Explorer THE REGISTRAR GUIDE
2012
Training tips for registrars by registrars
New GPs for you to meet!
How to survive general practice training Top tips for exams Negotiate your contract with confidence What’s new at GPRA?
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About this guide Explorer is produced by General Practice Registrars Australia (GPRA).
The name Explorer reflects the aim of the guide — to help registrars explore their future career options during the training years. It is set out in colour-coded sections for easy navigation. This publication has been produced using sustainable, environmentally friendly printing techniques and paper. This reflects GPRA’s ethos of supporting tomorrow’s GPs and their families in their quest for sustainable careers in general practice.
Produced with funding support from
FSC LOGO
Welcome To both new and seasoned GP registrars — welcome aboard the 2012 edition of Explorer!
The Explorer registrar guide is here to help you navigate through the journey of a lifetime — GPland. The guide is an initiative of General Practice Registrars Australia (GPRA), compiled with the GP registrar perspective in mind. Other registrars or former registrars have written many of the articles. It aims to touch on the important things that are good to know early on, as well as tips and new developments relevant to all registrars.
“The 2012 edition includes new information, such as online exam tips, what to do after fellowship, and updated favourites, such as self-care for GP registrars.” 2
Visit our website — gpra.org.au
It covers the nuts and bolts of registrarship, including how to build a doctor’s bag, an overview of Medicare, and pointers for prescribing. It simplifies the confusing but important stuff like the structure of GP training, and the requirements of the two colleges. The world of general practice training is ever-changing, and the 2012 edition includes new information, such as online exam tips, what to do after fellowship, and updated favourites, such as self-care for GP registrars. All this is interwoven with truly inspiring glimpses into the lives and activities of individual GP registrars. A big thank you to all the contributors, mostly GP registrars with busy lives, who have generously shared their wisdom, experience and bright ideas. As the Explorer name suggests, these training years can be the perfect time to adventure through the varied terrain of this awesome profession, and challenge ourselves with the opportunities available before deciding on a niche. I hope this edition of Explorer will help you to travel with confidence. Dr Christine Willis Medical Editor Explorer 2012
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Message from the GPRA Chair “We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time.” — T.S. Eliot It is my pleasure to introduce the Explorer guide for 2012 in my capacity as the new GPRA Chair. The GPRA team hopes that this guide provides you with directions and ideas that enrich and diversify your career as you explore the exciting landscape of GP training and beyond. GPRA is the voice of the next generation of general practitioners. We represent the interests of you as GP registrars and support you through the training program. We strongly advocate on key issues affecting GP registrars, provide resources for exam preparation and help you to maintain your resilience and preparation for beyond the training program. We encourage you to get involved and remain informed because your input shapes our
responses to core issues. This guide explores some of the avenues through which GP registrars can get involved. I have heard many stories about how colleagues came to venture into general practice. Their exploration involved direct fully-mapped out paths, as well as labyrinthine routes complete with pit stops. My journey falls somewhere between the two. In medical school, what I wanted to be when I grew up seemed dictated by what rotation I was currently in. General practice always came into view, but I had my share of distractions. In the end, I learnt that general practice offered me the right work-life balance, as well as opportunities to pursue other career aspirations. Now in my final weeks as a GP registrar, I look through the Explorer guide and recall all the exciting opportunities it presented to me. In writing this, I have come full circle yet feel there is so much more out there waiting to be explored. I hope in your own exploration that this guide continues to inform and inspire. Welcome to general practice! Dr Edward Vergara GPRA Chair 2012
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Visit our website — gpra.org.au
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Contents On the cover GPRA registrar members
18 30 72 96
GPRA member benefits The structure of GP training First day survival tips The many faces of general practice
