Latest News

Full Transcript

[00:00:00] Ryan Kevelighan: Hello and welcome to the latest in our One-in-focus series where I'm delighted to have Dr. Jim Ferry with us today. Great to have you here today, Jim. Thank you very much for coming and giving us your time here. And as you know, we're trying to showcase the interesting lives of doctors and people that are out and about in the field.

Jim, you've got an extensive career starting off in Scotland in the 70s, I believe they qualified as a GP, later as a specialist obstetrician. You transitioned across to Australia at some point in the depths there. There was a stint in Canada and various other places. You're a well-known feature in Manly as well with a long career there as well.
And I think there's… there's even somebody in our office whose family member has been delivered by your fair hands at some points. So, it's a… it's a small world. I'll hand it over to you Jim and give us brief background on yourself.

[00:00:44] Jim Ferry: Okay, pleasure to be here, Ryan. I hope I can be of some help to people who are thinking of doing locums. My name's Jim Ferry, as you've mentioned, I'm in my, uh, 60s, rather well into them, may I say. I was born in Glasgow, brought up in Glasgow. I did my medical degree in Glasgow, and I did a year of internship in Scotland, and a six-month ONG term in Scotland.

But I had itchy feet, and I went to work as a sort of rural GP in Canada, in Newfoundland actually. And that was a very interesting experience and I learned a lot. While I was in Canada, I passed a thing called the LMCC. I could have stayed in Canada, but I decided it was way too cold. I worked in Texas for three months.
While I was in Canada, I received my green card or whatever the equivalent is for Australia. And I was able to go to Australia and I decided that I'd like to go to Australia for six months. And that was, um, almost 40 years ago.

When I came to Australia, I worked for a few weeks with a GP deputizing service. And the less said about that, the better, Ryan. I then got a job in St. Margaret's Children's Hospital for six months, and then the government, in its wisdom, decided to close St. Margaret's Children's Hospital in Darlinghurst. And at that time, there was a local GP in Manly who advertised for a locum because he was going on his first holiday in nine years to Greece. I took over as his locum. He went to Greece and unfortunately, he had a stroke and he died in Greece. I suddenly found myself with, his practice in Manly and I built up that general practice so that it was one of the biggest, if not the biggest, in Manly. And I did that for about five or six years.

I wasn't 100 percent satisfied with being a GP because I felt that was a glorified triage for a lot of people. I decided I would like to specialize. And I had been doing some GP obstetrics in Manly. My pathway into spatiality was very unusual. As a GP I passed the part one, which was a bit unusual, and I worked in Royal Prince Alfred for three years, and then the Royal Hospital for Women for three years in my training, and then I’ve done my last year of training in the UK in Essex.
I always intended to come back and work in Manly because I love Manly and I love living in Manly. So, I came back and I did some locum work before I got a job as a VMO at Manly. A VMO stands for visiting medical officer. So, at the very beginning of my career, I'd done some locums in Darwin and Alice Springs in Rockhampton. I then became a VMO in Manly Hospital, and I started in private practice in Manly, and I built up a very, very big, mixed obstetric and gynecology practice in Manly. I did that for at least 25 years.

And because of that, and because I live in Manly, I'm reasonably well known in Manly. I did that until I decided it was time to give up private practice. And I gave my private practice to a colleague and we had a very seamless transition and he's doing extremely well now. I simply just gave him the practice and all the equipment and it gave him a huge leg up for which he seems to be very grateful. I decided… well, I'm retired, but I'm not quite ready to give up yet. So, I decided that I would do some locums again. And that's what started me in a, what I call locum land.

[00:04:33] Ryan Kevelighan: It's a good name for it. Very, very fitting. What year did you give up your private practice?

[00:04:37] Jim Ferry: The end of 2020, 2021,

[00:04:41] Ryan Kevelighan: So relatively, relatively recent then.

[00:04:43] Jim Ferry: I always intended to give up the practice, and Andy was itching to go and I had him working, slowly working him into the practice and working myself out of it. So, the succession planning was quite good. As I say, there was… there was a family tragedy that probably expedited my decision to quit private practice.

[00:05:03] Ryan Kevelighan: It's a very good job that quite a few people like yourself don't fully retire because in certain skill sets, especially like obstetrics, it would be a much different situation if people did actually retire age and not pick up any further work because there's a real gulf of skill set in that area.
We see that time and time again. So, I'm guessing you get very, uh, very well received around Australia when you turn up to provide your services.

[00:05:26] Jim Ferry: Most places I go to, they say, “Thank you for coming. And we're very grateful to have you.” And a lot of them are really delighted to have you. The thing is, it's a shame because I keep thinking it's a shame, they can't put a USB into a port in the side of my head and download that knowledge that I have.
It seems an awful shame just to leave and that knowledge is gone forever. And that's one of the motivating factors for doing locums. I have all this knowledge and experience and it seems an awful shame just to waste it. And that's exactly what you do when you retire, you know what I mean?

[00:06:02] Ryan Kevelighan: Well, it's a great opportunity now in these latter years for yourself when going around the place and sharing that knowledge around. Did you always know that you wanted to be a doctor?

[00:06:10] Jim Ferry: No, of course not. I mean, I was brought up basically in a very rough, slummy area of Glasgow. Well, there was… I'm one of ten kids, and my father was a labourer and frankly speaking, people like us didn't become doctors. That was very unusual. I was brought up in a place called the Gorbals in Glasgow, and…

[00:06:29] Ryan Kevelighan: I'm familiar with the Gorbals.

[00:06:32] Jim Ferry: And for somebody… for somebody like me to become a doctor was strange.
And when I first went to university, I couldn't believe that there were half the kids in the first year of medicine that were from private schools. I had no idea that private schools existed. The funny thing is I felt very, um, out of place my first year in medicine and I gravitated towards the other working-class kids.
And we realized one thing I think, is that we were as bright as these other kids, but we weren't as confident.

[00:07:04] Ryan Kevelighan: Yeah. It's a bit…bit like the imposter syndrome type thing that…

[00:07:07] Jim Ferry: Yeah. But no… at one point I wanted to be a pilot. In fact, I was actually accepted by BOAC at the time. That's how far a long ago it was…

[00:07:15] Ryan Kevelighan: Goodness me.

