General Practice Students Network GUIDE 2011
www.gpsn.org.au
What I like about general practice Catch the First Wave Postcards from GPland GP salary show and tell
About this
Guide Aspire has been prepared by THE GENERAL PRACTICE STUDENTS NETWORK (GPSN), AN INITIATIVE OF GENERAL PRACTICE REGISTRARS AUSTRALIA (GPRA). The name Aspire reflects the aim of the guide to assist medical undergraduates in making informed decisions about their future training and career aspirations. It is set out in colour-coded sections for easy navigation. The publication has been produced using sustainable, environmentally friendly printing techniques. This reflects GPRA’s ethos of suppor ting tomorrow’s GPs in their quest for sustainable careers in general practice.
1
Contents On the cover What I like about general practice Catch the First Wave
22 58
Postcards from GPland GP salary show and tell
121 142
Ship to shore Part-time, smart time
134 138
How to apply for GP training
6 / Money matters About this guide Welcome A message from the GPSN Chair
1 4 6
1 / ASPIRING TO general practice Why choose general practice? Love your work Unmasking the myths Why I chose general practice – Dr Mike McKeough My life in general – Professor Michael Kidd Quick quiz GP timeline Who knew?
8 12 18 22 26 30 32 34
2 / General practice at med school 5 ways to experience general practice as a med student Network with GPSN: an initiative of GPRA Hello. I’m your GP Student Ambassador A year in the life of GPSN GP shout out Diary of a breathtaking conference – Nikole Fry The GPSN First Wave Scholarship program My First Wave experience – Emily Jenkins Other scholarships for med students 6 top tips to make your GP rotation count My GP rotation gave me goosebumps – Daina Rudaks 2
36 38 44 52 54 56 58 60 64 68 70
Surviving med school: how to prioritise – The girl with the blue stethoscope
72
3 / after med school, what next? 4 ways to experience general practice as a junior hospital doctor The GP mindset in hospital Test-drive general practice with the PGPPP The PGPPP and me – Dr Sebastian Rees
76 78 82 84
4 / the gP training experience
142 145
148
8 / info file GPSN Calendar 2011
150
GPRA and GPSN would like to acknowledge the support of our patron, Professor Michael Kidd AM. Professor Michael Kidd is Executive Dean of the Faculty of Health Sciences at Flinders University and a Past President of the RACGP. His research interests include general practice, medical informatics, health policy, medical education, safety and quality in primary care and the primary care management of HIV and hepatitis C.
GPRA and GPSN wish to acknowledge our sponsors for supporting this publication:
The structure of GP training 88 Regional training providers in Australia 94 Understanding the moratorium 96 The RACGP Fellowship 98 The RACGP’s Fellowship in Advanced Rural General Practice (FARGP) 102 The ACRRM Fellowship 104 RVTS: an alternative pathway to fellowship 110 Joining forces with the ADF 114
5 / design your own GP career Destinations unlimited Travel while you train Postcards from GPland TV GP Wings of care My island home Crime drama
What you can earn Incentive payments
7 / Applying for general practice training
118 119 121 122 125 128 131
GPSN Founding Sponsor: MDA National Insurance Pty Ltd GPSN Founding Partner: General Practice Education and Training Ltd Founding Benefactor: Dr Jerry Schwartz, Schwartz Family Co. Major Sponsors: Australian College of Rural and Remote Medicine, Avant Mutual Group, General Practice Training Valley to Coast, Matraville Medical Complex, Medical Indemnity Protection Society Ltd, Medical Insurance Group Australia, MIMS Australia, National E-Health Transition Authority Ltd, North Coast General Practice Training, Northern Territory General Practice Education, Royal Australian College of General Practitioners, The Doctors Health Fund and Victorian Aboriginal Community Controlled Health Organisation Business Partners: Australian Doctor and Medical Observer Editor: Jan Walker. Medical Editor: Kristen Tee. Graphic Design: Marie-Joelle Design & Advertising. Marketing: Kate Marie. Printing: Daniels Printing Craftsmen. GPRA and GPSN wish to thank all the contributing authors for their work and guidance. We also thank General Practice Education and Training (GPET) Ltd and the Commonwealth Department of Health and Ageing for their continued support and assistance. Cover image: Adelaide medical student, Daina Rudaks. For Daina’s full story, see page 70. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the publication. All efforts have been made to ensure that material presented in this publication is correct at the time of publishing. Due to the rapidly changing nature of the industry, GPRA does not make any warranty or guarantee concerning the continued accuracy or reliability of the content.
3
Why is Avant the smart choice for medical students?
Welcome Hello medical students. Welcome to the 2011 edition of Aspire, a guide to general practice designed for medical students by GPSN.
G
PSN (General Practice Students Network) is the student arm of GPRA (General Practice Registrars Australia) and it aims to inspire medical students to look more closely at the field of general practice. Aspire is a useful and compact guide encapsulating many reasons why general practice is a career worth aspiring to. It includes the latest information on general practice pathways, interspersing various aspects of the general practice lifestyle with snippets of personal experience from those who have worked in the field. On these pages, you will find a plethora of information delving right into the hard facts of finance, training pathways and career options offered by general practice.
4
Thank you to all our GPSN members for your interest in exploring general practice. It is a delight to see so many students involved in the club and we appreciate your input and enthusiasm. We are always keen to have new faces in the GPSN team so contact your local General Practice Student Ambassador to get involved. On behalf of GPSN, I hope you enjoy reading this edition of Aspire. Please direct any feedback on the guide to aspire@gpra.org.au. We trust you will continue to learn and grow in your capacity as a future doctor and wish you all the best in your career. Kristen Tee Medical Editor Aspire 2011
ďƒź
FREE medical indemnity insurance cover*
ďƒź
FREE ‘Careers in Medicine’ and ‘Electives’ handbooks
ďƒź
Australia's largest 'in-house' medical defence team
ďƒź
Clinical risk management education and resources
ďƒź
Experienced medico-legal advisors 24/7
ďƒź
Support at every stage of your work/life journey
“On these pages, you will find a plethora of information delving right into the hard facts of finance, training pathways and career options offered by general practice.�
Protect your career. Call 1800 128 268 today! www.avant.org.au
*IMPORTANT: Professional indemnity insurance products available from Avant Mutual Group Limited ABN 58 123 154 898 are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your objectives, ďŹ nancial situation and needs before deciding to purchase or continuing to hold a policy with us. Please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268.
A message
from the GPSN CHAIR
In 2008 as a first year student I attempted to grab a free GPSN pen and ended up with a copy of Aspire as well.
S
ince then I’ve been involved at GPSN UNSW’s club as a Secretary, a General Practice Student Ambassador and last year was lucky enough to be elected GPSN’s Chair. My interest in general practice came from having GP mentors who have contributed their own time to my learning in clinics, hospital and Indigenous health. Thanks to them I’ve been involved in surgery, done placements in Indigenous communities and developed confidence in my clinical skills. It is the variety of practice I’ve seen that has made general practice an attractive option to me. Enough about me though, 2011 is shaping up to be an exciting year for GPSN. We’ll be kicking off with a sweeping reform of our IT and media platform. 6
An exciting new program we’re implementing is GPSNews. This short program will feature GPSN local clubs and highlight the key reforms taking place in general practice. I encourage you to check out your local GPSN club for three key reasons: money, power and looking sexy! GPSN offers you a chance to access some great scholarships such as our First Wave Scholarship and funds keen club members to attend conferences right around Australia. Knowledge is power and by checking out GPSN you’ll certainly be well informed about your career options. There is nothing sexier than intelligence and by checking out GPSN you have a chance
to improve your clinical skills, learn from great speakers and set up mentoring relationships.
“2011 is shaping up to be an exciting year for GPSN.” In 2011 my free pen still gets the job done, though it’s a bit rough around the edges (much like its owner). GPSN has been a greatly rewarding experience and I encourage you to experience it yourself. I hope you enjoy Aspire and find it a useful introduction to general practice. Chris Timms 2011 GPSN Chair gpsn.chair@gpra.org.au
1
Aspiring to general practice
1 / Aspiring to general practice
Why choose general practice? Flexibility, variety and time for a life outside medicine. What more could you ask of your career? s a medical student, the idea of choosing general practice is not always top of mind.
A
hours, make a real difference in your patients’ lives and still have time for your own personal life.
When considering possible career paths, it’s likely that somehow the penthouse of your brain space is reserved for the “hospital specialties” while general practice resides in the basement, perhaps a little forlorn and forgotten.
It’s something you come to appreciate as you move through your clinical, intern and hospital training years, and experience the realities of long shifts and on-call duties.
This is unfortunate, because general practice is endlessly stimulating and fascinating from a professional point of view. It also happens to offer the best work-life balance in medicine. Ah, work-life balance – now there’s a concept! In general practice you can do a good day’s work within sensible
8
Your time becomes a very precious commodity. But don’t get the idea that general practice is only for those who want more time off. General practice is also renowned for its flexibility, variety and continuity of care. Not to mention the daily intellectual rigour of being at the frontline of diagnosis.
“When considering possible career paths, it’s likely that somehow the penthouse of your brain space is reserved for the ‘hospital specialties’ while general practice resides in the basement, perhaps a little forlorn and forgotten.”
Choose life. Choose to be a GP. You can follow your pet passions and discover new ones in general practice. You can sub-specialise and shape general practice to suit you. Like emergency work? Mental health? Aboriginal health? Paediatrics? Geriatrics? Procedural work? Research and teaching? All of the above? You can do them all in general practice if you choose. Because the thing about choosing general practice is that it gives you choices. And that includes the choice to have a great life at work and a great life beyond it.
Dr Abhi Varshney
“General practice is a specialty in its own right. The training program is quite difficult but you’re well supported. It’s not an easy option.”
What general practice offers Dynamic, team-based medicine Continuity of patient care Flexible working hours The opportunity to sub-specialise
9
1 / Aspiring to general practice
L ve your work 6 GPs and GP registrars share why they love working in general practice. There are almost as many reasons why GPs love their work as there are GPs. These are just some of them.
“Love the challenge.” “I still get a buzz out of being the person to make the diagnosis, and we get the majority of diagnosis in medicine.”
Dr Jenny Lonergan GP, New South Wales General practitioners in Australia are in the frontline of health care, doing more diagnosis than any other specialty. Every day as a GP you use all the knowledge you’ve learnt at med school, not just a small part of it. It’s a daily brainteaser that’s both stimulating and satisfying.
12
“Love the variety.” “I didn’t want to refine my broad medical degree down to one area and nothing else. I want a spectrum of medicine, not just a small part.”
Dr Stuart Anderson GP, Victoria As a GP your job is to know a little bit about a lot. But you can also follow your passions by subspecialising in the areas of medicine that interest you the most, including procedural work. The diversity in general practice medicine means there is always stimulating and challenging work, with the reward of making a difference in patients’ lives, solving their medical problems and helping them to be healthy throughout their lives.
“Love the people.” “I love being able to simply talk to patients and interact with kids. Most days it doesn’t feel like work at all.”
Dr Jeremy Keh GP registrar, GP Synergy General practice is a “people” profession. It involves more patient contact and continuity of care than any other specialty. You get to know your patients and their families over time as people, not just as acute hospital cases. You also work closely with other medical professionals. Allied health professionals, social support professionals, your GP colleagues and specialists are all part of the dynamic team model in general practice.
13
1 / Aspiring to general practice
Generally speaking General practice salaries
“Love the rewards.” “I earn enough money, but unlike some hospital jobs I also have the time available to spend it!”
Dr Allison Turnock GP registrar, General Practice Training Tasmania
“Love the lifestyle.” “What I love about general practice is the flexibility of the lifestyle. I love my three-day weekends and finishing work at 5pm.”
Dr Brinthan Kathirgama Kanthan GP registrar, Central and Southern Queensland Training Consortium
Full-time GP registrars average $70,000 to $150,000 a year. Full-time GPs can average up to $200,000 or more a year depending on the nature of the practice and hours worked. General practice also offers opportunities for part-time work and training. There are extra incentives for rural and remote work. For more information about income, see page 142.
General practice training The Australian General Practice Training (AGPT) program involves from three years (basic Royal Australian College of General Practitioners curriculum) to four years (Australian College of Rural and Remote Medicine curriculum and RACGP rural skills and academic year options). Some recognition of prior learning (RPL) for post-intern year hospital training may reduce training time. For more information about training, see page 88.
General practice registrar support General practice registrars are well supported by their regional training providers (RTPs), colleges and the peak body for registrars, General Practice Registrars Australia (GPRA). For more information about GPRA, see page 38.
The personal and professional rewards of general practice are matched by the financial rewards.
One of the greatest attractions of general practice is work-life balance.
GPs earn a good income, usually without the extremely long hours worked by some other specialties.
General practice is family-friendly, and allows you the flexibility to enjoy a life outside medicine. It’s the easiest medical career to pursue part-time or structure around family or other interests.
The earliest time you can apply is during your intern year, which means you enter the program as a second year postgraduate, or you can apply any time after. For more information about how to apply, see page 148 or visit www.agpt.com.au.
On-call duties and shiftwork can be minimal or zero. You can work pretty much anywhere and enjoy the climate and community that suits you.
Visit www.gpaustralia.org.au, www.agpt.com.au or the college websites www.racgp.org.au and www.acrrm.org.au. There is also lots of helpful information at www.gpsn.org.au.
14
How and when to apply
More information
15
1 / Aspiring to general practice
Your Five Essential Brain Foods “Love the training.” “It’s great fun socialising with other GP registrars during education releases, workshops and conferences.”
Dr Yvonne Wang GP registrar, CoastCityCountry/ GP Synergy GP training is a postgraduate vocational program that can commence after intern year and finishes with the achievement of fellowship after three or four years as a GP registrar. Much of the training is conducted under the supervision of experienced GPs, often in private practice. Programs can be tailored to suit individual interests and if necessary may be done part-time, which is not an option in most other specialties.
16
Research study shows GPs very satisfied
5
3
More than 80% of GPs are happy with their working conditions. Over 80% of GPs believe they use their abilities in general practice. 90% of GPs enjoy the variety of life in general practice. These findings were recently published in MJA The Medical Journal of Australia from the ongoing MABEL study “Medicine in Australia: Balancing Employment and Life”, which shows high levels of professional satisfaction. The survey was conducted with almost 4,000 GPs in all sizes of community including over a third rural communities. McGrail M, Humphreys J, Joyce C, Scott A, Kalb G. “Professional Satisfaction and General Practice: Does It Vary by Size of Community?” MJA 2010; 193 (2): 94-98. Password protected online copy at www.mja.com.au.
4
2
1
1 Australian Doctor Website and e-newsletter Daily breaking news and chat. Visit www.australiandoctor.com.au 2 Australian Doctor Everything you need, every week.
3 How to Treat Weekly clinical update, CPD and annual yearbook. 4 Rural Doctor The monthly fi x for rural docs. 5 Australian Doctor Education Seminars developed by GPs for GPs.
1 / Aspiring to general practice
Unmasking the myths
“Many consider a lifestyle of flexible, sociable working hours and part-time options better than money in the bank.”
General practice attracts many misconceptions. Take a look at the real face of general practice.
Myth 1
Myth 2
Myth 3
Myth 4
Reality
Reality
Reality
Reality
Yes, coughs, colds, paperwork and elderly patients are part of general practice. However, each day is diverse involving all kinds of people and conditions. Families and children are a big part of a typical family practice. There are numerous minor surgical opportunities. These may include the removal of moles or cysts and applying stitches. You can sub-specialise or take on a portfolio of roles at different locations, so you’ll never be bored. Diagnosis is at the core of general practice.
GPs are on the frontline of medicine as leaders of the multidisciplinary and inter-specialty medical team. They see the first presentation of health and psychological burdens and are responsible for making decisions that will impact the patient’s health outcome. Many rare and unusual presentations will be first seen by the GP. Due to their broad skills, GPs are equipped to work overseas or in disadvantaged communities. As a GP, you never know what will come in the door.
The average annual income for a full-time Australian GP is up to $200,000 or more. GPs earn a higher average income than most non-medical professionals including lawyers, veterinarians, architects, engineers and accountants. Compared to family practitioners elsewhere in the world, Australian GPs are among the highest income earners, above countries like France, Germany and Canada. Yes, it is true that GPs on average earn less than most other medical specialists. But many consider a lifestyle of flexible, sociable working hours and part-time options better than money in the bank. For more information on general practice incomes, see page 142.
General practice was recognised as a specific discipline of medicine in 1978, gaining official classification as a medical specialty in 1989. In 1999 the Australian Medical Council (AMC) included general practice as one of 17 specialties then recognised in Australia. To be accredited as a general practitioner in Australia requires an additional three to four years of training through the Australian General Practice Training program as a GP registrar, with the endpoint being Fellowship of the Royal Australian College of General Practice (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM). For more information, see page 88.
General practice is about coughs, colds, paperwork and aged care.
General practice is about the full scope of medicine.
GPs don’t practise complex and challenging medicine.
GPs practise complex, challenging medicine every day.
GPs don’t earn much money.
GPs earn good money.
General practice is not a medical specialty.
General practice is officially a specialty and GPs are “general specialists”.
Contributed by Kristen Tee and Jan Walker 18
19
General Practice in Indigenous Health Victoria
What are you doing about Indigenous Health? Indigenous health is a national priority, with Aboriginal and Torres Strait Islander Australians still dying years earlier than other Australians and suffering from a wide range of preventable diseases and treatable illnesses. As a GP working in Indigenous health, you are likely to make a bigger difference to health outcomes than in any other area of medicine in Australia today! • Practice a holistic approach to primary health care in a cultural context by training at an Aboriginal Community Controlled Health Service (ACCHS). • Get an appetite for Indigenous health by volunteering or doing your GP placements at the ACCHSs. • Connect with GP Supervisors and the recent and current GP Registrars training in Indigenous Health. • Experience complex medicine including chronic disease, preventive health care, health promotion and public health management. • Train under inspirational GP Supervisors and Aboriginal Health Workers with years of experience and in-depth knowledge of the clinical status and cultural aspects of the community.
