When a doctor books a shift in a public hospital emergency department and walks into the staff room for handover, there is a reasonable chance another doctor in that room has prescribed medication for them, reviewed their imaging, or provided specialist advice within the last twelve months. The term doctors for doctors describes this reality more than any formal program. Clinicians treat colleagues not because of a special policy, but because both parties work in the same health system and cross paths regularly. The question is not whether it happens, but how it should be managed when it does.
Why Doctors Treat Other Doctors
The reasons doctors end up providing care to colleagues are often logistical. A junior doctor develops acute appendicitis overnight during their own shift and presents to the same ED where they were working an hour earlier. A surgeon refers a fellow consultant for an orthopaedic opinion because they know the subspecialty expertise sits three floors up. A registrar notices a skin lesion on a peer during a teaching session and offers to biopsy it the following week. Geography, access, and familiarity all contribute.
There are also structural reasons. In regional and rural Australia, the pool of available specialists is smaller. A hospital with two general surgeons on rotation will inevitably find those surgeons treating each other's families or referring to one another's subspecialty interests. In smaller private practice networks, the same dynamic applies. You refer within the group because that is the group.
Some doctors prefer being treated by colleagues. The shared language reduces explanation time. Clinical history can be taken more efficiently. There is an assumption, not always warranted, that a colleague will prioritise your case or understand the time pressures you are under when returning to work.
When Professional Boundaries Blur
Treating another doctor introduces complications that do not exist in standard clinical relationships. The British Medical Association outlines these in detail, noting that professional distance is harder to maintain when both parties share the same workplace hierarchy, rostering conflicts, or departmental politics. A registrar who refers their consultant for an opinion may feel pressure to accept advice they would otherwise question. A consultant treating a junior colleague may hesitate to order investigations they would routinely request for a stranger, assuming the patient has already self-diagnosed or self-managed.
Documentation standards can slip. Informal corridor consultations replace formal appointments. Written records are not always created. Billing becomes awkward. Does the treating doctor charge a colleague for after-hours advice? Does the colleague expect professional courtesy, and if so, how is that documented for Medicare or private health insurers?
Then there is confidentiality. Shared electronic medical records mean that colleagues in the same facility can access each other's files unless specifically restricted. A doctor admitted under a colleague's care may not realise how many other staff members can view their admission notes, pathology results, or prescribed medications. Clinical privacy becomes harder to enforce in close-knit teams.
Models of Peer Support and Occupational Health
Some organisations formalise doctors for doctors care through occupational health services. Public hospitals in New South Wales, Queensland, and Victoria typically offer staff clinics where employed doctors can access primary care, immunisations, WorkCover assessments, and pre-employment medicals. These services are usually delivered by salaried medical officers who are not rostered in clinical departments, reducing overlap with day-to-day patient care.
The model separates workplace medicine from the clinical services the doctor provides to patients. A surgeon who injures their hand during a procedure is seen by the occupational health team, not by the orthopaedic consultant they refer to regularly. Records are kept separately. Return-to-work planning is managed by someone outside the usual departmental structure.
Peer support programs take a different approach. Rather than providing medical treatment, they offer structured psychological and professional support following critical incidents, complaints, or performance reviews. Economic evaluations of these programs indicate measurable reductions in burnout and sick leave when clinicians can access confidential support from trained peers who understand the clinical environment. The distinction here is important. Peer support is not clinical care. It does not replace a GP or psychiatrist. It supplements formal care by providing someone who has been through a similar experience and can speak to it without needing extensive background.
For more complex mental health needs, many hospitals and medical organisations now contract external providers specifically so that doctors are not treated by colleagues. This removes the conflict of interest and ensures the treating clinician has no workplace relationship with the patient. The AMA Physician Well‑Being Program in the United States has built an entire framework around external, independent services for exactly this reason.
