Battling Locum Burn-out

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This morning I was sitting in the coffee-shop in the Perth domestic airport, filling in time before my Sunday morning flight. I’m getting to be a bit of a regular there now, almost at the stage where I can ask the barista for “the usual” with some degree of confidence. I was heading back to South Australia, this time for a two week locum on Kangaroo Island.

This will be my seventh locum trip in 9 months, and I have to admit, it’s getting pretty tiring. The novelty of travel is wearing off a little and I’m finding it harder and harder to leave each time.

Most people would be familiar with the feeling of starting a new job; that strange mix of anxiety and excitement, always trying extra hard at the beginning to be likeable and fit in. It takes a little while before you start to settle in, learn everyone’s names, figure out where the tea room is, work out the local systems and become more efficient at doing your job. Well – I’m that “new girl” every 5 or 6 weeks, and I never ever get to the stage of feeling completely comfortable and efficient at my job, particularly when I’m extending beyond my existing skill set into new areas such as emergency medicine or palliative care.

On top of the new job, I’ve also got the extra challenge of living in a new house, in a new town where I often haven’t been before, don’t know my way around and might only know one or two people, or sometimes none at all. I’m trying to work out how to live a good life in a strange place and am continuously interacting with people I’ve only just met. Again, this is pretty exhausting. Sometimes it becomes easier just to hibernate in my accommodation and not make the effort to get to know yet another group of new faces. Fighting off loneliness and isolation is an ongoing battle.

I always look forward to coming back to Perth for a couple of weeks in between work trips, but this has it’s challenges too. I’m not there often enough to get involved in any regular activities, and people are so busy with their own work and social lives that there’s a fair bit of loneliness and thumb twiddling even when I am back in my own place. It’s funny how now even home doesn’t always feel like it should.

It’s a weird kind of life; disorientating, disruptive, disconnected and completely lacking in routine or continuity. I’m always coming or going, packing or unpacking, meeting new people, saying goodbye, switching in and out of time-zones.

But it’s also interesting, exciting, stimulating and rewarding. I’ve been to some absolutely amazing places that I never would have had the chance to visit, seen some spectacular scenery, enjoyed immersing myself in local pastimes, eaten lots of delicious regional foods, practiced some fascinating medicine and met a whole heap of great people, making some awesome friends along the way. I still can hardly believe that I actually got paid to come and spend 6 weeks in the Kimberley region (which by the way has just been named number two in the Lonely Planet’s list of top regions in the world)! I’m far more confident, adaptable and broadly-skilled than I was a year ago. I’ve also had the flexibility of having lots of spare time to do other things like go to conferences, work on my writing projects, travel overseas, dabble in a bit of FOAM and bake a hell of a lot of macarons.

I’ve now arrived on KI, and the stunning coastal scenery and bracing sea air has filled me with renewed energy and contentment. It’s reminded me of how ridiculously lucky I am to be doing this work; to have the kind of job where I can just up-and-go wherever I feel like visiting, because sadly they are desperate for doctors almost everywhere in rural Australia.

The question then becomes: how long do I keep doing this for? For although I am getting my fill of adventure, I am desperately lacking continuity and community, so I think the answer is “not too much longer.” In fact I don’t have any more work booked after this KI job, which is both liberating and scary. I probably don’t really deserve a break just yet, and my mother, who can always be relied upon to put me in my place, tells me, “Penny, you can’t really complain that you need time off. You’ve hardly done ANY work this year” and she does kind of have a point. However, I wanted to give myself a bit of time over Christmas to have a break from the merry-go-round of coming-and-going, catch up with family, think about my options and make a plan for next year, which will almost certainly involve a more permanent move out bush.

I get quite pensive when I see that my little apple tree is starting to flower and form it’s new tiny apples. I have no idea where I’ll be living when they start to ripen up in Winter next year and my vision of the future remains stubbornly hazy. But hopefully all of this time on the locum road will eventually lead me back to a community where I can feel truly at home one day. Until then, I’ll continue to enjoy all the delights that this wide brown land has to offer.

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16 thoughts on “Battling Locum Burn-out

  1. Totally sympathise with locum fatigue. Have been locuming as my only job, as an ED Consultant for 3.5 years now. The kids are old enough to know when I’m gone, the places that offer locum jobs are sadly the places that can’t attract full time doctors, usually because there are major problems that make them difficult/unpleasant places to work, and living out of a suitcase has definitely lost its sheen. Add a few flight cancelleations/major delays (a recent trip home was meant to take 1 hour, it ended up taking 7 hours….) and airports/flying as your commuting route similarly loses its appeal. Like you, I’m thinking about settling down next year, but deep down I’m apprehensive about letting go of the incredible flexibility that the locum lifestyle offers. My wife calls it the “Peter Pan” life, and at some point I’ll have to grow up and get a real job, but I may just hold out for a few more months…

  2. Totally sympathise with locum fatigue. Have been locuming as my only job, as an ED Consultant for 3.5 years now. The kids are old enough to know when I’m gone, the places that offer locum jobs are sadly the places that can’t attract full time doctors, usually because there are major problems that make them difficult/unpleasant places to work, and living out of a suitcase has definitely lost its sheen. Add a few flight cancellations/major delays (a recent trip home was meant to take 1 hour, it ended up taking 7 hours….) and airports/flying as your commuting route similarly loses its appeal. Like you, I’m thinking about settling down next year, but deep down I’m apprehensive about letting go of the incredible flexibility that the locum lifestyle offers. My wife calls it the “Peter Pan” syndrome, and at some point I’ll have to grow up, get a haircut, and get a real job…

    • Great comment, Andy!
      Yes – I can totally relate to the feeling that I know I really do need to settle down but the absolute flexibility is so addictive. I wish you luck with your search. 🙂

  3. Great read! Eloquent, heartfelt and spot on! Your point about home not always feeling like it should was particularly poignant.

