At the completion of this article, the reader should be able to prepare their practice for a locum optometrist, including:
• Know the equipment necessary for a successful locum
• Develop strategies to facilitate seamless locum experiences
• Review the trading structure options and tax obligations of a locum
• Understand the importance of thorough record keeping
• Know what to include in patient notes to practice optometrists, and why
It takes two to locum: the visiting optometrists and the resident practitioner. As Andy Shao points out in this non-clinical CPD article, some preparation by both parties can make the experience gratifying and successful for all.
Andy (Yixiang) Shao
Specsavers Mobile Optometry Team
My name is Andy Shao and I am a mobile optometrist for Specsavers based in Perth, Western Australia. I’ve been in my current role for the past year and a half, and my position has given me the opportunity to enhance not only my clinical knowledge and skill, but also my understanding of myself as a clinician-at-work, as well as my personal life outside of work.
For the locum or mobile optometrist
The experience of being a mobile optometrist for Specsavers is similar to that of a locum.
We are expected to work in different clinical settings almost daily and our workdays can vary greatly – every clinic has its own intricacies and ways of operating. Because of this, it’s important to be adaptive and well-prepared for anything the day can throw at you.
This includes having all the necessary equipment with you:
• Alger brush and foreign body remover, especially in regional settings where there is less accessibility to care and higher incidence of foreign body injuries.
• Amsler grids or access to printable templates. Less accessibility to ophthalmology care means more responsibility on the patient to monitor for any progression which may require further investigation or treatment, and more importantly, on you as the clinician to give the patient the appropriate advice and care to allow for best outcomes.
Travelling to different clinics almost daily means meeting a lot of new colleagues and forming and building these relationships in the short amount of time you are there.
Due to these time restrictions, your actions and behaviour will have a greater impact on their impression of you, especially during your first meeting.
Reputation is critical to being a mobile optometrist or locum, as you are your own ‘brand’ and employers look not only at your clinical skills and performance, but also in your ability to work smoothly within the team.
• Be punctual and attend morning team huddles. This can make a great impression on team members, as it shows your willingness to participate and work with the team. This also gives you sufficient time for the team to show you the layout of the practice and their way of managing their diary and clinic etc, as well as answering any questions you have before starting the day.
• Be proactive and help the team when possible. This piece of advice is especially relevant today, as from my experience, most practices are short on staff and will often be running on a skeleton crew especially if there are last-minute illnesses. This may include doing your own pre-testing as well as taking the patient to start frame-styling if no dispensers are available for a handover.
Being often in new clinical settings will mean you don’t have the pre-existing rapport with colleagues and this needs to be built at the time. Often this can lead to more difficulty in effective communication, especially when handing over a patient.
As every patient’s visual needs are unique, it is essential to gather the relevant information to formulate the best and most appropriate recommendations for their needs. As optometrists we are familiar with building trust and relationships with the patient over the course of the consult, so we can recommend and deliver the best health and visual outcomes for the patient. However, sometimes this is not as easily communicated to the dispenser during a handover, especially when working in a new or foreign environment without the established relationship between the optometrist and the dispenser.
It’s important to make sure the patient understands our recommendations and address any concerns they may have prior to the handover; this allows the patient to have a better understanding of what to expect from the coming discussion with the dispenser and leaves less room for uncertainty in both parties.
During the handover, it is important to check in for any final questions the patient may have, or offering assurances and demonstrating that the patient’s concerns have been actively addressed during the consult. It is also important to communicate to the dispenser any relevant details of the management plan, which may include a specific recall period or the need to book in for additional testing or review.
Sometimes it may be helpful to highlight or write any additional notes on the patient board which may go unattended, especially in a busy clinic where another colleague might take over during the dispensing process. This reduces the risk of incomplete care or management for the patient.
Effective note taking and best patient care
Thorough and effective record keeping is essential as a mobile optometrist or locum, especially if you are working only for one day at that specific location and won’t be returning in the near future.
This becomes especially important in the case of ocular emergencies or acute conditions which require therapeutic management, such as keratitis or uveitis. I’ve worked in clinics where I was the only therapeutically-endorsed optometrist, so I had the responsibility of providing appropriate care for the patient as well as giving the next optometrist clear notes for review.
Sometimes it is helpful to take an anterior slit lamp photo with your phone and either give the photo to the patient to show the next optometrist or securely store the photo on the computer or patient file. Having access to a photographic view of their condition is often much more helpful than trying to describe their signs, which can lead to confusion or uncertainty.
In other cases where immediate review is not necessary, it’s important to write effective notes to allow best patient care. Make your notes easy to understand for the next optometrist. Include a clear management plan and an appropriate recall period, as well as communicating these to the patient and front staff if necessary.
For optometrists employing a locum
If you are an optometrist partner/owner of your own business considering a locum, there are a number of points to consider.