It is important It is challenging It is inspiring
Is it for YOU?
Are you interested in Indigenous Health? Contact the GP Education and Training Officer at VACCHO. 5-7 Smith St, Fitzroy VIC 3065 P: (03) 9419 3350 E: enquiries@vaccho.com.au W: www.vaccho.com.au
Victorian Aboriginal Community Controlled Health Organisation
1 / Aspiring to general practice
“There is a lot of perceived glamour attached to the hospital specialties by medical students but they don’t necessarily translate into a glamorous life in the end given the long hours and shiftwork.”
Why I chose general practice Dr Mike McKeough As a medical student, Port Macquarie GP registrar Dr Mike McKeough dismissed general practice as a career. But after experiencing the reality of general practice he changed his mind.
Did you see yourself in general practice as a medical student? To be honest, I was a sceptic and a critic of doing general practice as a student. I didn’t really appreciate the value of general practice and the contribution it made to patient care.
How is general practice viewed by medical students and hospital doctors? Within the hospital system there is a bit of a culture of undervaluing general practice. There is a lot of perceived glamour attached to the hospital specialties by medical students but they don’t necessarily translate into a glamorous life in the end given the long hours and shiftwork.
When were you first exposed to general practice? I had a John Flynn Scholarship as a med student. I spent two-week blocks over four years in Ayr in far north Queensland with a general
22
practitioner, Dr Paul Martin. He’s one of the best doctors I’ve ever seen – a true rural generalist. He did his own general surgery, his own obstetrics, he managed his patients in a general practice and the hospital patients as well.
What were your career plans as a hospital doctor? I was leaning towards one of the surgical pathways or maybe an academic role. I don’t think I seriously considered general practice until I was halfway through hospital.
What finally steered you towards general practice? I got more experience in general practice at the end of my second year of hospital training when I did a rural relieving term in Tully. As part of a Queensland Health program you go to a rural town and work as their town doctor for a time. There was another doctor so we shared shifts.
Mike’s tips on choosing the right specialty Think about the life you want not just the job you want. How much time will be left for family and outside interests? Get experience in lots of different areas. This is the only way to find out where your passions lie. Get exposure to general practice. Take every opportunity to do GP rotations. When you begin your internship, the PGPPP gets you out in a community general practice as part of your hospital training. Join GPSN at uni and the Going Places Network in hospital. They have some cool events, and you’ll get to meet others with an interest in general practice.
“I can remain passionate about work because my life is in balance.”
23
1 / Aspiring to general practice
“I was leaning towards one of the surgical pathways or maybe an academic role. I don’t think I seriously considered general practice until I was halfway through hospital.”
Was it confronting at that stage of training to practise as a GP?
What else do you like about general practice?
Confronting, challenging and exciting. Having worked in the hospital system, and being subject to the politics, hierarchy and personality differences, I came to enjoy the freedom and flexibility. It also helped me build confidence.
The freedom to travel anywhere. When we’ve finished our fellowships, my wife and I are planning to do some travelling medicine by taking GP locum jobs in the rural and remote areas of Australia and the Pacific islands, working a couple of weeks then taking a couple of weeks off. You can get work just about everywhere, filling in for GPs who want to take leave. General practice is our ticket to so many experiences.
Where are you working now and what would be a typical day for you? I’m working at a family-owned practice in Port Macquarie with five doctors and two registrars. My typical day starts at about 8am. I usually see about 25 to 30 patients with 20-minute consultations and an hour’s lunch break.
What do you most enjoy? I can remain passionate about work because my life is in balance. I get most weekends off, so I can spend quality time with my wife, Kalani, who is also a GP registrar. In hospital we hardly saw each other. I enjoy sports – tennis, touch football, golf, and I’m learning to surf. I also enjoy outdoor adventure like bushwalking and canyoning. We often go away for weekends, something not easy to plan with hospital rosters.
24
1 / Aspiring to general practice
My life in general Professor Michael Kidd
“I discovered that it is OK to cry with the people who call you their doctor.”
GPSN patron and GP academic, Professor Michael Kidd, reflects on choosing general practice as his life’s work and the lessons it has taught him.
“Why do you want to be a doctor?” It is the question I am sure every new medical student is asked at some time by their friends and their family and the people they meet at parties. In my case the answer was simple. I wanted to use what skills I have to help people. I wanted to make a difference.
Breadth of medical practice At the time that I graduated from medical school, like many young doctors, I was initially not at all certain about which area of medicine I was going to choose as my specialty. Over the next few years I signed up for rotations in internal medicine, paediatrics, obstetrics, emergency medicine, psychiatry, public health and rural and urban general practice. I discovered that general practice offered me the chance to cover the breadth of medical practice and work in each of the medical disciplines I enjoyed. It offered me the chance to really get to know my patients. It offered 26
me the chance to be my own boss and practise medicine the way I thought best. It gave me the opportunity to work in urban, rural and outback Australia and in other countries. I chose general practice.
Big black car On the way to arriving at that point, I had some great role models. Our family general practitioner when I was a child was the doctor who had delivered me. My mum would take me
“In my fifth year as a medical student, I undertook an elective in general practice with Dr Don Cordner, the Melbourne Football Club legend and a Brownlow Medallist in the 1940s.”
to see him at his clinic in his home or, when we were bed-bound, he would make house visits, driving around the neighbourhood in his big black car. He was wise and patient and kind. As a teenager, and during my years as a medical student, I went to a general practice run by a young husband and wife team. They didn’t treat me like a kid. They were non-judgmental about my lifestyle. They supported me during my angst-ridden teenage years and tackled my ever-increasing hypochondria – like most medical students, I was certain that I was experiencing the early stages of many of the diseases we studied at university. I was amazed at how quickly I got over the very early stages of amyotrophic lateral sclerosis.
Kind, gentle manner In my fifth year as a medical student, I undertook an elective in general practice with Dr Don Cordner, the Melbourne Football Club legend and a Brownlow Medallist in the 1940s. Dr Don worked from his surgery in the then semi-rural
area of Diamond Creek in outer Melbourne. He spent most of his day driving around the district providing palliative care to the people of his community who had chosen to spend their last days at home with their families. His kind, gentle manner, practical approach and unwavering commitment were an inspiration.
Local legend During my general practice training, I worked in several different general practices with wonderful general practitioners. The most memorable experiences were provided during my rural general practice term, working with Dr John Pickering in Dimboola in Victoria. John worked as a solo doctor, with his only respite occurring when he had a registrar attached to his practice. He was an all round rural general practitioner – an obstetrician, anaesthetist, surgeon and physician. He was a talented emergency medicine physician, and skilled at palliative care and chronic disease management. He was the local expert in 27
1 / Aspiring to general practice
“Working in general practice with people affected by HIV, I discovered something new about human existence every single day.” public health issues and the leading health care advocate for his local community. He was, and is, a local legend.
able to help some people and, in some small way, make a difference. I also started to learn from my patients and grow as a human being.
who trusts you to help them die with dignity is a very special privilege. And I discovered that my patients are my greatest teachers.
Academic registrar
HIV medicine
I also had the opportunity as a registrar to complete an academic registrar term at Monash University working with international GP legends like Neil Carson, John Murtagh and Chris Silagy while I learned to be a teacher and researcher as well as a clinician.
Working in general practice with people affected by HIV, I discovered something new about human existence every single day. I discovered that I couldn’t do it all, but I could do so much more by working as a member of a wonderful, diverse and highly skilled team. I discovered the camaraderie between general practitioners that supports us in our important work. I discovered the significant contribution I was able to make in preventive care and health promotion. I discovered the joys of working with a team of other dedicated health professionals. I discovered that wisdom started to appear with experience.
Professor Michael Kidd AM is a general practitioner and the Executive Dean of the Faculty of Health Sciences at Flinders University. A Past President of the Royal Australian College of General Practitioners, he is now the President-Elect of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA). He is patron of the General Practice Students Network.
When I completed my fellowship, I faced the challenge of deciding what sort of general practice I would work in. As it happened, the choice was simple. It was the early 1990s and the HIV epidemic was raging among the gay male community in Melbourne. As a gay male, I felt I had an obligation to do something to assist my peers who were affected by this dreadful disease. I started working at the Gay Men’s Health Centre set up by the Victorian AIDS Council. I started to feel that I was genuinely 28
I learned that in general practice, it is important to focus attention on the physical, psychological, social and spiritual impact of the conditions
affecting the people who trust me for their medical care and advice. I discovered that my patients often knew more about their condition than I did. I discovered that it is okay to cry with the people who call you their doctor. I discovered that being able to assist someone 29
DISCOVER
1 / Aspiring to general practice
Quick quiz
Is general practice the career for you? Take this quick quiz to discover whether you and general practice were made for each other.
SOMETHING NEW
A
1 Would you prefer:
4 Would you prefer:
A Dealing with patients with various health problems? B Dealing with patients with one particular type of health problem?
A Working in the community? B Working in the hospital system?
2 Would you prefer:
A Being able to train and work part-time? B Having limited opportunities to train and work part-time?
A Seeing the same patients and their families over an extended period of time? B Seeing a bigger proportion of new patients?
3 Would you prefer: A Regular hours with limited weekend work? B Variable rosters, shiftwork and on-call work?
30
B
5 Would you prefer:
If your answers were mostly As then a career in general practice could be a good match for you.
iPhone app Available on the
App Store or call 1800 800 629
1 / Aspiring to general practice
GP timeline
Opportunities to experience general practice from med school to fellowship There are many ways to experience general practice as you move from your student years through to your prevocational hospital years and beyond. Here’s an at-a-glance guide.
Uni year 1 and 2
Uni all years
GPSN First Wave Scholarship program* See page 58.
Join the General Practice Students Network (GPSN)* See page 41.
John Flynn Placement Program (JFPP)* See page 64.
Other scholarships, bursaries and grants* See page 64. General practice rotations
Hospital prevocational
GP registrar vocational training
Join the Going Places Network* See page 79.
Australian General Practice Training program (AGPT) See page 88.
Prevocational General Practice Placements Program (PGPPP)* See page 82.
Or Remote Vocational Training Scheme (RVTS) See page 110. Join General Practice Registrars Australia (GPRA)* See page 38.
* These experiences are optional but recommended experiences on the path to a general practice career.
32
33
1 / Aspiring to general practice
Who knew? Consultations between Austra lians and their GPs each year: 100 million
Percentage of people who consult their GPs at least on ce a yea r: 90%
GP regist ra r trainin g pla ces: 90 0 in 20 11 rising to 1,20 0 by 20 14
Genera l to rural GP registrar ratio: 55% genera l pathwa y, 45% rural pathwa y
34
M al e to femal e GP regist ra r rati o: 35% mal e, 65% femal e
2
general practice at med school
2 / General practice at med school
5 ways to experience general practice as a med student Curious about general practice as a career? Or perhaps you’ve already decided that being a “general specialist” is your calling. Here are some simple things you can do right now to get a taste of general practice and help your career whichever way it goes.
36
1
Join GPSN See page 41.
4
2
3
See page 58.
See page 64.
Apply for a GPSN First Wave Scholarship
Apply for the John Flynn Placement Program
5
Apply for another Make the most scholarship, of your GP bursary or grant rotations relevant to See page 68. general practice See page 64.
37
2 / General practice at med school
JOIN NOW
Network with GPSN: General Practice Students Network An initiative of gpra
GPSN is the student arm of General Practice Registrars Australia, known as GPRA. It’s creating a buzz at medical campuses all over Australia. Have fun, make friends and establish valuable networking contacts while you learn hands-on professional skills for your future career.
W
hether you have your sights on a career in general practice or you have an open mind, joining GPSN is one of the best things you can do at med school – professionally and personally.
What is GPSN? GPSN stands for General Practice Students Network. It is the first national student organisation with a focus on general practice. There are active GPSN clubs at medical university campuses across Australia. Since its establishment in 2007, GPSN membership has leapt to around 5,600 and continues to grow. GPSN is the first step in a continuum of activities organised under the umbrella of General Practice Registrars Australia (GPRA) to promote general practice as a career of choice. The General Practice Students Network (GPSN) is active in medical universities across Australia. At teaching hospitals, the Going Places Network brings together prevocational doctors with an 38
interest in general practice. For general practice registrars, GPRA provides support and advocacy during training. GPSN Membership Growth 2009-2011 6000
We seek to correct misconceptions about general practice. We promote the benefits of general practice as a career. We champion the importance of general practice’s role in the overall medical landscape.
What does GPSN do?
5000
We provide a range of educational and professional resources of interest to all medical students including: Academic events. Professional development events. Social events. An e-newsletter and website. A scholarship.
4000 3000 2000 1000 0
Professor Michael Kidd AM
Jan 09
Jul 09
Jan 10
Jul 10
Jan 11
GPSN’s aims in life We empower medical students to make informed decisions in choosing their future vocation.
Who supports GPSN? GPSN is administered by GPRA and financially supported by General Practice Education and Training (GPET). The original idea came from medical student and general practice enthusiast Joe Rotella, who was GPSN’s founding Chair.
GPSN patron MBBS (Melbourne) MD (Monash) DCCH (Flinders) Dip. RACOG FRACGP FACHI FAFPM (Honorary) FHKCFP (Honorary) FRNZCGP (Honorary) MAICD Professor Michael Kidd is Executive Dean of the Faculty of Health Sciences at Flinders University and a Past President of the RACGP. His research interests include general practice, medical informatics, health policy, medical education, safety and quality in primary care and the primary care management of HIV and hepatitis C. GPSN is proud to welcome such a distinguished figurehead of Australian general practice as the inaugural patron of GPSN. See page 26 for Michael’s article on being a GP.
39
It’s free!
GPSN dream team
Dr Michael Wong
“People are more interesting to me than any particular medical specialty – that’s what attracted me to medical general practice in the first place.”
The head of the GPSN family is the GPSN Executive, which manages national operations. Chair: Chris Timms (University of New South Wales) gpsn.chair@gpra.org.au Vice-Chair: Patrick Tam (University of Wollongong) gpsn.vc@gpra.org.au National Secretary: Hannah Bennett (James Cook University) gpsn.ns@gpra.org.au Publications Officer: Stephanie Garner (Flinders University) gpsn.publications@gpra.org.au IT Officer: Dave Townsend (University of New England) gpsn.webmaster@gpra.org.au IT Officer: Peter Ryan (University of New England) gpsn.itofficer@gpra.org.au The GPSN Executive leads the GPSN Council, which includes: One GP Student Ambassador (GPSA) from each Australian medical school. One Executive Officer (XO) from each Australian medical school. One Secretary (Sec) from each Australian medical school.
Join GPSN now Membership of GPSN is open to all students enrolled in an Australian medical program. As a member of GPSN, you become an Associate Member of GPRA. Member benefits include: Free professional activities. Seminars, clinical workshops, career expos and more. Free self-development opportunities. Become involved in an organised student body that offers opportunities in leadership and the chance to participate on national committees – we are always looking for enthusiastic people! Expand your CV, forge networks, enjoy travel perks. GPSN First Wave Scholarship opportunity. You’ll be eligible to apply for the GPSN First Wave Scholarship program. Free guides. Receive a free copy of this guide containing a wealth of information about general practice as a career path. Free e-newsletters. Receive a monthly e-newsletter and quarterly mailouts to keep you up to date with GPSN activities. Financial services and advice. Get free professional advice via GPRA’s business partners.
3 ways to join! Send us an email by writing to Chris, our GPSN Chair, at gpsn.enquiries@gpra.org.au. Join online at www.gpsn.org.au. Contact your local GP Student Ambassador (see page 44).
The GPSA, XO and Sec run the local GPSA club for their medical school. GPRA’s national office in Melbourne provides administrative support.
40
41
How GPRA supports the next generation of GPs GPRA’s vision GPRA is the peak voice for the next generation of general practitioners. We improve the health care of all Australians through excellence in education and training and ensure that general practice is a medical specialty of choice.
Provide feedback to Government and stakeholders on GP training policy Provide services to promote general practice as a career and support future general practitioners
STEP 1
STEP 2
STEP 3
medical students
prevocational doctors
GP Registrars
GENERAL PRACTICE STUDENTS NETWORK First Wave Scholarship Program – providing early positive exposure to general practice Events »»Social »»Educational »»Career Publications »»Aspire guide »»GP Companion Website, e-newsletters Mentoring Member benefits such as discounts
GOING PLACES NETWORK Events »»Educational »»Networking Publications »»Going Places guide »»Going Places magazine Website, e-newsletters Mentoring Member benefits such as discounts
GPRA MEMBERSHIP Advocacy and support during training Negotiation of pay and conditions Member benefits such as discounts Publications »»Explorer guide »»GP Companion Website, e-newsletters Professional development workshops Exam help »»www.onlineexamresources.org.au Self-care help »»www.rcubed.org.au
2 / General practice at med school
Hello.
I’m your GP Student Ambassador
Have you met the General Practice Student Ambassador (GPSA) at your university? He or she can open the door to all kinds of cool events. Here our GPSAs share their thoughts on general practice and life in general. Contact your local GPSA now.
44
Bond University
Deakin University
Flinders University
Griffith University
James Cook University
Megan Smith
Katherine King
Yaman Mujawaz
Samantha Nataatmadja
Lauren Prictor
gpsn.bond@gpra.org.au
gpsn.deakin@gpra.org.au
gpsn.flinders@gpra.org.au
gpsn.griffith@gpra.org.au
gpsn.jcu@gpra.org.au
Three words that describe me: Friendly, introverted, curious.
Three words that describe me: Gullible, nauseatingly organised.
