fading job...anyone ?

There is a case conference every week in our hospital. Unlike those big big hospital which hold their respective department meeting/conferecent, we could only hold this combined case conference due to lack of doctors . The case conference usually follow with administration meeting. Last week, our deputy hospital director(admin) had told us that they planned to intake one of the part timer(who did locum for us during the weekend) to our team. In most of the rural hospital, doctors are reluctant to do night shift - especially ED shift. The law had required hospital with 100+ beds to have a 24 hrs operation ED. ED shift are stressful - paeds, surgery and medical....sometimes some O+G emergency may show up. In some hospital(as in ours), the ED doctor will need to cover the wards as well. A stressful job indeed. The pay is considered handsome in the rural area as one would be paid RM 100(non-taxable)/hr. A shift is around 12 to 14 hrs, so one would walk away with RM 1200-1400 per shift.But in the city, the pay is less and 1 night shift is around RM 500-800. A resident under trainning earn around RM 9k to 15k depending of the hospital they are working. A good side income indeed if those resident willing to do these locums. But as most of the training hospitals are situated in the city and the residents are supposed to report by 7:30am for morning meeting thence it would be difficult for them to do these locums in rural area and rushed back to their primary trainning hospital. Another factor which affect the availability of locum night shift ED doctors was trainning. Before the PGY1(post graduate year 1 ) training ERA, graduates start their specialty training as soon as they leave school - lack of exposure, now it is improving but not satisfactory yet though...the ED training was too short in Taiwan - 3 years only, I recalled weeks ago, there was this senior ED physician(professor grade ?) who replied a letter in the forum of the "Apple Daily"- He claimed that the ED physician training was 5-6 years and asked the public to trust their skill; all I wanted to say is 5-6 years my AXX...the bigger the hospital the more focus of its training in medical and surgery(not in the respective department but in ED itself) with the paediatrician and O+Glogist seen their relevant patients in this kinda of hospital ...to make the situation worst - such rural hospital would require night shift doctor to cover their wards as well...few were interested in such job in the past and now only some left... Those who moonlighting about this job could be classified into : 1. Residents who were very short of money 2. "Rover" - denied specialty training/examination : work in clinic/very small hosptial in the day light and doing night shift here and there .. 3.Specialist who was once in the 1st category but later unwilling to give up such skill and moonlighting once a while to see if he could still do it o 4.Specialist who was once in the 1st category and just returning favor / or don't know how to say no to their ex-night shift's hospital management. 5.Medical graduate without practicing license... They would need courage and extraordinary physical and mental endurance as deprivation of sleep is the major stress factor apart from the variety of patients. At the present moment, the resident pay is considered good compared to other occupation so only a handful of doctor wanted to join category 1. Those in catergory 2 are less nowaday and fading from the health care chain - do not have a wrong idea: these group of doctors usually make a very handsome income. Only a few left in category 3-4 as they came from category 1. The 5th category has the least member as the local health department has strictly enforcing the medical act. Just like Malaysia system, notifying the local health department while doing locum is a must and violating the rule maybe fined both the local health department and the general health insurance scheme. Notification should be done by the primary employer and the locum organization jointly so approval from your employer is needed to do locum here and there. All this restriction had made the locum bussiness worst. The part timer mentioned above is a "rover"... the management had asked me if I could adjust my current shift and I complied partially to their request....I was looking forward to it actually although my income may become less, but I might get rid of some night shifts. Unfortunately today, our offer was rejected and we were back to square 1... I am hoping one day, I could do only 1 night shift per week, my white hair is increasing in a great speed for the past 2 years....