Locum medical officers: who will care for us?

SINCE 7 June 2020 – mid COVID-19 pandemic – I have consistently and regularly been working for one health service as a locum medical officer.

My shifts between 12 October 2020 and 26 March 2021 were a 7 days on/7 days off roster, at times with additional shifts during my off week (usually on short notice) as the health service was struggling with a staffing shortfall.

The health service I work for as a locum is located a few hours’ drive from the capital city, and locums like myself often have to cross state borders to get to the workplace. We are accommodated in town and away from our usual residence and family during the course of the locum, either because of on-call requirements and/or physical distance between the place of work and our usual residence and family (in my case, both). The longest stint saw me away from home for almost an entire month from 26 June to 20 July 2020.

My duties as a locum medical officer include assessing, treating and managing patients presenting to an acute hospital, including presentations to the emergency department (ED). Throughout the pandemic, my work included assessing suspected COVID-19 patients.

Despite doing the same job as my non-locum peers and being exposed to the same risks as my non-locum peers, as a locum I do not enjoy the same benefits: I have not been issued a work identification nor an access swipe card despite repeatedly requesting one. I have been told by medical administrators that they don’t issue these to locums. When I am on-call and am called back to the hospital after hours, I have to ring the doorbell and wait in the cold and the dark for a member of staff to let me in, despite being called back in to attend presumably time-critical emergencies.

There is no job security as there is no guarantee of shifts in the already short periodic contract measured in weeks, and I have booked shifts cancelled by the hospital. There is no sick or medical leave, no annual leave, and no access to the COVID-19 leave that my non-locum peers have.

Because I have to cross state borders to get to work, during the pandemic it was not unheard of that locums have been refused passage across state borders as various lockdowns occurred. This effectively rendered the locum stuck, either unable to go home or see family or unable to go to work (locums generally do not get paid if they do not go to work).

At the height of the pandemic and state border closures, the mood at work could often be described as bleak, fear often palpable especially when it came to assessing and treating suspected COVID-19 patients. Yet frontline health care workers like myself, locums or otherwise, continued to make silent sacrifices to provide health services and to serve communities experiencing a shortage of medical staff, well aware of the risks of doing a job as a frontline health care worker and constantly reminded by media reports of colleagues becoming unwell and testing positive for COVID-19.

As Australia rolls out the country’s COVID-19 vaccination scheme, there is some optimism now in the mood at work. Internal email correspondence from managers on 19 February 2021 stated:

“Staff in our Phase 1a priority group will start receiving the … vaccine from Monday. This group includes those at highest risk of exposure to COVID-19-positive patients [eg, EDs] … Staff identified to receive the COVID-19 vaccination in Phase 1a will be contacted directly in the coming weeks and informed about how, when and where they will be able to get vaccinated. You will receive a personal invitation to register.”

I continue to wait patiently to be “identified to receive the COVID-19 vaccination” and to be “contacted directly”.

By early March 2021, I saw my non-locum medical peers who are doing the same job working in the same health service at the same acute hospital and in the same ED being offered and receiving a COVID-19 vaccine. Conversation with other colleagues at that time – nurses, paramedics, and the ward clerk – suggested that they had received a COVID-19 vaccine.

The initial optimism in late February has turned to disappointment and a loss of confidence in the government.

Locum medical officers like myself make silent sacrifices as we travel to work to provide health services in communities experiencing a shortage of medical staff. At the time of writing (27 April 2021), I continue to put in shifts to continue to work as a locum medical officer at the same acute hospital doing the same job as I have been throughout the pandemic since June 2020, but without an offer, invitation or the ability to obtain a COVID-19 vaccine for myself.

My experience so far leads me to conclude the following:

Australia’s roll-out of the COVID-19 vaccination, ostensibly in priority groups “consistent with guidance from the World Health Organization,” is in theory only; inequity and a “naked display of privilege” exist akin to that reported at elite health services overseas in terms of who gets offered a vaccine and who does not, who has the know-how to be able to obtain a vaccine and who cannot.

As a frontline health care worker I am yet to be offered a COVID-19 vaccine and do not have the ability to obtain one, while at the same time the media reports that select groups have been given “priority access” (the words “out of the queue” have also been used).

I am also thus led to believe that in Australia there are frontline workers and then there are frontline workers. Locum medical officers are Australia’s forgotten frontline health care workers in the COVID-19 pandemic.

Who will care for us?

Dr Chee Koh is a clinical academic and a generalist who is passionate about advocacy for decency, social issues, injustice and the perils of institutional power, both within the clinical and academic context and within our society.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.