Diary of a supernumary surgeon...

OK, OK, I know it's been ages since my last post, but children just keep getting in the way, and there's so darn many of them. I'm not even sure they're all ours... Anyway, I am determined to get this blog up to date today, so first of all, Nick...

Nick's job is not going according to plan so far. In theory, a visiting fellow should (a) have at least one operating list a week which is all his, (b) be attached to one specific surgeon and (c) ideally be able to contribute to the on call rota in order to supplement income.

Sadly, in Nick's case, none of the above is true. As it stands now, he is pretty much only observing in theatre as every time he goes to an operation, there is an Australian registrar in attendance at the public hospital and a 'surgical assistant' (bored GP) in attendance at the private hospital. No-one has indicated that he has any kind of priority to assist, in fact one surgeon said when he turned up 'What are you doing here? You don't need to be here.' I don't think it was meant in a nasty way - but still...

I think he has wielded a scalpel once so far, and this was for an ACL (soft tissue knee repair) which he has no interest in doing long term and is not supposed to be focusing on here.

He is not attached to one single surgeon, but rather gets a list of what three or four of the main surgeons are doing each week and where he might want to go (clinic and theatre)

There does not appear to be any possibility of contributing to the registrars' on call rota.

In addition to all of the above,

• we discovered after arriving that Nick is actually working on a self-employed basis, and therefore we had to wait for his ABN (Australian Business Number) to be issued before he could bill for his time
• in addition to the ABN, it took a month to get a tax file number before he could bill...
• because of this status, he is taxed at 30% on 100% of his income - which we are responsible for putting to one side (oh heck..)
• after finally getting state registration, turns out they have mistakenly only listed him as working at two out of the three hospitals and have missed Geelong Private - without registration he cannot get a provider number, without a provider number he cannot bill for any private assisting...
  
• under the terms of Nick's visa, he can only work at the three (two!) Geelong hospitals he is registered for, so therefore can't do locum shifts elsewhere though they are desperate for Orthopaedic surgeons here
• they have just employed a locum GENERAL surgeon for a week to cover staff absences here in Geelong because they couldn't get an Orthopod and never thought to ask Nick. Though of course with no provider number, he couldn't have done it anyway...

So anyway, he has spoken to his boss (R), shown him the volume and complexity of surgery he has been doing at home and told him that the fellowship as it stands neither lives up to its description nor meets Nick's requirements. R said Nick can expect to be first assistant or lead surgeon anytime a consultant does not have a local trainee, otherwise just to go to whichever surgeon's list has the surgery which interests him and observe. Unfortunately, when Nick told one of the other surgeons last week that he would be joining him at his hip list, he didn't seem too chuffed and said he would need to speak to R... So obviously the message isn't filtering through the department.

Doesn't seem to me like there is any buy in from any of the surgeons apart from R - no-one seems to know what to do with a fellow or even seem to want one. I don't see why Nick should have to muscle his way into theatre and I don't see why the unit should get the kudos of offering a fellowship without everyone supporting it. Nick is getting mighty cheesed off - as he said, he is supposed to be honing his skills, not becoming de-skilled, but he is going to see how the next couple of weeks go and take it from there.

It's not possible to change hospitals on the visa we are on (and I don't think my sanity could take another Australian visa application) but we could of course go elsewhere - like New Zealand!! - so anyone planning a visit, hold off for a wee while till we know what country we are going to be in!!