1
About this guide
2
Welcome
4
A message from the GPRA Chair
1 GPRA and you 10
Your GPRA support team
3 Term allocation and choice 56 Getting your practice placement 58 Your practice interview 62 If things go wrong
12 With you on your journey
4 Preparing for practice
14 The GPRA team
66 Things to do before your first GP term
16 On our agenda
72 First day survival tips
18
76 The GP mindset in hospital
Member benefits
20 What’s new for registrars at GPRA?
80 Going bush
22 Who knew?
84 What every VMO should know
24 A year in the life of GPRA
86 The Medicare maze
2 Your GP training experience
92 Prescribing pointers
30 The structure of GP training
96 The many faces of general practice
36
Getting more involved
5 Exploring your options 97 Travel while you train
38 Understanding the moratorium
98 Aboriginal and Torres Strait Islander
40 The RACGP Fellowship
43
RACGP’s Fellowship in Advanced
102 Community spirit
Rural General Practice
104 About academic training posts
health training
46 The ACRRM Fellowship
106 A passion for research
50 RVTS: An alternative pathway to fellowship
108 Owning it — business
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110 The medical all-rounder — rural-remote
Joining forces with the ADF
6 Visit our website — gpra.org.au
GPRA would like to acknowledge the support of our patron Professor John Murtagh and his contribution to general practice.
112 Special interest — sub specialise 114 Prized position — urban
6 Exams and assessments 118 Top tips for exams
7 Money matters 126 National Minimum Terms and Conditions 131 Employee to contractor 133 Incentive payments
Prof. Murtagh is Adjunct Professor of General Practice, Monash University and Professional Fellow in the Department of General Practice, University of Melbourne. He practices part-time as a GP at East Bentleigh and has teaching responsibilities at three Melbourne-based universities. He is also the author of several internationally adopted text books including General Practice. Platinum Sponsors: Avant Mutual Group Limited and Healthscope Medical Centres GPSN Founding Sponsor: MDA National Insurance Pty Ltd Major sponsors: Victorian Aboriginal Community Controlled Health Organisation, Medical Indemnity Protection Society, North Coast GP Training, Doctors Health Fund, Aspen Australia, MIMS Australia, Australian College of Rural and Remote Medicine and The Royal Australian College of General Practitioners.
8 Keeping your balance
Advertisers: The Medical Insurance Group, Medfin Australia, Health 24-7 Medical Recruitment Service.
136 Stress less — six tips and tricks from GPs
Business Partners: General Practice Education and Training (GPET), Australian Doctor, Reed Medical Education, Healthed and Medical Observer.
138 Part-time, smart time
9 Info file 142 Learn to speak GP 146 GP web directory 152 GPRA Calendar 2012
GPRA Editorial team: Managing Editor, Laura McGeoch; Editor, Jan Walker. Graphic Design: Peter Fitzgerald. Business Development Managers: Marie Treacy, Kate Marie, Naomi Sher. Print: Graphic Impressions. ©2011 GPRA. 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 permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, 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 was correct at the time of printing and published in good faith. Due to the rapidly changing nature of the industry, GPRA does not make any warranty or guarantee concerning the accuracy or reliability of this content.
GPRA — The future of general practice
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gpra.org.au Your online resource for everything you need to help you get through your training and negotiate your first employment contract. Exam resources — webinars, study tips, case studies oney an M e th Mor RS
2011
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Publications — GP Companion, More than Money: A Negotiation Guide for GP registrars, Explorer guide
R GP
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Professional development — finance, medico-legal, contracts National Minimum Terms and Conditions — policy document, interpretations, assistance
Go online to keep up to date with how GPRA is working for you.
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GPRA and
you
GPRAsupport team Your
Here’s a brief introduction to who we are, and how we support you on your journey to becoming a GP.
What is GPRA? GPRA stands for General Practice Registrars Australia. We are the peak national representative body for general practice registrars in Australia. One of our most important functions is to support you as a GP registrar throughout your training and represent your interests.