Credentialling and Competency When Doctors Self‑Refer
A locum anaesthetist working across multiple sites in regional Victoria notices intermittent visual disturbance and refers themselves to a private ophthalmologist. The ophthalmologist knows the patient is a doctor and adjusts the consultation accordingly, skipping parts of the history and assuming the patient understands the differential diagnoses. The anaesthetist does not disclose that the visual symptoms began after a prolonged night shift with minimal sleep, because they assume it is unrelated. Three weeks later, the symptoms are diagnosed as related to uncontrolled hypertension that was never discussed.
This is a credentialling problem dressed as a communication problem. The ophthalmologist assumed competency outside their own specialty. The anaesthetist assumed they could self-triage. Neither assumption was unreasonable, but both led to incomplete care.
When doctors self-refer, they often bypass the gatekeeping steps that protect other patients. They do not wait for a GP referral. They book directly with a specialist, sometimes a colleague, sometimes a friend. They interpret their own pathology before the treating doctor has a chance to review it. They adjust or cease medications without follow-up. This is not arrogance. It is convenience layered with overconfidence in one's own clinical knowledge outside of one's own specialty.
The risks are well-documented. Doctors are statistically more likely to delay seeking care, underestimate symptom severity, and continue working while unwell. Physician well-being policies from the World Medical Association specifically address this, noting that the culture of medical training discourages help-seeking and penalises perceived weakness. A doctor who admits to mental health concerns, chronic pain, or substance use may fear career repercussions, licensing issues, or judgment from colleagues. So they manage it themselves, or avoid managing it at all.
Informal Consultations and Workplace Culture
Informal consultations between doctors are common. A surgical registrar asks an ICU consultant about post-op fluid management in the corridor between cases. A psychiatry trainee asks a cardiologist whether a particular SSRI is safe in a patient with a prolonged QT interval during a lunch break. These consultations are efficient and often clinically appropriate. They also sit in a grey area when it comes to documentation, consent, and liability.
If the advice given is wrong and the patient suffers harm, who is responsible? The doctor who asked the question, or the doctor who gave the answer? If no formal referral was made and no file note exists, was it a consultation at all, or just a professional conversation? Medical defence organisations routinely advise against this kind of informal advice, but the culture of medicine makes it nearly unavoidable. Doctors for doctors interactions often begin as informal exchanges that only later require formal follow-up.
Locum Work and Treating Colleagues Across Sites
Locum doctors encounter the doctors for doctors dynamic differently. A locum emergency physician working a weekend shift at a regional hospital may treat a GP from the neighbouring town who presents with chest pain. The two have never met. There is no prior relationship. The GP does not expect special treatment, and the locum does not offer it. The interaction is clinically straightforward.
But if that same locum is covering a hospital where they previously worked as a staff specialist, they may find themselves treating former colleagues, junior doctors they once supervised, or consultants they trained under. Professional courtesy becomes harder to define. Should the locum fast-track a colleague's imaging request? Should they disclose clinical findings to the patient's head of department, who happens to be someone they worked with for five years?
For hospitals managing complex rosters, partial or full roster management ensures locum doctors are briefed on these dynamics before they arrive. Facilities with high locum usage, particularly in anaesthetics, emergency medicine, and intensive care, benefit from clear policies on how locums should handle colleague presentations. Without that clarity, locums default to individual judgment, which varies widely.
Travel-based locum roles introduce another layer. A doctor flying interstate for a two-week placement in a rural hospital may be the only specialist in that discipline on-site. If a colleague develops acute illness during that period, there is no one else. The locum becomes the treating doctor by default. This is especially common in psychiatry, obstetrics, and general surgery, where regional facilities rely on rotating locum cover to maintain service continuity. The specialties covered by locum placements across Australia reflect this pattern.
Telemedicine and Remote Colleague Consultations
Telehealth has made doctors for doctors consultations easier and more ambiguous. A locum psychiatrist in Darwin provides a remote consultation to a GP registrar in Perth who is experiencing burnout. The consultation is billed through Medicare. The treating psychiatrist is credentialed and registered in both jurisdictions. The GP registrar discloses that they are currently working in a rural practice and cannot take time off for an in-person appointment. The psychiatrist agrees to ongoing sessions via telehealth.
