Rural Australia could be the beneficiary of an influx of young British doctors looking abroad to escape swingeing cuts to junior contracts in their homeland. By Katie Silver.
UK doctors heading to Australia
It’s a quarter to midnight when Costa Kanaris finally calls me. I’ve been waiting most of the afternoon. Still, I can’t complain – he’s in the middle of a 14-hour shift tending to critically ill children at Royal Manchester Children’s Hospital.
After finishing medical school, Kanaris worked first as a paediatrician and then did his doctorate, and he now works as a paediatric intensive care doctor. His gruelling hours are not uncommon.
“It’s a long road,” he says with a laugh.
Kanaris works, on average, 76 hours a week. Once it was 112 hours in seven days. With his wife also working as a paediatrician, they spend just one weekend together each month as a family with their three-year-old daughter.
“The NHS [National Health Service] is not very family-friendly. It breaks my heart every time my daughter says, ‘How come you go and look after other children and you don’t look after me?’ ” he says.
“With the new contract I will see them even less, and with less pay.”
He’s referring to a dispute in Britain over junior doctor contracts that has been brewing for several years, and which is causing many doctors to look abroad for better employment options. Australia may benefit from an influx of well-qualified Brits, willing to work in fields and regions where there are shortages.
The British government wants to reform how doctors are paid, labelling the current compensation system outdated and unfair. But after talks broke down, with no agreement reached, ministers announced they would be imposing new workplace contracts in June. Junior doctors are undertaking strike action in protest.
On the face of it, the new contracts are to the benefit of junior doctors as they include a salary increase of 13.5 per cent. But for most, take-home pay will decline as they won’t be paid nearly as much in penalty rates for working nights and weekends, or as much in overtime.
Kanaris says his pay will drop 15 per cent, while his wife’s will be slashed by one-quarter.
The difference reflects that the new arrangement hits part-time doctors harder, and they are more likely to be women. The British Department of Health acknowledges the disparity, writing that the “changes may, in isolation, disadvantage women”.
“This is very archaic – it’s not the Middle Ages anymore,” Kanaris says.
The British parliament is also currently debating a bill to exclude healthcare workers from a European law that would limit their working hours.
“The unit is trying to run a shift with increasingly less funds and increasingly fewer staff,” Kanaris says of his workplace. “There’s old machinery they can’t replace. It’s tragic to see how the NHS is gradually being eroded by not enough funding.
“As a physician what makes me happy is seeing my patients be safe and get gold-star care,” says Kanaris. “Instead, I’ve seen the overall standard decrease over the last 10 years.”
Kanaris is one of Britain’s 55,000 junior doctors. For him and his wife, and many like them, it’s all become too much, and they have decided to leave the country.
Australia has long been a destination for British doctors, as it has sought to make up for staff shortages with attractive conditions. Kanaris and his wife are now moving to Melbourne, where Kanaris has been appointed a clinical fellow at the Royal Children’s Hospital.
But Dr Stephen Parnis, vice-president of the Australian Medical Association, says doctor shortages here are not what they once were.
“Over the space of a decade we’ve gone from having a profound shortage, where we were very dependent on international doctors, to now where we do have enough doctors, and even an oversupply.
“But our issues now are in terms of maldistribution and shortages in certain specialities,” Parnis says, referring specifically to psychiatry and general practice. He says Australia also appears to be falling short in the fields of dermatology, ophthalmology, geriatrics and certain areas of pathology.
One of the most significant problems is getting Australian doctors to live beyond the capitals.
“There’s not a shortage of doctors but they’re not coming to rural areas,” says Ewen McPhee, president of the Rural Doctors Association of Australia.
With graduate numbers having more than doubled in the past decade, McPhee says we are determinedly training medical students on the assumption they will spill over to rural areas where they are most needed. “Basically, that’s not happening,” he says.“We have a major reliance on international graduates to fulfil that shortage.”
McPhee cites his home state of Queensland, where 80 per cent of rural doctors come from another country. “In my town, it’s over half the GPs.”
British doctors, he says, are an obvious boon.
“If you’re looking for high-quality, well-trained clinicians, you turn to the UK. They’re the people you want.”
Rob Parker, the Northern Territory president of the AMA, agrees.
“The Northern Territory has done really well out of British doctors,” he says. “And a lot of bright young British doctors find [working for organisations such as aeromedical rescue service] CareFlight quite fulfilling.”
The region faces significant health challenges. There’s a “significant disease burden” among the Northern Territory’s Indigenous population, Parker says, noting the 12-year mortality gap, and high incidences of diabetes, cardiovascular and renal diseases.
“The really remote areas would be quite challenging to British doctors as they’d need to understand Aboriginal culture and the context of Aboriginal illness. But with a bit of orientation, they’d probably find it quite fulfilling,” he says.
Peter Latham is one British junior doctor who has successfully made the antipodean move. The 30-year-old is working in emergency in Mackay, Queensland, after leaving the Midlands in February. He describes the move as relatively easy, having acquired a job within a week of landing in Australia.
“I make a thousand pounds more here each month than I did working for the NHS,” he says. “In the UK there’s no overtime or fatigue pay. They’re just ignored.”
He also works fewer hours each week and lives in a penthouse – complete with gym and sauna – just 20 metres from the sea.
“I do rub it in to friends at home,” he says.
While he originally planned to return to Britain after two years, Latham says the furore over junior doctors’ contracts is making him contemplate whether he’ll ever go home.
“If the contracts are imposed and I returned to the UK when I had planned, I would fall right into a workforce that will be deserted. I predict a lot of people will desert the NHS. There’ll be a smaller workforce with rising demand from patients – it’s really scary.”
Latham says quite a number of British-based junior doctors have contacted him on social media to ask how to make the move.
“There’s definitely a rise in demand,” he says. “Normally 75 to 80 per cent of doctors will apply for a speciality each year while the other 20 per cent will take a break. Now, only 50 per cent are going into specialising. The other 50 per cent are sitting back and waiting for it to pan out, or they’re going to Australia or Canada.”
Data from Britain’s General Medical Council sings a similar tune. For doctors to leave Britain they must first request that the council send a certificate proving their qualifications to the destination country. Over the past seven years, the numbers requesting certificates be sent to Australia hovered between 1600 and 2000 annually. This doubled last year to 3317 doctors, and this year’s numbers suggest a trend. A survey last week by the British Medical Association found eight out of every 10 medical students will be more likely to work in medicine outside Britain as a result of the new junior doctor contracts.
“It’s sad. I really enjoyed the NHS,” Latham says. “The people you work with are fantastic but the job is being made impossible.”
The Rural Doctors Association’s Ewen McPhee agrees, labelling Britain’s new contracts “horrifying”, “bizarre” and “short-sighted”. Doctors here are alert to defending working conditions in the face of British-style reform.
The AMA wrote to the British high commissioner in Australia to express its alarm.
“We’re quite shocked with how our British counterparts are being treated,” says Parnis.
“There are many similarities between the two medical systems [and] from this side of the planet, it is very much that the UK government has made a serious mistake.”
For the Kanaris family though, Australia means a fresh start.
“Melbourne is regarded as the mecca of paediatric intensive care,” Kanaris says. “The guidelines, research – it all comes from there.
“Melbourne will give us both the chance to work in a safer environment where we are valued, and where we get to have longer time together as a family, which is what life is about.”
This article was first published in the print edition of The Saturday Paper on Apr 30, 2016 as "Flying doctors".
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