Understanding the Role of a Resident Medical Officer in Relief in New Zealand

Recruitment adverts for resident medical officers (RMOs) in the field of "relief" often confuse junior doctors who are unfamiliar with the healthcare system in New Zealand and this unique area of medical practice. This article aims to shed light on the role of the "Relief Junior Doctor (RJD)", its scope of practice and responsibilities, its advantages and disadvantages and why this job could be the right career step in your medial career.

New Zealand has a deficit of medical graduates to fill all the RMO vacancies in the national healthcare system and relies on international medical graduates (IMGs) to work in these roles on a short term or permanent basis. For some IMGs, New Zealand is a destination of choice for vocational (residency) training in a specialist field whilst for others it offers a short term opportunity for a fellowship program or just experience of life and medical practice in a different and exquisitely scenic country.

One issue which intrigues seekers of house officer and registrar jobs is the role of the relief junior doctor, usually a house officer and less frequently a registrar, and the inevitable decision of its appropriateness as a starting job in New Zealand.



What is a Relief Junior Doctor?

Relief junior doctors (RJDs) are defined as postgraduate year 2 or higher (PGY2+) house officers and registrars who provide cover for absent colleagues. A PGY2+ junior doctor is generally expected to be rostered to at least one 3–4-month relief rotation per year. This “relief system,” although not entirely exclusive to New Zealand (it also features in Australia), is more ubiquitous and prevalent in the New Zealand healthcare workforce and creates a significant number of vacancies.

The RJD position exists primarily as a service requirement to plug deficiencies in junior doctor rosters, and provides the RMO with a wide range of clinical experience across several specialities. However the consequence is a sub-optimal and fragmented clinical experience which undermines the educational value of the rotation due to compromises in the continuity of care, curriculum and supervision. To at least partially compensate for the inconvenience, RJDs are paid two pay-categories above the usual (ie, non-RJD) pay category.

The exact nature of the work required of the RJDs varies. During workhours(ie, 0800–1600), RJDs may be allocated to certain specialties for the entirety of their rotation (eg, cardiology relief), or work as general relievers. After-hours, RJDs fill gaps in the on-call rosters based upon need and each RJD’s level of expertise. By contract, employers are required to inform RJDs of their rosters at least two weeks in advance. This is particularly relevant for on-call duties, as allocation for work-hours duties may change on the day if an RJD is required to be re-deployed to cover lastminute day gaps.

The Types of Relief

The New Zealand Resident Doctors’ Association (NZRDA) and the Specialty Trainees of New Zealand (STONZ) agreements with Health New Zealand stipulate that RJDs ought to make up approximately 1 in 7 house officers and 1 in 5.5 registrars, approximately 14–18% of junior doctors and define three types of leave:

1. Formal Leave: annual, sick, bereavement, educational or parental leave
2. Other Leave:  rostered days off (RDO) and night shifts
3. Short Notice Relief (SNR): last minute after hours gaps in rotas. Any junior doctor (whether relief or not) may be rostered by their employer to cover SNR and the SNR period can be up to seven consecutive days, and typically commences on a Saturday. This attracts a higher rate of pay.

1. Clinical Duties: A relief junior doctor is extensively involved in patient care and responsible for admitting patients, taking histories, conducting physical examinations, and organising investigations and treatment plans. An important aspect of this role is the frequent change of departments, providing a broad wealth of experience in a variety of specialities, but simultaneously requiring the knowledge and ability to practice in these fields.
2. Communication: Effective communication is at the heart of this role. Relief house officers liaise with the appropriate senior medical officers or consultants, and hand over patient management to the permanent medical team.
3. Record Keeping: Detailed and diligent record-keeping is a vital part of this role. Relief house officers are tasked with maintaining accurate and timely patient records, ensuring that all care and correspondence is appropriately documented.
4. Work Unsociable Hours:  Unsociable hours and night shifts are a frequent component of the RJD's duties whilst covering the leave of other RMOS, often at short notice.
5. Training Sessions: RJD's are expected to attend relevant educational and training events with other RMOs. These are of educational value even although the work experience may not be accredited for specialist training.



Advantages of the Relief Junior Doctor Role

1. Covered leave for junior doctors is one main advantage of a robust relief system. Working together with their employers, junior doctors can take time-off for holiday, study, courses, conferences, paternity and child-care and sickness (especially on short-notice).
2. Increased pay rates: to compensate for the inconvenience of relief rotations, specifically varied daily schedule and sub-optimal continuity of care, RJDs are financially compensated at higher rates than non-RJDs.
3. Flexible work schedules: the relief system is an avenue for junior doctors to work flexibly or on a part-time basis. Moreover, the pool of RJDs provides a “buffer” should any non-relief vacancies arise.
4. Broad general clinical experience: relief rotations provide RJDs a wider view of the various departments within a hospital, which is especially useful for junior doctors on short-term contracts and international medical graduates who are gaining experience of the healthcare system in New Zealand.

Disadvantages of the Relief Junior Doctor Role

1. Lack of Time Accreditation for Specialist Training: the main drawback of relief rotations is the lack of time-accreditation by several Training Colleges, as relief rotations are often viewed to offer less supervision and educational value. For example, the Royal Australasian College of Physicians only allows up to a maximum of six months of “other” rotations, which may include relief. The College of Intensive Care Medicine only accredits relief rotations (as part of the trainee’s non-core experience) if at least four weeks are spent in a single medical sub-specialty. Similarly, candidates applying for surgical training with the Royal Australasian College of Surgeons can only accredit relief periods (often >4 consecutive weeks, although the exact duration varies) if spent in a single surgical specialty. At the current rate of one guaranteed relief rotation per year (and occasionally two), this often results in prolongation of training and eligibility to sit College examinations. However, as relief rotations tend to entail fewer learning, teaching and clinical supervision opportunities, it is not surprising that the Training Colleges impose such strict accreditation criteria.
2. Lack of Job Satisfaction:  RJDs anecdotally find less satisfaction in relief rotations due to the lack of patient-care continuity, familiarity with departmental guidelines, overall team cohesion and structure and routine in day-to-daywork. RJDs’ general lack of satisfaction with relief rotations may even lead to increased absenteeism, which negates the purpose of the relief role.



Who Is Suitable for a Relief Junior Doctor Job?

The Relief House Officer or Registrar job has its pros and cons as detailed above and yet it is appropriate short term career option for some junior doctors. Undeniably demanding, the role requires resilience, adaptability, excellent communication skills, and a commitment to providing the highest standard of patient care whilst offering unparalleled exposure to a broad spectrum of medical specialities. It lays a solid foundation for any blossoming medical career.

The RJD is a sound option for:

• Doctors eligible for general or provisional general registration with the Medical Council of New Zealand (see information about registration with the Medical Council of New Zealand).
• Doctors who seek wide experience of the New Zealand healthcare system whilst preparing for specialist training (especially if uncertain of choice of speciality)
• House officers or registrars aiming to work short term in New Zealand without embarking on specialist training
• Doctors who value flexible or part time work schedules
• Doctors who are seeking higher pay than the regular RDANZ or STONZ rates

For those of you ready to rise to the challenge and further your career by becoming a relief house officer, we can help you through the process. If you would like to learn more about how we can help you, feel free to connect with us and register your CV or browse the advertised jobs on our website.

Further Useful Information

While you continue your job search, Odyssey Recruitment provides useful resources to keep your career moving in the right direction. Begin the application process now, and then learn more about how we can help you.