Tuesday, 21 October 2014

Reflections - looking back at the year that was

My Aussie sojourn ,at least physically speaking began almost a year ago to the day.
Mentally of course, I had been toying with the idea for a good 6 months prior. In fact, when we flew to Australia early November last year I had already had my AMC application approved.

After a 3 week holiday here, having met friends and made new ones and having looked at potential places to work in we went back and I remember vividly how I told my wife she had 1 month to decide what she wanted to do. I was already in Australia mentally and just needed the go ahead from my wife as she had her family in UK and it was a very big move for her.

The rest as they say is history. It still took us 5 months to get everything sorted and I flew out, alone at first in the first week of May.

Looking back these are my reflections on how things have gone. How I would do a few things differently and what I would look for were I thinking of moving Down Under now. Call it a Primer on emigrating to Australia (for GPs that is)

First decision: go through and agent or DIY??
We wanted to make sure we were ready to move and wanted to see what the country we were proposing to relocate to was like first hand. So, we decided on a DIY approach. I did contact agents and only used them to shortlist potential places (so I knew where to go and look!). Others, the vast majority I am told are perfectly happy to never visit before hand and just accept positions via an agency
Pros and cons: Obviously if you go through an agent they do all the legwork for you including help with applications like the hideously complicated AMC one and you get the job sorted and only then leave UK. Saves on the first trip but also gives you freedom about resigning from current position in UK etc only when everything else is sorted. Cons- you have no idea where you are going (having said that lots on help is available online like Facebook groups and other online forums)
If you go DIY like me then prior to leaving you know exactly where you are going and have already met you employer, colleagues etc and having this knowledge helps in looking for houses, schools etc. but obviously a scouting trip to Australia isn't cheap. We took it as a holiday first and foremost and even if I had decided to not move, I wouldn't have any regrets on that front as we did have a fantastic holiday!

But, I am dismayed at how agents are being portrayed in online fora and facebook in particular.
I think there are now enough UK Drs in Australia who have their own surgeries and are now looking at Social Media to recruit UK GPs. These people in particular are portraying Agents as some sort of money grabbing Fly by Night operatives. 
I have heard sentiments to this effect- ''agents send you to horrible places''. ''Agents charge $25K for a visa'' and other such non sense. First of all if you are planning to emigrate, you- the emigre pay the agent nothing at all- even on successful placement and secondly; your agent is often your one and only contact in Australia. 
An agent may interview and negotiate with several people for 1 position and only get payed by the employer once the candidate takes up the position. They do a hell of a lot more than just find you a job. They help with all aspects of immigration and their role doesn't end when you land a job. My agent was in contact with me even after I started working and only signed off after my 3 months were over. I did deal with my practice through her on various issues after I started working as I felt it was a much better way of doing things and my agent was aware on the Employer's behaviour at all times as well. I know of several people who negotiate with one place and then change their mind and go elsewhere. Think of the agent- they may spend months with you and you can go elsewhere and they get paid nothing!
Its a demand and supply situation. Currently, Australia needs Drs therefore Australian employer's bear the cost. Never look a gift horse in the mouth!

If someone offers you a job via Social Media and you like it, by all means accept it. But I can guarantee you one thing: No GP owner of a surgery can give you the help and guidance a Recruitment agent can. I did my applications myself for reasons mentioned earlier. But several people I know did absolutely nothing. They just sent CVs to their agents who then did the applications for them and this can be several hours of your life. Above all remember that Recruitment Agents are recognized and regulated. 
An owner of a surgery may offer to help you but they are not recognised immigration or recruitment agents. So, choose wisely!
My advice to potential employers wishing to recruit via Social Media would be this: Negotiate a better price with the agents. If you have done the leg work in finding a Dr, the agent now only has to help with the process. So offer them say $15K instead of $25K but don't for heaven's sake tell your prospective client to go it alone. It's nerve wracking trying to emigrate and the support provided by Recruitment Agents is needed!
When I open my own surgery this would be my preferred strategy.