Most memorable med school experience: Sitting barrier exams while 34 weeks pregnant.
Most memorable med school experience: Hearing Bob Brown speak at the Global Health Conference in Hobart in 2010. He is such an inspiring person and it reminded me that medicine is a fantastic career path and there are so many exciting opportunities awaiting me.
Best GPSN event: I was impressed by a talk given by a rural GP who was able to customise his career exactly the way he wanted it. After becoming a GP, he travelled to Africa and worked with various disadvantaged communities. Later, wanting to enhance his skills as a GP, he completed an “extra skill” fellowship. He couldn’t decide between anaesthesia, emergency or obstetrics so he did them all.
Most memorable med school experience: I’ll always remember the first time I was able to see a patient on my own, successfully diagnose and, as approved by my doctor, suggest treatment for them.
Most memorable med school experience: Working the New Year’s Eve shift in the emergency department. It’s enough to make you a teetotaller.
Funniest med school moment: Too many! I can’t pick just one. There seems to be a funny moment most days. What I like about general practice: Continuity. It’s a privilege to get to know patients and their families over time.
GPSN events for 2011: An icebreaker in early February, a clinical skills night in May, a careers night in September and our AGM in October.
GPSN events for 2011: We have many compelling events planned for 2011 including workshops in sports medicine, birthing, cannulation, suturing, and extra rural skills training in anaesthesia, emergency and obstetrics.
What I like about general practice: General practice appeals to me for many reasons. First, it offers a great work-life balance. Second, I love the freedom that allows you to direct your career towards your unique interests and even sub-specialise. And third, I feel passionately about providing quality, ongoing care in the community and would love to be involved.
Funniest med school moment: I received a letter from an insurance company addressed to Dr Lauren Prictor and I was only in my first year. Quickest degree ever! Best GPSN event: I attended a careers night with presentations by some inspirational general practitioners from Thursday Island. It showed me that there is a diverse range of fields that a GP can train in and I left with the understanding that general practice is what you make it.
45
2 / General practice at med school
Monash University Amanda Nikolic
University of Adelaide
gpsn.monash@gpra.org.au
Dana Quah-Smith and Chien Yen Poh (Yen)
Three words that describe me: Organised, energetic, fun.
gpsn.adelaide@gpra.org.au Dana and Yen job-share in the role of GPSA at their uni.
Most memorable med school experience: Meeting and spending time with my great year group of Monash meddies. GPSN events for 2011: We will have another third and fourth year practice OSCE session early in second semester. We are also planning a membership drive and a combined Monash and Melbourne Uni function.
Three words that describe me (Yen): Bubbly, enthusiastic, driven. Best GPSN event (Dana): For me it was the Breathing NEWLIFE into General Practice Conference. It was encouraging to see so many people with so many ideas about the promotion of general practice and its value in society come together. GPSN events for 2011: We’ll definitely continue with our clinical skills workshops and Live Well Study Well Workshop which have always been a hit with the students.
46
University of Melbourne
University of New England
University of New South Wales
Sophie White
Dave Townsend
gpsn.umelb@gpra.org.au
gpsn.newengland@gpra.org.au
Vivian Yeung and Nancy Jia
Three words that describe me: L arger than life.
gpsn.unsw@gpra.org.au Vivian and Nancy job-share in the role of GPSA at their uni.
Most memorable med school experience: Shaving my head with four friends for “shave for a cure”. And more recently, Saturday night at the Darwin mud racing while in the Northern Territory for the John Flynn Placement Program. What I like about general practice: I like the prospect of not having to sleep standing up against a theatre wall. I like the idea of having a life beyond my job. And I especially like the idea of getting to know people in the community – old and young alike. GPSN events for 2011: We’ll live out our dreams hacking and stitching pigs’ trotters.
Most memorable med school experience: All I can remember is procrastinating and then cramming, followed by more procrastinating and cramming. What GPSN means to me: GPSN is about overcoming misconception and building enthusiasm for the opportunities of general practice. Best GPSN event: Going to GP10 in Cairns with other GPSN winners. Amazing talks during the day followed by cocktails around the pool.
Three words that describe me (Vivian): Spontaneous, loud, fun. Most memorable med school experience (Vivian): Raising the most money in the Amazing Raise. An awesome friend designed our costumes. Three words that describe me (Nancy): Light emitting diode. What GPSN means to me (Nancy): GPSN is my megaphone. In advocating general practice through GPSN, not only will we be able to attract more fresh minds to this oft-belittled career path but we will also have a chance to help a medical student find their true calling.
University of Newcastle Asad Abdi gpsn.newcastle@gpra.org.au Three words that describe me: Friendly, outgoing, enthusiastic. Best GPSN event: Without a doubt, the First Wave Scholarship Workshop weekend in Melbourne. The speeches were very inspiring and informative about the life of a GP. However, the best aspect was being able to socialise with med students from universities across Australia and sharing each other’s experiences of med school during a night out in Melbourne, as well as building friendships with people who will become potential colleagues in the future.
47
2 / General practice at med school
University of Notre Dame Fremantle
University of Notre Dame Sydney
University of Queensland
University of Sydney
University of Tasmania
University of Western Australia
Dana Ihdayhid
Alexis Bain
Maelle Morgan
Priyanka Dixit
Bridget Hilliard
Paige Tucker
gpsn.notredame@gpra.org.au
gpsn.undsyd@gpra.org.au
gpsn.uq@gpra.org.au
gpsn.usyd@gpra.org.au
gpsn.utas@gpra.org.au
gpsn.uwa@gpra.org.au
Three words that describe me: Caring, sincere, hardworking.
Three words that describe me: Motivated, ambitious, fun.
Three words that describe me: Canadian, Indian, Indonesian.
Three words that describe me: Loyal, passionate, caring.
Three words that describe me: Blonde, sporty, stubborn.
What I like about general practice: Flexible working hours, an opportunity to practise every aspect of medicine, scope to subspecialise and interaction with a diverse range of people.
Most memorable med school experience: The first week of first year in 2010 and med camp.
What I like about general practice: You can follow a patient’s health over a lifetime as well as possibly three generations of their family.
Funniest med school moment: Having a patient call me Paprika. My name is Priyanka but who doesn’t love a little spice.
Funniest med school moment: We have a well-meaning but sometimes confusing pathology lecturer who has given us some brilliant metaphors over the years.
Most memorable med school experience: Getting accepted. Four years on and I still haven’t recovered from the shock. Besides that, getting to know my fellow med students has been very memorable. They are all amazing people with great gifts. Of course, discovering the GPSN at UWA and being involved in the development of the program has also been a highlight.
GPSN events for 2011: We will make a presentation at the orientation camp. We plan to be involved in the combined first and second year medical school lunch and we will run a clinical skills night that will also include some presentations by GP registrars.
48
What I like about general practice: The diverse skills that can be gained and the opportunity to apply them in a variety of different fields.
What GPSN means to me: GPSN people are fun and social but they are serious about promoting great health care both for the community and for doctors through general practice.
GPSN events for 2011: We will promote GPSN on orientation day and also hold a hands-on clinical skills night. We intend to have an academic night with guest speakers and a social event promoting general practice.
GPSN events for 2011: We are planning a GP mentor program for second years. We want to set up students with kits they can use to approach their local doctor and get first-hand experience in the GP clinic.
What GPSN means to me: GPSN is about meeting new people, having fun, learning new skills and spreading awareness about general practice. Best GPSN event: The Breathing NEWLIFE into General Practice Conference. From surviving boot camp and dressing up like aliens to meeting Dr Feelgood and taking a picture with the former PM Kevin Rudd, GPSN kept the surprises coming.
Chronic inflammation: “It’s like two kids in the back of a car when one hits the other and he hits him back and they are both whacking each other and you smack one and smack the other and say ‘shut up’!”
What I like about general practice: Variety and flexibility. No two days would be the same. You must be a “generalist”, not just focusing on one body part.
49
2 / General practice at med school
University of Western Sydney
University of Wollongong
Australian National University
Nat Vo
Vanessa Hewitt
Still hiring
gpsn.westsyd@gpra.org.au
gpsn.wollongong.gpra.org.au
gpsn.anu@gpra.org.au
Three words that describe me: So sleep deprived. Med school does that to you.
Three words that describe me: Passionate, honest, open-minded.
Most memorable med school experience: One thing I won’t forget is the first time I looked at the head of a cadaver sliced so that you could see the brain and the face at the same time. It was just incredibly confronting.
Most memorable med school experience: Our GP placement using a thermal cautery and burning a hole through a toenail to treat a subungual haematoma.
Do you belong here? Are you interested in getting involved in organising GPSN at your uni? Develop your skills in medical management while you build your networks. Have fun, enjoy travel opportunities and meet new people. For the ANU General Practice Student Ambassador position, please contact gpsn.chair@gpra.org.au. If you would like to assist the GPSN Executive at other universities, contact your local GPSA.
Funniest med school moment: During a lecture, the lecturer was told that recently a man got cervical cancer. The question was how. My friend answered “Was it Richard?” (Richard is our slightly effeminate male friend.) It’s okay, Richard laughed too.
50
What I like about general practice: Having the opportunity to develop relationships with patients over time and having a chance to not only help fix them but also promote positive health changes in their lives, their families and a whole community.
2 / General practice at med school
A Year in the life of
GPSN 2010 GPSN recruitment, Deakin University
Suturing workshop, Griffith University
52
Breathing NEWLIFE into General Practice 2010, Canberra
53
2 / General practice at med school
GP shout out 2010 saw a number of innovative competitions that challenged med students to get creative in spreading the word about general practice as a career choice. GPSN essay winners
AMSA YouTube stars
GPSN invited med students to write a 500-word essay on closing the gap in Indigenous health care. Pictured are the five winners, who won a trip to the GPET Convention in Alice Springs in September 2010.
Clockwise from back left: Kerina Costantini (University of Queensland), Todd Cruikshank (University of Notre Dame), Benjamin Veness (University of Sydney), Patrick Tam (University of Wollongong) and Matthew Ruhl (Griffith University). 54
who each won $1,500. See it on YouTube by typing “AMSA Bob’s Big Decision” into your search engine.
GPSN on song Tomorrow’s GPs are an animated bunch judging by AMSA’s short video competition. In the lead-up to the 2010 Australian Medical Students’ Association (AMSA) conference in Hobart, med students were invited to make a short video selling general practice to their peers. The winner, featuring plasticine animation and a catchy music track, was Bob’s Big Decision by Mercia Eminoglu, Sashie Howpage and Aarani Somaskanthan from the University of Western Sydney,
Delegates to GP10 in Cairns were invited to create a song, poem, poster, video or photo on the theme of general practice as a career choice. Five students won flights, accommodation and conference registration. They were Marisa Harvey (Deakin University), Dave Townsend (University of New England), Joanna Troscianczuk (University of Queensland), Benjamin Veness (University of Sydney) and Manik Mayadunne (University of Western Sydney).
2 / General practice at med school
Diary of a breathtaking conference Griffith University General Practice Student Ambassador Nikole Fry kept a daily diary of her experiences at the 2010 Breathing NEWLIFE into General Practice Conference. Day 1 – Arrival Today the three of us from Griffith University, Chayel, Nicole and myself, flew in from Brisbane to Canberra. Chayel and I had come to the conference last year and were excited to be bringing along our new recruit. We arrived in Canberra expecting the autumn March days to be cold, but to our surprise it was actually quite warm, so off with the jackets! We settled into our rooms, then quickly went to the conference room for a warm welcome from our Executive Committee. We heard great stories from GPs who are living the dream, how GPSN is going and future directions for GPSN, GPs and medical students.
About the Breathing NEWLIFE into General Practice Conference The Breathing NEWLIFE into General Practice Conference, known as BNL, is an annual event held in Canberra. A joint initiative between GPRA and GPSN, it brings together registrars, students, educators, supervisors and politicians from across the country. General Practice Student Ambassadors and GPSN office bearers from universities Australiawide are funded to attend and enjoy an introduction to a career in general practice while rubbing shoulders with the thought leaders in Australian health care. The 2011 Breathing NEWLIFE into General Practice is scheduled for 24 March.
In particular, I really enjoyed the talk from Dr Sally Cockburn (Dr Feelgood) who gave a fantastic speech about her varied career. I even plucked up the courage to ask her if she could squeeze in a trip to Griffith Uni for our GP careers fair.
stakeholders and MDOs about how they fit into our relationship with GPSN and GPRA.
As always, the day was catered and the food was fantastic. Later that night, we all dressed up in some pretty snazzy costumes for a nice relaxed dinner at the hotel.
Day 3 – Parliament
Day 2 – Getting stuck in Today was about teaching the basics of running GPSN at our local unis for the newcomers and brainstorming new ideas for those who had attended before.
That night we headed to a lovely restaurant for a hard-earned drink and dinner.
As always, the highlight was our much anticipated trip to Parliament House for a fantastic day with the Minister for Health. We had an unexpected visit from the then Prime Minister Kevin Rudd. I think the entire hall became star-struck and wanted to talk to him and get a photo. It is always such a great day at Parliament House.
We were able to talk to politicians and have our voice heard. We had round-table discussions about our wants and needs as students, interns and registrars and put this information to the people who can make a difference for us. The cocktails evening was great and gave us an opportunity to make some good contacts that might profit our club and hear some amazing stories from GPs and registrars. With my passing on to final year medicine and handing over GPSN to four fresh-faced first years, I feel heartbroken to realise I won’t be back.
Contributed by Nikole Fry, 2010 GP Student Ambassador, Griffith University
We also heard presentations from our
“We had an unexpected visit from the then Prime Minister Kevin Rudd. I think the entire hall became star-struck and wanted to talk to him and get a photo.” 56
57
2 / General practice at med school
The GPSN First Wave Scholarship Why not apply? What: GPSN First Wave Scholarship program – GP exposure opportunities currently available at participating Australian universities.
The GPSN First Wave Scholarship program gives first and second year med students early real-life exposure to general practice. Are you in the first or second year of your medical degree? Would you like to experience what it’s like to work in general practice while establishing professional relationships with dedicated doctors? Then think about applying for the GPSN First Wave Scholarship program. The experience would be invaluable – and would certainly add some sparkle to your CV!
The program was initiated by GPSN to provide positive, early, structured exposure to general practice, specifically in outer metropolitan and academic settings. The program is continuing to expand from 60 scholarships in 2010-11 to 80 scholarships in 2011-12 to 100 scholarships in 2012-13 across all medical universities in Australia.
DO IT NOW The GPSN First Wave Scholarship program will be advertised at participating campuses through GPSN or for more information visit www.gpsn.org.au. Applications open on 16 May 2011 and close on 15 June 2011. Refer to the GPSN website for further information.
“The program was initiated by GPSN to provide positive, early, structured exposure to general practice, specifically in outer metropolitan and academic settings.” 58
Contact W: www.gpsn.org.au E: firstwave@gpra.org.au T: 1300 131 198 A: GPSN First Wave Scholarship Program, General Practice Students Network National Office, 517 Flinders Lane, Melbourne VIC 3001
Why it began: There was previously a lack of opportunities for first and second year medical students to gain real-world exposure to general practice in an urban setting. There was also a desire by GPSN to raise awareness of general practice and its role in health care. Who’s behind it: GPSN, General Practice Education and Training (GPET), participating Australian medical schools and participating general practices. How it works: There are two streams – Clinical and Academic. Candidates apply via a formal process. Scholarship recipients are teamed with a general practice preceptor who mentors them. The experience principally involves working for a number of supervised sessions in a clinical practice (Clinical) or doing a research project or other academic activity (Academic). Academic scholarship winners will also do some clinical sessions. Scholarship activities are generally scheduled during the post-Christmas summer holidays. Participants also attend an orientation workshop. Who can apply: First and second year students at participating Australian medical schools – check whether yours is currently a participant in the scholarship program.
59
2 / General practice at med school
My First Wave experience Emily Jenkins
T
he pre-clinical years of medical school are important years of learning and self-discovery that lay the foundations for long careers in the medical world. While no curriculum is perfect, many universities, including mine, are struggling to appropriately prioritise the various demands upon student time – and career guidance is left wanting. Adequate time must be allocated to considering the most important question of these early years. That question. That question that never goes unasked, whether it be by the consultant you’re supposed to be shadowing for the afternoon (or the intern you instead get palmed off onto), by the guy or girl you try to make polite conversation with in the coffee line, by the long lost family friend who hasn’t seen you since you were “this big”, 60
or worst of all, by your fellow meddies. Yes, that question. “So what type of doctor do you want to be?”
Sexiness scale I think it’s fairly true to say that general practice has a little bit of an image problem. On the specialty sexiness scale it sits somewhere between radiology and deregistered practice nurse.
“This wasn’t a matter of falling out of love with any of the various “ologies” I had now been introduced to, rather I wanted to marry them all…”
But what is perhaps the greatest shame about all this is that if med students regard general practice as a specialty at all, it’s very much as a second-rate one – a tier below the standing of other “proper” specialties. Coming from an emphatically non-medical background I think I was particularly susceptible for this mentality and the surreptitious pressure
Emily Jenkins, a medical student at Monash University, gives her personal take on the GPSN First Wave Scholarship program.
that exists to aim for what the masses deem to be the highest echelons of medicine. So along with my peers I spent my first year of medical school falling madly in love with whatever specialty had featured in the preceding lecture.
Medical polygamist However, one thing I gradually came to realise as I matured into a marginally wiser second year student was that I could not really see myself in many of the career options I had been throwing around in my head. When it came down to it I just didn’t want to commit myself to one tiny little area of medicine. This wasn’t a matter of falling out of love with any of the various “ologies” I had now been introduced to, rather I wanted to marry them all: a medical polygamist who would be able to do a little bit of everything. But equally importantly, I didn’t want my experience of medicine to only show me what could go wrong. I wanted to be involved in sickness but also in health. In essence, I wanted to work with people, not with illnesses. And so the seed of
general practice was planted.
