How to step into new shoes

Former general practitioner South Ockendon, Essex (b Burma 1913; q Calcutta 1938), died from bladder cancer on 28 June 2003.​2003. Figure 1 He was a military medical student trained to...

This article is a brief consideration from an individual perspective about locum spiritual care practice gained from experience working in psychiatric and geriatric units, emergency departments and neurological disease wards. The article addresses questions such as, “What is it like being a locum?” “What are some of the issues for the locum practitioner, the organization, the field of spiritual care?” Locum work in the spiritual care field is not new, but the ongoing professional development of spiritual care as a recognized professional discipline requires it to be carefully examined in the light of best practice spiritual care in the healthcare sector. A version of this personal reflection was originally presented at the Spiritual Care Australia national conference, “Inspiration in Diversity: The Shifting Sands of Spiritual Care” (SCA, Melbourne 2016).

Let’s dispense with the normal pleasantries: what the hell is going to happen to all our recently qualified general practitioners? Locum work is drying up, out of hours rota sessions...

Underemployment is a reality for many new graduates, who accept locum or part-time work as an alternative to unemployment because of lack of opportunities. We sought to analyze orthopedic surgeons' Ontario Health Insurance Program (OHIP) billing data over a 20-year period as a proxy of practice patterns and hypothesized that billing in the first 6 years of practice would be affected by underemployment and locum. We analyzed the annual average billing totals of orthopedic surgeons, broken down by year of graduation, year of billings, and number of surgeons billing in that year. We analyzed public census data of the Ontario population size as a proxy of orthopedic demand. A 2019 cross-sectional analysis showed that around 15 surgeons per graduating year were billing in Ontario from the 1995 to 2016 cohorts, while 2017 and 2018 saw an increase to 30 and 36 actively billing surgeons, respectively. The number returned to more historical numbers in 2019, with 20 actively billing surgeons. For those surgeons billing in Ontario, billing trends have been roughly stable, with average billings increasing each year for the first 6 years in practice (p < 0.001). Year of graduation did not have an effect on the first 6 years of billings (p > 0.5). Billings were stable after 6 years in practice (p > 0.09). The Ontario health care system has not expanded to support more orthopedic surgeons despite the aging and growing population; despite our growing population, the number of surgeons being trained and retained has not matched this growth. Further research needs to be done to guide optimal health human resource decision-making.

We studied the rate of participation of psychiatric nurses in mental healthcare in Kenya. A simple questionnaire was delivered to 50 nurses attending a mental health meeting of the National Nursing Alliance of Kenya in April 2012. Of the 40 nurses with psychiatric nursing qualifications, 19 worked specifically as psychiatric nurses; among those employed as general nurses, half their case-loads were mental health patients. Ten per cent of psychiatric nurses had run a private clinic (75% of them general clinics) and 15% were doing private locum work alongside salaried employment. Kenya would need to increase the number of psychiatric nurses 20-fold in order to achieve an internationally recommended ratio (for low-income countries) of 12 psychiatric nurses per 100 000. It appears psychiatric nurses are migrating internally to nursing positions in other areas of healthcare, aggravating the 'brain drain' in mental health.

Ian Fraser Kerr Muir: A Gentle Giant of Plastic Surgery

We currently have an excellent GP specialty training programme where trainees are very well supported in all aspects. Once qualified, however, many GPs not only feel isolated but also have to face challenges such as looking for a job, organizing locum work, understanding quality and outcomes framework, etc, while also dealing with the real, exciting and rewarding work that is general practice. Additionally, this often involves a move to a new area, where there is a need to get to know the local services and medical community. These problems together with the new and important revalidation and relicensing hoops to jump through can induce great uncertainty, vulnerability and sense of isolation in the initial stages of your life as an independent practitioner. This is a far cry from the regular educational and supportive peer group meetings that most of you have in your training.

Practice NursingVol. 23, No. 11 ProfileLoretta Dunn: New ways of workingLoretta DunnLoretta DunnSearch for more papers by this authorLoretta DunnPublished Online:29 Sep 2013https://doi.org/10.12968/pnur.2012.23.11.578AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 November 2012Volume 23Issue 11ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 29 September 2013 Published in print 1 November 2012 Information© MA Healthcare LimitedPDF download