Marlene Buckler, MD, FACEP

     Locum Journey: Overseas and In Canada

     In the summer of 2007, after fifteen years of full-time emergency medicine practice, I decided to treat myself to a year off.  The relentless pressures of twelve- hour shifts in a busy Florida ER were beginning to take their toll and I was overdue for a rest.

     My long-standing marriage had ended and the thought of living on my own resulted in both excitement and a modicum of trepidation.  After a few months off, having time to my self to regroup and savor some of life's simple pleasures began to feel exquisitely therapeutic.

    Perhaps I would just retire and concentrate on writing and developing my website.  But like most ER doctors, the challenges and satisfaction of treating patients still held a certain appeal, so at the end of the year, when a job opportunity in New Zealand presented itself, I said an enthusiastic yes to travel and to adventure.

    Picturesque Wanganui sits on a meandering river on the southwestern coast of the North Island of New Zealand.  The city's population of almost 40,000 is comprised mainly of European descendents and of Maori, New Zealand's indigenous people.  The warm welcome I received both at the hospital and in the community proved to be an omen for things to come.

    Most international flights enter New Zealand at its largest city, Auckland.  With 1.4 million of the country's total population of 4.3 million, Auckland is indeed a modern and stimulating city.  Foreign doctors arriving to work in New Zealand are required to meet with a representative of the NZ Medical Council before being granted a final license to practice.  This requirement gave me a day to explore the “City of Sails” before flying on to Wanganui.  Having arrived in September, spring in the southern hemisphere, I was treated to sunny weather, perfect for walking around the Auckland waterfront.

    New Zealanders have been ranked as among the happiest people in the world.  This will come as no surprise to anyone who has visited that enchanted South Pacific island nation.  Everywhere the visitor is greeted to down-home hospitality, friendly faces and some of the most beautiful scenery on the planet.  Add in delicious food, some of the best hotel accommodations anywhere, low crimes rates and a high standard of living and it's easy to see why one visit, even a six-month-long one, will never be enough.

    New Zealand enjoys a modern health care system with state of the art medical practices.  Free health care to citizens includes Accident and Emergency (A&E, i.e. ER) and in-hospital care, lab and x-ray, pregnancy and childbirth services, specialist care and subsidized prescription medications. School children get free dental care.

    Though all modern medical technologies are available and are utilized, there seems to be less reliance on CT's etc. and more emphasis on history and physical exam.  Remember those days?  Specialists are willingly come to the ER to evaluate patients and surgeons never ask “What did the CAT scan show?” when you call regarding a patient with abdominal pain.  The surgeon comes and sees the patient.  It is felt that a person should not be exposed to the radiation of a CT scan just because the surgeon doesn't want to be inconvenienced.

    Almost all patients have a doctor in town, a GP (general practitioner).  When discharging patients from the ER one knows that follow-up care will be provided. This spirit of community support and concern for the welfare of others is typical of New Zealand.

    Locum doctors are not well paid in the land down under but most are provided with free use of a vehicle, accommodations and transportation to and from the country.  Doctors are not sued, though one can be reported by a patient to the health board. 

    So, if you can afford to take a financial loss and a six to twelve month break from your current American ER job, there is no doubt you would be welcomed with open arms.  You'll not regret your decision to experience emergency medicine in the land the Maori call “Aotearoa'

    After returning from the adventure overseas and resting for a couple of months, I left Florida, bound for my native land, to work for six months in the ER at Queen Elizabeth Hospital (QEH), in Charlottetown, the capital of Canada's smallest province, Prince Edward Island (PEI).  I had not worked in a Canadian hospital since immigrating to the USA in 1993.

    Some Americans are under the impression that Canada's universal health care system leaves many of its citizens without timely treatment. Though it is likely that Canadians will wait longer than their American counterparts for some elective surgeries such as hip replacements, etc. emergency care is no different than that in the States, at least no different in any negative way.

    ER's in Canada evaluate and treat all patients who show up, just as is the case in the US.  EMS and triage systems ensure timely care for all who need it.  At the QEH, a teaching facility and the major referral hospital for PEI, specialists are not only willing to come evaluate patients in the ER, they are actually pleasant about it.

    Follow-up care for patients who may go home, but need to see a specialist, is often accomplished by the following day.  How's that for service?  And believe it or not, suicidal and psychotic patients are admitted to the hospital (not transferred elsewhere), and five Psychiatrists taking turns on call, actually come see patients in the ER.

    Medical and surgical patients too sick to go home are admitted to their GP's, to a hospitalist or to appropriate specialists.  I never encounter any resistance when calling to have a patient admitted.  In fact I would say that the QEH medical staff is the happiest and most cooperative group I have ever encountered.

    My daughter's plans to start Veterinary Medicine at UPEI influenced my decision to work in Charlottetown.  It has turned into a six-month locum, sailboat racing all summer, excellent pay and working with a great group of ER docs and medical staff.  I have been asked to return next summer and plan to do so.  What's not to like?

    The recent emergency medicine climate in the USA and especially in Florida has become unfriendly to non-boarded docs. More and more doors are closing.  Despite recent work force studies illuminating the reality that the supply of RT/BC EM physicians will not meet the demand for 20-30 years, if ever, hospitals persist in turning away highly competent ER doctors.

    In New Zealand and in Canada there is an appreciation for knowledge and experience.  Doctors are respected for their skills and competence.  Of course residency training is valued, as it should be, but those who began their careers when emergency medicine was a younger specialty are seen as a valuable resource to fill a need that won't go away any time soon.

    My permanent home is in Florida and I will likely return to practice there soon, but for now I am off on another adventure, this time to England for a few months' work. Doing locums can be fun and fulfilling.

    If any of you wants to know more about it email me by visiting my website at www.StayOutOfMyER.com

                         Marlene Buckler, MD, FACEP

                         www.StayOutOfMyER.com

                         Sarasota, Florida