Orientation workshop With this budding interest I naturally jumped at the chance to be involved with the GPSN First Wave Scholarship program as an opportunity to further my understanding of general practice. I was lucky enough to be selected and in September 2009 headed up to Sydney for an orientation workshop. This was an intensive weekend of inspirational guest lecturers, GP “mythbusting”, personal experiences of current GPs and GP registrars during the training process and in practice, and of course an introduction to the scholarship itself. I found this to be a very positive experience. It was very refreshing to be in a forum in which general practice was not seen as a second-rate option, but instead was embraced and promoted.
Placement Back in Melbourne I was placed with GP registrar Dr Mark O’Meadhra at Rowville 61
2 / General practice at med school
Dr Georga Cooke
“Reflecting back over my placement now, what really stands out is the variety.”
Health, which thanks to my trusty GPS I discovered to be a large multidisciplinary clinic located in the south-eastern suburbs of Melbourne. My key objective for the placement was to get a sense of what general practice was really like and Mark kindly consented to put up with me for a solid week so that I could try and achieve this. Reflecting back over my placement now, what really stands out is the variety. I spent the majority of each day sitting in on Mark’s consultations, but far from the steady stream of coughs and colds I was expecting, I saw everything from broken bones to blood pressure checks, slapped cheek to suspicious lumps, contraception advice to chest pain. Several consultations would have been ideal for a “dealing with emotion” OSCE.
detailed history and examination necessary with a complex presenting complaint. What I loved was that there really was no “typical” day or “typical” patient. Simply watching Mark in action was an incredible learning opportunity – not just to see his competency when questioning or examining patients, but also to pick up on all the tricks of the trade which only come with experience, and the many subtle nuances of non-verbal communication.
Clinical exposure
Tricks of the trade
Opportunities for clinical exposure – especially quality patient time – in pre-clinical years are few and far between, so the clinical side to the placement proved an invaluable learning experience. With so many musculoskeletal injuries presenting, I could really consolidate these examination skills.
One patient came in so unwell he was immediately sent to hospital, others were simply there for routine immunisations. Consultations could be as short as a script renewal, or have a
Mark also had me listening to chests and taking blood pressure at every chance. Even more excitingly, I was able to do some cryotherapy,
62
syringe out a few ears and inject the local anaesthetic and suture up after a skin tag excision. A further added bonus was the opportunity to spend time with several of the other health care professionals working at Rowville Health, and experience an efficient and effective team approach to health care provision. This included spending time in the mole clinic, with a physiotherapist and with a chiropractor.
Inspiration What my placement highlighted to me was the variety, lifestyle flexibility and continuity of relationships with patients offered by general practice. I immensely enjoyed my time at Rowville Health, and found it enormously inspiring to have the opportunity to be mentored by such an enthusiastic and passionate doctor.
“Doing general practice doesn’t mean you miss out on the exciting things or the emergencies or the intellectually interesting problems.”
Was my placement what I was expecting? Not really. It was better! This experience has got me pretty hooked. And as for that question? I feel I can finally answer it with confidence. I want to be a GP.
Contributed by Emily Jenkins 63
2 / General practice at med school
Other scholarships for med students These scholarships, bursaries and grants can broaden your experience, boost your bank balance and make your CV look sharp. Please note, this list is by no means exhaustive.
Rural scholarships John Flynn Placement Program (JFPP) The John Flynn Placement Program offers medical students the opportunity to experience general practice in a rural community, spending eight weeks over a number of years (usually two weeks a year over a four-year period). The scholarship covers travel and accommodation costs. Students are also provided with $500 a week during the placement to cover food and living expenses. Students are matched with an experienced rural doctor in the same community each year and are expected to finish the entire eight weeks by the last holiday period following the completion of their medical course.
64
The Australian College of Rural and Remote Medicine (ACRRM) administers the program on behalf of the Australian Government. For further information, contact the JFPP Program Coordinator or the Support Officer at ACRRM on 1800 231 231 or email jfpp@acrrm.org.au.
Applications open and close early each year.
“I love being recognised by locals when I return to my placement community each year and have revelled in the chance to gain the additional clinical experience offered by the John Flynn Placement Program.” Teena Downton
Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme The RAMUS Scheme aims to give students from rural areas the same opportunities in medicine as their urban counterparts. It provides students from rural areas with financial assistance while they complete their medical degree. Australian citizens or permanent residents are eligible to apply. They must have lived in a defined rural area in Australia for a minimum of five consecutive years or eight cumulative years from their fifth birthday up until they entered medical school. Each scholarship is worth around $10,000 per annum. Every year approximately 100 new scholarships are made available for students. For further
information, visit the National Rural Health Alliance (NRHA) at www.ruralhealth.org.au or call 1800 460 440.
Applications open in early November 2011 and close in January 2012.
Medical Rural Bonded Scholarships
the university where they have been accepted to complete their medical degree. For further information regarding the application process, please contact the medical schools directly as they invite expressions of interests in different ways. Information can be found at www.health.gov.au/ mrbscholarships or you can call 1800 248 720 or email mrbscholarships@health.gov.au.
The Medical Rural Bonded (MRB) Scholarships are offered as part of the Australian Government’s Rural Health Strategy, which aims to provide improved medical services to rural and regional communities. There are 100 scholarships annually worth over $23,000 a year each.
AMSA Medical Student Bursaries
Students must commit to working six continuous years in rural or remote Australia after they complete their medical training. Students must also express an interest in obtaining an MRBS place with
The Australian Medical Students’ Association (AMSA) offers various bursaries to assist medical students. Bursaries for 2011-2012 were not finalised at the time of printing. Check www.amsa.org.au for updates.
General scholarships
65
2 / General practice at med school
Australian Defence Force Medical Scholarships
MIGA Elective Grants Program
The Australian Defence Force (ADF) sponsors students who are interested in pursuing a medical career in the Navy, Army or Air Force.
Launched in 2004, this program is sponsored by Medical Insurance Group Australia (MIGA) and provides financial assistance to medical students who undertake their elective in developing communities.
The ADF covers costs involved in completing a medical education including HELP/HECS fees, tertiary institution fees, student union fees, textbook costs, a rental allowance, and full medical and dental treatment. Students are also paid a salary with superannuation included. Graduates are required to serve as a Medical Officer for the number of years they were sponsored plus an extra year. To look for positions, visit defencejobs.gov.au. For more information, call the ADF on 13 19 01.
Applications are open all year. 66
at www.miga.com.au or 1800 777 156.
Applications open on 2 May 2011 and close at 5pm (CST) on 26 August 2011.
Indigenous scholarships
The program offers up to five grants, each consisting of a $2,000 elective grant to assist in meeting travel costs and a $1,500 medical support grant to assist in the purchase of medical or other aid for the community the student visits.
Puggy Hunter Memorial Scholarship Scheme
The 2011 program is open to current medical students in Australia who are student members of MIGA and wish to undertake an elective program in a developing community between March 2011 and February 2012. Further information and an application form is available from MIGA
The scheme was created to boost the number of Indigenous people in Australian professional health positions.
The Puggy Hunter Memorial Scholarship is awarded to Aboriginal and Torres Strait Islander people who wish to undertake a medical degree or other allied health degrees.
As a full-time student, successful applicants receive assistance valued up to $15,000 per year for the duration of their course. If the
applicant chooses to complete their course part-time, they will receive assistance up to the value of $7,500 per year for the duration of their course. Information can be found on www.rcna.org.au or you can contact the Royal College of Nursing Australia (RCNA) on 1800 061 660.
However, students currently in their first year of medicine are eligible to apply. Applicants must also be eligible for ABSTUDY. Students receive up to $9,000 worth of assistance for every year of their degree. More information can be found on the AMA website www.ama.com.au.
Applications for 2012 are due to open in mid-2011.
Applications for 2012 open late in 2011 and close early in 2012.
Australian Medical Association (AMA) Indigenous Peoples’ Medical Scholarship The Australian Medical Association also offers scholarships to Indigenous Australians who wish to study medicine. Students who are currently enrolled full-time at an Australian medical school and have successfully completed at least their first year in medicine are eligible to receive the scholarship. 67
2 / General practice at med school
Student Medical Indemnity
6 top tips to make your GP rotation count
Join MIGA and kick start 2011 with a
How do you get the most out of doing prac in a general practice? These tips will help.
1
Be positive
4
Meet and greet
Approach your general practice rotation in a positive manner and seek to make the most of all learning opportunities.
Actively participate in orientation to the practice by meeting all the staff and understanding their roles.
2
5
3
6
Define your interests
Give some thought to your interest areas in general practice and your specific personal learning objectives.
Talk to your teacher
Meet with your GP clinical teacher at the start of the placement to discuss and formulate key learning objectives with the intention of reviewing these later.
Learn about admin
Seek to understand administrative processes within the practice including billing and referral systems.
Protecting yourself is paramount MIGA offers a FREE medical indemnity protection package for medical students – great cover and benefits, no hassle, no cost. Join before 29 April 2011 and you’ll be in the running to win 1 of 3 $1000 gift cards from your choice of the following retailers:
Download GP Companion
GP Companion is a handy reference of GP clinical guidelines and data compiled by GPSN to assist medical students on GP rotations. Download it as an e-book at www.gpsn.org.au or ask the General Practice Student Ambassador at your university for a pocket-sized hard copy. And don’t forget to have fun!
Contributed by Amit Vohra and Jan Walker 68
$1000 boost!
Joining is easy, simply visit MIGA’s booth during orientation or go to www.miga.com.au and complete the online Application Form available on the Student Page.
Study with confidence 1800 777 156
•
miga.com.au
Adelaide (Head Office)
Brisbane
Melbourne
Sydney
For competition terms and conditions refer to www.miga.com.au. Authorised under NSW Permit No. LTPM/10/00483, ACT Permit No. TP 10/02676.1. Insurance Policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by the Medical Defence Association of South Australia Ltd. Before you make any decisions about our Policy, please read our Product Disclosure Statement and Policy Wording and consider if our policy is appropriate for you. Call MIGA for a copy or visit our website. © MIGA November 2010
2 / General practice at med school
My GP rotation gave me goosebumps Daina Rudaks
Adelaide med student Daina Rudaks, who recently returned from a rural general practice rotation in Whyalla, explains why.
D
id you ever read a Goosebumps novel? You know the ones, where you have to choose your own adventure? Where you are led through different twists and turns to an alternate ending depending on your choices? I don’t know about you, but I sometimes used to flip back a few pages to rediscover where I had chosen one path so that I could read the other version... looking for something I liked more.
Why am I writing about Goosebumps you ask? Well, in my mind, the experience of medical school and a career in medicine is a little like a Goosebumps novel. There is an infinite range of choices and, unlike a conventional novel where the ending is the same for all, everyone arrives at a slightly different endpoint, having taken varied journeys along the way. 70
Some 390km away from home, I settled in very quickly into the shared student accommodation with others on their own adventures in the form of surgical, nursing and podiatry placements. To be perfectly honest, I wasn’t quite sure what to expect from the placement, having completed the first half of the year in large metropolitan hospitals. After day one, it was clear – expect anything and everything, but no traffic. Broken bones, first presentations of high blood pressure, sixweek baby checks, rashes in children, coughs in adults, sore joints in the elderly, abdominal pain – and this was just the first day!
Choose your own adventure
“Throughout medical school, the adventures you get to choose are presented to you in the form of clinical rotations and electives.” Growing confidence My confidence grew enormously throughout this placement. In my short few weeks I found that not only was I able to become part of a practice and community but I also gained a true understanding of just how large a range of presentations there are to a rural general practice, and the difficulties of accessing services from such locations.
Throughout medical school, the adventures you get to choose are presented to you in the form of clinical rotations and electives. Some will immediately take your fancy, some will make you wish you could flip back a few pages and choose the other, and some will surprise you.
I found very quickly just how true it is that people living in the country are welcoming, open and very willing to help you learn. This partly because rural communities, more than we in the city realise, are in need of more practitioners.
I am only part way through my Goosebumps novel of medical school, as this has been my first year of clinical rotations, one of which was a general practice placement with the Spencer Gulf Rural Health School.
Every placement is different. Every preceptor is different. This is what helps to shape our choices as we continue to choose our own adventure as we move through our careers. Who knows what twists and turns await me, but this was certainly a placement for which I did not wish to turn back the pages.
Expect anything and everything My rural placement saw me travelling to Whyalla, a town I had never visited, despite having grown up in South Australia.
Twists and turns
I was no longer just reading about symptoms, I was the first one hearing about them from the patients in front of me and trying to make sense of their stories. I was not looking at photos of signs in my textbooks, but seeing and eliciting these myself to try to arrive at a reasonable diagnosis. My clinical skills were certainly being put to the test, and it was great.
Maybe you’ll be surprised too.
Contributed by Daina Rudaks 71
2 / General practice at med school
Surviving med school: how to prioritise
More stress-busting tips from the girl with blue stethoscope The girl with the blue stethoscope has more tips on de-stressing the med school experience on her blog.
Getting your priorities straight is essential to managing stress according to the Brisbane med student and blogger known as “the girl with the blue stethoscope”.
I
f you cannot prioritise, you will not survive medical school. That may sound extreme, but it is very true. If you got into med school, you are probably already pretty good at prioritising, but compared to other areas of study, medicine is so huge that you need to improve on this skill rapidly to keep your head above water. There are so many things that you feel expected to know and do, and you will never have time for them all, even if you had twice the hours in your day. I have tried to write out my priorities as they are, but they do change from time to time.
1
Personal health and hygiene. Yes, I need to shower and eat breakfast. I also need to go to the GP on occasion. My dentist regularly nags at me because I don’t see her often enough and I’m not an obsessive flosser, but I don’t really care. I brush twice a day and don’t need fillings, so beyond that is just too much for me. Medical students get sick, too, so get that Pap smear done, keep up to date on your jabs and health 72
checks and make sure that you are still around to finish the course. You can generally schedule these things around your class times or rotation obligations, so make sure you keep up with them.
2
Aim to be a safe and competent doctor. This is my number one priority after being alive and in one piece. This is why I desperately try to be better at pharmacology than I already am (and why it terrifies me that we don’t cover more of these things in our course). This is why I like to focus on the “red flag” diagnoses that you should never, ever forget about. The things that will kill your patients, or seriously harm them if you drop the ball. There are the diagnoses that you need to think a little bit laterally to spot. Then there are seemingly small things like the decimal place or the units on a drug chart. This is scary stuff. What is the point of doing really well in medical school if you aren’t a safe doctor? This might mean that you have to speak to somebody at your school or clinical rotation
thegirlwiththebluesteth.blogspot.com
if you feel that you are not being properly supervised or taught, or find alternative ways to learn. As one wise person told me, if you are in court defending yourself a couple of years from now because you didn’t know how to do something as well as you should have, they won’t be interested in your excuses about not being taught properly in medical school.
3
Passing exams. I know it might sound obvious, but it is sensible to do your best to pass your exams. I would like to think that if you used common sense and studied topics from the viewpoint of how you will be thinking as a doctor, you will be fine. You might not be. It depends on the course. Don’t forget to name the most likely diagnosis first and use common sense. Past papers can be very useful, so look at them to see the type of question you might be asked, but don’t forget to
study more than just the past exams and don’t forget aim number 2. You can split your content into what you really need to know, what you should know and what you would like to know if you had the time.
4
Study may have to come first, before other things that are more fun. Yes. this hurts, but it is true. You need to have some fun, but it needs to be in moderation, and your learning needs to come first. Really important family gatherings are something that you should try not to miss if you can. Less important get-togethers may have to become a lot less frequent. If you never, ever miss an episode of Neighbours or CSI, you may have to change your priorities.
“There are so many things that you feel expected to know and do, and you will never have time for them all, even if you had twice the hours in your day.” 73
2 / General practice at med school
This is one of the reasons that some medical students get the reputation for working and partying hard. They spend most of their time studying their butts off, then when it is time to let their hair down, they get it all out of their system in one hit. I favour a more balanced approach, but we are all different. I’m more of the tortoise to their hare. Binge drinking is dangerous and I feel strongly that there should not be medical student society events that endorse it. Clearly I’m odd, but if you are studying so very hard to fill your brain with knowledge and build up a respectable career, why take part in an activity that can seriously harm or kill you, or ruin everything that you have worked so hard to achieve? I like alcohol, but binge drinking on the scale I have seen in medical school has been an unpleasant surprise.
Need help? If you feel you aren’t coping with things, who can you turn to? Your university counselling service. They can offer a listening ear, practical study tips and, if required, referral to other professional help. Your GP. If you are worried or depressed, it is really helpful to talk things over with your general practitioner. Beyond Blue. The national website designed to support people with depression. Visit www.beyondblue.org.au.
5
RCUBED. A website developed by GPRA to give GP registrars, prevocational doctors and medical students real resources to build resilience. Visit www.rcubed.org.au.
These are the priorities that have helped get me through medical school so far. Things might be different for you, and that is okay. The most important thing is to learn to take things one step at a time and to work out what you need to do the most, and get that done.
www.rcubed.org.au
Occasionally you may have to take some time out to recharge. This might be as long as a weekend off uni work, or an hour or two to watch your favourite movie. I would choose to pass exams over taking some time out, but if you can afford it and need to de-stress, see if you can salvage some valuable time for yourself, even if it is just an hour or so for a massage or to get your hair done.
Good luck. 74
Contributed by the girl with the blue stethoscope
3
after med school, what next?
3 / After med school, what next?
4 ways
to experience general practice as a junior hospital doctor
Planning for your intern year and beyond? It’s easy to get swept up in the “hospital specialties” during your hospital training but remember you can gain valuable experience in general practice while in hospital too. Even if you are undecided about your future career direction, these hospital experiences will help your career in general practice or any other specialty.
