Surely being a locum is all about doing a few weeks' work, charging megabucks to do surgeries and then zooming off as an expedition doctor, watching wildlife in Africa while treating the odd case of sunburn. In your dreams.
True, locums have flexibility, but as most quickly realise, flexibility comes at a price. GP partners and salaried GPs are buffered by the structure of the practice while locums have to manage everything for themselves.
Locums, like a self-employed businessman, all too often work when they would be better off home in bed, or at least with their feet up resting. Under pressure to fulfil commitments and to pay the mortgage, we exempt ourselves from the counsel we offer patients. And the cost can be to our long-term health.
Probably the most important step a locum can take to maintain a healthy work-life balance is to do a personal audit. And like all audits, it is only useful if it is acted upon and repeated at intervals.
Sit down and ask yourself some basic questions. Involve your family; their quality of life is at stake as well as yours. What are your financial needs now and in the foreseeable future? How do you see your career developing and what are your ambitions, both professional and personal?
How much money do you need? And how does this translate into hours of work per week, month or year? Is such a workload sustainable? If not, how can you increase your rates or cut your costs?
You may need to prioritise income generation for a while, but set limits. And if you are continually in danger of toppling over the financial cliff, revise your priorities. How important is it to send your children to private schools? Will the family really enjoy a holiday in Disneyland in Florida more than camping in France?
Beware of conscience creep: don't allow pleading practice managers to manipulate your good nature. Build time off into your schedule. Make sure that you block off important days so you don't miss seeing your daughter in the school play or your son scoring a hat-trick.
Build in holidays. Ring fence these areas as rigorously as the royal enclosure at Ascot. And if your family complain that it doesn't see enough of you, look for something you all enjoy together. Whether this is going to the local swimming or jigsaws, it doesn't matter as long as everyone has fun.
Insurance is important to peace of mind, but it always seems very expensive, until you need to call on it. Then it is worth every penny. Sure, if you could bear the cost of triplets, don't pay to insure yourself against multiple births. But if an accident or chronic illness would leave you and your family struggling financially, you need to protect against the risk.
Invest in your health, and heed your GP's advice and your own common sense. If you are not well, don't work. Other GPs at the practice can cover for a GP off sick, but locums have to be on top form every session they work.
Doctors who are unwell make more mistakes. And it is not just patients' health which is at risk. It's your health and your career too.
Burnout and 'rustout'
Burnout is a common problem. 'Rustout' (boredom at work) is also corrosive to happiness. If you are exhausted or bored how can you revive yourself?
A new professional interest perhaps. There are plenty of opportunities: teaching, medical politics or learning a new clinical skill, for example. Or a hobby.
Do something creative (interpret this broadly), which gives you back some of what medicine takes out of you. And you don't want to reach retirement wondering what might have been. So if you have a desire to work in the Australian outback or play the cello or climb K2, start planning now.
As a locum, you have to shoulder the personal administration of your career, which partners are spared, more or less, because there is the practice manager and practice accountant to look after most of it for you.
But even locums can delegate. Is there a locum chambers near you, or could you start one? A chambers gives you not only administrative and financial back-up but also colleagues.
Isolation is a threat to locums and if your work-life balance is out of kilter, colleagues offer a sounding board and a way of recalibrating yourself. If you are persistently at the wrong end of bell-shaped satisfaction curve, you need to take action. A mentor could help you tilt your life back into balance.
Like everything else in a locum's life, achieving a satisfying work-life balance is no one's responsibility but yours, and it is in your hands. It's your life and happiness, and your family's too. It's worth working at.
- Dr Harvey is a freelance GP in central London
|Get the balance right|
Do a work and life audit involving your family and their priorities.