Rural generalist jobs going to locums who cost twice as much, doctors warn

Tasmanian public hospitals are spending millions of taxpayers’ dollars unnecessarily by using locums rather than rural generalists, doctors say.

Every other state allows rural generalists to fill shifts in public hospitals, says the Rural Doctors’ Association of Tasmania (RDAT), which estimates that a locum doctor costs $1,127,500 a year compared with $500,600 for a rural generalist. 

“Our modelling shows that the cost is more than double to employ locums to do this work as it would do to employ the rural generalist doctors that the state is now training,” said RDAT president Dr Ben Dodds.

“These funds need to be redirected to invest in a rural generalist doctor model, which will create a sustainable workforce from junior doctors through to senior specialists.”

RDAT found that the cost of relying on locums was even greater if they were registrars — $626,400 for a locum versus $236,770 for a salaried registrar. 

It said locums were filling six FTE positions in emergency and anaesthetics in the state’s north-west, meaning the Tasmanian Government was paying $3.7 million more than it would if it employed rural generalists instead.

The modelling assumed a locum worked 261 days a year for $3600 a day, with 20% agency costs. 

This was more than double the cost of a salaried fellow, even with professional development allowances, car allowances and rural retention payments, RDAT said.

Dr Dodds said the effects went beyond the budget as locally trained rural generalists were moving to the mainland to work in their specialty.

“Utilising a rural generalist model not only would achieve significant savings but also improve patient outcomes,” Dr Dodds said. 

“A revolving door of temporary doctors means lost time for orientation, clinical governance and performance management, and issues around continuity of care for patients within the hospital.”

Tasmanian Health Minister Jacquie Petrusma told The Mercury that the government had delivered on its commitment to open opportunities for rural generalists to work in Tasmanian hospitals, with “several positions” advertised in recent months.

“Further work is also underway in the state’s north-west to assist these doctors to work more in our hospitals,” she said.

“Recruiting more rural generalists is part of our healthcare recruitment blitz.”

Tasmania’s spending on locum health staff had tripled in three years, according to figures released last year by the Tasmanian Department of Health. 

The cost of outsourced health staff was $182 million in 2023-24, including $105 million for locum doctors and $77 million for agency nurses, the figures showed.