Is this a standard patient-doctor relationship, or a colleague-to-colleague consultation? Both. The fact that the patient is a doctor does not change the clinical responsibility, but it does change the context. The psychiatrist may spend less time explaining diagnostic terminology and more time addressing the specific pressures of rural practice, locum rostering, and professional isolation.
Research on telemedicine consultations between clinicians shows that both parties generally report high satisfaction when specialty expertise is otherwise inaccessible. Remote consultations allow doctors in under-resourced areas to access subspecialist input without leaving their post. But the same research highlights concerns about incomplete assessment, lack of physical examination, and documentation gaps when consultations are delivered casually or without full record-keeping.
When telehealth is used for informal advice rather than formal care, the line blurs further. A locum surgeon in a regional hospital sends a photo of a post-op wound to a plastics colleague in Sydney and asks for an opinion. Is that a referral? A consultation? A favour? If the advice leads to a change in management and the patient deteriorates, the medico-legal exposure is unclear.
Interstate and Cross-Jurisdictional Issues
Locum doctors working across state lines regularly encounter colleagues from other jurisdictions who seek clinical advice or informal consultations. A registrar rostered in Queensland may ask a visiting anaesthetist from Victoria about credentialing requirements for a procedure they want to learn. That conversation is professional development, not clinical care. But if the same registrar asks the anaesthetist to review their own ECG because they are experiencing palpitations, it becomes a clinical interaction.
Registration and indemnity requirements differ across states. A doctor registered in New South Wales providing medical advice to a colleague in Western Australia must consider whether that advice constitutes practice in WA, and whether their insurance covers it. AHPRA registration is national, but indemnity policies are not always uniform. Medical defence organisations assess risk based on where the care is delivered and where the patient resides, not just where the treating doctor is registered.
For locums moving between jurisdictions frequently, this becomes a recurring question. If you provide advice to a colleague while rostered in one state, but the colleague is located in another, which jurisdiction applies? The question is not hypothetical. It arises in telehealth consultations, after-hours phone advice, and informal teaching sessions that cross into clinical guidance.
Mental Health, Substance Use, and Mandatory Reporting
One of the most difficult aspects of doctors for doctors care involves mandatory reporting. In Australia, medical practitioners are required to report colleagues who are practicing while impaired by physical or mental illness, including substance use disorders. This obligation sits uncomfortably alongside the expectation that doctors will support one another and provide confidential care.
A locum ICU consultant notices that a fellow intensivist they are working alongside appears disoriented during a handover and smells of alcohol. The consultant does not report the incident immediately, instead offering to cover the rest of the shift and suggesting the colleague take time off. Two weeks later, the same colleague is rostered again and the behaviour recurs. At what point does professional courtesy become negligence?
Mandatory reporting laws exist to protect patients, but they create a significant barrier to doctors seeking help. If a psychiatrist treating a colleague for depression is required to notify AHPRA the moment that colleague discloses suicidal ideation, the colleague is less likely to disclose it. If a GP treating a surgeon for opioid dependence must report that surgeon to the medical board, the surgeon is less likely to seek treatment. The result is underreporting and delayed intervention, which increases the risk to both the doctor and their patients.
Some jurisdictions have introduced exemptions or safe harbour provisions, allowing doctors to access treatment without triggering automatic reporting if they are compliant with a structured support program. These programs are typically run by independent bodies, not by colleagues or employers. The goal is to separate treatment from oversight, so that doctors can access care without fear of immediate professional consequences.
Managing Dual Relationships in Smaller Medical Communities
In regional Australia, dual relationships are unavoidable. The only cardiologist in a rural hospital may also be the president of the local medical association, a colleague's personal friend, and the parent of a child in the same school as another doctor's child. Professional boundaries are real, but they exist within a small community where personal and professional lives overlap constantly.