76
1
Join the Going Places Network
2 Choose GP-friendly hospital rotations
This peer group club for prevocational doctors is the hospital equivalent of the General Practice Students Network (GPSN). It’s a fun way to find out more about general practice or network with others who have similar interests. For further details, see the GP Ambassador at your hospital or visit www.gpaustralia.org.au/goingplaces.
Choosing the right hospital and rotations as an intern and beyond can help ease the way to a career in general practice. See page 78.
3
4
Test-drive general practice Attend a general practice with the PGPPP careers night at your hospital The Prevocational General Practice Placements Program (PGPPP) enables you to work in a community general practice as part of your hospital training. See page 82.
Coming along to a GP careers night at your hospital is a great way to find out more about a general practice career and what the training involves.
77
3 / After med school, what next?
the gp mindset
in hospital Once you begin your hospital training, there are ways to keep your mind on general practice while working in hospital.
D
uring hospital terms, it’s easy to be occupied with the usual duties of caring for too many patients and constantly being paged. Often, little time is left to think about how your hospital experience can help you as a GP in the future. Here are a few points that will help you make the most of your hospital experience. Choose your terms. Choose terms that will give you experience with common GPmanaged conditions. Mandatory rotations are listed in the box opposite. General terms such as general medicine and general surgery may be more relevant than super-specialised placements. Accident and emergency terms are always a great opportunity to experience a wide range of presentations and to learn acute care skills, timely management and referral. Any experience with skin, ears and eyes will stand you in good stead. During your prevocational years, if a Prevocational General Practice Placements Program (PGPPP) term is offered at your hospital, take full advantage. 78
Fine-tune your practical skills. Ask nurses to teach you skills such as giving vaccinations (especially to children) and dressing wounds. Ensure you can place common types of plaster casts with confidence. Pick up useful procedural skills. Learn procedural skills that may be useful in general practice; for example, joint aspirations and injections, excision of cysts and skin lesions. Learn the art of referrals. Think about what information is pertinent on a referral letter sent with a patient to emergency. Discuss the referral process with consultants. What do they like in a referral? What tests should be ordered prior to referral? How urgently do they need to see particular cases?
GPSN TIP Join the Going Places Network at your hospital. It’s a fun way to learn more about general practice and network with peers and mentors with an interest in general practice. Visit www.gpaustralia.org.au/goingplaces.
Choose the right hospital and rotations Choose a hospital and terms that will give you experience with common GP-managed conditions. There are rotations and experiences that are considered to be mandatory preparation for the Australian General Practice Training (AGPT) program. There are four compulsory rotations: Medicine (preferably general medicine but as this is not available in some hospitals, a rotation that offers broad medical experience) General surgery Accident and emergency Paediatrics In addition, each college requires certain other hospital terms and particular courses to be completed. For more information about compulsory hospital rotations for general practice training, refer to www.agpt.com.au, www.racgp.org.au and www.acrrm.org.au.
Be curious about management decisions. In addition to the acute management decisions you will have made in the hospital setting, as a GP you will also be initiating and monitoring long-term management of chronic conditions. Talk to your consultants and registrars about 79
Dr Sarah McEwan
up-to-date guidelines and approaches to chronic disease management.
“As a Wiradjuri Indigenous woman, I have an interest in Aboriginal and rural and remote health. I will never forget my first delivery as a GP obstetrician – it cemented all the reasons why I chose the profession.”
Find out who’s who. Identify people who may be good information sources when you are working in the community; for example, hospital registrars, consultants, CNCs.
80
Practise your writing. Take particular notice of writing comprehensive and prompt discharge summaries, and don’t be afraid to call GPs to tell them their patients are coming home. Keep good records. Take care with your record-keeping to ensure you have proof of all of your relevant hospital experience and copies of all term assessments to make future recognition of prior learning (RPL) easier to achieve.
Contributed by Dr Kate Beardmore, Dr Kate Kelso and Dr Kirsten Patterson
3 / After med school, what next?
Test-drive general practice with the
“Whether or not you’re seriously considering a GP career, the PGPPP will greatly enhance your medical training.”
PGPPP
Want to hit the freeway beyond the hospital gates and get a feel for the open road of general practice? Then take a spin with the Prevocational General Practice Placements Program (PGPPP).
The PGPPP – the Prevocational General Practice Placements Program – is a way for hospital doctors to try general practice out in the community. Whether or not you’re seriously considering a GP career, the PGPPP will greatly enhance your medical training.
Work in community general practice You’ll work as a valued colleague in a city or country practice and live in the community while experiencing a real change of pace from the hospital setting.
Your salary and super continues Your salary and superannuation will be paid as usual so it’s a seamless move. Plus funding for educational resources, travel and accommodation may also be included.
Who is eligible? To be eligible for the PGPPP you can be an intern, international medical graduate or junior doctor who is not enrolled in another specialty program. However, there is some flexibility possible.
FACT FILE Your Junior Doctor Manager will have information on the PGPPP. Or seek information from the providers which deliver the program and General Practice Education and Training (GPET) which manages the PGPPP. Visit www.agpt.com.au or www.gpra.org.au.
What will you gain on the PGPPP? A real-life experience in general practice over and above that of undergraduate training. Direct patient contact in a range of primary care settings such as private general practice, Aboriginal medical services, drug and alcohol services and community-based facilities. A greater understanding of how primary and secondary heath care settings work together. Confidence and independence to take into future training and work environments. Personal mentoring by respected GPs. Great networking opportunities.
Junior doctors doing the PGPPP enjoy the sense of autonomy, direct contact with patients and the guidance of respected GPs – not to mention the regular hours.
82
83
GET MORE
3 / After med school, what next?
The PGPPP and me Dr Sebastian Rees
GP Ambassador, Queen Elizabeth Hospital, South Australia
For Dr Sebastian Rees, seeing his own consulting list of varied patients in a community GP practice was a training highlight. Where did you do your PGPPP? I did my PGPPP at Athelstone Medical Centre, about 25 minutes out of the centre of Adelaide. 


How did you feel about doing the PGPPP at first? I was a little apprehensive. It was my second intern rotation and although I was getting into the swing of things there was (and still is) so much I wasn’t sure about. After orientation and a day or two at the practice the fear soon faded.
What was your experience like? I had a fantastic time. I was working with a really friendly, energetic team of people who cared about the health of their community. Influencing patients’ current and future health was important to me, not to mention having a GP with 20 or 30 years experience in the office right next-door. I have to say I learnt a lot.
How did your GP placement compare with hospital work? There are no ward rounds, which most people would agree is a bonus. Generally, 84
things are done on a more personal level. You are exposed to a wider variety of medical disciplines, perhaps paediatrics, dermatology,
ONLINE
Today’s e-news delivered to you Now with greater frequency, more useful features and online-only content, each MO e-newsletter includes the day’s vital news, plus unique themed features.
MONDAY The latest news, with news focus
THURSDAY The latest news, with gp life
t .PTU SFBE OFXT t &TTFOUJBM JOGP GSPN 5(" .#4 BOE .FEJDBM #PBSE DPVSU SFQPSUT t #MPHT BOE OFXT GFBUVSFT
t 0OF DMJDL MJTU PG BMM DPNQFUJUJPOT t %S (BEHFU o OFX POMJOF POMZ UFDI DPMVNO t .JMMBSE DBSUPPOT BOE NPSF (1 IVNPVS
TUESDAY The latest news, with clinical review t 'PDVT PO DMJOJDBM DPOEJUJPOT o DPWFSBHF of crucial clinical issues, in one location t .BTUFSJOH UIF .#4 o TZOPQTFT PG .#4 JUFNT TJNQMJm FE CZ (1 FEJUPST t 5IF DMJOJDBM JOGP SFBE CZ ZPVS DPMMFBHVFT
FRIDAY The latest news, with gp community t 5IF CFTU PG ZPVS POMJOF DPNNFOUT t (1 CMPHT t "TL "O &YQFSU ZPVS m OBODJBM or legal questions
“It was a good reminder of why I became a doctor.� minor trauma, mental health and travel medicine all in a couple of hours.
How did the hours and work-life balance compare? A working day generally began at 8.30 and finished at 5 with the occasional late start or early finish. This was a fantastic change from the much longer working weeks in the hospital, for myself and my partner.Â
What range of work did you actually do? Work consisted of clinic consultations, helping out with minor skin excisions and some school visits for vaccinations.
PLUS: Registrar online t Registrar stories t Guide to guidelines t Patient handouts t Ask An Expert medicalobserver.com.au/registrar
medicalobserver.com.au
FREE SIGN-UP FOR MO E-NEWSLETTERS Register for e-newsletters. Sign up at medobs.com.au/member/register Already a member? Opt in for e-newsletters at medobs.com.au/member/edit
MEDICAL
3 / After med school, what next?
4 What were the highlights? The highlights were the relationships that I formed with patients and really feeling as though you were making a difference. It was a good reminder of why I became a doctor.
What key things did you learn about medicine or yourself? I was reminded that illness is not neatly divided into specialties and sub-specialties as we see in hospitals. Separating the coughs and colds from a potentially life-threatening illness is something that challenges all GPs. Sometimes the hardest job is finding out why the patient has really come to see you.
“Teaching was structured twice a week but in reality took place after most of the patients I saw, usually in the form of a brief chat with the GP over a chocolate biscuit.�
86
What kind of support and teaching did you have? The support was excellent. I learnt a huge amount running my own consulting list but also through checking my diagnoses and management plan with a senior GP with years of experience. Teaching was structured twice a week but in reality took place after most of the patients I saw, usually in the form of a brief chat with the GP over a chocolate biscuit.
What advice would you give other junior doctors about the PGPPP? Whether you are interested in general practice or not I would certainly recommend this placement to give you a greater appreciation for what primary care is all about. During my rotation I experienced some of the most interesting and challenging medicine and really feel I am more equipped and prepared for hospital work because of it.
The gp training experience
4 / The GP training experience
structure of GP training
THE
The GP Training Landscape
Here’s a quick overview of the who, what and how of GP training.
I
f you are a little confused about the structure of general practice training, that is probably because GP training is organised differently to any other vocational training program in Australia.
What is the difference? Nearly all other training programs in Australia are essentially run by the colleges such as the College of Physicians, Surgeons or Emergency Medicine. The colleges select applicants, provide training material, play a part in organising educational activities (although these are primarily delivered by the relevant hospital) and set training standards and the examination. Registrars work in the hospital system under the supervision of consultants. GP training most obviously differs in that, other than the 88
initial year of hospital terms, it often occurs in a private practice setting. What may not be as obvious is that the two colleges of general practice, the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM), are not responsible for all aspects of GP training.
Who is GPET (General Practice Education and Training Ltd)? GPET is a wholly owned government company established in 2001 by the Commonwealth Government to fund and oversee general practice vocational training in Australia. Australian General Practice Training (AGPT) is the name of the training program for GP registrars. GPET contracts with regional training providers (RTPs) Australia-wide, which deliver
the AGPT program to about 2,500 GP registrars. Selection of candidates is initially organised by GPET in conjunction with RTPs, who interview applicants.
What are RTPs? RTP stands for regional training provider. RTPs deliver the AGPT program in their designated region. Delivering the program through local providers enables a targeted response to local health workforce and health care needs. Candidates applying for GP training are asked to nominate and rank in order of preference the RTPs in which they are willing to train. The administration of the training program, delivery of educational activities and training material are provided by the RTPs.
Australian Government
General Practice Education and Training Ltd
Australian General Practice Training
Prevocational General Practice Placements Program (PGPPP)
Australian General Practice Training program (AGPT)
Training Providers
Hospitals/Practices
Quality General Practice Experience
Vocational Training
Vocational Training
Fellowship of the Australian College of Rural and Remote Medicine (FACRRM)
Fellowship of the Royal Australian College of General Practitioners (FRACGP)
Vocational Recognition
89
4 / The GP training experience
AGPT Program Endpoint Qualifications and Fellowships FACRRM qualifications (ACRRM) Year One
Core Clinical Training Time 12 months
FRACGP qualifications (RACGP) Possible equivalence* <=>
+ Year Two
Primary Rural & Remote Training 2 x 6 months
Year Three
2 x 6 months
Joint training opportunities are available†
Year Four
Advanced Specialised Training 12 months
GP terms GPT1 – 6 months GPT2 – 6 months
+ Joint training opportunities are available†
GPT3 – 6 months Extended Skills – 6 months
FRACGP (VR)
+ Note: Fourth year is for FACRRM and FARGP candidates
12 months
+
+ Primary Rural & Remote Training
Hospital Training Time
Possible equivalence* <=>
Advanced Skills Training (12 months) for FARGP
FACRRM (VR) * Credit given for AGPT training already undertaken towards one fellowship, prior to undertaking a second or third fellowship. † Can be achieved in dual-accredited practices or posts.
Note: Although this table is presented in a linear format, both colleges have flexible training options to enable registrars to plan their training around their own needs and interests. See the college websites for more information. 90
For those who wish to train in isolated remote locations, there is another alternative to the RTPs – the Remote Vocational Training Scheme (RVTS).
What is the role of the two colleges of general practice? RACGP and ACRRM set training standards, set examinations and assessments, accredit training placements and sign off on completion of training by registrars.
What are the endpoint qualifications and fellowships? Attainment of the Fellowship of the RACGP (FRACGP) or the Fellowship of ACRRM (FACRRM) is necessary to become vocationally recognised for independent general practice in Australia under the Medicare system. ACRRM has specifically designed its curriculum to meet the needs of doctors practising in the rural and remote context. However, fellows of ACRRM may ultimately practise
anywhere in Australia – rural, remote or urban. The RACGP’s curriculum is designed to prepare GPs for practice in any setting. Those who want to complement their FRACGP with more specialised rural and remote skills can do the RACGP’s Fellowship in Advanced Rural General Practice (FARGP) as an additional optional qualification. Registrars may wish to complete one, two or three qualifications (FRACGP, FACRRM and FARGP) and this can be integrated into the training course from the beginning.
Geographical classification system Training pathways and obligations are designed around the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system, developed by the Australian Bureau of Statistics and used by many government agencies.
FACT FILE For more information about the Australian General Practice Training program, visit www.agpt.com.au or the college websites www.racgp.org.au and www.acrrm.org.au. There is also plenty of helpful information at www.gpaustralia.org.au. You can also speak to a local RTP or your GP Student Ambassador.
RA1 is major cities and can be defined as urban locations. RA2-5 are grouped in progressively more remote locations spanning regional and remote. The ASGC-RA system is also the basis for the General Practice Rural Incentives Program (GPRIP), which provides incentive payments to GPs and registrars in rural locations. 91
4 / The GP training experience
Who’s who ACRRM Australian College of Rural and Remote Medicine AGPT Australian General Practice Training program FACRRM Fellowship of the Australian College of Rural and Remote Medicine FARGP Fellowship in Advanced Rural General Practice FRACGP Fellowship of the Royal Australian College of General Practitioners GPET General Practice Education and Training Ltd GPRA General Practice Registrars Australia RACGP Royal Australian College of General Practitioners RLO Registrar Liaison Officer RTP Regional training provider
What are the training pathways and obligations? Registrars can enrol to do the general pathway or rural pathway. Doctors from overseas who are subject to the 10-year moratorium are usually required to do the rural pathway. Registrars in each pathway are required to fulfil certain training obligations.
General Pathway RA1-5 Registrars in the general pathway of the AGPT program can train in RA1-5 locations. (Many registrars in this pathway have chosen it with the intent of becoming urban general practitioners. However, such a choice does not preclude a change in career direction, which has often occurred after registrars have worked in and enjoyed general practice in rural areas.) General pathway registrars have the flexibility to fulfil a 12-month general pathway training obligation by electing one of the following options: 1. 12 months training in a rural
92
location classified as RA2-5. 2. 12 months training in an
outer metropolitan location. 3. 12 months training in a non-
capital city classified as RA1. 4. 12 months training comprising two of the following: » »Six months training in an outer metropolitan location. » »Six months training in a rural location classified as RA2-5. » »Six months training in a non-capital city location classified as RA1. » »Six months training in an Indigenous health training post in an Aboriginal medical service.
Rural Pathway RA2-5 Rural pathway registrars are required to undertake their training in rural locations RA2-5. The rural pathway requires registrars to undertake the majority of their general practice training in rural areas. Registrars in the rural pathway who meet eligibility criteria can benefit from the Australian Government’s General Practice Rural Incentives Program, known as GPRIP (see page 145).
Registrars in both pathways also need to complete certain mandatory hospital rotations (see page 79).
Personalised learning The AGPT program is personalised to meet the individual goals and career aspirations of each registrar and is a composite of in-practice learning and external education and training arranged by the RTP. Medical educators, supervisors and mentors help guide learning to shape the registrar’s future career.
General Practice Registrars Australia (GPRA). GPRA works hard on behalf of GP registrars to identify and rectify any problems and inconsistencies that may occur when there are so many different stakeholders involved in GP training.
“Medical educators, supervisors and mentors help guide learning to shape the registrar’s future career.”
Contributed by Dr George Manoliadis and Dr Jenny Lonergan
Flexible aspects of training The AGPT program is known for its flexibility. Part-time training is a popular feature, especially for women having babies. Parental leave and other reasonable leave breaks may be negotiated. Transfers between RTPs may be possible to arrange if the registrar has a strong case.
How GPRA helps With so many different entities involved, each with a slightly different focus, it highlights the importance and relevance of
93
4 / The GP training experience
Regional training providers in Australia There are numerous regional training providers (RTPs) across Australia. The sweeping diversity of Australia’s geography and people gives rise to a localised vocational training model that responds to clinical challenges specific to each region.
It also opens the way for GP registrars to tailor their training to suit their particular interests and passions – and see Australia along the way. You can visit all the RTPs from one convenient source at www.agpt.com.au.
Where should you go for… Protection? Support? Advice?
