea Lake, Victoria, with spectacular mirror-like reflections after rain.
“Get over here fast! Take the road to North Nitch. Turn left at Weehawken. Sharp right at South Stitch.”
Finding your way amongst a barrage of jobs, flights, towns and countries requires attention to the smaller details. Always check and double check your itinerary, especially if someone else booked it. Set the right time zone on all your devices. Make sure there is time for airline transfers between flights. Check the baggage limits for those noisy little twin-props. Join the frequent flyer programs and take a load off in the lounge.
Find out about the accommodation, so you can plan what to bring, especially if you like to do your own cooking. Ask for the on-call roster in advance and book in for a solid orientation when you arrive. I’ve had to intubate a patient before anyone even asked my name.
Orientated to patient’s larynx… tick…
“And my poor Bar-ba-loots are all getting the crummies because they have gas, and no food, in their tummies.”
I learned the hard way that I may not find time to get to the shops or they aren’t open the day I arrive. Some locations provide staff meals for free or cheap, so make sure to ask. I usually take enough food for the first two days and a stick-blender for quick and easy smoothies, with protein powder and trail-mix as backup.
Resist the temptation to bring fresh fruit and veg across borders. Quarantine, don’t muck around. Support the community and local commerce whenever you can and check out the farmer’s markets. As painful as it may be to buy a *cringe* $10 lettuce, remember the locals are stuck with these prices.
Fellow staff members can be really generous too: I’ve had a little esky with freshly filleted fish appear on my doorstep one early morning, followed by pawpaw and bananas the next. Why, yes, of course I’d love to work here again!
“I’m sorry to say so but, sadly, it’s true that Bang-ups and Hang-ups can happen to you.”
(Oh, the Places You’ll Go!)
With no sick leave entitlements, it’s important to have the right cover in place. Look at different options for income protection, travel insurance and private health insurance. Especially if your hobbies, like mine, are a little on the risky side. It’s reassuring to know you’re covered when scrambling up cliffs to see the Sky Churches in Ethiopia, or slip-sliding on the frozen Zanskar River in Ladakh at minus 40, or braving the crush of Chinese tourists in Zhangjiajie, or going out for a pint on Friday night in Glasgow.
“Off again! On again! In again! Out again!”
(The Sneetches and Other Stories)
Doing frequent locum placements and traipsing around the world living out of a suitcase/backpack/yak-friendly duffel can be a somewhat disrupted lifestyle. One financial year while calculating my home office expenses, I realised I’d only spent 70 days at home and rarely more than three in a row.
This year I’ve resolved to spend more time at home, to tame my six acres of Wet Tropics into a self-sustaining permaculture food forest. It’s good practice for if I ever find my ‘forever home’.
So, if you’re considering locum work, perhaps you’ll be inspired by a quote from the good doctor…
“You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose.” Oh, the places you’ll go!
Dr Rae Madison
If you’re interested in locum opportunities in Queensland, contact Queensland Country Practice.