What GPRA does for you GPRA is run by registrars for registrars.To keep registrars’ interests at the forefront of our work, we: your pay and your conditions of • negotiate employment through the National Minimum
Terms and Conditions
a variety of resources to support you • provide throughout your training
for your interests and provide a direct • fight channel to raise any issues
your views to the Minister for • represent Health and Ageing and other stakeholders
•
offer peer-to-peer support and report on any issues that require improvement — registrar liaison officers (RLOs) are a link between the regional training providers and GPRA. In addition to representing GP registrars, we promote general practice as the medical specialty of choice to:
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Visit our website — gpra.org.au
students — through the General • Medical Practice Students Network (GPSN).
•
Prevocational doctors in hospital — through our initiative called the Going Places Network.
The future of general practice At a time when general practice is undergoing a generational shift, GPRA represents the emerging new generation of GPs as the voice of the future. We provide critical feedback to stakeholder organisations and the Australian Government to help shape the direction of GP training. We have strong links with other key organisations involved in GP education and training so we can work together for the common purpose of advancing the profession and the health care of all Australians.
About GPRA’s structure Your RLO, GPRA Advisory Council, GPRA Board and management team all have a role to play. Each regional training provider (RTP) employs one or more RLO to help you with your training. The RLOs sit on the GPRA Advisory Council and communicate via an email list server, forming an Australia-wide network to provide solutions to local and national training issues.
1 GPRA and you
Join now! GPRA also has a board of nine directors who are elected from GPRA’s membership at each Annual General Meeting in September.
Do it now
Given GPRA’s expanding role, this includes board positions for a prevocational doctor and a medical student.
Get involved by becoming a GPRA member (see page 19), raising issues with your RLO or contacting us directly:
The board is responsible for:
Level 4, 517 Flinders Lane Melbourne VIC 3001 (03) 9629 8878 membership@gpra.org.au gpra.org.au
• corporate governance • financial sustainability • advancing registrar issues with appropriate organisations. The board relies on the advisory council, which consists of RLOs from every RTP, to provide feedback and information on registrar issues. From this input, the board can develop policy to improve general practice training.
Join our online community Be part of our online community. GPRA’s website puts all the information you need at your fingertips. Stay current on everything from National Minimum Terms and Conditions (NMTC) to conferences and professional development workshops. Our ‘members only’ section has exam resources and information on subcommittes . (see page 16)
GPRA — The future of general practice
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Withonyou your journey 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 the medical specialty of choice.
Provide feedback to government and stakeholders on GP training policy
Step 1: Medical students
General Practice Students Network Events • - networking opportunities
- social - educational - career
Wave Scholarship Program • First — providing early exposure to
Provide services to promote general practice as a career and support future general practitioners
12
Visit our website — gpra.org.au
general practice
•
Publications - Aspire guide - GP Companion
• Website, e-newsletters • Member benefits, such as discounts as they arise
1 GPRA and you
Step 2: Prevocational doctors
Step 3: GP registrars
Going Places Network
GPRA membership
• Events - networking opportunities
• Advocacy and support during training • Negotiation of pay and conditions preparation resources • -Exam webinars
- social - educational - career
• Publications - Going Places guide - Going Places magazine - GP Companion
• Website, e-newsletters benefits, such as discounts • Member as they arise
benefits, such as discounts • Member for services and events
•
Publications - Explorer guide - GP Companion
• Website, e-newsletters • Professional development webinars
GPRA — The future of general practice
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The GPRA team
CEO Amit Vohra
Policy Director Emily Farrell
National Operations Manager Membership and Marketing Sarika Shah
Manager: Going Places Network Emily Fox
State Coordinators WA; SA;VIC/TAS; QLD; NSW Nicole Bonne — VIC/TAS Tracey Handley — QLD Susan Morrison — NSW Louise Comey — SA WA — WAGPET
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Manager: Membership Development Renata Schindler
National Manager Organisational Development Margo Field
Manager: Communications and Publications Laura McGeoch
Evaluation, Research and Reports Officer Cameron Adams
GPSN and First Wave Officer Alex de Vos
Senior Communications Adviser To be advised
Senior Accounts Adviser and HR Officer Rebecca Qi
Administration Officer: Membership Development Allisha Hiscock
Graphics Officer Peter Fitzgerald
Corporate Services Officer Joshua Steele
Visit our website — gpra.org.au
National Manager Business Development Marie Treacy
Sponsorship and Events Officer Naomi Sher
The GPRA
1 GPRA and you
Board
Chair: Dr Ed Vergara
Dr Holly Deer
Dr Emily Farrell
Dr Anne Kleinitz
Dr Clark Maul
Dr Bennie Ng
Dr Piotr (Peter) Swierkowski
Dr Allison Turnock
Dr Mary Wyatt GPRA — The future of general practice
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ouragenda On
GPRA’s top priority is to find new ways to support GP registrars. Part of this role is to promote the benefits of a general practice career and support you on your journey from a student to a GP. Here’s just some of the work we’ve been doing.
