Solution to costly locums ignored for 15 years

And, sorry, what's the difference between a locum and a VMO again?

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NSW Health Minister Ryan Park has ordered a special inquiry into health spending that will cost nearly $16 million and take up to two years, when an earlier recommendation could solve the expensive locum doctor issue. 

NSW spent $1 billion on visiting medical officers in 2021-22, Nine newspapers reported this week. Dr Amanda Cohn, NSW Greens MP, said a state-run workforce registry would be a much cheaper solution and be “extraordinarily beneficial for the health system”. 

“It’s such low-hanging fruit for NSW Health which will address both continuity of care for patients and recoup enormous savings from the inefficiency that we can reinvest into the health system. It’s also something that’s quite achievable to change in a short amount of time,” Dr Cohn told TMR. 

Dr Cohn moved a motion in parliament in June, that using for-profit recruitment agencies to fill roster gaps in hospitals was “inefficient and expensive” adding that she was not the first to suggest a centralised register of casual doctors.  

She referred to Justice Peter Garling SC’s 2008 Special Commission of Inquiry Acute Care Services in NSW Public Hospitals, which advised NSW Health to create a  healthcare worker register for causal vacancies. 

Fifteen years later the recommendation remains unactioned which Dr Cohn said is possibly partly due to 12 years of a Liberal National Government in NSW. 

“The former government had a track record of privatising essential assets and services. So, ideologically and politically, with the previous government, it may not have been in keeping with their agenda,” she said. 

However, if the Labor government of 2008 had followed the Garling report recommendations, a centralised casual doctor workforce registry would have been created within 12 months. 

Dr Cohn said a lot has changed since 2008 and that she is not opposed to the new government doing another special commission of inquiry.  

“However, I would urge them not to wait for the results of another inquiry to start making some of these very obvious changes,” she said. 

Dr Cohn also told parliament that harmonising the onboarding and credentialing of doctors between local health districts would enable a more efficient and timely flow of human resources.  

When Dr Cohn worked as a locum in regional NSW she regularly had to undertake online onboarding training, including modules such as hand washing procedures and using electronic health records. 

“One placement asked that I undertake 15 hours of online training modules. It’s a real barrier to the deployment of health workers temporarily from one LHD to another,” she said. 

Dr Cohn said the different onboarding requirements between LHDs was also “a real bugbear” for local doctors to take a placement in new LHD especially given that the online training was usually expected to be completed unpaid. 

Dr Cohn’s motion to NSW parliament received support across party lines.  

Meanwhile, the NSW Treasurer has inadvertently “denigrated” hard-working Visiting Medical Officers by confusing them with highly paid casual locums, says the NSW AMA. 

At the annual Health Services Union conference earlier this month, state Treasurer Daniel Mookhey said he was surprised at the cost of VMOs. 

“We’re about to tip over into $1 billion per year. We spend more per capita than on VMOs in Queensland and WA which have a more dispersed health system,” he said. 

The Treasurer said the state government would ensure the upcoming special inquiry into health care spending “looks into” the high cost of VMOs. 

Dr Michael Bonning, NSW AMA president, told TMR the Treasurer had conflated the people who work as VMOs with those who work as top-dollar locums. 

“The Treasurer’s comments denigrate the role of VMOs in NSW,” said Dr Bonning.  

“VMOs have long-term consistent contracts. Many have been working 20, 30, 40 years in a location. It is incredibly hurtful to a group who have worked hard and valiantly throughout the pandemic, and before, under trying and underfunded conditions.”  

Dr Bonning said that goodwill was a key retention lever for these doctors who “could easily go and practice elsewhere”. VMOs have generally felt support from the public health system in the past, he said. 

“But if the leaders of Parliaments go on to diminish their contribution to the workforce and the system then they may well end up leaving. That would be a far worse outcome for the system, which would then ultimately have to rely more on locums,” he said. 

Dr Bonning said the current spotlight on costly locums was the result of policy that disincentivised hospitals from allocating longer-term contracts in their staff budgets. 

“These hospitals don’t want to spend the money upfront on a [VMO] doctor and so they end up spending on the back end on locums,” he said. 

Dr Bonning said that the issue was a structural problem created by not contracting doctors appropriately through staff specialist and VMO arrangements.