[00:07:16] Jim Ferry: BOAC is British Overseas Airways Corporation or something. And I was accepted to be a pilot. Of course, when I was younger, I wanted to be a clown in a circus, and I wanted to be a fireman and all the usual things. But now I wanted to kick above my weight, given where I came from. And, uh, my parents, they had no money, but they did unusually at that time, uh, in the circumstances in which I was brought up valued education. And I'd done well at school and looking back I think I'd done it well just to please my parents more than anything else.
And academically I was quite good so, basically, just to see if I could do it. Somehow, we did, you know.

[00:07:56] Ryan Kevelighan: Well, there you go, it's a good job you did and it's a good job you were quite good academically. You mentioned before you moved from the UK across to Canada first, is that right?

[0:08:04] Jim Ferry: Yes.

[0:08:04] Ryan Kevelighan: What… what… what drove you to make that move? Is it the sense of something different, adventure, or some other reason or?

[00:08:10] Jim Ferry: No, I remember my mindset at the time and my mindset was this. Here I am, I've been offered several jobs as a GP in the south side of Glasgow, including the GP practice that my family went to. The principal of that really wanted me to join the practice. But I thought to myself, “Well, am I going to spend the next 40 years of my life in the south side of Glasgow? Or am I going to have an adventure or two before I settle down somewhere?”
And I decided the latter. And I thought, “Well, I'm going to go to Canada. I'll learn stuff. I'll work there and it'll be interesting.” And I ended up as I've already said, working in Canada and working in Texas and starting work in Sydney, Australia.
Yes. And I don't regret that by the way.

[00:08:55] Ryan Kevelighan: Did you notice a significant difference between Canada versus the US versus Australia?

[00:09:01] Jim Ferry: Absolutely! Canada was a socialized medicine that was just coming in in Canada then. First of all, the difference in lifestyle in Canada. I arrived there in the winter. And, uh, I've never known cold like it, especially in Newfoundland and the East Coast. I thought Scotland was cold, but when I got to Canada, that was another level.
I lasted for three months in Texas and decided, “No, I really would like to go to Australia.” Australia was… I enjoyed, I really enjoyed, Sydney. I mean, I arrived in Sydney, I didn't know anybody. I got a one-way ticket from, Toronto, via Las Vegas, via San Francisco, via Hawaii, and via Sydney.
I left a Canadian winter which was about minus 10 degrees and I ended up… I arrived in Sydney and it was 40 degrees and it was quite a difference, yeah.

[00:10:16] Ryan Kevelighan: What was it like transitioning back then? Like… cause it was obviously quite, quite some time ago. You… I'm guessing you probably didn't have an agency. Did they… did you just go door-knocking when you got here? Did you have a connection?

[00:10:25] Jim Ferry: I forget exactly how I got the, uh, GP deputizing thing. There was no internet in those days.

[00:10:32] Ryan Kevelighan: No, of course.

[00:10:33] Jim Ferry: I think there was a magazine and I just wrote to them. It was snail mail essentially.

[00:10:38] Ryan Kevelighan: Yeah, yeah.

[00:10:38] Jim Ferry: It was normal mail believe it or not in those days. See, the thing is, I was young then, and everything was an adventure.
So, I didn't think of the downside. I arrived with a suitcase and, please don't laugh, but it was full of medical books, and they were really heavy. People don't do books anymore, but my suitcase was full of medical books.

[00:10:58] Ryan Kevelighan: Well, you say that, but we still have locums that go out and we have to get them extra baggage so they can take their, uh, their, their study books with them.

[00:11:06] Jim Ferry: Yeah, I mean, like, I find that odd now. I mean, one thing I have found as a locum is that I've had to get more IT savvy because you have to upload and download so many credentials. But that's getting off the track. I arrived and I worked as a deputizing GP, but as I say, it was only a stopgap. I arrived in Sydney and I literally hadn't anywhere to stay and I asked the taxi driver, where the best place in Sydney to stay was and he said Kings Cross.

[00:11:36] Ryan Kevelighan: That would have been interesting back in those days.

[00:11:37] Jim Ferry: So, the first three weeks of my time in Sydney, I stayed in Kings Cross. But the reason I ended up at Manly was, um, I used to go all over Sydney with this deputizing GP service. And one day, our patch was the Northern Beaches. And I'm talking about from Dee Why to Manly. I thought, if I'm going to stay in Sydney, this is where I'm going to live because I really love the Northern Beaches. And that's exactly where I did live at.
Again, you'd look at the Sydney Morning Herald, and you would find, uh, you know, advertisements for sharing apartments. And I went… I sort of applied to the Manly ones, and there was a Glaswegian flight attendant who worked for Qantas and I applied there, and we got on really well.
And so, I started sharing an apartment with him in Fairlight, which is next to Manly, which is probably why I ended up getting that GP locum in Manly. So that explains, in a very shortened version how I ended up in Manly.

[00:12:41] Ryan Kevelighan: It's a very different world these days. I'm, I'm old enough to remember just the back end of people applying to adverts in papers and magazines and stuff like that, at the same time, the internet was coming in at the front end. For people younger than me listening, you know, it's, it's quite a hard thing to imagine not being able to just go online and select finding somewhere to live and then viewing pictures online and having a look at an interactive map and all this type of stuff when they… when they move over. You know, it's a, it's a different, different times, different world.

[00:13:06] Jim Ferry: Well, I mean, you just didn't jump on the internet and back in the day, there was no internet,

[00:13:11] Ryan Kevelighan: Yeah, none of course.

[00:13:11] Jim Ferry: There was no email

[00:13:12] Ryan Kevelighan: I remember the back end of those days well. So you had your career in Manly. I'm not sure how much you want to touch on it, but I mean, you, you, took over, the practice and built it to be even more so successful, etc., over a number of years. Did you do any extra work outside of that, in that 25-year period? Or were you dedicated to just working in Manly and that's what your, your entire focus was?