What should I ask at an interview? This is a question often posed to me when someone is planning to come over. Again, my advice is this: it's you who are interviewing the Employer not the other way round. They need you, not vice versa. Actually, they are not even your employer- they are your sponsor and you are an independent contractor (think of them as agents managing your appointments, billings etc)
So what should you ask?
My checklist:
1) Percentage billings is obvious. But, again think carefully. I was offered 60% in one place and 65% at another. So 5% difference? Actually 11.5%- the 60% was inclusive of GST whereas the 65% has GST at 10% on top which equates to 71.5% of gross billings

2) Patient numbers- this is the biggest issue and hard to negotiate but well worth trying to sort out prior to arrival. Percentage billings mean nothing if the numbers don't stack up. 100% of zero is still zero and 60% in a busy place may well be more than 65% in a less busy place. In my view you need 150-200 patients per week for a Full Time Equivalent (FTE) Dr in a bulk billing practice. So ask how may FTE Drs they have and how many patients they see a week (Weekends are extra and excluded from this calculation)

3) Minimum Income Guarantee(MIG): Obviously the higher the better. But, what happens when this period ends? A practice may entice you with higher MIG but again if the patient numbers are not there, after this period ends, what happens? 

4) Review date: Usually there is a period mostly of 3 months or so when the MIG ends. Then, its up to you really. However, in your contract I suggest a more formal review be put in place and clauses for extending this period if need be also stipulated. Why? Read on!

I end on a warning note and apologies in advance if I ramble on a bit but I am interested in Health Economics- a sad side effect of being involved with a CCG and thus my views are tainted! Those of you who have read my previous posts will understand. 
In Australia at the moment there is rapid expansion in GP services. Here, GPs are broadly divided into 2 types- the traditional UK model which would equate roughly to the mixed billing model. 
The other, more relevant one to us is the Bulk billing model. These are called Medical Centres and are not the same as traditional GPs who just happen to charge less! Medical Centres are mushrooming- current trend is to have one in every shopping mall. This has far reaching implications with regards to points 2-4 above.
Medical Centres compete with each other on 1 thing solely- service provision. Convenience of location and opening hours are obvious. But less waiting times is also very important. Medical Centres are more like UK Walk in Centres- several patients a day are new. When there is lot of competition, the centre with least waiting times may win customers. With DWS restrictions and a virtually unlimited supply of UK Drs this is what I believe is happening. 

People are on a recruitment spree- if your pockets are deep enough to pay for the Agent fee and the initial MIG period then you can employ as many Drs as you want. This allows you to promote your Centre and extend the opening hours- 12 hrs a day 7 days a week is not unusual.
More Drs are required to fill in this rota particularly over weekends. But, during the week the numbers simply don't stack up 
After your MIG ends and there are no patients what will you do? Work longer, more unsocial hours and weekends- the main reason for coming here is lifestyle and this will be the first casualty. The Centre looses nothing. Lets say everyone is on 60% billings and the centre does 10,000 dollars worth of business in a day- the owners cut is 4000 regardless of the number of Drs. Logic says it would be better if it was 5 Drs billing 2K each, but it could be 10 Drs billing 1K each and the centre still earns the same amount. Why do they do it? It gives patients better access (Zero waiting times) and also DWS positions have been taken and if the area becomes non DWS the Centre now has an edge compared to say another centre who can cannot now recruit (Aussie trained Drs don't work in Bulk Billing Medical Centres period!) 

So I would suggest Drs put a clause in their agreement. When MIG ends there will be a review of patient numbers. If the patient numbers don't add up and you can in no way earn more if not as much as your MIG then the centre is failing in its contractual duty to provide you with patients and thus MIG should be extended. If everyone else is earning enough and only you aren't then clearly it's your fault- but I don't see that happening!

Let me know your thoughts, particularly if you like me have emigrated recently. If you don't agree with my views please do criticize.

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