NSW government promises crackdown on ‘unsustainable’ cost of temporary doctors
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Published July 11, 2023
Sydney Morning Herald, 11 July 2023
NSW Health Minister Ryan Park has vowed to crack down on the use of private recruitment firms to plug holes in the state’s creaking hospital system, saying the government’s over-reliance on costly third-party companies is unsustainable.
The Herald revealed on Monday that NSW is paying millions of dollars to companies accused in some cases of deliberately driving up staff costs while discouraging doctors from taking permanent roles in the public health system.
Temporary health workers now cost NSW about $1 billion dollars annually, while $148 million is spent on locum doctors who command fees of up to $4000 a day working mostly in under-resourced regional hospitals.
The private companies which find those staff attract an average payment of 15 per cent of a doctor’s fee.
Park, who has ordered a special commission of inquiry into health spending due to release its terms of reference imminently, said the system had become “over-reliant” on what he described as a “temporary fix to regional and rural health worker shortages”.
“It is simply unsustainable,” he said. “I am determined to see more of our health spending flowing directly to clinicians. There is a very reasonable community expectation that we reduce this type of spending.”
Concern about what Greens MP and former locum doctor Amanda Cohn described as “incentivised price-gouging” has prompted calls for the government to adopt a 2008 recommendation by a previous special commission of inquiry. It called for NSW Health to develop its own centralised recruitment database.
While Park would not commit to that, he said measures such as a single-employer model for rural general practitioners and regional health worker study subsidies aimed to address “systemic and structural factors underpinning the state’s dependence on these agencies”.
“This won’t be achieved overnight or with a single policy, but rather a holistic suite of initiatives,” he said.
But Max Drakeley, a senior recruitment partner at Prescript Recruitment, one of 59 firms registered with NSW Health to provide locum doctors, questioned whether the system was equipped to handle the often complex and last-minute nature of placements.
“The vast majority, 90 per cent or more, of the health services we assist are in regional and remote areas, and we’re talking about a very small administrative team, sometimes one person, doing the job of rostering, managing receptionists and nurses. It’s a very, very tough job [and] they have very little capacity to take on the hard graft of going out and finding a doctor at short notice,” he said.
“Often these gaps appear out of nowhere because a doctor is sick or has to leave at short notice, and they will pick up the phone to me and say ‘Oh my god, someone isn’t coming in tomorrow’.
“I’ve lost count of the number of times I’ve placed a doctor in NSW Health services in the far west or southern NSW where if we didn’t get someone credentialed and flown out, there wouldn’t have been a doctor on site.”
Cohn raised concern about some recruitment agents actively seeking higher “crisis rates” from NSW Health by waiting to fill vacant positions, something Drakeley denied witnessing.
“It’s a stressful enough job as it is without waiting until the last minute to fill something,” he said. “It’s much easier for us to go and find a doctor with two weeks to spare than it is to wait around for the rates to go up.
“I’ve never seen it, certainly not here anyway.”
The examples of agencies seeking higher costs were described by the NSW head of the Australian Medical Association, Dr Michael Bonning, as “not a principle by which we want to run our health system”.
While Bonning said third-party companies can fill an important role by handling the burdensome red tape foisted on temporary doctors, “the current system has its downsides”.
“There are good operators and probably others more with their own intentions at heart rather than the health system,” he said. “If some people are holding back information for financial gain, for example, that’s not a principle by which we want to run our health system.”