[00:13:32] Jim Ferry: In my practice in Manly, in my O&G practice in Manly, um, no, I, I dedicated myself totally to the practice. When you're a private obstetrician you have to dedicate yourself because you're essentially on all the time. You can't, for instance, unless you've got somebody to cover you, you have a beer even, even one beer I reckon, because if you had to go in for a delivery and you smelled of alcohol, it's not a good look.
And so essentially, I barely drank for 25 years. I still don't much because you just can't… you're on all the time. Essentially people don't realize this as a private obstetrician. I mean, I did gynecology as well, and I did a lot of gynecology, but, the… the other thing about working in Manly and working in the Royal North Shore is you've got a lot of very good colleagues to call on. And so, I built up a network of friends, surgeons who, for difficult cases, would come and help.
And so, it was a very satisfying practice. As I say, I can walk around Manly now, and I've delivered half the population in Manly. And it's a nice feeling, because I'm sort of out of it, but I've still got a legacy and I find that very nice. To be honest, I took lots of holidays, because it's the only way you can really survive in private practice as a private obstetrician. It's a very big commitment to be a private obstetrician. It's not like being a private dermatologist. I've no apologies to dermatologists, but it's not the same.

[00:15:01] Ryan Kevelighan: No, it is a whole different level, isn't it, in terms of just the interaction with the patient. Because if they have you as their, your obstetrician, their obstetrician, sorry, you know, there's, there's an expectation that you are gonna be the person that does the, uh, the final part of the process.

[00:15:13] Jim Ferry: Well, it's a very big deal for a woman to get a private obstetrician.

[00:15:15] Ryan Kevelighan: Of course, yeah.

[00:15:16] Jim Ferry: And when I meet women in the street or in the supermarket or whatever, the fact that you've been there for the most important moment of their life, it's a big deal.

[00:15:26] Ryan Kevelighan: Yeah. No, of course.

[00:15:27] Jim Ferry: Even if it was a normal delivery, for them it's not necessarily a normal delivery. The main thing when you're in private practice, you build up the trust of women and, when they're in labour and when you come walking into the labour ward, when they're about to have the baby, the look of relief in their face, because you've built up a relationship with them and this is very important this relationship. This trust is very, very important and it may even only be a normal delivery or even a routine caesar, but to them it's anything but routine. For you it's routine, for them it's not. And if you have to do an emergency caesar, and you can stay calm, and you do it because you do it all the time, they never ever forget that, ever. And it's a lovely relationship you have with people, and private practice has its rewards, to be honest.

[00:16:15] Ryan Kevelighan: I'm sure it's the same for yourself, but I've spoken to other obstetricians in the past that have delivered up to three generations in the same family and that type of thing, which is, it just shows that ongoing legacy and commitment being dedicated in the local area and, having the same family come back to you as the trusted obstetrician.

[00:16:30] Jim Ferry: It's a bit like the old-fashioned GP used to be, you know?

[00:16:34] Ryan Kevelighan: Yeah. You'd always go to the same GP back in the day in your local village.

[00:16:37] Jim Ferry: Yeah. I mean, they don't exist anymore, but I was a solo GP before I became an obstetrician, and it was the same deal. People got to trust you, and a lot of people were devastated when I said I was leaving general practice because you're actually an important person in their life. That's a privilege that you don't take lightly.

[00:16:56] Ryan Kevelighan: We see it all the time as well. Rural GPs, especially, you know, they've… they were, they were such an integral part of the community and in many cases they've been there for many years. So, when there is a, you know, a time for them to move on or retire or whatever the circumstances might be, it can be really unsettling for the community, especially if they can't get some form of equitable, reasonable replacement, et cetera. It's just a… it can cause all sorts of problems.

[00:17:19] Jim Ferry: The problem is when you work in a small place and you're a GP and you know everybody's secrets, and then you have to live with them and socialize, it's almost like a dual role you're playing, you know?

[00:17:30] Ryan Kevelighan: It's like being a barman or a priest, you know?

[00:17:32] Jim Ferry: Yes, exactly.

[00:17:33] Ryan Kevelighan: You know a bit of everyone's business, you know. So, in recent years then, you've taken on some extra locum work and then you've, you've retired away from Manly and started to do a bit more locum work. I mean, what are you experiencing about that? In doing this, at this stage in your career, are you finding it different in the early days of your career when you did some part of it? Is it giving you a fresh sense of a bit more of adventure, etc., getting back out and about and that type of thing?

[00:17:56] Jim Ferry: The first thing I'll say is my experience as a private obstetrician-gynecologist in Manly didn't truly prepare me for being a locum in some of the places I have been. It absolutely didn't. When I go to various places, I say to them, look, you know, and I'm quite honest, I'm sure my private practice in Manly didn't prepare me.
I used to think that that represented a cross-section of Australia, my practice in Manly. I couldn't have been more wrong. I was working in a bubble within a bubble. I call, I was working in a Vanilla Land, and people understand that. If you go from an upper-middle-class practice in Manly and you suddenly find yourself in Derby with the indigenous people, it's truly very, very different indeed. It's like another planet, you know?

[00:18:47] Ryan Kevelighan: Manly must be a bubble within a bubble if it made a chat from the Gorbals and not realized.

[00:18:51] Jim Ferry: And it's just I never had to think about it. I realized that, uh, Manly is not Australia. It's, it's nothing like normal Australia. And I have worked though, um, in the last few years in Darwin and Alice Springs, and in many places, Port Macquarie and Kempsey and Moruya and Bowral and Shoalhaven and Grafton and Mildura, Bendigo, and in WA. I worked in Port Hedland, Derby, Fiona Stanley and Esperance.
So, I think I can honestly say I've got a good all-round view of locum lands in Australia.

[00:19:27] Ryan Kevelighan: Yeah, well, there's a, there's a big, broad, differences there with those places you just listed, because as you say, you've been to numerous places and they're in very different locations. Some of them are more metropolitan, some of them are very remote, some of them are in warmer climates, some of them in cooler climates.
So, there's a, there's a big difference there in terms of the experiences that you'll have had. What are your thoughts on the different cultures as you go around the place and how it makes a change on the experience for potentially both sides, both parties, both you as the doctor and the hospital staff and patients?

