Australian planning to work as a GP locum in Ireland? Read on….
WARNING/ DISCLAIMER
The opinions, comments and pure sarcasm in this blog post are mine and mine alone! Read at your own risk!
Introduction-and a word of advice to EU doctors
This blog post is written for Aussies but don’t let that put you off. A lot of the general comments can be applied to you if you are from another country, however, bear in mind that there is a world of difference between EU doctors and non-EU doctors. If you are a doctor from the EU its like this: you can plonk yourself in Ireland and not speak a single word of English. You get registered virtually automatically and can stay in Ireland as long as you please-so if you are EU, stop reading and have a nice day!
Having said that, God help you and your patients if you do NOT speak English to an adequate standard-the authorities will not stop you, but YOU should-it is morally indefensible for you to come to this country and not be able to communicate and give people the service and professionalism that they deserve and expect.
Note: There is an exception, and that is you wish to take up a State contract with GMS contract (contract Irish GP’s have with the State to see private patients), you will be required to sit an IELTS exam and achieve a score of 7.5 or higher. However as a locum, no English exams are required whether you hold General or Specialist registration with the IMC.
This blog probably applies most to Aussies, Kiwis, Canadians, South Africans, and any Yanks who discover that there IS a world outside the United States of America.
OK so you are an Aussie GP, what needs to happen?
I won’t go into the motivational stuff-working in Ireland is wonderful and compared to the isolation of Australia to be able to travel to every point in Europe within 2-3 hours is a real change. So… I assume you are motivated by the opportunity to live in Europe, and are adventurous enough and open-minded enough to want to try and work in a different system.
Irish Medical Council (IMC) registration
Registration with the IMC is the first essential step. The good news is you can still apply for mutual recognition as a GP in Ireland if you have the FRACGP. Registration is granted for unsupervised practice under a certain section of the Act. Get you paperwork correct and submit the hard copy documents and you will find that for Australians, the process is pretty straightforward. It took me the grand total of 6 weeks from start to finish. But I’m bloody good with my paperwork and I kept in regular contact with the Council. It helps greatly that we speak the same language. Get this sorted before you arrive in the Republic.
In summary here is the process:
• Set up an online account @ www.medicalcouncil.ie
• Upload documents requested
• IMC will verify uploaded documents and request that your documents be submitted by post for further verification
• Documents Submitted by post must be notarised and translated (where necessary)
• Registration will be obtained within 6 weeks from date your documents arrive at IMC by post
• DO NOT DRIP FEED DOCUMENTS BY POST OR YOU WILL KEEP GOING TO THE BOTTOM OF THE PILE AND NEVER GET REGISTERED
Medical Defence
Professional indemnity (PI) insurance is required if you want to practice in Ireland. There is good news and bad news with this. The bad news first: although your Australian insurer will cover you for overseas practice, this does not mean your employer in Ireland will accept this as adequate. You will need to get local PI cover. The good news is that the Medical Protection Society (MPS), which is the biggest insurer in Ireland will cover you. There is also another mob called “Medisec”
Obviously, you have to make application, and the good news is that, unlike Aussie PI firms, they will cover you for non-continuous periods in a year. In other words, if you only work in Ireland, say, 2 months then go travelling for 2 months, you can suspend your subscription for the 2 months you are not practising. I reckon that’s pretty good.
Continuous Professional Development/ Professional Competence Scheme
The good news here is that the RACGP QI&CE is accepted as evidence of adequate CPD. Thank goodness Australia has, probably, the highest regarded GP CPD program in the English- speaking world. Note however, that if you stay in Ireland for longer than a month, you may have to apply for the Irish College of GP program-check with the MCI.
Working with Children – Child First Certificate
Ireland unfortunately has had a pretty traumatic history of child sexual abuse over the past century. In order to work as a GP (or anybody who comes into contact with patients where the HSE pays you, doctors, nurses, pharmacists, medical secretaries, receptionists), you will need to complete an online course known as the Child First Certificate that makes you aware, as a provider, of child exploitation and its signs and initial management. It is provided by the HSE, which is the health service provider in Ireland. You will need to finish this course online and download the certificate to present to your employer or locum service. I thought the course was brilliant-why? To me, the Irish accent sounds like music, so in a strange way, it was a pleasure simply to listen to the people they used as actors in the training.