Policy and advocacy GPRA has employed a Policy, Evaluation and Reports Officer – Dr Cameron Adams. Cameron’s role includes the facilitation of policy development through working closely with GPRA subcommittees, the Chair and CEO to author discussion papers and submissions. Some key policy areas GPRA will be working on in 2012 include support and training for Aboriginal and Torres Strait Islander junior doctors and registrars, the quality and standards of in-practice teaching, and furthering recognition and support for registrar medical educators.
Subcommittees GPRA subcommittees exist to progress an issue or idea of importance, and are one of the primary drivers of GPRA policy development. GPRA subcommittees cover a range of issues, and are an opportunity to get to know and support registrars, brainstorm, find solutions and improve general practice in Australia. GPRA subcommittees are working parties that not only promote discussion and provide support, but produce outcomes and work with industry bodies to make sure these outcomes are embraced and implemented. 16
Visit our website — gpra.org.au
Significant outcomes already produced by the subcommittees include the registrar medical educator job description being accepted by RTPs, as were the recommendations for safe working hours and greater support for ACRRM registrars. GPRA’s subcommittees are looking at the following areas:
• Support and advocacy for ACRRM registrars • Support for registrars in Aboriginal Medical Services • In-practice teaching policies • National Minimum Terms and Conditions • Practice allocation policy • The role of registrar medical educators • RLO issues • Safe working hours Joining a subcommittee is a great way to help, get your ideas heard and make a difference. Meetings are usually held via a web-based teleconferencing platform. For more information, email subcommittee@gpra.org.au
1 GPRA and you
National Minimum Terms and Conditions (NMTC) for registrars As part of our work to support GP registrars, we negotiate the National Minimum Terms and Conditions for GP registrars every two years and indexation to salary occurs each year. The NMTC will be revised during 2012. We also have resources for registrars to help them to negotiate their contract.
Webinars After reading the countless feedback forms and surveys, GPRA now supports registrars through online webconferences on the following topics:
GP First — working with junior doctors and medical students GPRA continued to work hard to foster an interest in general practice among its student and junior doctor networks through the General Practice Students Network (GPSN) and the Going Places Network. There is now a GPSN club in every Australian university medical school (20 in total) and 48 hospital-based GP Ambassadors in 44 training hospitals.
GPRA
miles
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Here ’ achie s a snaps vemen h ts fr ot of so 1. Ma me o om t r f G he su ch 2011 — bcom GPRA past year PRA’s . m ittee launc 2. Ma (now rch 2 hes fi 8 0 rs c 11 in to o Exam preparation — tal) t in nference Breathin celeb Parlia g New ra ment 3. Ap Hous tes its fi Life (BNL Negotiating GP contracts fth a e ) lauril 2011 — nniver O nche sary d — 5 SCE exa 4. Ma m 00+ Business development regis prep web lau y 2011 — G tratio inars nche o in g P ns d gpa 5. Ma ustra laces Ne Information on upcoming webinars twor lia.or ex y 2011 — F k g .a p webs u un anded to irst Wave ite is advertised through the iversit 10 S y med 0 and of cholarsh 6. Ju f ic ip e r n monthly e-newsletter. s a e e l sch d 20 1,0 ool in at every 00 m 11 — Goin Aust g Pla embe 7.Ju ralia c r e s s Ne n twor Ho e 2011 — G k rea urs d PRA ches iscus relea 8. Ju se s gu ly 2011 — M ion paper s Safe W ide fo orkin o r e t g r GP h 9. Au regis an Money trars : lau gust 2011 launc A negotia — Ne nche hed tion w d gps 10.Oc n.org GPSN w .au ebsit we tober 2011 e binars — Fu tu launc hed f re Series ollow ing re interactiv e gistra r req uests
• • •
GPRA — The future of general practice
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Memberbenefits Being a member of GPRA is FREE and gives you all sorts of professional and personal perks. Core membership benefits Pay and conditions — We negotiate your • pay and conditions of employment.
