‘Almost everything about life in Sydney feels better’

Four weeks in an emergency department gave Laura Brown a glimpse of her future

Laura Brown gets her citizenship from  mayor of Sydney Clover Moore.

Laura Brown gets her citizenship from mayor of Sydney Clover Moore.

 

This article forms part of an Irish Times Abroad series focusing on healthcare workers. Where are the job opportunities for those interested in moving overseas? How do salaries and working conditions compare? Irish healthcare professionals already working overseas, from dentists in the UK to psychiatric nurses in Tasmania, have been sharing their experiences with readers. See irishtimes.com/abroad for more.

For the past four years Laura Brown has been finishing her training as a doctor in Sydney. The 29-year-old from Castleknock in Dublin, studied medicine as an undergraduate at University College Dublin and graduated in 2010. Her year as an intern at St Vincent’s University Hospital was “one of the best and one of the worst years” of her life, she says. The cuts being made in Ireland make it less and less appealing as a place to work, she adds.

What took you to Australia?

When I was in my final year of medical school I came to Sydney on an elective with my best friend and we spent four weeks as students in an emergency department. I think this was what first sparked the idea of working in Australia. A huge number of Irish graduates come here on a working holiday after completing their intern year. Of my graduating class I estimate that about 30 did so.

My initial plan was to spend six months working in Australia and six months travelling the world. I fully intended to return to Ireland, where I already had a job secured on an SHO (senior house officer) scheme in paediatrics. I got a job at the same emergency department that I had attended for my elective, as did one of my university classmates, and so we came to Sydney together.

I quickly fell in love with Australia and, by the time I had completed my intended six months of work, I had decided that I was staying indefinitely. I have been in Sydney now for four years.

What do you do there?

I’m employed as a full-time emergency trainee in Sydney, in a position that would be equivalent to an SpR (specialist registrar) training position at home. I have just over two years of training time left. Should I be able to jump the small hurdle of fellowship exams in that time then I will be eligible to apply for consultant positions.

How does working as a doctor in Australia compare to Ireland?

Almost everything about my working life in Sydney feels better, and I have struggled over the years to try to put into words exactly why this is so. I think the first and biggest difference is my hours. In Australia I work a 40-hour week. In Ireland I routinely worked double that, in fact I remember submitting timesheets with the number of hours I worked per week in triple digits.

In Australia we work shifts. I am rostered to start and finish work at a particular time. There is a period of overlap between the end of my shift and the start of the next to allow for an effective handover to take place and for me to tidy up any jobs I might have before leaving.

This happens not only in emergency departments but on the wards, where non-consultant hospital doctors might be rostered on for a week of night shifts and then be given a week off.

What happens in practice in Ireland?

In Ireland, once or twice per week I would work my day job, continue working all night, and then start my day job again in the morning.

If I was lucky I would be sent home from my day job at about midday the day after having worked all night. This was completely dependent on the team with which you were working, and I remember often being made to feel like I was shirking my duties for leaving by more senior members of my team who were left to pick up my slack. If I do have to stay after my shift in Australia I am paid overtime, no questions asked. My seniors encourage me to claim overtime for any excess hours that I work, and will sign off and approve timesheets with overtime hours.

How does the work culture differ?

At work I feel better supported by my senior colleagues and by nursing staff. Nursing staff here cannot believe that most nurses in Ireland do not perform basic procedures such as electrocardiograms (ECG), venepuncture and inserting cannulas. Many of the nurses in Ireland are capable of doing these tasks but don’t, as it is not in their job description. They will instead call the intern, who is already stretched. I remember being called at 4am to perform a routine ECG and blood test on an asymptomatic patient – tests that here would be performed by the nurses – and bursting into tears as it was the first time I had sat down to have anything to eat since 6am the day before.

What would you change about the Irish health service?

In Australia there is a designated “sick relief” doctor to provide cover for doctors who might be ill. This doctor is paid a token fee for being on call, even if they are not called in. As such, it is possible and even encouraged to take legitimate sick days when necessary, so that the doctors caring for patients are appropriately fit for the job. That needs to happen in Ireland too.

In Ireland it is unheard of to call in sick as there is no one to replace you. So it is up to your team to pick up the slack. HR seem indifferent about this and do not see it as their responsibility to find a replacement.

I recall a medical registrar calling in sick five days in advance and no replacement being found. I had been a doctor for about six weeks at the time and diagnosed a patient on the ward with a STEMI – a massive heart attack. There was no medical registrar for the ward, the medical registrar for the emergency department refused even to talk to me because she was already so stretched, and the cardiology registrar on call refused to talk to me as an intern until I explained that there was literally no one else available to help me manage the patient.

I was rostered to work Christmas Day and on December 23rd the intern meant to be working with me called in sick. Again, HR washed their hands of the situation, and I was left to work two people’s job for 24 hours. HR did not pay me any extra. Out of the goodness of their hearts some of my friends came to work an hour each to help relieve me. They were not paid either.

Another time I developed norovirus while at work overnight. No one was available to relieve me, so I had to continue to work, occasionally having to run from a ward into the hallway to vomit before washing my hands and returning to my patients. Although I knew I posed a risk of spreading infection to them, if I didn’t keep looking after them, no one else would.

The other time I had to call in sick was with a back injury when I physically could not walk. My team were incredulous, and I was back to work the next day.

Do you see yourself returning to Ireland some day?

I find it difficult to imagine returning to Ireland when my hours and lifestyle here are so much better. Ongoing cuts and re-negotiations of consultant contracts make returning home unappealing both in terms of lifestyle and finances. I can understand the lure of home in terms of friends and family, but the working situation is truly off-putting. As such, I intend to stay in Australia in the long term.

This article forms part of an Irish Times Abroad series focusing on healthcare workers. Where are the job opportunities for those interested in moving overseas? How do salaries and working conditions compare? Irish healthcare professionals already working overseas, from dentists in the UK to psychiatric nurses in Tasmania, have been sharing their experiences with readers. See irishtimes.com/abroad for more.