[00:19:57] Jim Ferry: Well, as I said, most of the hospital staff are very welcoming and most of them say “Thank you.” A lot of them say “Thank you for coming” most of them, they’re used to locums and, very few of them actually seem to resent locums. They seem to love locums and places like this really need locums because even if not a lot happens in the smaller places, when it doesn't happen, you really, really need to be there.
What you have to suss out very quickly is the culture of a place and you have to ingratiate yourself very quickly and be likable very quickly basically become friendly and let people know that you are friendly. You are… you wish to be helpful, you, you're very approachable. And that might seem very obvious to say, but the stories I hear about some locums who are quite aloof, and are not contactable, and some of them can be lazy, you know? And you've just got to send a message out to people that you're glad to be there. You're delighted to be there. You want to help and make yourself likable and speak to some key people right away. And by that, I mean, the head of theater, midwifery staff, the chief medical officer, the local surgeon. and the local anesthetists, because these are people who you will need and your relationship with them is actually very important.

[00:21:18] Ryan Kevelighan: Yeah, some very good advice. I think it's the way people should approach life in all aspects anyway if they can be, go in friendly and open. And, uh…

[00:21:25] Jim Ferry: Well, you must be friendly. You must be open. You must be seem to be approachable and likable and helpful. If somebody says, “Do you mind doing this?” I'll say, “I'll do my best. Thank you.” And the other thing, by the way is be honest about what your limitations are as well.

[00:21:39] Ryan Kevelighan: That's a very important one because you end up with people working in situations where they may or may not feel comfortable, which can then have ramifications.

[00:21:46] Jim Ferry: Absolutely. And I'm, I'm quite comfortable with saying “No, I'm sorry,” but I'm not happy. I remember going to one place and this is just a small example but they had an operating list for me and I was supposed to turn up and do this operating list and it was an operation with which I was not familiar and not only was I not familiar with this operation, I hadn't even met the patient. I insisted meeting the patient and the patient duly turned up at the clinic, and it was a makeshift clinic because they didn't actually have a clinic because the local doctor had been seeing everybody in his own rooms.
And this is part of the example I'm saying about. You've got to get to know the local culture and the local facilities. And this woman, when I examined this person she insisted in the operation and I felt that, A, I didn't feel that that was appropriate and, I wasn't comfortable doing the procedure anyway. And she got very, very upset but I felt that I was doing the right thing and I did the right thing. But you get… you get issues like that where people's expectations or the institution's expectations of you are more than you can offer.
That's very rare by the way. Very, very rare, but it does occasionally happen. But be honest about your, um, limitations too. That's all I can say.

[00:23:04] Ryan Kevelighan: Yeah, I know indeed. We have very frank and honest opinion conversations with people on our side of the fence as well. And we really try and vet people into making sure that they don't end up in a position that they're not going to be comfortable with. And usually escalates to the point where we try our utmost to get the locum doctor on the phone to another doctor at the facility that they're planning on going to so that there can be a doctor-to-doctor conversation.
So instead of having, what is fundamentally a salesperson, try and regurgitate what they think is, uh, is the reality for the doctor.

[00:23:35] Jim Ferry: Well, it's, it's very interesting. Um, one aspect is, escalation of care, and especially in a small place, you have to very quickly learn who the… who you escalate care to, and quite often you have to phone up and ask advice from doctors at major metropolitan centers. And quite often you have to make the decision, about getting somebody out.
And the issue I have had in some instances is I have procrastinated about sending somebody out, and I have regretted that. If in doubt, get them out especially with the Royal Flying Doctor Service in remote areas, because they can take a long time. Don't be scared to escalate and if you're not totally comfortable with the situation, especially in obstetrics, somebody who is premature, and who you think may be going into labour, don't wait until they go into labour. Get them out.
The worst that can happen is that they end up, going, sitting in a metropolitan hospital for a few days and they get flown back. It's very important to, know how quickly to escalate and the facilities of a place. And I have learned that the hard way.
There's one case actually, looking back I should have sent her away the night that she came in. I won't go into the details of it, but, I thought, “No, I can do this.” But, uh, I…I was thinking purely of my own abilities. I wasn't thinking of the backup available, or rather the lack of backup available.
And the next morning, I spoke to the CEO, and he had a wry smile on his face and says, “Well, James, you know what you should have done last night?” And I said, “Yes, I do.” And you learn. You never stop learning, by the way. and I always say to my junior staff, especially in the big metropolitan areas, I say to them, and with total honesty, you know what, I learn more in a day than you guys do.
I'm still learning. I learn every day. Being a locum and especially in different places, you learn stuff every single day.

[00:25:29] Ryan Kevelighan: Would you say that's your favourite part about locum, Jim? You know, that you get to keep on learning every day and new experiences?

[00:25:35] Jim Ferry: Yes. and to be honest, the fact that you're useful is a very big part of it for me. Being useful, being needed, doing things that to you as a consultant are simple, but to the other people is not, is a big deal. And also, some places I work with GP obstetricians, some places I work with registrars and residents, and taking them through a Caesar or taking them through an instrumental delivery, or even a laparoscopy, they're very grateful, and I really got a kick out of being helpful.
It's very, very important for a locum to impart any knowledge he or she has, as much as they can. And I enjoy that. The other thing is, um, the staff, especially in the smaller places, but even in the bigger places, truly appreciate the fact that you're willing to teach and you're willing to, sit down and talk about things.
It's very important that you're useful that way. Very important indeed. And quite often I'll get the opportunity, I will give little talks and various things, and it's always appreciated and I enjoy it.

[00:26:39] Ryan Kevelighan: Yeah, well, it gives you a real sense of purpose, I'm guessing, as well. It's sort of because you’re getting the rewarding feeling of the outcomes of what you're doing and you can see in live time as well. We come back on some of the good things as well, what do you not like about locum, Jim?

