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At the heart of general practice since 1960

Maintaining a dual career in Australia and Britain

Dr Rob Macdonald works as a GP for half the year in Australia and half the year in London. Here’s how he does it


Dr Rob Macdonald

Age 56

Role Locum GP in London and Australia

Location All over Australia – Sydney, Melbourne, northern Tasmania, central Queensland and Perth. In the UK, mainly in practices in north or east London

How do you split your time?

For the past three or four years, I have split my time almost equally between London and Australia, returning to my homeland down under when the autumn sets in in London in October, and going back to the UK in March, often with a holiday in between. My friends call me a migratory bird, flying south in winter and north in summer.

I have a flat overlooking the beach in Perth and a flat in London, which I rent out through websites like Airbnb when I’m not there. If I work outside Perth in Australia, I can usually stay with friends or relatives.

I’ve spent time in both countries for most of my career: I finished my training in Australia in 1983 and first came to the UK in 1986. I work as a locum GP in both places, and altogether I reckon I have worked in about 100 practices on both sides of the equator. I love the freedom, flexibility and diversity this gives me.

What’s the main disadvantage of working like this?

Probably duplication – I have to maintain two sets of regulatory cover – for the GMC and Australian Health Professional Regulation Authority (AHPRA) – and have two medical defence policies. I have to do enough work to pay off this double cost before seeing any income. I also have to keep updated with the clinical and regulatory changes in both countries.

How different is the work?

General practice is very similar in the UK and Australia – 90% of what you say to the patient remains the same. There are obviously some differences, though. In the Australian system we get paid per consultation, so I normally do 15-minute appointments to give patients better value for money. It also means that administrative tasks done by GPs in the UK are left to non-medically trained staff in Australia, so doctors can do work they are trained for and generate income for the practice.

Patients in Australia also know better what they’re entitled to, so sometimes we find ourselves under greater pressure to cater to their wishes, particularly in areas like analgesics and hypnotics. Also, if they don’t get their needs met at one practice, they’re entitled to go to another surgery. It’s not unusual for a patient to have two to three practices they attend selectively.

Australian practices tend to be larger in terms of the number of practitioners, with more proceduralists like minor surgery teams on site. This corporatised healthcare provision generally works well.

However, if I’m in rural Australia, I do need to be prepared to perform more minor procedures, partly because rural hospitals have fewer specialists available on a regular basis – one reason I haven’t signed up for much rural work.

The provision of healthcare for work-related injury is bigger in Australia because of a highly structured provision of worker’s compensation for injuries or illnesses acquired at work. In general, the doctor gets paid more for these cases because the bill is met by a workplace insurer. Also, in Australia you need a note from your doctor for a day or two absence from work, so writing sick notes is one of the commoner reasons for a consultation.

Is the patient population different?

The patient population between London and Australia is massively different. The lists in London are so varied and diverse it can be challenging, especially with patients whose first language is not English. Some illnesses also vary: in Australia, there are a few more sunburn cases or creepy crawly bites, but this is not a big part of the work.

How does your life outside work differ in both places?

In London, there are lots of intellectual events in the evening and I miss going to these talks when I’m back in Perth. Perth is more outdoorsy and I enjoy sailing in Australia. However I tend to go cycling more often in Britain where the scenery is more interesting.

Most of my immediate relatives are in Australia, but I have lots of friends on both sides of the equator.

I don’t know where I will settle when I retire, or if I will just keep doing this until I drop.

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Readers' comments (14)

  • Vinci Ho

    Like everything , advantages and disadvantages as per each individual
    All the best , mate

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  • This is obviously interesting.

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  • less that 183 days in each country and you don't pay any taxes?

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  • I do the same with Canada and yes you do have to pay tax. Whichever is most generally

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  • Food for thought.

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  • Interesting article and good luck to you.
    Hell of a lot better than the slow death of partnership.

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  • Why on earth are you coming back to work in the UK for 6 months? Having had experience in both countries and working in Oz now, Australian general practice trumps UK for many reasons to which you will be privy. Surely work in Australia for 8 months and have a 4 month break?
    To non Oz Gps here a quick comparison. UK=red tape, massive over regulation, bend over, jump through one hoop while barking like a sheep dog, Oz=simple 3 yearly CPD cycle, no revalidation (yet). UK=MDU fees £7000-17,000, Oz= £750-2500. UK=10 min appts, Oz= 15 min appts. UK= home visits, Oz=virtually none. Uk=average pay GP £56,000 - 100,000, Oz= £110,000 - £250,000. Generally oz pts much nicer, and non demanding unlike UK pts. GMC=fear for your life, feel constant persecution and live like your living under ISIS, AHPRA = much nicer regulatory body, better reputation. UK = working day 8am to 7pm if your lucky, Oz= 9-5 pm, with 1 hour lunch break. UK = chuck lots of extra puts on list, with no reward, Oz= paid per case, do thank you I could do with the extra income. The list goes on and on. So seriously, why on earth are you coming back to work in the UK for 6 months??

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  • UK = get paid well even if you work only 6 sessions (i.e paid for not seeing patients). Australia - you get paid only if you see patients.

    UK = patients generally can't get rid of the GP who may not treat them well because of so called practice boundaries. Australia - you can see a GP who treats you well even if they are 20 miles from your home.

    So working in the UK is obviously more appealing.

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  • UK = you have monopoly in owning surgeries as newly qualified GP's can't open their own. Australia - You can open your own surgery anywhere you like.

    So why bother going to Australia.

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  • UK partnership is no monopoly. You are effectively stuck with a business model with dwindling returns. Plus with property prices plunging you may even be in negative equity, effectively trapping you in even if you wanted to leave. Partnership fine 10 to 15 years ago, you have to be crazy to go into one now.
    If you are a half decent GP there is plenty of work in Australia, choose your location wisely and bring your flip flops and sun cream. Seriously there is no comparison. I've worked in both countries, most UK to Australia GP's won't tell you the full facts, for fear of getting more UK doctors arriving and causing increasing competition in Australia. Enjoy the UK NHS and regulation, you're welcome to it.

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