    Based on my own (admittedly very limited) experience of doing rural locums, and through talking to many others who had done much more of this kind of work than I, it appears to be a wonderful short term or infrequent intermittent option. Particularly appealing and beneficial early in one’s GP career e.g. immediately after Fellowship, as you have done, or late – “working grey nomad” / semi-retirement, The drawbacks (which you so beautifully described) tend to overcome the positives for most doctors pretty quickly, even in those without family/ property/ practices or other such encumberments!

    http://www.genevieveyates.com

  4. Great points there. I was looking to see how this journey will go as I was pondering locuming as well. Over the last 2 yrs as a reg, I’ve worked in 5 practices and I feel the need to settle already. I often get asked by the patients ‘are you here long term?’ and comments around ‘once I’ve found a good GP they leave!’
    Also with supervisors that have been in the area for 20+ years, when I’ve called them into the room to look at a rash for example ‘I remember delivering you’ A GP obs who has pretty much delivered all the kids in the region!

    And from another supervisor where it would be difficult for him to sit in as an ECT visitor as he would know all the patients and it would be awkward.
    I feel that its only once you get into an area for a while ie more than 6 months, even longer? that I’d really get to know the person, their family and community.
    Hopefully my next practice will be long term. My current supervisor is asking me ‘where do you see yourself practicing in 10-15 years? What? That long in the future? The more I think about it the more logical it seems.

    You mentioned about the apple tree. I was thinking along the lines of a tree- when young, it gets exposed to different environments. There comes a time when it requires it to be put permanently in the ground. ie hard for it to take root in the ground if its been dug up from time to time.

    I had even been thinking about 6-12 months of FIFO. That’s in between locuming and settling down. What do you think about this?

  5. good article Penny! I am writing this at an airport now on my way to my FIFO gig at Mt Isa RFDS. Have switched to this FIFO work this year and it seems to be a good balance. You go to the same job regularly but dont live there.
    I agree the travelling part is not real fun but must say in my time at home I get to do more academic stuff and feel re-energised when return to the job

    its flexible and the only thing missing is continuity of care but I have done that before for enough years so dont feel bad about enjoying the flexibility of part time FIFO work!

    have fun on KI and when you see Tim, punch him in both arms for me…please

  6. Dear Penny
    I totally relate to the feeling of fatigue settling in and the disorientation etc that goes with starting a new job. I am a gp locum myself but unlike you staying in one country – I work in various countries . For me the challenge is learning the trade names of drugs and the local system as well. I try to keep my travels to 3-6 months at one location. I’m now in South Africa and will be here for 5 months. Try to maybe take longer locum gp stints and see if that works for you. Don’t be too effected by your mums words as I’m sure you do realize that you do work 🙂 have a blessed holiday . Remember life is not all about work . Just go with the flow …..

  7. Hi Penny,
    In a much smaller way I know what you mean – I locumed for the last 3 years, but only around one city.

    I noticed that there are 2 types of locums:
    – Firstly the career locums who are doing it either to compliment their family lifestyle and thus are happy to bumble along as locums forever. Or there are the political, passionate locums who are proud of their status of being people who can wizz in at a moments notice and see patients they dont know.

    – Secondly, people like me, (and you too by the sounds of it!) who miss the continuity and stability that being in one place brings.
    I locumed to bring me freedom to other things with my career but I always saw it as a temporary option because I felt quite empty with regards to the job.

  8. I protest! You’ve misrepresented me 🙂 I know you work hard and you deserve a break. Besides, I can’t wait to spend some time with you

    • Ah mother dearest… I have no objection to your comments. You know I value your wise input immensely and appreciate the dose of reality you inject into my sometimes chaotic thought processes. Looking forward to seeing you too! xx

  9. Hi Penny!

    I don’t know how you do it! I always had a minor meltdown just changing rotations in the same hospital! I think my OCD didn’t really cope very well with change. Or maybe it’s my minor autism? Or maybe my social phobia? Who knows! (I like to think I have many flavours that make me interesting!)

    I could do locuming for a short period of time but I do like my stability to some degree. I am jealous of what you do for the freedom but quite comfortable in saying I couldn’t do it. Ah all it will take is some country boy to snap up your heart and before you know it you’ll have 3 kids, a paddock full of cattle, and a piece of wheat between your teeth.

    Shall I call you farmer Pen from now on? 😉
    Cheers, Rob.

    • Ah Rob … between you assigning me to a life of agricultural / domestic bliss and Tim Leeuwenberg attempting to set me up with the local KI shearers, what chance do I have of ever returning to my urban existence. 😉

  10. I know the feeling… but the locus life does have many benefits, one being that it keeps you free of the local politics of any hospital/practice.

    I’ve locumed (is that a word?) long enough to now have 2 semi-regular jobs, with enough time off to at least think about doing all those things I promised myself when I started the locum life.

    Hope you keep enough time free to keep writing – I enjoy your blogs (or has Dr Robb been successful in his match making? 🙂

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