[00:26:51] Jim Ferry: Well, basically, I live on the Waterfront Manly and if it's a beautiful day and I'm about to leave, I say, “Why am I doing this?” Because I really feel like an nice swim in that lovely blue azure water, you know? Sometimes you miss certain family things. Sometimes, to be honest, it's like, you really just can't be bothered going, if that's the truth, you know what I mean?
Sometimes you just would rather just…. because I enjoy just sitting around and walking around Manly. I've got plenty of friends here. Being away, especially for family things can be difficult, although, I will qualify that by saying that as a locum you can pick and choose your dates. So, I can't dwell on that aspect too much.
I don't like to travel very much. I don't like sitting and waiting around airports very much. To be honest, the main aspect is the first day because you've got to get up. You've got to pack. You've got to travel and then you get there and you've got to pick up the car get into your accommodation and then you've got to find somewhere to go to eat or get some groceries and cook.
So, the first day is quite hectic. And of course, you don't get paid for that, but that's all right. So, I guess it's a travel time. The thing is I've been offered plenty of short-term locums, at attractive rates for four, say, or five days, but in actual fact, it's not four or five days. That's actually seven days because it's a day there and a day back. You've got to remember that.

[00:28:24] Ryan Kevelighan: When I first started doing this, um, quite a few years ago now, there was a lot of talk about travel day pays, and I think it was when some of the rates used to be lower in the market. They used to be… it was more common that travel days were put in, or half a day there, half a day back and that type of thing.
But then those seem to disappear from the market over, over the following years after getting into this. And, uh, I think that the rates increased somewhat and then, uh, and then they sort of washed that through. But, uh, you're right with the travel, like if anyone's ever experienced traveling quite a lot, initially it's a bit exciting, can be a bit glamorous sometimes, etc. and feel a bit, you know, something different. But once you do the same thing more than a few times, it can become quite tedious.

[00:29:02] Jim Ferry: The other thing is, of course, things go wrong. Like you can turn up, and there's no baggage allowance. You have to pay for your baggage, or turned up at the hired car, and there’s a $6,000 excess, and you've got to pay a fortune for that. Or a couple of times I've turned up to pick up the car and I've had to pay for the car myself. It was refunded.
Or a couple of times, they forgot to, uh, book my accommodation. Not your agency, I might add, but you know, things like that. I've actually turned up at hospital accommodation and there was somebody in the accommodation I was supposed to be staying in. So, there's all that.
But to answer your question, what I don't like about locums, apart from that, from the medical aspect, what I don't like about going to, uh, especially new places, you've got to learn. It's a nightmare. Sometimes the medical information system, the new IT system, and you've got to basically get into the culture right away. Find out where everything is and it can be quite unsettling for the first couple of days.
Finding out what the roster is, how things work, where you're supposed to be, how busy it is, who the key people are. It really can be quite unsettling for the first couple of days.

[00:30:17] Ryan Kevelighan: Did you find that some places give you a good induction when you get on-site, or?

[00:30:23] Jim Ferry: Very few places give a decent induction. I have literally turned up at a place once and they said, “Oh, you're the new obstetrician. There's an emergency caesar in theatre. Could you go there right away?” I had to say, “Well, okay, first theatre, could you let me in please?” Cause I didn't… hadn't even picked up my swipe card.
Find out where you change. Walk into theatre. A bunch of strangers with a big smile saying, “Hi, I'm Jim Ferry. I'm the obstetrician and there's a patient there waiting for an emergency caesar.” You don't know her from a bar of soap. That has happened. So, to be honest, I'm not saying that that's common. In my experience, very, very few locums have the luxury of even an hour's orientation.

[00:31:06] Ryan Kevelighan: Yeah, I think it's a reflection on the challenges in the wider healthcare sector, you know, it's just everybody's under such level of pressure, staffing shortages. There's always in some form of semi-crisis it feels. So, it's probably a reflection on that, but I think quite a lot of places do very well based on the circumstances that they're in, but we, we, as an agency are trying our best to improve it.
So, we're, constantly talking to clients these days about the inductions that are being conducted and trying to make sure that they are being inducted and also try and help improve them. With some of them that they're doing, whether we can help and get some of the information out to them in advance, we try that as well.
It is funny you mentioned though, the travel and accommodation and the flights and the car hires and all that, I think that is one of the biggest challenges from an agency point of view as well. Finding doctors is difficult, getting them into the right job is difficult, but then getting them there, getting them the right car flight, and then making it all work and accommodation is another, fun and merry-go-round on its own.

[00:31:57] Jim Ferry: Well, that in itself can be stressful, especially when it doesn't go right. I mean, you know, I mean, I've, I've arrived at airports where the car hire, Avis, Europcar, there's nobody there, you know. And it can be quite confounding. I find there’s a lot of locum agencies outsourced it to another travel agency. Sometimes you go with Jetstar. Sometimes you go with Qantas. It can be quite confusing, the whole thing.
But again, I'm not making a big deal about that. I mean, on the whole, you usually end up getting there. As I say, the other thing I'd like to talk about is, and it’s nothing to do with you, is every state, and even within states, there's a totally different medical information system. It astounds me that there's not one uniform system throughout Australia.
In WA, there's a different system from South Australia, which is totally different from Victoria, which is totally different from New South Wales. None of them talk to each other. I will work, where it's a very itinerant population. And somebody will have had an operation somewhere.
And do you think that we can look that up in My Health Record or any? No. It's just not available. I can't for the life of me, figure out why they didn't have a uniform IT medical information system, for Australia. I mean, it is one country.
And these things can be quite difficult to navigate, especially if you, for instance, that caesar that I'd done, um, the second I arrived there, I then had to figure out, and it was quite complex how to do an electronic record of the operation. And this is very, very medically, legally important. And I had to, sort of, try and figure out. And it was a small place so there was no juniors to help me. I had to try and figure out how to navigate sort of a computerized medical record of the operation. This is where you can get into trouble because, um, you don't record everything as you should be doing. And this is part of the process or lack of process of induction.