*New England/North-West ^Sydney Central and South/South-West
NT Northern Territory GP Education
QLD Queensland Rural Medical Education + Central & Southern Queensland Training Consortium QLD Tropical Medical Training
QLD Central & Southern Queensland Training Consortium
WA WAGPET SA Adelaide to Outback GP Training
NSW North Coast GP Training NSW VIC Beyond Medical Education
SA Sturt Fleurieu GP Education & Training SA Sturt Fleurieu GP Education & Training + VIC SA Southern GP Training VIC SA Southern GP Training VIC SA Southern GP Training + VIC Victorian Metropolitan Alliance
94
NSW GP Synergy* NSW GP Training Valley to Coast
MIPS – where members matter!
NSW GP Synergy^ NSW WentWest
Medical Indemnity Protection Society Ltd. Call 1800 061 113 | www.mips.com.au
ACT NSW CoastCityCountry Training NSW VIC Bogong Regional Training Network VIC Victorian Metropolitan Alliance TAS GP Training Tasmania
DOCTORS FOR DOCTORS Medical Indemnity Protection Society Ltd (MIPS) is an Australian Financial Services Licensee (AFS Lic. 301912). MIPS Insurance Pty Ltd (MIPS Insurance) is a wholly owned subsidiary of MIPS and holds an authority issued by APRA to conduct general insurance business and is an Australian Financial Services Licensee (AFS Lic. 247301). MIPS arranges general insurance covers for MIPS members, including the MIPS Insurance medical indemnity policy underwritten by MIPS Insurance. Any financial product advice is of a general nature and not personal or specific.
4 / The GP training experience
Understanding The
moratorium
Have you come to Australia from overseas? Then there may be restrictions on where you can practise. Doctors from overseas are being welcomed to help fill Australia’s GP shortage. However, to ensure these doctors work in the geographic regions that address these workforce shortages, the Commonwealth Government has certain policies that apply to international medical graduates (IMGs) and overseas trained doctors (OTDs).
What is Section 19AB or the 10-year moratorium? Section 19AB of the Health Insurance Act 1973 states that medical practitioners subject to the moratorium are not able to attract Medicare benefits unless they practise 96
in designated locations in rural, remote and outer metropolitan areas. GP registrars under Section 19AB do their vocational training in the rural pathway.
How long does it last? Originally, the geographic limitation on provider numbers lasted for 10 years, which is why the scheme was known as the 10-year moratorium. However, there have been recent changes that allow doctors to reduce their time requirements by up to five years, depending on the Remoteness Area (RA) of the location where they practise. The Australian Standard Geographical Classification
– Remoteness Areas (ASGCRA) system classifies locations from RA1 to RA5 according to their remoteness, with RA1 being the most urban (major cities) and RA5 (very remote) the most remote. The more remote the areas they work in, the more doctors can reduce their moratorium time.
Who is under the moratorium? The moratorium applies to: Overseas trained doctors who did not obtain their primary qualification in Australia or New Zealand*. Overseas doctors trained in Australia or New Zealand who began studying in Australia or New Zealand under a temporary visa and
subsequently obtained their primary qualification from an Australian or New Zealand university.
When does the moratorium start? The period starts from the time you become registered as a medical practitioner in Australia.
FACT FILE
Find out more. For more information, visit www.agpt.com.au or www.doctorconnect.org.au. Your personal situation. Doctors requiring detailed advice about their individual circumstances should contact the Department of Health and Ageing Workforce Regulation Section – 19AB@health.gov.au.
* From 1 April 2010, doctors who were permanent residents of Australia or New Zealand at the time of commencing their primary medical training at an Australian Medical Council accredited medical school in Australia or New Zealand are no longer be subject to section 19AB of the Health Insurance Act 1973.
97
4 / The GP training experience
the
RACGP
Fellowship
Fellowship of the Royal Australian College of General Practitioners certifies competence for delivering unsupervised general practice services in any general practice setting in Australia. What is the FRACGP? Fellowship of the Royal Australian College of General Practitioners (FRACGP) is held in high esteem around the world, with successful completion certifying competence to deliver unsupervised general practice services in any general practice setting in Australia – urban, regional, rural or remote. The international recognition of the RACGP Fellowship is expanding, and it is now recognised in New Zealand, Ireland, Canada and Singapore. The RACGP conjoint fellowship examinations continue to be delivered in Malaysia and Hong Kong.
98
Vocational training towards FRACGP Vocational training towards FRACGP is three years full-time (or part-time equivalent), comprising: »» Hospital training (12 months) – four compulsory hospital rotations: general medicine, general surgery, emergency medicine and paediatrics; plus three hospital rotations of your choice, provided they are relevant to general practice. »» General practice placements (18 months) – completed in approved teaching practices, with a compulsory term (minimum of six months) in an outer metropolitan area or rural and remote area. »» Extended skills (six months) – can be completed in a range of RACGP-approved settings, including advanced rural skills, an overseas post, an academic post or extended procedural skills.
Further training options The advanced academic term is an optional fourth year, allowing part-time work within a university department and part-time work in clinical general practice. Optional advanced rural skills training (ARST) can be undertaken at any time during training which offers additional procedural skills in rural general practice. The RACGP also offers a Fellowship in Advanced Rural General Practice (FARGP). (For further information, see page 102.)
Contributed by the Royal Australian College of General Practitioners
GPSN TIP If the option of working overseas is important to your future career plans, the FRACGP is more widely recognised internationally than the FACRRM at this time.
About the FRACGP examination
Am I eligible to sit the examination?
When can I apply to sit the FRACGP exam?
The FRACGP examination comprises: Two written segments – the Applied Knowledge Test (AKT) and Key Feature Problems (KFP). Plus one clinical segment – the Objective Structured Clinical Examination (OSCE).
To be eligible to sit the college examination, all registrar candidates are required to: Have current medical registration in Australia. Be a current financial member of the RACGP. Have achieved certified competence in a recognised cardiopulmonary resuscitation course (CPR) within 36 months before enrolment. Have completed eight active units of training in the Australian General Practice Training program or have completed at least 12 months in the Remote Vocational Training Scheme (RVTS).
Registrars must have completed eight active training units in the Australian General Practice Training program to enrol in the KFP and the OSCE. Registrars may enrol in the AKT after completing six active training units if this is supported by their medical educator, and two of these active units must be from completion of general practice term 1.
Each segment can be completed and paid for separately, so you can undertake the fellowship exams at your own pace. Passing the AKT is a prerequisite to presenting for the OSCE. All three exams need to be completed within a threeyear period of first passing a written exam.
RVTS candidates are eligible to enrol in the college examination following satisfactory completion of 12 months in the RVTS, in addition to the standard RACGP eligibility criteria.
FACT FILE For more information, visit www.racgp.org.au.
99
Committed to shaping the future of general practice
The RACGP journey towards general practice (via the vocational training route)
Medical school (4-6 years)
As the national leader who sets and maintains the standards for quality clinical practice, the RACGP is working hard to shape a stronger general practice future. The College has embraced the concept of e-health; is actively involved in the development of national e-health initiatives; is at the forefront of the national health reform; and continues to ensure that general practice remains a satisfying and rewarding vocation for current and future GPs. As a RACGP resident/intern member, you can become involved in shaping the future of general practice. Your RACGP resident/intern membership also provides you with the practical clinical resources and online learning tools you need to support your medical training and journey through general practice.
Internship year (PGY1)
(this can be completed before or during general practice training)
General practice training (3 years)
RACGP Fellowship examination
PGPPP (optional)
4th year additional training in advanced rural skills training or an academic term (optional)
Successful completion of RACGP training and assessment
RACGP Fellowship
Join the RACGP or renew your RACGP resident/intern membership today www.racgp.org.au/residentintern or freecall 1800 331 626
Postgraduate resident years (PGY2)
Continuing professional development
Fellowship in Advanced Rural General Practice (FARGP) (optional)
4 / The GP training experience
The RACGP’s Fellowship in advanced rural general practice (FARGP)
FACT FILE Find out more about the Fellowship in Advanced Rural General Practice (FARGP) by emailing di.schaefer@racgp.org.au at the RACGP’s National Rural Faculty, calling 1800 636 764 or visiting www.racgp.org.au/rural.
The FARGP is a fellowship that extends the FRACGP program to offer advanced training in the skills required for rural and remote practice.
What is the FARGP? The Fellowship in Advanced Rural General Practice (FARGP – pronounced “farGP”) recognises advanced rural skills and additional training undertaken by GPs in preparation for practice in rural and remote Australia.
Am I eligible to enrol in the FARGP? To be eligible for FARGP, registrars need to: Have completed (or be working towards completing) a minimum of 12 months of training in accredited rural training posts. Hold or be enrolled in the Fellowship of the RACGP award. Be a current financial member of the RACGP. Be a general practice registrar enrolled in the Australian General Practice Training (AGPT) program
102
or the Remote Vocational Training Scheme (RVTS). Have completed (or be working towards completing) 12 months in an accredited advanced rural skills training post.
Can I complete the FARGP at the same time as the FRACGP? You can undertake the FARGP while completing your RACGP Fellowship, enabling you to complete two highly respected RACGP Fellowships in four years. Training to the RACGP curriculum and FARGP curriculum is closely integrated so all the requirements can be achieved concurrently.
FARGP-specific educational requirements
education modules – “Working in Rural General Practice” and “Emergency Medicine”. 160 hours of elective educational activities, which can include workshops, clinical audits and online learning activities. Submit a portfolio of educational activities for final assessment.
How flexible is the FARGP? The FARGP is flexible and selfpaced. The educational activities have a strong practice-based focus. There is no final exam for the FARGP – assessment is based on a continuous assessment framework.
Contributed by Di Schaefer, RACGP National Rural Faculty
Advanced rural skills training An important component of the FARGP is advanced rural skills training (ARST). Each ARST has its own curriculum guidelines and assessment process. Registrars may choose to complete an ARST post in an area of interest or of value to a rural community including: Anaesthesia Obstetrics Surgery Emergency medicine Mental health Child and adolescent health Adult internal medicine Small town rural general practice Aboriginal and Torres Strait Islander health Individually designed ARST (approval by the RACGP National Rural Faculty is required, after consulting your medical educator)
Registrars need to complete these FARGP-specific educational requirements: Two core distance
103
4 / The GP training experience
ACRRM Fellowship
The
The Australian College of Rural and Remote Medicine (ACRRM) has specifically designed their GP training program to meet the needs of the rural and remote practitioner. What is the FACRRM? Fellowship of ACRRM is an approved pathway to vocational registration and unrestricted general practice anywhere in Australia. It is a four-year integrated training program for registrars wanting to train for rural and remote medicine. The training occurs in an “on the job” environment as a registrar in an accredited general practice, Aboriginal medical service, Royal Flying Doctor Service or as a Medical Officer in an accredited hospital setting. Candidates wishing to achieve a Fellowship of ACRRM are able to choose from three training pathways: 104
the Vocational Preparation Pathway delivered by regional training providers with funding from GPET; the Remote Vocational Training Scheme (RVTS) for doctors working in isolated rural communities who find it difficult to leave their community to participate in training; and the Independent Pathway, administered by ACRRM, which is suitable for doctors with experience in rural and remote practice who prefer self-directed learning. For more information on which pathway is most suitable for you, see the ACRRM website.
primary rural and remote training
core clinical training
Vocational training program components The ACRRM training program comprises three stages of learning and experience (see flowchart on page 108). Core Clinical Training. Candidates complete 12 months of training in an ACRRM-accredited metropolitan, provincial or regional/rural hospital. This should ideally include rotations in general medicine, obstetrics and gynaecology, anaesthetics, general surgery, paediatrics and emergency medicine. Primary Rural and Remote Training. Candidates undertake 24 months of training in a combination of rural or remote ACRRMaccredited hospitals, Aboriginal
MSF
advanced specialised training StAMPS
miniCEX medical services or general practices/community-based facilities, or a combination of these. The registrar works with increasing autonomy and manages an increasing range of conditions. The specific procedures, breadth and depth of practice are defined by the Primary Curriculum and Procedural Skills Logbook. Advanced Specialised Training. Candidates undertake 12 months of training in one of 10 ACRRMaccredited disciplines listed in the flowchart on page 108. Many FACRRM candidates undertake training in a procedural discipline.
MCQ FACRRM assessment Candidates must work in accredited training posts and successfully complete the following assessments: Multisource Feedback (MSF), Mini Clinical Evaluation Exercise (miniCEX), Multiple Choice Question (MCQ) exam and Structured Assessment Using Multiple Patient Scenarios (StAMPS).
For more information, visit www.acrrm.org.au, call ACRRM on 1800 223 226 or contact ACRRM Vocational Training, training@acrrm.org.au.
There is considerable flexibility in the timing of the assessments and candidates are able to undertake each assessment component within or close to their local community.
modules and at least two emergency skills courses approved by ACRRM (for example, EMST/ELS/PHTLS or equivalent, APLS, ALSO).
FACT FILE
To achieve FACRRM, candidates must also successfully complete four ACRRM online education 105
Dr Joseph Ngui
Frequently asked questions
“In medicine, I couldn’t pick one specialty I wanted to do for the rest of my life; I like surgery, anaesthetics, paediatrics, obstetrics, psychiatry. So general practice suited me well.”
Candidates enrolled in the AGPT can elect to train to either or both the FACRRM and the FRACGP. FACRRM training is open to both rural and general pathway registrars. However, general pathway candidates who wish to pursue FACRRM will need to undertake training within ACRRM-accredited training posts.
How is FACRRM integrated into the AGPT program?
106
Can candidates do both qualifications at the same time? Yes, but requirements for placement, duration of training and completion of training are different between the FACRRM and FRACGP. Candidates seeking both fellowships will need to talk to their RTP about a program that complies with both colleges.
What is the difference between the ACRRM and RACGP training pathways? The ACRRM program is an integrated program that usually takes four years post-internship. While some posts are suitable for both ACRRM and RACGP candidates, this is not automatic and cannot be assured. ACRRM has a different curriculum and different requirements for accreditation of training posts. ACRRM candidates must train in posts accredited by ACRRM.
Contributed by the Australian College of Rural and Remote Medicine
4 / The GP training experience
The ACRRM Training Program
ACRRM Registrar Core Clinical Training (CCT)
Primary Rural and Remote Training (PRRT)*
Advanced Specialised Training (AST)†
12 months
24 months
12 months
In any of the following: • Rural hospital • Aboriginal medical service • Rural general practice • RFDS
Location is dependent on the specialty requirements
In an ACRRMaccredited or Postgraduate Medical Council (PMC) hospital Terms in: • General medicine • Obstetrics and gynaecology • Anaesthetics • General surgery • Paediatrics • Emergency medicine
Training to be through ACRRM-accredited training posts
Undertaken in one discipline from the following: • Anaesthetics • Obstetrics and gynaecology • Surgery • Population health • Remote medicine • Emergency medicine • Indigenous health • Adult internal medicine • Mental health • Paediatrics
* Primary Rural and Remote Training and Advanced Specialised Training may be undertaken in any order after the Core Clinical Training year. † Primary Rural and Remote Training and Advanced Specialised Training may be undertaken in any order after the Core Clinical Training year.
108
4 / The GP training experience
RVTS:
an alternative pathway to fellowship RVTS trains GP registrars working in rural and remote locations, where accessing mainstream training is impractical or impossible.
The Remote Vocational Training Scheme (RVTS) offers GP registrars working in rural or remote locations a unique remote training experience and an alternative pathway to fellowship.
Remote training and supervision RVTS trains its registrars via distance education and provides remote supervision. No location is too remote and the program is structured to meet the needs of solo practitioners. Education is delivered via: Teletutorials. Weekly 90-minute education sessions via teleconference. On-site teaching visits. An experienced rural practitioner visits the registrar to observe consultations and
110
provide feedback. Face-to-face workshops. Registrars meet for five days of practical training twice a year. Remote supervision. Each registrar is allocated a supervisor who acts as a mentor and provides clinical and educational advice. RVTS registrars enjoy the same level of support as their big city counterparts, no matter how remote they are, and can be found practising as Royal Flying Doctors, District Medical Officers, with Aboriginal medical services and in private practice. They serve a variety of communities, from farming and mining towns through to remote Indigenous communities. Many work in solo practice.
Dr Vincent Cornelisse
A remotely supervised GP registrar Dr Vincent Cornelisse lives in the farming community of Biggenden, around an hour from Bundaberg. He’s the only GP in a town of 650 residents and one of only a handful of registrars in Australia training for fellowship remotely. The Remote Vocational Training Scheme (RVTS) trains, supervises and supports Vincent from a distance. The alternative was leaving his community to access training. “RVTS is awesome, and you can quote me on that,” he says.
The challenge of solo rural practice suits Vincent perfectly. “I see and deal with a massive variety of presentations and don’t have to wrestle an army of residents and registrars to treat an interesting patient,” he says. Vincent also works as the hospital’s Medical Superintendent, providing 24-hour emergency care, and also looks after inpatients and nursing home residents. Being a solo rural GP isn’t for everyone, but it is rewarding. “I get to be a real doctor!” he says.
111
4 / The GP training experience
+ SMRK 4 PEGIW 2)8;36/
8EOMRK E JVIWL PSSO EX +IRIVEP 4VEGXMGI %R MRMXMEXMZI SJ +46%
“RVTS registrars enjoy the same level of support as their big city counterparts, no matter how remote they are.” Eligibility RVTS is an independent, Australian Governmentfunded program with its own application process and annual intake of 22 registrars. Applications open in May each year for training starting the following February. Geographic location is the key eligibility requirement. To apply, applicants must be working in an eligible location, or have arrangements in place to be in an eligible location at the commencement of training. Applicants must provide continuing, whole-patient care. Preference is given to doctors working in solo practice and those who cannot access Australian General Practice Training (AGPT) programs. 112
Once accepted, the registrar remains in the same location throughout their training. Check the RVTS website for complete eligibility criteria.