This is not unique to rural practice, but it is more pronounced. A locum obstetrician covering a regional hospital for three months may be invited to social events with the local GP network, attend the same medical education sessions, and be asked to provide informal advice on cases outside their booked shifts. Saying no to these requests can damage professional relationships that are necessary for effective collaboration. Saying yes can create expectations of ongoing availability, blurred boundaries, and resentment when the locum eventually leaves.
Hospitals that rely on long-term locum placements to maintain service continuity often see these dynamics play out. A locum who stays for six months becomes embedded in the local medical community. They are no longer an outsider, but they are not permanent staff either. They may be asked to provide care to colleagues, review colleagues' family members, or supervise junior doctors they socialise with outside work. Managing these relationships requires clarity about role, scope, and limits.
The same issues arise in specialist private practice. A small anaesthetics group covering two private hospitals will inevitably find its members treating each other's patients, reviewing each other's cases, and occasionally providing care to each other. If one anaesthetist becomes unwell and requires surgery, another member of the group will likely provide the anaesthetic. Professional courtesy is expected, but so is full documentation, informed consent, and appropriate follow-up. The personal relationship does not remove the clinical responsibility.
Documentation, Billing, and Medicare Compliance
When doctors treat other doctors, billing often becomes informal. A dermatologist excises a lesion from a colleague during a lunch break and does not raise an invoice. A psychiatrist provides six sessions of therapy to a junior doctor and bulk-bills every session as a favour. An orthopaedic surgeon reviews a fellow consultant's MRI and writes a handwritten note instead of a formal report.
None of these scenarios comply with standard documentation or billing requirements. Medicare rules require that services claimed are clinically necessary, appropriately documented, and delivered according to the schedule. Professional courtesy does not exempt a doctor from these requirements. If a service is provided for free, it can still be documented. If it is billed, it must meet the same standards as any other consultation.
The tension arises because doctors expect flexibility when dealing with colleagues. Charging full fees feels transactional. Not charging at all feels appropriate, but creates ambiguity about whether the service was delivered as a formal consultation or as informal advice. Medical defence organisations recommend full documentation regardless of billing. A file note that says "informal review for colleague, no charge" is better than no note at all.
For hospitals employing locums, this matters. If a locum provides care to a staff member during their rostered shift, is that part of their contracted duties, or a separate service? If the staff member later claims the care was substandard, does the hospital's indemnity cover it, or does the locum's personal insurance? Contracts should specify how these situations are managed, but many do not.
What the Evidence Says About Outcomes
There is limited research on clinical outcomes when doctors are treated by colleagues, but the available evidence is not reassuring. Studies on physician self-treatment and informal colleague consultations consistently show higher rates of diagnostic delay, incomplete investigation, and deviation from standard care pathways. Doctors treating other doctors tend to assume higher baseline knowledge and skip steps they would not skip with other patients.
This does not mean the care is always substandard. In many cases, it is equivalent or even superior, particularly when the treating doctor understands the specific context of the patient's work and can tailor advice accordingly. A sports physician treating a surgeon for a hand injury understands the functional demands of the job in a way they would not for a non-medical patient. That context improves outcomes.
But the risk of bias is real. A cardiologist treating a colleague may overestimate that colleague's adherence to medication, underestimate their cardiovascular risk because they appear healthy, or avoid ordering investigations that might reveal something serious. The patient, being a doctor, may withhold information they consider irrelevant or embarrassing. Both parties may avoid difficult conversations about prognosis, lifestyle modification, or mental health.
The solution is not to prohibit doctors from treating colleagues. That is impractical. The solution is to acknowledge the risk and apply the same standards of care that would apply to any other patient. Full history. Appropriate examination. Documented consent. Clear follow-up. No shortcuts.
Doctors treating other doctors is a structural reality in Australian healthcare, shaped by geography, access, and professional relationships. The risks are manageable when documentation, consent, and professional boundaries are maintained. For doctors working locum shifts across multiple sites, understanding these dynamics before you arrive matters. Best Practice Medical connects doctors with locum opportunities across Australia and ensures placement details, credentialling expectations, and workplace culture are clarified before the first shift.