[00:34:01] Ryan Kevelighan: Yeah, stuff does stem on… from that about the computer systems are a challenge as well in just trying to get people access into them. It's interesting you mentioned about there being a different system in all the different states and territories because we have had a national medical board now for 14 years.
You would have thought that it might have progressed to a national computer system. But, uh, but again, that's a little bit out of my lane that is to be honest with you that side of things.

[00:34:24] Jim Ferry: Actually, if you speak to most locums, especially if they go to a new place in a new state, you've really got… it takes a couple of days even for the smartest guy, they just get the hang of it, you know?
For instance, there's actually, you've got to have about six different apps open. You've got an app for, you know, seeing patients and, doing progress notes. But you've got an app for, um, the medical imaging. You've got an app for e-referral. You've got an app for results. You've got another app for booking. And, I mean, it… I don't know who designed these medical information systems. It was certainly… all I can say is it certainly I wasn't a working doctor.

[00:35:01] Ryan Kevelighan: I know, indeed. So, look, going back onto the agency side of things then, what would you tell people to expect from a locum agency?

[00:35:09] Jim Ferry: First of all, be friendly and be accessible. You should get the impression from your locum agency that they want to make it as smooth as possible. You've got to explain to them that when you first join an agency, they're going to have to ask you for a tsunami of credentials, probably about 10 to 15 different credentials.
But once that's done, it's done. And then you've got to give them a CV of course, and you've got to have references. But credentialing and the compliance can be quite challenging especially if you're not used to it and I wasn't used to it at first. And that's what stops people changing so much from agency to agency, because there's so much paperwork.

[00:35:53] Ryan Kevelighan: Yeah, you wouldn’t have experienced much of it while you were in your private practice world, would you? Because it…

[00:35:57] Jim Ferry: I experienced none of it, you know.

[00:35:59] Ryan Kevelighan: Yeah. And then this is… this is some of the challenge we get is when you've got senior people who've never experienced it before. I am positive about the paperwork process in totality because it's important for everyone's safety. But at the same time, it is a… it is a big process to get it done once. And that's one of the biggest benefits of an agency often is the… the assistance with that.

[00:36:17] Jim Ferry: Well, you have to be a bit IT savvy, I mean as I say, by the way, most of the locums that I see, not all of them, but most of the locums I see are either overseas medical graduates or transitioning to retirement fellows. That would make up a big chunk of locums, and there's a lot of transitioning to retirement fellows, and that means they're of a certain age where they're not super IT comfortable or IT savvy.
But you have to become that because you have to upload and download lots of different documents and, have the email for the current health board and, you, you, you cannot do this job without a laptop.

[00:36:56] Ryan Kevelighan: No, I'd agree. Say, you have to be at certain level of competence, IT Savvy. We've had a few people we've helped in the past and assisted them. I supposed it's another reason why we… we actually ended up making a platform. I don't know whether you've used it yet or not, called Health Pass, and we've tried to make it as user-friendly as possible. It's digitalized the entire end-to-end credentialing process to the point of everything that could be digitalized, but it's through what we hope is being seen as a user-friendly, uh, platform.

[00:37:24] Jim Ferry: One question I always ask, they ask for references, and that's fine, and I've got plenty of people who give references, but I always say, “How long are you going to take?” Because I always make sure that they don't hit the poor doctor who I say is going to give my reference with a, a huge, massive, long list of, computerized list of, uh, that's going to take him 15 minutes or so.
I say, “Just please phone this person up” and ask them a question and don't take more than five minutes of their time. It doesn't take any more than five minutes for somebody to see if you're any good or not, you know.

[00:37:59] Ryan Kevelighan: Unfortunately, the hospitals in the system make us get standard formats for these things, but we've come up with methods to make it short and sweet. So, which again, again, another thing that we're up to behind the scenes, but, uh…

[00:38:10] Jim Ferry: One thing I find about hospitals is most hospitals, they'll get stuck in one little aspect. It might be a module, or it might be, um, working with children, it might be… but they'll get stuck in one little aspect. And they'll be very adamant about having that whether it's useful or not. For instance, they insist on FSEP3 and PROMPT and neonatal resuscitation.
Other places just don't worry about that at all, but they'll worry about a special IT module or have you done the fire safety module. So, it's strange how the various places get stuck on various small issues. None of which have any relationship to any of the others, you know? And you just have to wear that, you know? You just have to get used to that.

[00:38:59] Ryan Kevelighan: There's a standardized sort of bare minimum credentialing benchmark across the country and then all the different locations then start putting the extra levels of credentialing on top of it. And you're right, it does differ. It differs on a state by state, district by district.

[00:39:12] Jim Ferry: The thing is that working with children…I can't understand why working with children has to be, can't be a national thing. Each state has its own working with children parameters.

[00:39:23] Ryan Kevelighan: We've actually been pushing for that and trying to lobby for that for years now. Eight states and territories all differ. But there's some complications in it, as you know,
So, I think one of the things we spoke about when we were having a quick chat prior to this was just about how big Australia is. You know, for example, like WA is, what is it, 13 times the size of the UK? I can't remember. It creates different challenges that I think your average person who's, for example, a UK or Irish graduate who's come over here, who's maybe been in Australia for a year and hasn't seen the sights.

[00:39:52] Jim Ferry: First of all, WA rural health…in fact, WA metropolitan health would not survive without overseas doctors and especially Irish doctors. I just want to make that statement. The other thing I want to make before I answer, and you can ask that question again, is surely with an international medical graduate who's desperate to come to Australia, and most of them are, why don't they make it compulsory that they must work in rural areas for five years? I do not understand. That would solve a lot of problems.

[00:40:23] Ryan Kevelighan: They technically do through the Medicare, system for GPs, but then you've got the issue with the junior, more junior doctors going out to the rural areas where they don't have the supervision level requirements to meet them. So, they don't have the ability to supervise in some of these areas in any volume. So that's what keeps that particular piece, I believe, a bit of an issue.