The endpoint This three to four-year program meets the requirements for fellowship with both RACGP and ACRRM. Twelve-month training is available in advanced skills curricula such as anaesthetics, obstetrics and emergency medicine.
Contributed by the Remote Vocational Training Scheme
.SMR XLI FACT FILE What: Train for FRACGP, FACRRM and FARGP in rural or remote locations. Who: The registrar who enjoys the independence of rural or remote practice but wants a supportive training environment. For more information, contact RVTS on (02) 6021 6235 or visit www.rvts.org.au.
&)'31) % 1)1&)6 ¯ -8´7 *6))
+SMRK 4PEGIW 2IX[SVO
)\TPSVI XLI [SVPH SJ +IRIVEP 4VEGXMGI 1IQFIV FIRI½XW +4 JSGYWIH RIX[SVOMRK ERH IHYGEXMSREP IZIRXW %GGIWW XS E PSGEP +4 %QFEWWEHSV EX ]SYV LSWTMXEP ¯ SV E RIEVF] LSWTMXEP ¯ XS LIPT ERW[IV ]SYV +4 VIPEXIH UYIWXMSRW 1IQFIVWLMT SJ E JVMIRHP] ERH WYTTSVXMZI PSGEP GSQQYRMX] SJ NYRMSV HSGXSVW 6IKYPEV I RI[WPIXXIV YTHEXIW [MXL MRJSVQEXMSR SR ]SYV PSGEP IZIRXW ERH XLI PEXIWX SR EPP XLMRKW +4 8LI +SMRK 4PEGIW QEKE^MRI ¯ E KVIEX UYEVXIVP] QEKE^MRI WLS[GEWMRK XLI ZEVMIX] ERH GLEPPIRKIW SJ +IRIVEP 4VEGXMGI 8LI GLERGI XS LEZI PSEHW SJ JYR
.SMR XSHE] :MWMX [[[ KTEYWXVEPME SVK EY KSMRKTPEGIW %R MRMXMEXMZI SJ
+)2)6%0 46%'8-') 6)+-786%67 %9786%0-%
8LI JYXYVI SJ +IRIVEP 4VEGXMGI
4 / The GP training experience
Joining forces with the
ADF
Around 2.5% of GPs train in the Australian Defence Force. It’s an opportunity to develop leadership skills and specific medical skills in a challenging environment.
T
raining as a GP registrar in the Australian Defence Force (ADF) offers opportunities and challenges.
Generally, composite terms are accredited only after an initial full-time civilian term, usually a three-month rural term.
ADF registrars must meet the same educational requirements but there are some specific policies relating to ADF GP registrars. These include leave provisions, transfer between RTPs and modified requirements regarding work in outer metropolitan and rural areas.
Civilian and military posts
While most ADF registrars will select the general pathway, exposure to rural general practice provides valuable experience in the decision-making, leadership, teamwork and clinical skills that can be utilised for ADF clinical practice in Australia and when deployed. Deployments may be prospectively accredited for training.
General practice terms are undertaken through a combination of civilian and military posts, known as composite terms. The unique demographic of the military necessitates concurrent exposure to the broader Australian community to ensure experience in areas such as paediatrics and geriatrics.
Initially, Medical Officers (MOs) in the ADF are encouraged to specialise in primary care. This is important because whether in Australia or deployed, ADF personnel need access to high quality primary health care. There are also opportunities to specialise in public health,
114
Dr Alison Thomas
A GP with military precision
L
ieutenant Commander Alison Thomas has been a military doctor since 1994 after joining the Navy on a scholarship as a fourth year medical student at Monash. “It’s a wonderful career,” she says. “I’ve done aviation medicine, spent six months in the UK, I’ve dangled out of helicopters and been ‘action stations’ in the Gulf – I’ve loved every minute of it.” There is a focus on emergency medicine and similar skills to rural general practice
including self-sufficiency in remote locations. Alison’s assignments have included several overseas deployments as a ship’s doctor. She saw active service in the Gulf, which involved the memorable experience of being winched onto an American ship and taken to an Iraqi oil tanker to treat a stroke patient. After a stint in civilian general practice, Alison returned to Permanent Navy in late 2009. She now works as a Medical Officer for Joint Health Command in Canberra.
115
4 / The GP training experience
medical administration, occupational medicine and sports medicine, known as the force protection specialties. Generally, the procedural specialties (surgery, anaesthetics, orthopaedics) required for providing higher level care on deployments reside within the Reserve Forces.
ADF Medical Officer recruitment Most ADF MOs are recruited as medical students, some from universities and others from within the Services. A small number join as direct entry qualified medical practitioners. Medical students and trainees are considered ADF members and attract a salary and ADF benefits such as superannuation, allowances, medical and dental care, and accommodation options while under training. The MOâ&#x20AC;&#x2122;s primary duty is to train at medical school, then complete PGY1 and 2 prior to their first full-time posting to an ADF unit. At the unit, the MO receives further training, in parallel with the AGPT, including officer training, early management of severe trauma (EMST), and specialist courses such as aviation medicine or underwater medicine. At the same time, the MO gets acquainted with the military medical system.
Clinical competency levels Clinical employment is based on progression through clinical Competency Levels (CL). Beginning at CL1, MOs who have completed initial courses and a period of supervised primary care are recognised as CL2. MOs at CL2 have basic skills and are considered suitable for remote supervision in an operational deployment environment. Those who have achieved FRACGP or FACRRM progress to CL3. 116
DO IT NOW Medical students, prevocational doctors, GP registrars and fellows wanting to explore a career as an ADF Medical Officer (MO) may find it helpful to speak with a current ADF registrar. For more information or to apply, call 13 19 01 or visit www.defencejobs.gov.au. To speak with a Medical Officer in the ADF, telephone Commander Nicole Curtis, RAN, Staff Officer Medical Officers (02) 6266 4176 or email nicole.curtis@defence.gov.au.
Remuneration In return for supporting the initial medical training, the ADF requires a Return of Service Obligation (ROSO) or Initial Minimum Period of Service (IMPS). During internship and residency, Defence continues to pay the MO a salary, while wages earned from the hospital or other employers are paid to Defence. If hospital pay exceeds military pay, the difference is paid to the MO periodically. MOs at CL2 and above are reimbursed a further $10,000 annually for continuing medical education expenses.
Contributed by Dr Geoff Menzies
5
design your own gp career
5 / Design your own GP career
The
Destinations RACGP fellowship unlimited
General practice gives you the freedom to follow your passions, sub-specialise and virtually design your own career. Here are just some of the directions you may wish to explore.
Aboriginal health Academic medicine and research Anaesthetics Australian Defence Force Aviation medicine Dermatology Drug and alcohol Emergency Expedition medicine Family planning and sexual health Forensic medicine Geriatrics HIV medicine Men’s health
Mental health Musculoskeletal medicine Obstetrics Occupational medicine Paediatrics Palliative care Royal Flying Doctor Service Rural and remote medicine Sports medicine Surgery Travel medicine Tropical medicine Women’s health Plus many more
Travel while you train Strap on your backpack and make the world your consulting room while you train. It’s all possible in general practice. If you enjoy travelling and are keen to gain clinical experience in another country, both RACGP and ACRRM offer exciting opportunities to complete part of your general practice training overseas. Typically these are a six-month full-time position, although in some cases part-time may be possible. The overseas training terms are appropriate for registrars who have already undergone some training. Overseas terms have involved many locations including the United Kingdom, Ireland, USA, New Zealand, China, Malaysia and the Middle East (Australian Defence Force posts).
“As part of my training, I spent eight months in Southern Sudan with MSF. The assignment included maternal and child health and the emergency coordination of the cholera epidemic. The medicine was pretty mindblowing.” Dr Stratos Roussos MSF, Southern Sudan
Overseas terms are a fantastic opportunity to broaden your horizons while completing your general practice training.
118
119
d n la P G m o r f s Postca rd
Dr Genevieve Yates
“I wanted to choose where I would live and where I would work – aspects that just aren’t possible in other specialty training.”
“I worked in general practice in the town of Ballybofey in County Donegal, Ireland. I learned how to pronounce Irish names, appreciate potatoes five ways and work in a different health system. In all, I loved my Irish exchange.” Dr Kelly Seach Irish exchange program
Fact file For further information regarding overseas training posts, visit the college websites www.racgp.org.au or www.acrrm.org.au.
120
your be yond Venture sh zone. Pu comfort ndaries . your bou e. d, e xplor In a wor That’s w
tr aining ye hat the GP
ar s are all
abou t.
es of GP al-life stori re e ar s e riety wing pag rate the va In the follo s that illust st o er. p re d ca an ce as a registrars eral prac ti n ge f o y it and divers
121
5 / Design your own GP career
The segment on The Circle is about making health accessible to viewers. If it means they’re going to go to their GP and ask about the topic we’ve discussed then I think that’s what matters. The producer gives me the topic a few days beforehand. On the morning of the shoot I go into the Channel 10 studios in South Yarra and talk to the producer about any last minute things. Usually I’ve got one or two key messages that I’m trying to get across.
TV GP
Then I’ll go into hair and makeup and wait in the greenroom. I often get to meet a celebrity or two. During the election campaign I met Bob Brown, the Greens leader, and lots of other politicians.
media + academic + clinical
Dr Deepa Daniel
Flick on the TV before Dr Phil and Oprah and you may catch Melbourne GP registrar Dr Deepa Daniel giving health advice on The Circle. So how did she get the gig? It all started when The Circle contacted the AMA’s public affairs department seeking a young female doctor for a medical segment. Having previously been involved at AMA Victoria’s Section of General Practice, Deepa was known to the AMA team. She auditioned – and won the role. Deepa sees her media work as an interesting side project and a chance to air important public health messages. The rest of her week is devoted to her academic registrar position, which combines teaching and research at Melbourne University, medical editing at the RACGP’s Australian Family Physician journal and clinical work at her mother’s general practice.
I’ve covered topics such as influenza vaccines, men’s and women’s preventive health, and sleep deprivation in early parenting. Our contraception segment was the funniest because I had all sorts of props but through our humorous approach we were able to tell people about the risks of STDs. My segment on The Circle is only one Wednesday morning a fortnight, so my main focus this year is my academic registrar position.
I’m doing a special skills academic year funded by GPET that gives me a day at a university, a day at Australian Family Physician doing medical editing and three days in clinical general practice. Typically I spend Mondays at AFP, and we get manuscripts coming in for peer review. My Wednesdays are usually spent at the Department of General Practice at Melbourne University. I’m doing a research project in vitamin D and its association with chronic muscle pain. I spend some of my time doing that and some of my time teaching medical students doing general practice rotations. I spend the other three days in a small bulk-billing clinic my mum set up in 1980 or so, where she still works. The clinic is in a lower socioeconomic area with quite a high migrant population, particularly African immigrants. I like trying to deal with social issues as well as physical complaints for my patients. I really grew up at my mum’s practice in a lot of ways. I went there after school and I worked there as a receptionist on Saturday mornings for a long time so I already knew a lot of the patients.
Note: Dr Deepa Daniel’s role as a media GP on The Circle is an extracurricular role and is not officially part of her GP training. 122
123
Need clinical information fast? Ask your companion.
Wings of
care RFDS + rural Dr Katie Williamson
An essential reference guide ns for General Practice rotatio
Sponsored by
STUDENTS NETWORK GENERAL PRACTICE and AMSA joint initiative of GPRA A
Download the GP Companion eBook at www.gpsn.org.au.
Dr Katie Williamson grew up on Sydney’s northern beaches with no plans to be a doctor, much less a rural GP literally out the back of Bourke. Armed with a degree in forensic science and having already taken one career detour from lab work to pharmaceuticals account manager in an advertising agency, she became disenchanted with her job in her mid-20s. She was browsing through the medical trade press on behalf of her pharmaceutical client one day when a thought suddenly struck her: “I could be a doctor!” She successfully applied to do a postgraduate degree in medicine at the University of Sydney and says she has loved medicine ever since.
125
5 / Design your own GP career
“When you’re working for the RFDS you can see that you’re saving lives – that the guy who’s fallen off his motorbike with the fractured femur would die.”
I wanted to work with the Royal Flying Doctor Service to throw myself in the deep end. I was a GP registrar and did the RFDS term as my advanced rural skills post for my Fellowship in Advanced Rural General Practice with RACGP. It involved a temporary transfer from my regular RTP, North Coast GP Training, to a regional one, Beyond Medical Education.
With the on-call side of things we’d get phone calls from the outlying communities and stations, probably about 30 to 50 a shift.
I was based at Broken Hill and about half was clinic work and half was on-call and retrieval.
When people drive through or live in the outback there’s no ambulance service. If you have a car accident, if you hit a kangaroo or roll your car, if you ring triple 0 there’s no one there. So the RFDS has the contract to provide the emergency services.
On clinic days we’d fly out to remote towns like Tibooburra, Hungerford, Menindee and White Cliffs. Some weren’t even towns, they were someone’s house, and people in surrounding stations would come in.
126
A lot would be phone advice. Patients would have their own medicine chest and we could often prescribe over the phone. Once or twice every shift we would get a call that would result in a retrieval flight.
FACT FILE The Royal Flying Doctor Service has positions for registrars on an ongoing basis Australia-wide. For more information, visit www.flyingdoctor.org.au, “Contact Us/ Career Enquiries” section.
We would have calls from patients who may have been hit by a bull or come off their motorbike or had a car accident or a mother with a sick child. I would decide whether an ambulance should be sent from say Broken Hill or whether we needed to send a plane. In the team you have the doctor, the flight nurse and the pilot. The flight nurses are fantastic. They would organise all the equipment and a ventilator if I said the patient may need intubation and they would get the pilot to organise the flight.
People are so appreciative. You can work even in country towns and you don’t seem to be doing a lot of saving lives. You probably are when you’re managing chronic diseases, but when you’re working for the RFDS you can see that you’re saving lives – that the guy who’s fallen off his motorbike with the fractured femur would die. I met my partner, David, through RFDS – he’s an RFDS flight nurse and a country boy – and we’ve settled in Mudgee now. I work at a local practice and he’s still flying with the RFDS. I love the rural lifestyle and the diversity of rural general practice.
As a registrar if it was something I felt I wasn’t capable of handling, I could always ask my supervisor to come with me.
127
5 / Design your own GP career
My island home
Indigenous + remote + retrieval + tropical I’m doing first year general practice training with ACRRM through Tropical Medical Training but I’ve already done some anaesthetics and intensive care training during my hospital time. The job is really that of a rural generalist. Obviously it’s mainly an Indigenous population so you have all the typical chronic health problems like diabetes and kidney disease. That’s overlaid with acute emergency cases and retrieval because of the remoteness and also some unusual infectious and tropical diseases other GPs would rarely see.
Dr Alex Kippin
It’s a vision that will stay with Dr Alex Kippin forever. As the helicopter blades whirred, the sun danced on the idyllic turquoise ocean reefs and islands laid out in breathtaking splendour below. And there he was sitting in the chopper hand-ventilating a critically ill child. “It was such a surreal mismatch of experiences,” he reflects. But then everything about working as a doctor on Thursday Island is unique.
128
Thursday Island lies off Cape York at the northern tip of Australia. As the administrative capital of the Torres Strait Islands, its 3,500 inhabitants are a mix of local Indigenous people and public servants. Getting there involves a two-hour flight from Cairns, plus a ferry or helicopter ride from the airport on neighbouring Horn Island. The narrowness of Thursday Island means it has no airport of its own. This extreme remoteness makes the evacuation of acute cases challenging. But Alex loves a challenge.
No other job has that level of helicopter retrievals and critical medicine as well as infectious diseases, tropical diseases, chronic disease and general practice. There isn’t really a typical day. I spend my time between the local Thursday Island Hospital doing emergency work, general practice clinical work at a community primary care clinic on Thursday Island and then clinic work and retrieval work on the other islands. Every three weeks I’ll go out in a helicopter and do a three-day fly-in fly-out clinic on a couple of the other islands. It’s an idyllic, pristine part of the world. When I’ve finished work I’ll get to go spearfishing.
The next week I’ll be giving paediatric anaesthetics for a dental case or flying out in a chopper in the middle of the night to resuscitate and intubate a child who’s acutely ill on one of the outer islands to bring them back for an air transfer. It’s really quite amazingly dynamic. There is a team of 12 doctors who service all the islands, but only a couple of us do anaesthetics so there’s a lot of on-call. In one incredible week you wouldn’t believe the cases I saw. A two-week-old baby with focal seizures from bacterial meningitis, an 18-month-old with sepsis from an infected V-P shunt stabilised and sent south, a child with shigella dysentery with severe dehydration and close to death – we were able to resuscitate him. I had a middle-aged lady with necrotising fascitis and organ failure who we sent down to the ICU unit in Cairns, I had a four-kilo baby with bilateral pneumonia and respiratory failure who I managed to not intubate and get away with bubble C-PAP. I can work a lot of hours but I love it. One of my most memorable moments was when one of the locals taught me how to spear a fish.
129
5 / Design your own GP career
FACT FILE Tropical Medical Training offers posts at Thursday Island Primary Health and Thursday Island Hospital suitable for registrars in GPT1, GPT2, GPT3 and rural terms. Visit www.medicaltraining.com.au.
“No other job has that level of helicopter retrievals and critical medicine as well as infectious diseases, tropical diseases, chronic disease and general practice.”