Good communication with the locum prior to their shift is essential. It builds the relationship prior to meeting them, especially if it’s their first time working at the practice. Remember to provide the locum with a contact number, in case they require any assistance during their shift and other staff aren’t able to help with certain queries.
It’s also important to make sure the locum is aware of their start time and working hours, giving them the necessary information to set up their provider number for the practice such as ABN and contact details for the practice, and any other useful information which can assist with their travel and finding the practice. This may include information about any dedicated staff parking areas or alternative arrangements for parking, which is especially useful if the practice is based within a shopping mall or in an area with limited parking options.
Informing the team about the locum’s upcoming shift and delegating the clinic coordinator/manager or another staff member to greet and show them around the practice once they arrive is very helpful in settling them in, as well as discussing other details they should be aware of. Inviting the locum to the morning team huddle can also help them settle in as any concerns can be easily addressed before opening for the day.
Often times, different practices will have different equipment and machines available, as well as specialised care the clinic may be responsible for. Before booking the locum in, it may be beneficial to check with them any specialty cases they are comfortable seeing and if there are certain demographics or conditions they may struggle with. This may include complex contact lens fits and assessments, paediatric care with very young children or infants, low vision patients or co-management with ophthalmologists. Keeping an open channel of communication before their shift can reduce the risk of any incompatibilities or difficulties they may face on the day with certain specialty care.
This may also apply for busy clinics running on shorter testing time, as some locums may not be comfortable working a 20-minute clinic and may require or request for longer test times. Therefore, it is important to check with the locum beforehand when booking them in to make sure they are comfortable with the set testing time. It may be appropriate to block out some admin time for them to catch up or write referral letters and reports if the clinic is expected to be very busy in the day. This may be done either during the day or towards the end of their shift depending on the practice’s preference.
Checking availability of locums and booking them in advance can save stress during busy periods of trade. This may be dependent on location as some cities and areas have a larger pool of locums and mobile optometrists available, whereas smaller cities and regional towns may struggle to find cover on short notice.
In Perth, there is a significant shortage of locums during the year so planning ahead and checking for optometry cover well in advance is recommended, even more so for remote areas where locums may have to be flown from interstate.
Being a locum isn’t for everyone, but I can honestly say there is really nothing quite like it.
Whether you choose to be a Specsavers mobile optometrist or to locum, the experience offers travel and the flexibility to make lifestyle choices that a permanent role may not allow.
For the optometrists who employ locums, it’s important to be clear with them – and yourself – about your expectations around productivity, clinical testing and staff support.
For the locum, it’s important to understand that ‘work’ is an important part of the acclaimed ‘work-life’ balance that the experience of being a locum affords. Ultimately, although being a locum offers a lot of freedom, it’s based on your ability to keep and stay organised – with your patient notes, with your handover notes and with your finances. If you are a self-starter that can do this and stay flexible, I can almost guarantee you will enjoy your time as a locum.
Crunching the numbers
Members of Specsavers’ mobile optometry team provide relief for Specsavers practices. And although it’s a lot like a locum position, these positions come with full-time contracts and benefits such as sick leave and annual leave.
Being a locum can be rewarding or frustrating. You have the power to make it successful, but it does take some preparation and planning. First off, there are a number of financial requirements when working as a locum that don’t apply when you’re a full- or part-time employee (you won’t receive sick leave, holiday leave, carer’s leave, superannuation or other employee benefits). Locums are also at the mercy of the needs of business, which can fluctuate depending on the location you are working for.
The best advice I can give any optometrist considering establishing themselves as a locum is: get more advice. There are a lot of legal and financial requirements involved in setting yourself up, but consulting with an accountant who specialises in taxes can help lower the barriers.
Locums operate under ‘sole trader’ or ‘company’ trading structures. As a sole trader you don’t have to register a business name, as you can use your own personal name. As a sole trader you can also use your individual tax file number (TFN). However, you’ll need to manage your own superannuation, payroll tax and insurance.
For a sole trader, ensuring you have the right insurance coverage is very important.
A sole trader owns all the business assets and is responsible for all the liabilities of the business. Liability is unlimited, it can include your personal assets, including any assets you share with another person, such as a jointly-owned home or money in a joint bank account.
Usually, a company has members (shareholders) who own the company and directors who run it. But an independent contractor can set up a ‘one-person company’ with a sole director and member. While ‘companies’ have limited liability, ‘directors’ can be personally liable. Regardless of your status, insurance is required.
The provision of optometric locum services is a taxable supply for the purposes of Goods and Services Tax (GST). If you anticipate that in a year you would earn more than $75,000 from being a locum, you have to register for GST. (In order to register for GST you will also need an ABN).
You can register for GST and a range of other requirements depending on your tradingstructure, through the Australian Taxation Office (www.ato.gov.au/Business).
Don’t forget superannuation
If you are providing locum services as a sole trader, you are responsible for your own superannuation arrangements. This is also important to remember when you are setting a pay rate for a locum assignment – remember to include your superannuation rate in your expenses.