[00:40:43] Jim Ferry: That seems to me on my travels. I have met very, very many overseas doctors, most of whom, I must say are very, very excellent, very lovely people, and we're lucky to have them.
With regard to the question… I'm sorry for diverging there, but with regard to your question about how big, WA is, well, WA is the size of Western Europe. But it's only a population of about two and a half million or three million. And there's a lot of very, very remote communities, which make them exceptionally expensive to service. It's compounded by the fact that a lot of the remote communities are indigenous and they have got major health issues. I'm astounded by the health issues.
And these poor people, they're living in very remote communities. The issue is that getting health access for these people is very, very difficult. I naively thought before I'd done Locums at the Royal Flying Doctor Service was some romantic thing with about three planes. It's actually a multi-billion-dollar business or enterprise and it's got about 80 or 90 planes and they're always busy.
The health system would collapse without the Royal Flying Doctor Service. And it's a very, very essential part of the whole system. And as I said, it would fall apart without them. And it's very expensive too, I would add.

[00:42:13] Ryan Kevelighan: I can imagine there's nothing… there's nothing cheap anyway in the system and certainly not flying planes around with, uh, with medical practitioners on it and one of Australia's biggest beauties is the country and the geography of it. But again, it's one of its biggest issues is just the tyranny of distance in every angle.

[00:42:28] Jim Ferry: Most of these places don't have an MRI, for instance.

[00:42:30] Ryan Kevelighan: Yeah.

[00:42:31] Jim Ferry: And so they have to be flown just to have an MRI. People in the city don't realize how lucky they are compared with people who live remotely. And as you say, by remotely, it doesn't have to be that remote.

[00:42:43] Ryan Kevelighan: No, not at all. And that should be not too far away from places. Well look, we've spoken quite a bit about your locum life and your previous career and stuff like that which has been very interesting. I mean, you've also got quite an interesting non-medical life. I mean, would you like to mention anything about telling… one of the things I get involved in conversations with doctors quite a bit about sometimes is about business interests and other sources of income outside of medicine to sort of have a… have a back full position for when the day comes that they might not wish to be in medicine and whatever that might look like. Is that something that you've, you've been involved with yourself?

[00:43:15] Jim Ferry: I think it's important, and… and most doctors have outside interests, at least I would hope so. Well obviously, there was my family, which is very important, and they still are of course. You say what do I miss out on by being a locum? Well, I have almost a daily coffee with one of my sons, Christian. And I miss that a lot when I go and do locum work to be quite honest with you. I miss just that daily chat with Christian. Uh, I speak to him on the phone but it's not quite the same thing.
Anyhow, to get back to other interests, yes, I actually in my earlier career as a GP, I played state league soccer.

[00:43:54] Ryan Kevelighan: Okay.

[00:43:55] Jim Ferry: And that's very important. By the way, again, I'm going to digress. I think that to be the best you can be as a doctor, especially in a stressful situation, like, uh, being a locum is, I think it's important to be physically fit. Now, you might think, what's that got to do with locuming? I think it has everything to do with locuming.
If you're physically fit, then it helps you emotionally and psychologically deal with the stresses of turning up to a place where nobody knows you and being expected to provide specialist services. And being physically fit is very, very important. I exercise for at least an hour a day. I do that as much for my head as my body. One of the reasons I do that is to make me a better doctor. You might think that's a long bow but it's actually not. And it's very, very important to be physically fit and it helps you cope with the stress of this job.

[00:44:52] Ryan Kevelighan: Yeah, there's a lot of connection between the two in, in all different types of careers. But I was going to say you…when you exercise daily, are you… are you swimming out the front?

[00:44:59] Jim Ferry: I'm swimming out the front. People say I shouldn't because the harbour you can be eaten by a shark, but…

[00:45:03] Ryan Kevelighan: You risk that every day, do you?

[00:45:05] Jim Ferry: I risk that every day. The first thing I do when I go to a place is find out where the nearest running track is or where the nearest pool is. And I make that a point of finding out where I can go at least for running.

[00:45:17] Ryan Kevelighan: You’d be a lot safer on the running track than you would in the water outside, the beautiful azure water outside the front there?

[00:45:23] Jim Ferry: Yeah, well, not many people swim in the harbour, but…

[00:45:26] Ryan Kevelighan: Yeah.

[00:45:27] Jim Ferry: I’ll take my chances right.

[00:45:28] Ryan Kevelighan: No, no, I'm touching wood. I'm touching wood there. That would give you some good luck. Any other final comments, advice, or anything you'd like to pass on? Any pearls of wisdom or…?

[00:45:36] Jim Ferry: Well, first of all, you asked me about, um, I get into developing. So, I've had a parallel career in developing. I've done some developing. And I own Level 5 where my colleague who is now running my practice works. And there's also an IVF clinic there, a pathology clinic, and some other specialists as well. So that's a source of income.

[00:45:58] Ryan Kevelighan: Yeah.

[00:45:59] Jim Ferry: I also… I'm the landlord of the original 4 Pines microbrewery in Manly.

[00:46:06] Ryan Kevelighan: Ah, yes. I forgot about this.

[00:46:07] Jim Ferry: That's a handy source of income. Plus, I like the idea that I own a piece of Manly's heritage because it is a bit of Manly's heritage. It's the original 4 Pines microbrewery. I also have a barber shop where my son works. So, I've got a lot of little business interests like that.
So, to be honest I don't have to work but I choose to work. The reason I choose to work… one of the reasons is it's good to be useful, and I just don't like any sort of waste. And to be honest, if I retire, all this knowledge that's in this little head of mine will be wasted. And to me, that's not quite right.

[00:46:44] Ryan Kevelighan: On that note, what do you see the next few years looking like? I know you mentioned you were going to have a holiday middle of this year and whatnot, but do you see yourself, um, still doing this locum work out in the field for the coming next few years and…?

[00:46:54] Jim Ferry: Well, for the next year or two year, I keep saying to people, I'm one bad… really, I mean in obstetrics, things can go very bad very quickly. I'm one horrible case away from retiring. That's one thing that stresses me out is, if you get a really horrible case, and believe me, they happen in obstetrics, your ability to cope with really horrible cases is not… as you get older, you just don't really want to be involved in any nasty cases anymore.
And an obstetrician she can't plan everything, especially not these. And the other thing is when you're working, say, in a remote area and something bad happens, there's nobody around to counsel you. They don't have psychologists out there. They don't have anybody out there who can help. So as long as things go well, I will continue to do it.