Crime drama Forensic medicine
Dr Tristan Crowe
A phone call at 3am. A dead body in a foggy woodland clearing. The forensic doctor, clad top to toe in biohazard overalls, busily examines the deceased and gathers evidence. Cut to the same body on the mortuary slab and the same doctor with scalpel poised. Popular forensic crime TV shows, from Silent Witness to CSI, make such plot lines familiar. But how does it compare to real life? Registrar Dr Tristan Crowe spent a term at the Victorian Institute of Forensic Medicine and says his role was not quite like the TV scenario. “No dead bodies! That’s the forensic pathologists downstairs,” he says. Instead, Tristan worked in the clinical forensic medicine unit as a Forensic Medical Officer – a resource that assists police to gather evidence by clinically examining alleged victims and assailants.
130
131
5 / Design your own GP career
I had just come back from a stint in Indonesia as a Medical Officer on remote mine sites and I wanted to continue the theme of doing things that were a little bit different. I saw this ad for forensic medicine in Melbourne and put my hand up. The fact that it was at Southbank was a bonus because I was keen to work in the city.
Physical assaults were less urgent. Bruises are still going to be there in the morning. You would photograph and describe the injury. Certain patterns of injury indicate certain things – four small bruises together can suggest someone being firmly grasped. If there were fractures, we would use the X-rays ordered by the emergency physicians in our report and we would also interpret a surgeon’s report if applicable.
The Victorian Institute of Forensic Medicine is part of the Department of Justice. It’s a separate entity to the police although they work with the police. As Forensic Medical Officers we tried to keep ourselves at arm’s length.
The third main task was fitness for interview. When the police arrest someone, if they are unsure of their state of mind, or an illness, they may not be capable of being interviewed. In those circumstances, they would call an MO out to assess the patient.
There were three main day-to-day jobs relating to sexual assault, physical assault and fitness for interview. With sexual assault you could be called out in the middle of the night because DNA and semen evidence deteriorates quickly with time. The alleged victim would see a counsellor first, then you would see them, explain the process and do the forensic medical examination. If it was a penile-vaginal rape, you’d take the appropriate swabs. If there were any bruises or bite marks, you’d take photographs. You get taught how to use an SLR camera. If there was a question of someone having their drink spiked or something like that you’d take a blood or urine sample and send it to pathology.
132
FACT FILE The Victorian Metropolitan Alliance regularly offers forensic medicine terms. For more information, contact the Victorian Institute of Forensic Medicine on (03) 9684 4480. Other RTPs may be able to offer posts at similar local organisations. For GPs, there are opportunities to do forensic work as a sideline, especially in rural areas.
We were also asked to give the police phone advice about a certain medical condition that an alleged assailant or victim may have. Writing medico-legal reports is central to the job, and you have to appear in court. I enjoy the theatre of court.
“There were three main day-to-day jobs relating to sexual assault, physical assault and fitness for interview.”
I was really impressed that I got the opportunity to work there. They’re high calibre intellectuals and they’re really striving to do a good job.
133
5 / Design your own GP career
Ship to shore Ship’s doctor
Dr Marisa Magiros
Dr Marisa Magiros has a passion for travel so when a friend told her about a position as a ship’s doctor with P&O in the UK, it sounded like a dream job. Her friends imagined a leisurely life treating mild seasickness and sunburn followed by cocktails at the captain’s table, but it was far more challenging than that. Marisa had to manage many serious cases, from heart attacks to asthma, and there were a number of evacuations of critically ill or injured patients, like the elderly woman who broke her hip and was disembarked by sea plane in Fiji. She says doctors at sea need skills in accident and emergency, intensive care, public health, occupational health and safety, general practice and are also responsible for managing the ship’s nursing staff and floating medical centre.
134
Note: Dr Marisa Magiros worked on cruise ships prior to commencing her GP training but her experience demonstrates a role that is open to general practitioners.
The way I got the job was serendipity. I had been working in London and Dublin hospitals, doing mainly emergency work. I heard about the opportunity and it was a way to work and travel and get paid. The cruise ships have sophisticated medical centres staffed by a doctor and two nurses on the smaller ships and two doctors and three or four nurses on the bigger ships. You’ve got a resuscitation room like a hospital, ward beds with monitoring, a lab so you can take blood tests, you can take X-rays, and there’s a pharmacy. You don’t have specialist staff to do any of that, you do it yourself. You have an orientation to learn those skills. Before starting, adult ALS is compulsory, and paediatric ALS and EMST are desirable. You have two types of patients – the passengers who pay privately and the crew who receive free medical care. In terms of
the kind of cases you see, it ranged from simple things like running out of medication to serious cases like heart attacks, treating pneumonias, sending them off for operations. Gastro is a big public health issue. You’ve got all ages, from children to elderly. We’ve actually had people die – we had a morgue. We’d have inpatients. If they were quite sick and we were away from land, the nurses would do 12-hour shifts, giving them medicine and monitoring them until we could get them off. You do a morning clinic and an afternoon clinic every day, and then you’re on call 24/7 for the entire contract. Each contract is four months, then you’d have two months off. I got to go to Alaska, the Caribbean, French Polynesia, the South Pacific. I sailed up the Amazon, which was amazing, through the Panama Canal, up to the Baltics and to Russia, the Mediterranean. When you’re a
135
5 / Design your own GP career
crew member, often you get to do tours for free. I’ve been to 95 countries – many as a doctor at sea. Being a ship’s doctor definitely improved my clinical skills. The experience also influenced my decision to train in general practice when I came back to Australia. I experienced what it was like having continuity of care with the crew and seeing how their problems resolved, and that’s something you get in general practice. I also enjoyed the autonomy, the same as you have in general practice, and then you call on a team to help you. After working continuously for four months on the cruise ships, I also came to appreciate how work-life balance is really important. I’m now training with GP Synergy in Sydney and loving it. I look forward to more travel, but this time it will be on holiday.
FACT FILE Cruises are one of the fastest growing sectors of the travel industry and cruise ship companies are constantly recruiting medical staff. Marisa worked for Carnival, which owns a fleet of cruise ship brands, from P&O Australia to the ultra-luxury Cunard. A search of the net will reveal many others.
“Being a ship’s doctor definitely improved my clinical skills. The experience also influenced my decision to train in general practice when I came back to Australia.” Professional Resources
»» Choosing a practice »» Managing work flow »» Planning and prioritising »» Goal setting »» Conflict within the workplace »» Managing a patient complaint
Personal Resources
»» Meditations »» Self-talk strategies »» Managing your own health »» Time management »» Physical fitness »» Inspiration »» Fun stuff
www.rcubed.org.au 136
5 / Design your own GP career
Part-time smart time The part-time training options and parental leave available to GP registrars make general practice training very flexible and family-friendly. The flexibility of general practice when it comes to working hours is one of the reasons many people choose it as their career path. The training program has the same flexibility with parental leave and part-time training an attractive offering. Of course, part-time training is especially attractive for those having babies and raising young children. However, the part-time option can also give other registrars the freedom to take up opportunities such as becoming a Registrar Liaison Officer (RLO) or an academic registrar.
138
When thinking about part-time training, consider the following: All components of the training program, with the possible exception of hospital time, can be undertaken on a part-time basis. You need to apply to your RTP for part-time training and have it approved by your RTP before you begin working part-time. Full-time is considered to be 38 hours per week, which includes all consultation time, education and program activity. Anything less than 38 hours will be pro-rata and affect GPRIP payments if applicable.
Minimum part-time is considered to be 10.5 clinical hours a week. Minimum hours are 10.5 hours a week over two days. You should negotiate the amount of practice-based teaching with your RTP during a term as a part-time registrar. You must attend educational activities that are required of you by your RTP. Most training usually occurs on weekdays. The RACGP states that general practice experience gained while working part-time is valuable and that it is likely to be
Dr Jemima Grant
Dr Mum
O
ne day, Dr Jemima Grant was consulting with a patient and suddenly became aware of an extra nipple in her bra. It was the dummy she had put there during the frenetic morning rush hour with her two young boys, aged two and four.
days for the local council then stays home and looks after the children for the rest of the week while Jemima works three and a half to four days at the local Aboriginal medical service and also works as an RLO. To top it off, she’s currently studying for her fellowship exam.
It’s at moments like these that she is acutely aware that life as a GP registrar mum can verge on chaos – but she wouldn’t have it any other way.
Jemima began part-time general practice training as a mother of one then took nine months parental leave after the birth of her second child before resuming part-time training. “For me, the part-time training has been wonderful. The lifestyle flexibility is why I did general practice,” she says.
Jemima and her husband, Damian, share work and parenting. Damian works three
139
5 / Design your own GP career
6 worth more than an estimation of time alone would indicate. This is why acceleration of part-time training to “half-time” training is available. It basically means that in order to have a 12-month term counted as the equivalent of six months fulltime you need to “accelerate” your training with a set of log diaries. These log diaries show that the number and range of patients seen are giving you adequate experience.
140
Taking parental leave All parental leave is unpaid. You need to apply to your RTP. Applications must be made in writing to your RTP in accordance with your RTP’s policies and procedures. The idea of a healthy work-life balance is part of the appeal of general practice.
Contributed by Dr Sarah Bailey
“For me, the part-time training has been wonderful.”
money matters
6 / Money Matters
What you can earn What do GP registrars and GPs earn? What are the hours? Here are some financial facts and figures. The earning power of GP registrars and GPs is excellent when you consider the flexibility and work-life balance of the profession.
GP registrar salaries Full-time GP registrars work a minimum of 38 hours a week. This includes education time and administration time. The actual hours of consulting (seeing patients) are usually between 27 and 33 hours a week. This can vary, especially in rural areas. Registrars can choose a set salary model or negotiate a percentage of income generated by the patients they see in the practice. In this case, remuneration is determined by how many patients are seen and whether there is bulkbilling or private billing.
according to the National Minimum Terms and Conditions (NMT&C) document agreed by GPRA and the National General Practice Supervisors Association (NGPSA). For each stage of training, there is a minimum salary or hourly rate of pay for the registrar. You will be pleased to note that GPRA has negotiated a significant increase of 7.5% for GP term 1 registrars. Alternatively, the registrar is paid a minimum of 45% of gross billings (whichever is greater). For 2011, the minimum rates are in the table on the opposite page.
Different remuneration systems
Minimum terms and conditions
Those GP registrars who do on-call and hospital VMO work should earn a minimum of 55% of the hospital billings.
During the first two GP terms (or ACRRM equivalent), GP registrars are guaranteed minimum terms and conditions of employment
Some registrars work in salaried practice, especially ADF registrars, those in Aboriginal medical
142
2011 Training Year Minimum Salaries plus 9% Superannuation Annual salary
Weekly salary
GP term 1 registrar
$70,000
$1,342.53
GP term 2 registrar
$84,162
$1,614.15
Examples of GP Registrar and GP Incomes Training stage
Location
Practice style % of billings paid
On-call
Average patient consultations (hours/week)
Weekly ($)
Annual ($)
GP term 1 (or equivalent)
Any
45%
N/A
4 patients per hour â&#x20AC;&#x201C; 28 hrs per week
$2,307
$120,000
GP term 2 (or equivalent)
Remote
Salaried hospitalbased Medical Officer, procedural work
1 in 2â&#x20AC;&#x2030;-3 days
60 hrs
$3,077
$160,000
GP term 3 (or equivalent)
Rural
50% mix billing, hospital admitting rights, procedural work (anaesthetics)
1 in 6 days
28-30 hrs
$2,788
$145,000
Locum (immediately after completing training)
Rural
60% mix billing, hospital admitting rights
N/A
38-40 hrs
$3,600
$187,200
Established GP (busy practice)
Rural or urban
65% private billing, hospital admitting rights
N/A
45 hrs
$5,175
$269,100
143
6 / Money Matters
Incentive services and some rural and remote hospitals that also provide GP services to the community. It is important to note that working in rural areas, doing procedural work and working as a hospital VMO tend to attract significantly higher incomes. However, even in urban areas GP registrars often earn more than what is stipulated in the NMT&C document. For GP registrars and GPs practising in rural areas and identified areas of need, incentive payments are available on top of a regular salary. (For more information, see page 145.)
What established GPs earn Established GPs can earn good money, with the actual amount dependent on the nature of the practice and hours worked. In addition, there is the opportunity to run your own medical practice if you choose. All this with flexible hours and choice of practice style!
Contributed by Dr Siew-Lee Thoo, Dr Naomi Harris and Dr Jason Ong
144
payments
Calculate your income online www.gpsn.org.au/ gpearnings Our online GP Earnings Calculator allows you to estimate your individual earning potential based on the kind of GP you want to be. You can also see some real-life examples of GP registrar and GP incomes on page 143. Incomes vary according to the number of patients seen, the type of work done and whether it’s at bulk-bill or private patient rates.
In addition to your salary, you can claim an array of other financial incentive payments as a GP registrar.
W
hen working as a GP registrar, there are a few financial incentives and reimbursements to be aware of. Several of these are Commonwealth Government incentives through the Department of Health and Ageing (DoHA) to encourage more GPs where they are most needed, such as rural, remote and outer metropolitan areas.
Accommodation Each RTP has an individual policy regarding accommodation and relocation subsidies for GP registrars. This may include subsidised rental accommodation in rural areas.
General Practice Rural Incentives Program (GPRIP) The General Practice Rural Incentives Program (GPRIP) applies on an equal basis for GPs and registrars (both locally and overseas-trained) working in rural locations. Payments are on a sliding scale calculated using the Australian Bureau of Statistics’ Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system. The more remote the area and the longer a doctor stays there, the higher the rewards (see Table 1).
HELP/HECS Reimbursement Scheme The HELP/HECS Reimbursement Scheme reimburses HELP/HECS fees to participants for each full-time year of medical training undertaken or service provided in areas designated as Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) 2 to 5. These reimbursements are scaled to reward doctors working in the most remote areas who will receive a higher level of reimbursement and recover their fee payments over a shorter period of time (see Table 2).
145
6 / Money Matters
GPSN TIP Find out about the financial incentives you may be able to claim in addition to your salary as a GP registrar. Visit www.gpaustralia.org.au.
More Doctors for Outer Metropolitan Areas Program
prepared to work in an outer metropolitan area for two years. Newly fellowed general practitioners are eligible for a total payment of up to $30,000. For those prepared to further commit to outer metropolitan areas by setting
This is another DoHA program applicable to GP registrars on the general pathway who have completed their training and are
up their own practice and staying for three years, there is a total of $40,000 available.
Table 1 – General Practice Rural Incentives Program (GPRIP) ASGC-RA classification
Period of time (years) in a rural location 0.5
1
2
3 - 4
5+
-
$2,500
$4,500
$7,500
$12,000
RA2 (Inner Regional)
-
$2,500
$4,500
$7,500
$12,000
RA3 (Outer Regional)
$4,000
$6,000
$8,000
$13,000
$18,000
*Other
RA4 (Remote)
$5,500
$8,000
$13,000
$18,000
$27,000
RA5 (Very Remote)
$8,000
$13,000
$18,000
$27,000
$47,000
*Payments for all eligible RA1 training placements will be made according to the category “Other”. Table 2 – HELP/HECS Reimbursement Scheme ASGC-RA classification
ASGC-RA1 (Major Cities)
ASGC-RA2 (Inner Regional)
ASGC-RA3 (Outer Regional)
ASGC-RA4 (Remote)
ASGC-RA5 (Very Remote)
Period of reimbursement
Not eligible
5 years
4 years
3 years
2 years
146
7
applying for GENERAL PRACTICE training
7 / Applying for GP training
8
how to apply for
GP training
info file
You can apply for general practice training during your internship year or any time after. When can I apply?
Am I eligible?
The earliest time you can apply for the Australian General Practice Training (AGPT) program is in your intern year, which means you enter the program as a second year postgraduate. You are also free to apply later in your hospital training.
You must have Australian or New Zealand citizenship or permanent residency, medical qualifications and medical registration. If you are a temporary resident you may be able to apply but only if you meet strict guidelines.
148
FACT FILE For more information about general practice training, see page 88 or visit www.agpt.com.au.
8 / Applying for general practice training
GPSN Calendar 2011 GPSN Local Events
National and International Key Dates Event
Dates
Event
GPSN Council Meeting, Canberra
23 and 25 March 2011 (Wed and Fri)
GPSN Icebreaker Events
Breathing NEWLIFE into General Practice Conference, Canberra
24 March 2011 (Thu)
GPSN Clinical Workshops/GP Experience Events
WONCA Asia-Pacific Conference, Philippines
21-24 February 2011 (Mon-Thu)
GPSN First Wave Scholarship Applications
Applications open Mon 16 May 2011, close Sun 5 June 2011
Global Health Conference, Sydney
29 June-3 July 2011 (Wed-Sun)
Australian Medical Studentsâ&#x20AC;&#x2122; Association Conference, Sydney
3-10 July 2011 (Sun-Sun)
GPET Convention, Canberra
7-8 September 2011 (Wed-Thu)
GPSN First Wave Scholarship Orientation Workshop, WA and SA
13-14 August 2011 (Sat-Sun)
GPSN First Wave Scholarship Orientation Workshop, Melbourne
27-28 August 2011 (Sat-Sun)
GPSN National Council Meeting
15-16 October 2011 (Sat-Sun)
Rural Medicine Australia (Australian College of Rural and Remote Medicine and Rural Doctors Association of Australia) Conference, Alice Springs
28-30 October 2011 (Fri-Sun)
AGPN National Forum, Melbourne
16-19 November 2011 (Wed-Sat)
150
GPSN Career Expos GPSN End of Year Events/Elections Check with the GPSN club at your university for details.
151
We want your feedback on Aspire 2011
We aim to continually improve the support we offer medical students and we value your opinions and constructive comments. • Were the articles and information valuable to you? • Are there any other topics you would like to see? • Is there anything you would like to see more of? • Is there anything you would like to see less of? • Do you have any suggestions for future topics? • Are you interested in writing an article for future editions? • Are you interested in assisting on the editorial team? Please send us your feedback by email aspire@gpra.org.au or by phone 1300 131 198
152
T: 1300 131 198 www.gpsn.org.au E: gpsn.enquiries@gpra.org.au