Emergency Registrar vs FACEM Locum Work: What Changes at Consultant Level

If you are building toward FACEM fellowship and doing locum work alongside your training, you already know the registrar locum market reasonably well. What is less clear — until you get there — is how significantly the consultant locum market differs. The differences are not just about pay rates. They affect how you access roles, what credentialing looks like, how supervision works (or stops working), and what hospitals are actually asking for when they call an agency.

This article is for emergency registrars considering the transition, and for FACEM consultants who are new to locum work and want to understand what the market looks like at their level.

The most visible change at consultant level is scope. As a registrar, your scope is defined partly by your training stage and partly by the supervision arrangements at each facility. You are building toward independent practice, and the credentialing process at each hospital reflects that — it asks about your training stage, your supervising consultant, and the specific procedures you are credentialed to perform independently versus under supervision.

As a FACEM consultant, you are credentialed for independent practice. The credentialing process shifts from "what can you do under supervision" to "what is your current scope and are there any restrictions on your registration." For most FACEM consultants, the answer to the second question is straightforward. The process is faster, and the conversations with hospitals are different — they are not asking whether you can manage a resuscitation independently; they are asking whether you have done it recently enough to maintain currency.

This sounds like a minor administrative difference, but it changes the texture of every placement conversation. Registrar placements involve more upfront discussion about supervision logistics. Consultant placements are more transactional — the hospital knows what a FACEM consultant can do, and the conversation moves quickly to availability, rate, and start date.

This is the difference that surprises most doctors making the transition.

As a registrar, most locum roles are advertised. They appear on job boards, agency websites, and hospital careers pages. The supply of registrar-level locum doctors is reasonably well matched to demand through these channels, and the process of finding a role is relatively transparent.

At consultant level, the market works differently. Many FACEM consultant vacancies — particularly at metropolitan hospitals — are filled through direct agency relationships before they are ever advertised. Emergency Department Directors and Workforce Coordinators have established relationships with a small number of agencies they trust to provide credentialed consultants quickly. When a gap appears, they call the agency. If the agency has a suitable consultant available, the role is filled. It never reaches a job board.

This means that as a FACEM consultant, your access to the best roles depends heavily on which agency you are registered with and whether that agency has the right hospital relationships. An agency with direct relationships at Fiona Stanley, Royal Perth, and Sir Charles Gairdner will have access to roles that a national agency without those relationships simply will not see.

At AU Locums Direct, our consultant-level FACEM placements are almost entirely through direct hospital relationships. We work with ED Directors and Workforce Coordinators at 27+ WA, NT, VIC and QLD hospitals, and most consultant vacancies come to us before they are advertised anywhere else.

Registrar locum rates are relatively standardised. They are set by award rates, enterprise agreements, and the going market rate for registrar-level cover, and there is not a great deal of variation between facilities of similar type and location.

Consultant rates are more variable and more negotiable. The factors that move consultant rates include:

Urgency. A hospital that needs a FACEM consultant to start Monday has less negotiating leverage than one planning three months ahead. Urgent gaps — where a hospital needs cover within 48-72 hours — typically attract a premium, sometimes significant.

Location. Metro Perth rates are lower than regional WA rates, which are lower than remote NT rates. The remoteness loading for a placement in Kalgoorlie or Broome is real and meaningful. For a placement in a remote NT community, it can be substantial.

On-call requirements. A placement that includes overnight on-call or weekend on-call is compensated differently from a straight day-shift placement. The on-call component is negotiated separately from the base daily rate.

Facility type. A major trauma centre placement is not the same as a smaller regional ED, and rates reflect that difference.

Duration. Short-term cover (one to two weeks) typically attracts a higher daily rate than a longer placement, because the hospital is paying for flexibility and speed rather than continuity.

As a registrar, most of these factors are either fixed by award or not negotiable in practice. As a consultant, they are all on the table, and having an agency that negotiates on your behalf — rather than presenting you with a take-it-or-leave-it rate — makes a material difference to your income.

The credentialing process at consultant level is faster than at registrar level, but it is not trivial. Each hospital has its own credentialing requirements, and the process involves verifying AHPRA registration, specialist qualifications, professional indemnity insurance, and currency of practice.

The practical difference is that consultant credentialing is less likely to involve back-and-forth about supervision arrangements and training stage, and more likely to be a straightforward document check. If your AHPRA registration is current, your FACEM fellowship is verified, your insurance is in order, and you have recent ED practice, most hospitals can credential you within 24-48 hours.

Where credentialing slows down at consultant level is when a doctor has been out of ED practice for an extended period, has a restriction on their AHPRA registration, or is seeking credentialing at a facility with specific requirements (trauma centres, for example, often have additional credentialing requirements for consultants).

At AU Locums Direct, we manage the credentialing process for every consultant we place. We know the specific requirements at each of our hospital partners, and we handle the paperwork so you do not have to navigate it yourself.

This is the change that most registrars underestimate until they experience it.

As a registrar, supervision is a constant logistical consideration. Every placement involves confirming who your supervising consultant is, what the supervision model looks like (direct, indirect, or remote), and whether the facility's supervision arrangements meet your training requirements. This is not just administrative — it affects which placements you can accept and which you cannot.

As a FACEM consultant, supervision is no longer your problem. You are the supervision. In some regional and remote settings, you may be the most senior doctor in the building, and the question shifts from "who supervises me" to "who do I supervise." This is a significant change in how you experience a placement, and it is one of the reasons many doctors find consultant locum work more straightforward than registrar locum work, despite the higher complexity of the cases.

If you are a registrar approaching FACEM fellowship and thinking about what your locum career looks like at consultant level, the key things to know are:

1. The best consultant roles are not on job boards. They are filled through agency relationships. Register with an agency that has direct hospital relationships before you need them.

2. Rates are negotiable at consultant level in a way they are not at registrar level. An agency that negotiates on your behalf is worth more than one that presents you with a fixed rate.

3. Credentialing is faster at consultant level, but you still need to have your documents in order. AHPRA registration, FACEM fellowship verification, and current professional indemnity insurance are the three things that need to be ready before you accept a placement.

4. Supervision stops being a constraint. This simplifies placement logistics significantly.

If you are a FACEM consultant who is new to locum work, the most important thing is to register with an agency that understands the consultant market — not one that treats FACEM consultants the same as registrars. The conversations, the rates, and the role access are all different.

AU Locums Direct places FACEM consultants and emergency registrars across WA, NT, VIC and QLD. Register as a FACEM Consultant or Register as an Emergency Registrar.