The first in a series of interviews with doctors who regularly work in after hours
Everyone seems to have a view on after hours companies of late but what’s it actually like to work for one?
We’ve heard a lot about after hours from the peak bodies and from parts of the primary care community in the comment columns of the various medical newspapers and GP only social media forums. But one voice that has been missing in most of the debate so far is that of the doctors who actually do after hours work.
Recently TMR was approached by National Home Doctor Service (NHDS) to help them with their recruitment efforts for new doctors via a standard advertising campaign. NHDS, the largest national provider of such services is growing and needs more doctors. In addition, there is a degree of natural turnover in the work force.
NHDS are very particular about the types of doctors they are seeking. Their description was nothing like you’d expect from some of the press you see. They are looking for doctors from all walks and stages of a GP career – trainees, registrars and GP fellows. Surprising to us was that just on 30% of their doctors are GP fellows many of whom also work in day time practices. The remainder of the workforce tends to be split evenly between doctors who are GP registrars or who are enrolled in the Practice Eligible Pathway program to eventually become a GP. We suggested NHDS let some of their doctors tell their own story. Here’s one of them:
Name: Dr Natalie Caristo
Status: GP Fellow in practice, MBBS BSc FRACGP since 2014, 36 weeks pregnant
• UNSW graduate 2009
• Worked in the hospital system for three years
• Works in suburban general practice in Sydney
• Started NHDS immediately on becoming a Fellow
Dr Caristo says she’s one of those people who likes to explore the edges and fill her day up. Although she was already working close to full-time in a suburban practice, she decided to try after hours, partly for a bit of extra money, but mainly because she was simply interested in finding out why it was like.
Before starting, she asked a few colleagues and nearly all of them replied, “Why would you want to do that? ‘You’ve got enough on your plate”.
“I got quite a bit of conflicting information from different people at the time”, says Dr Caristo.
“From a medical perspective, people were saying you’re in the home without history and no access to resources, so I thought at first I might be putting myself into a vulnerable situation.”
But Dr Caristo loved the work almost immediately. “A lot of what I heard about
after hours turned out to be perceptions and assumption, I think. There are things
to get used to. I was really surprised at the thoroughness of the induction process for instance. I really thought I could just put on my stethoscope and hit the road.”
“When I look back, I’m glad for all the pre-work, training and support. There is a benchmark
we all work to… the same protocols, the same equipment. You need that in a service like this.”
Dr Caristo loves the work for the variety – she says she sees a lot of category 4 and 5 type patients – but what she most loves is seeing patients in their homes and being part of the community.
“The patients and families are just so appreciative. When you step into these homes and reassure parents or aged care givers and give them clear guidelines about when to go to emergency or not, they feel so much more empowered.”
“I get a kick out of helping people in these situations because they do have a genuine need. We help families in really difficult situations. And they are so appreciative of what you do. It’s almost addictive.”
Of the controversy over after hours services, Dr Caristo says she can see a disconnect between what people think happens, and what actually happens.
“There is a stereotype that a lot of these patients are lazy and they aren’t that sick. You can pull out a discharge note and say ‘oh, only an upper respiratory tract infection, how urgent was that’? The reality is the diagnosis might not be seen as urgent when you look at the words, but if you walked into that parent’s home and saw that anxious mother, and spent 15 minutes counselling her about the difference between pneumonia and upper respiratory tract infection, and what to look for such as managing fluids, you’d think differently about what actually went on in such a call.”
And then there are the calls where she has saved a life.
“In one case when I got there a child was semi- conscious with an oxygen level of 85%. I called the ambulance immediately and spent the next seven minutes puffing Ventolin into the child thinking please wake up.”
In this case, Dr Caristo said the parents were not to blame. The circumstances unfolded too fast for them to understand the nature of what was going on.
As a pregnant mum, Dr Caristo says that she is even more aware of the situation of many families she visits.
“There’s a rational part of your brain where you have medical knowledge and are a doctor, and then there is just you being a mum and a dad who are really worried about something. If you go onto one of the Facebook groups for mums who are doctors, you can see that the non medical side kicks in occasionally.”
“People carry on about over-billing in after after hours but anyone of us can over service in our day jobs if we like. I don’t see the difference. It’s our call. Some GPs do care plans when they aren’t needed. It comes down to the individual doctor.”
At NHDS every patient is given a link to provide feedback and all negative feedback is dealt with via a review that involves one of the Medical Directors, the doctor on call and the patient.
“There is pretty good clinical governance at this group,” says Dr Caristo.
If you are interested in joining the NHDS team you can contact their National Recruitment Team at email@example.com, call 1300 643 737 or CLICK HERE. This article was paid for by National Home Doctor Service and developed by TMR.
If you want to read the full after hours ‘inside story’ with all four interviews and commentary CLICK HERE