Doctors on temporary service want job security

The content originally appeared on: Trinidad and Tobago Newsday

Health Minister Terrance Deyalsingh – SUREASH CHOLAI

Locum doctors in the public health system are tired and want some job security after working without a break for years.

Usually, a locum doctor is one who stands in temporarily for other doctors while they are on leave, are absent, or when a hospital or practice is short-staffed.

However, that does not seem to be the case in the public health sector.

One doctor in the North West Regional Health Authority (NWRHA) said, “How the locum started was because TT didn’t have enough positions to deal with the number of patients. So, they started hiring the doctors on a locum basis until the positions become available. But positions are becoming available and they are not making the locums permanent.”

He said in the public sector, locum contracts were for one, three or six months, and there were about 140 locum doctors in the NWRHA.

“Obviously as a young doctor coming out we just want a job so we would have picked up these short-term contracts for however long they were being given. But we have been working on these contract for two years straight and I know some people have been doing it for four years. And on these locum contracts you aren’t entitled to gratuity, sick leave, or vacation leave.

“The point is, the majority of doctors are locum doctors so if the majority of locum doctors decided not to work, it would shut down the public health care system. And there is no representation for locum doctors because we aren’t the higher up doctors. We are the house officers who keep everything running.”

House officers were the doctors members of the public saw on a daily basis. They manage interns and patients, take blood, and do the necessary daily tasks. Most of the house officers, he said, were locum doctors and they worked in most of the hospital departments including surgery, accident and emergency, medicine, urology and others.

He explained that there were four positions at a hospital – the interns who recently finished medical school, house officers, residents who were usually permanent, and consultants and heads of departments.

“The house officer is the first person you tend to see. They would be the one you see if you were to come in with an emergency at night. They are in the hospital all the time. The house officer would call and communicate about the patient to the resident, and they or the consultant will come in at night or the morning to see the patient.”

He added that there was a sharp increase in the amount of work because of the covid19 pandemic.

Some of the locum doctors who worked in the Accident and Emergency departments dealt primarily with covid19 patients, while some locum doctors worked in the parallel health care system at hospitals and step down facilities.

Because they had no sick leave, they had to work while they were sick. Because they worked with covid19 patients, they limited their interaction with their families and friends. Because they did not have vacation they could not recharge themselves or spend time with family members.

The situation was exacerbated by their shift system where they usually had to work the mornings or the nights of their “days off” so they technically did not get days off. Most of the time they took those hours to rest and maybe run some errands.

The pandemic, he said, was an added strain as, not only did many of them have to deal with the donning and doffing of personal protective equipment, but they had to see people die on a daily basis which had an emotional and mental impact on them.

They also had difficulties accessing financial services since their contracts were renewed every few months. So, even though they had been working constantly for two to four years, they were still considered to be temporary. Therefore, they could not access credit cards, loans or mortgages.

“A big hang up for us is that we are doing the same work as our colleagues who have permanent contracts. But they would be able to take vacation, use their sick days, and they also get paid approximately $1,200 more a month due to gratuities and allowances.”

They were also concerned for their jobs if they got seriously sick. He said locum doctors who got covid19 were given their quarantine time and returned to work. But he knew of doctors who contracted tuberculosis while working at the hospitals and, since they had to be at home for six months, their contracts were not renewed and they were replaced.

He added that he did some research and believed it was illegal to keep a locum working for more than year without giving them permanent status.

“We feel left out and unappreciated, especially when the minister (of Health, Terrence Deyalsingh) expresses gratitude for the doctors, and that time the public came out and clapped for the health care workers because the health care workers are still suffering.”