[00:47:44] Ryan Kevelighan: Good. It's… it's… as I keep saying throughout this, it's… it's great that there are people like you out there because in certain skill sets, especially obstetrics, you know, there's a… there's a real shortage of people that are abled in a position to do this type of work.

[00:47:56] Jim Ferry: Sometimes you develop a bit of the imposter syndrome. But I think most people if they're honest with themselves, they have that. What I do realize, especially working in, even in bigger places, is how much you've accumulated, how much knowledge you've actually accumulated over the decades. You tend to underestimate that but it's actually quite a lot. That all comes to the fore sometimes. Especially when things aren't going right or it's a difficult case, you tend not to panic.
I want to make one other point is, um, you spoke to me about, some places they grudge paying locum money or locum fees. They think it's too much.

[00:48:34] Ryan Kevelighan: Yeah.

[00:48:35] Jim Ferry: And I just want to make the point very clearly that the cost of not having a locum in many of these places far, far outweighs by a factor of 10 or even the hundreds far, far outweighs the cost of having a locum. Most places I go to, and I can think of a few examples where I have prevented a disaster simply by being there.
I'm talking about somebody who's got a severe ectopic pregnancy or sometimes whose head is stuck or sometimes, um, a severe postpartum hemorrhage and I'm the only person capable of dealing with that, these are potentially fetal deaths or even maternal deaths. And you only have to prevent one of them a year. And that has made the presence of a locum worthwhile.
I remember once. There was no obstetrician for two days which meant that anybody who was having a baby had to be flown which cost an absolute fortune. It cost ten times the amount a locum would have cost. And then the amount of, um, times that have saved the situation, which would have had severe medical-legal implications for the health board involved. The legal ramifications of me not being there wouldn't have saved them ten times the cost of a locum. I'm talking about hundreds if not thousands the cost of a locum. It's much, much more expensive not to have a locum than to have a locum, because sooner or later, something bad will happen and you will be very, very pleased that you've had a locum.
Many places I have worked, nothing much happens for a couple of days. But believe me, when there's a drama, it is a drama, and in obstetrics, it usually is a drama, and you must be there, you must be there, and the fact that you are there probably saved the local health authority a very, very great deal of money.

[00:50:31] Ryan Kevelighan: I couldn't agree with you more. We see it time and time again, the knock-on effect of there not being doctors in place and closing.

[00:50:37] Jim Ferry: I think it's a false economy, Ryan, not to have a locum,

[00:50:40] Ryan Kevelighan: I think in fairness to sort of reflect on the comment that I made to yourself, it’s not that everywhere feels like that. It's just that the general sentiment is that people always want permanent doctors. They don't want to be spending money on locums. It's probably a bit different out in the rurals and the more remote locations of the country.
But again, there's multiple different issues here at play because you've got different fields of medicine. Some are very locum heavy, some are less locum heavy. So. it's hard to put one sort of sentence across it. But, uh, overall, as we know, many, many, many places are very grateful for the service that gets conducted by the doctors and also even the locum agencies, It's just again, we're the first ones in the firing lines when there's any, grumbles coming back in the other direction.

[00:51:21] Jim Ferry: I'll say one thing that to be a good locum, it's not enough to be competent. Your personality is very important as well. As I said, you have to immediately almost ingratiate yourself with the local area and the local place and be kind, be helpful, be nice, and be a part of the team immediately.
And some people, the psychological makeup just isn't up to that. I have replaced many locums, and the comments made about the locums. And it's always, it's not usually to do with competence, it's usually to do with personality.
I once heard somebody say that locums are either mercenaries, misfits, or, um, missionaries. I totally disagree with that, of course. Most locums I see are actually overseas medical graduates trying to find their feet or transitioning to retirement guys like me.

[00:52:13] Ryan Kevelighan: And that's the thing. It's like anything. It only takes one or two bad stories or bad experiences, and then it creates a perception that there's much more of a bad going on when in reality, the majority of everything that's happening is actually very good, very positive. Dealing with people, Jim, it's like the old saying goes, there's nowt so queer as folk.

[00:52:30] Jim Ferry: Yeah, but the thing is, you know that you're popular or they like you because…

[00:52:35] Ryan Kevelighan: You get us back.

[00:52:36] Jim Ferry: They’ll say, “We like you and we want you to come back.” I mean, like, and most places they want me to come back. In fact, a lot of places offer me the job and they're very grateful and they would love you to come back.
And to be honest, that… that's a good feeling when they say, “We like you. And we would like you to come back,” you know. Call me a sucker, but I like when people say that, you know, it means that I've been useful. Those comments are as much about my persona as they are about my competence. So, I'll say it again, your personality as a locum is just as important as your competence.

[00:53:12] Ryan Kevelighan: Yeah, no, I think very, very valid comment and not just applying to doctors, applying to… applying to everyone.

[00:53:18] Jim Ferry: But in obstetrics, things can go bad very, very quickly, and somebody can have a severe bleed very, very quickly and you have to have somebody there. It can be quite scary at times. I… I really have to say that, it can be quite scary and it can be quite a lonely place at times,

[00:53:32] Ryan Kevelighan: Thank you, Jim very much for your time for the last, you know, hour or so. Hopefully, been enjoyable experience for yourself and I'm sure it will bring a lot of insight into a lot of people who may also being experienced locum and… and just like hearing the war stories as well, or whether it's a junior doctor that's not locum yet and wants to hear it from somebody who's, uh, experienced in many different places in multiple different countries.
So, uh, overall, very interesting and thanks again for your time, Jim. So, uh, we… we look forward to hopefully having you out and about and servicing in-need spots of Australia for the foreseeable future.

[00:54:05] Jim Ferry: Thank you, Ryan. As I say locuming isn't for everybody, but it can be quite rewarding, be it temporary or permanent. I look forward to doing it for the near future at least. So, thank you again, Ryan.

[00:54:16] Ryan Kevelighan: Much appreciate it, Jim. All the best.