• Free copy of the Explorer registrar guide. Free copy of the GP Companion, a handy • medical pocket reference.
•
Free e-newsletters and mailouts to keep you • up to date with activities and job listings.
•
development — We offer • Professional interactive online support to help you
Advocacy — We fight for your interests and provide a direct channel to raise any issues. Personalised advice — We offer personalised advice on the National Minimum Terms and Conditions document and what it means for you.
prepare for exams and understand the business of general practice.
Plus you receive:*
professional development and travel • Free opportunities through GPRA committees. for registrars to attend the General • Discounts Practitioner Conference and Exhibition (GPCE) Melbourne and Sydney (numbers are limited and eligibility subject to GPCE’s approval) and other professional development conferences and seminars as they arise.
of Complementary Medicine — • Journal 10% off one-year subscription, 20% off
two-year subscription.
Club membership — $200 off • Qantas Free online exam resources developed for • original price. registrars by registrars (see page 20 for more details). • Ramsay books and equipment —15% off. • Discounts to Healthed seminars for GPRA registrar members in the AGPT program. A corporate discount for Fitness First • memberships.
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Visit our website — gpra.org.au
1 GPRA and you
Join now Alumni and Associates membership This package is designed for ex-GP registrars who want to stay abreast of general practice issues, medical students and prevocational doctors plus anyone else who wants access to our national network of GP registrars.
If you’re not already a member, there are three easy ways to join and start receiving all the benefits. Online gpra.org.au Email membership@gpra.org.au Phone (03) 9629 8878
You receive:* e-newsletters and mailouts to keep you • Free up to date with activities and job listings.
development and • Professional networking opportunities through relevant
GPRA committees.
Discounted access to some professional • development workshops.
* Specific benefits of our membership packages may vary without prior notice.
GPRA — The future of general practice
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What’ s new for registrars at GPRA? At GPRA, we are always trying to find new ways to support our members and help them to get the most out of their training and career. Here’s how. Secure your win-win contract
2011
GPRA has released More than Money — A Negotiation Guide for GP Registrars.This is a 50-page guide for registrars with some fantastic tips about how to make sure M ore than you secure the right Mon ey contract. More than Money
GPRA e-newsletter and are only open to GPRA members. Go online to find out more gpra.org.au/exam-preparation-webinars
AN
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GUID
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concentrates on negotiation for GPT1 and GPT2 registrars, but many of the Secu guidelines apply to re y our winwin cont registrars and GPs at any ract career stage. Download your copy from gpra.org.au/negotiation-guide
Exam Preparation Webinars — Surviving (and Passing) the OSCE Want to know what really happens in the OSCE? Want to hear from your peers who have sat the exam? Want to do this for FREE? Scheduled twice a year in the month prior to each OSCE exam, the GPRA exam prep webinars provide members with personal experiences from registrars (now fellows) who have survived and passed the exam. Webinars are advertised through the
A+
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Visit our website — gpra.org.au
Got something to say? Join a GPRA subcommittee! GPRA has now set up subcommittees to give registrars, who are not RLOs, the chance to formally contribute to policy and advocacy matters. Six subcommittees were set up during 2011 — Registrar medical educator, RLO role, Practice Allocation, In-Practice Teaching, ACRRM registrars, registrars in Aboriginal Medical Services, National Minimum Terms and Conditions and Safe Working Hours. To be part of a subcommittee, email subcommittee@gpra.org.au
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Need some advice? GPRA Assist can help
The GPRA Assist phone line is one of the ways GPRA provides one-on -one help and advice to members. Some of the most common questions are about the National Minimum Terms and Conditions (NMTC), payments and location restrictions.