Permission to Work in Ireland – the Visa/Work Permit Process
Nowhere is the legislation so subject to change as work permits. Assuming you are not on the EU no-questions-asked category*, you will need some kind of work permit. The main permit for non-permanent work is the Atypical Working Scheme permit (AWS). This allows GP’s to work as locums for up to 90 days. You can leave Ireland effective 21st November 2019 for a maximum of 14 days during a 90 day permit, if you go over this 14 day allowance, your permit is void and you cannot re-enter the State There is quite a bit of documentation required to be submitted with the AWS permit application so the one who is going to help you in this area is your locum agency-more on this later, but I recommend arranging your locums through a locum service and NOT trying to do it yourself.
Getting a job
OK so you have done most of the above, as a GP you now have 2 options.
1. You can find a job yourself
2. You can use a locum agency
1 Let’s talk about option 1. Unless-and this is a big IF, you know the doctor who is going to employ you, you have got rocks in your head if you do this. To me, it is like lending your car to someone you do not know, good luck. You need to understand that GP in Ireland is much like Australia about 20 years ago in this sense: the solo GP is still the norm. Group practices are still in the minority, at least outside the big cities, and often where there are groups of GP’s you will find that, although they share certain overheads and costs, they operate completely separate practices in the one building! So Ireland has not ( yet) seen the corporatisation and “agglutination” in the medical services market we experienced in Australia the 1980’s.
So…what… you say. The corollary of this fact (=that most practices are solo) is this: there are a certain proportion of fruit loops who work solo GP simply because they cannot rationally work with anyone else. The problem with being the Aussie locum is that you do not know which practices are run by GP’s whose business practices are less than respectable or just plain slack, and which ones (=the overwhelming majority) are ok. Or to put it another way, you do not know which doctors will pay you once you finish. Add to that the fact that (as we all know) most doctors are slack when it comes to administration and documentation, so if you are reliant on that doctor getting the immigration AWS permit for you, you might be waiting a long time.
So unless the GP happens to be your uncle or someone you can have comeback with-don’t touch it! Use a locum service.
2 Just in case you are one of those people who have trouble picking up subtleties, let me state: I advise you to source your locums through a locum service. It is not a guarantee of an absolutely seamless experience but goes a loooooong way to ensuring the experience is a positive one. A good locum service will provide a local contact (vital for getting a PPS number-see below) and, if they are a good one, look after you.
No prizes for guessing which locum service I use-you work it out. And, NO, I do not own shares in the company and, NO, I am NOT getting 50000000 euros for writing this spiel. I can attest ( =from direct personal experience) that Tom runs a bloody good operation and I want to help him out by writing something for his website.
PPS number
The PPS number is like your ATO tax file number. If you do NOT have it, you will not perish. But your pay will-if you do not quote the number to your employer, they are obliged to take out a massive amount of tax, let’s say its 60%. The problem is that you must apply for the number in person in Ireland and you need an address in Ireland. This is where you locum service comes in. I applied for my PPS number and received it on the spot (more or less). The card turned up some weeks later at the locum service address. Job done.
Income tax
I am now getting writer’s cramp (=or the laptop equivalent of it) so will leave this topic for another day. But in summary: it is relatively straightforward to submit an income tax return at the end of the Irish tax year (=which goes from 1 Jan-31 Dec) and get a refund in Euro paid into your Ireland EUR account. The entire system is online and you can also claim income tax deductions online as well. Just to state: it can be done, and it is very straightforward. I submitted a claim for the 2018 tax year in January and the Euro were deposited into my account by March.
Pay
Your locum fees are paid at the end of the locum. Many GP practices still pay by cheque (remember those?). Usually the practice will pay you, but sometimes it’s the locum service, it all depends. The bottom line is this: compared to Australian GP locum pay, Irish GP locum pay is much lower. Also, there are not the extras you expect in Oz-like, for example, a vehicle. Accommodation is always paid outside Dublin but is never paid for weekends you are not on duty. My advice is: suck it in, if you are a Princess and expect to get the megabucks you get in Australia, don’t leave: stay in Alice Springs or wherever remote location you work. My other advice is this: shut up about the locum rates in Oz, nobody is interested, and, besides, it is not why you decided to come to Ireland is it?