As a medical recruiter, and (I am a little embarrassed to admit it) former health service manager, I can see some palpable parallels between working with the health system, and the absurd (but all to familiar?) characters in Alice in Wonderland.

It must have taken a Mad Hatter to design the current system for working as a locum in one Australian state (….to remain nameless). Not only are locum doctors expected to read over 450 pages of policies, and complete hours worth of online learning – they are encumbered by their current employer’s consent to work as locums in areas of critical medical workforce shortage. It’s also not a walk in the park for the the front line rostering people, who are restricted in terms of how much they can pay locum doctors in accordance with arbitrary geographical zones (which seem as though they were decided upon at a health department tea party). Here is the crux – the people making these decisions, however well meaning, are often at a critically dangerous distance from the reality of health care ‘in the trenches’.

What is the point of these polices? To provide better health care, of course. I’ve noticed how well it has worked – have you? Well, maybe not.

The aim is, of course, cost reduction. There is a Queen of Hearts in every health service, exacting sharp fiscal control on areas she may or may not have any understanding of, and proclaiming "Off with their heads" at the slightest hint of dissent or creative thought. New health service managers are often given no training, no expectations, no targets to meet, except "reduce the budget". When I started in a hospital, I felt like Alice, tumbling down a hole to who-only-knows-where, as there is only one way to reduce the budget – to reduce medical staffing. Trying to explain to a high level administrator that it is less expensive to pay our own staff slightly more to work unpopular shifts, than it is to bring in hundreds of expensive outside locums of questionable quality and skills was almost like putting my head through a wall.

More dangerous than the Queen of course, is the Cheshire Cat, the duplicitous sycophant whose sharp teeth are covered by a flurry of nonsensical and vexing arguments. These people are the worst enemy of medical recruitment – swiping away any attempt to boost staffing numbers, citing an endless array of policies, precedents, and alluding to the opinions of a distant CEO who is always at arms length. Here is a common scenario – we need a new emergency specialist. Can we advertise? "No, too expensive". Can we attend a conference to attract potential candidates "No, too expensive. Perhaps try a sandwich board in front of the train station". In their heart of hearts, they know it is less expensive to keep a position vacant than it is to fill it.

I can’t help but think that we are compelled to reject the reality presented to us by the looking glass – now is the time to agitate, question the system, and find your way out of the rabbit hole. What do you think we can do to change the system? Is it too late to turn it around?