GPRA ran the Future Series — online business-focused webinars — for the first time during 2011. The webinars put registrars in touch with experienced GPs and other experts who gave them first-hand knowledge about the business side of general practice.
If you need one-on-one help, call GPRA Assist on 1300 131 198.
Change alert! Here are some of the changes on the general practice landscape for registrars. criteria for combining GP training • New with another specialty…see page 30. AKT and KFP exams now • RACGP online…see page 122. for registrars reflect CPI • NMTC increase…see page 126.
Business development — Future Series
The Future Series covered four business streams: Successful Negotiation; Being a Contractor; Being the Boss (Solo Practice); and Sharing the Profits (Group Practice). Keep an eye out for information about the 2012 Future Series in the GPRA member e-news and online at gpra.org.au/future-series
registrars now classified as employees • GP …see page 131. If you are a registrar and would like change updates through our e-newsletter, become a member (FREE!) at gpra.org.au If you are a stakeholder and would like to receive our e-newsletter, email membership@gpra.org.au
GPRA — The future of general practice
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Who knew? lia 00 Austra 0 , 2 2 in 100 million GPs consultations between Australians 2,700 and their GPs GP r each year e on th gistrars ay, thw progr e AGPT a p l am ay ra thw gene in 20 12 55% rural pa rural 45% neral to ratio ge istrar reg GP 9 0 co % o at ns f A 0 lea ul u $180,00 verage a st t t str annual s for e on hei alia m inco a g ce r G ns in ork GPs w e standard a Ps ye full-tim ar 12 4 * k e e w average numb of patients er a sees each w GP eek
*From Australian Bureau of Statistics 2009-10 Health Care Services survey
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Visit our website — gpra.org.au
1 GPRA and you
Attention Young Doctors
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More information To learn more about the benefits of joining a Healthscope Medical Centre please contact Lachlan McBride on 0417 574 401 or lachlan.mcbride@healthscope.com.au
A year
in the life of GPRA 2011
We were out and about during 2011 — meeting with our members, going to major industry events and hosting our own events. Take a look at what GPRA’s registrar network, as well as its student and junior doctor networks, got up to in 2011. Breathing New Life (BNL) into General Practice conference Parliament House, Canberra 11—13 March 2011 GPRA’s annual threeday conference gives its three membership networks — students, junior doctors and registrars — the chance to network with each other and with leaders in the medical industry. The Federal Health Minister and Opposition Minister have been key note speakers at past BNL conferences.This year’s BNL conference will be held on 18—20 March 2012. Advisory Council Meeting Canberra, ACT April — October 2011 The GPRA Advisory Council, made up of registrar liaison officers (RLOs) from across Australia, meets four times a year. In September, the council met to talk about a range of registrar issues and policy, ensuring registrar issues remain at the forefront of GPRA. They had some fun too!
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Visit our website — gpra.org.au
1 GPRA and you
GPRA Board meeting St Kilda, Melbourne 9–10 July 2011 The GPRA Board meets several times a year, including two face-to-face meetings, so it can keep on top of registrar issues and continue to help steer GPRA forward. Board members also ‘talk’ online through an email list server.
Future Series webinars All over Australia! 24 October — 2 December 2011 Hundreds of GP registrars and newly-fellowed GPs logged on to learn about the business of general practice from experienced GPs. The Future Series gives participants the chance to get answers about their business future from those who have been there and done that.
Exam Preparation webinars All over Australia! April — October 2011 Registrars from all over the country got online support preparing for the OSCE exams. Designed to provide registrars with practical information to help them pass the exam, participants have described the webinars as ‘excellent!’ Go online to gpra.org.au/exam-preparation-webinars
GPRA — The future of general practice
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A year
in the life of the Going Places Network
Our Going Places Network members, junior doctors in hospital, got together and explored general practice. Practice skills workshop and dinner Adelaide, SA South Australian members updated their joint injection and otoscope skills while sampling some of the best pizza in Adelaide. Melbourne Networking dinner Melbourne CBD Sixty Going Places members, including GP Ambassadors, shared a fabulous three-course meal in one of Melbourne’s iconic laneway restaurants.
Australian Defence Force (ADF) and Going Places Network event Logan Hospital, Brisbane More than 200 junior doctors and medical students visited the fully-staffed Logan ADF Regimental Aid Post.
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Visit our website — gpra.org.au
GP By the Sea Wollongong, NSW Wollongong members enjoyed a delicious meal, a drink and magnificent views with like-minded colleagues interested in general practice.
A year
1 GPRA and you
in the life of the General Practice Students Network
Just starting out on their journey towards a medical career, GPRA’s student network had a very exciting year. GPRA administers the General Practice Students Network (GPSN), designed to help foster students’ interest in general practice First Wave Workshops Melbourne and Perth GPSN hosted interactive workshops in Melbourne and Perth for the recipients of the 2011 GPSN First Wave Scholarships. GPSN Council Meeting Melbourne Representatives from all 20 GPSN clubs attended the GPSN Council Meeting in Melbourne.
Monash University OSCE event Melbourne Monash University GPSN hosted a practice OSCE stations session for third and fourth year members.
UNSW Careers Night Sydney UNSW medical students explored the diverse pathways offered by a career in general practice.
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+ A
Go online for GPRA exam preparation help! • • + A Want to know what really happens with the OSCE?
Want to hear from your peers who have sat the exam — and passed?
to ask questions about the OSCE and • Want get some answers?
Join GPRA today (gpra.org.au) and get FREE access to exam preparation resources, including webinars, study partners plus handy hints and tips.
Visit gpra.org.au/exam-preparation-webinars
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Your
GP training
experience
The structure of
GP training A brief overview of the who, what and how of general practice training.
What is the AGPT program? The Australian General Practice Training (AGPT) program is the vocational training program for GP registrars.
What is GPET? General Practice Education and Training Ltd (GPET) is a government-owned company established in 2001 by the Australian Government to fund and oversee general practice vocational training in Australia.
Can I be enrolled in another specialty program while doing the AGPT program? Yes, this is now possible from 1 January 2012. This must be approved in advance by the RTP, be supported by your medical educator and be incorporated in your learning plan. However, you may not be enrolled in another program during your first six months of the AGPT program. Following this initial six months, you can do another specialty program part-time. See the Training Outside of AGPT Policy 2010 (effective from 1 January 2012) online at agpt.com.au/Policies/Policies/
What are RTPs? GPET contracts with 17 regional training providers (RTPs) Australia-wide. RTPs deliver the AGPT program in their designated region, enabling a targeted response to local workforce and population health needs. The RTP is responsible for administering the training program, training GP supervisors, and 30
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delivering educational activities and training material to registrars. For those who wish to train in isolated remote locations, there is an alternative to the AGPT program – the Remote Vocational Training Scheme (RVTS), which involves distance education and remote supervision. (see pages 50-51)
Is training funded? Training places under the AGPT program and RVTS are fully funded by government, and registrars are paid while training.
Other ways to fellowship
There are three other pathways to fellowship designed for experienced practitioners. The Independent Pathway, offered by the Australian College of Rural and Remote Medicine (ACRRM), emphasises self-directed learning. The Specialist Pathway, offered by both the Royal Australian College of General Practitioners (RACGP) and ACRRM, assesses the experience and qualifications of overseas- trained doctors. The Practice Eligible Pathway, offered by the RACGP, is another option that assesses doctors experienced in general practice, including overseas-trained doctors with at least one year’s experience in Australia. These pathways are not funded under the AGPT program and various fees are involved (contact the colleges for specific information).
2 Your GP training experience
The AGPT landscape 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 Hospital/practices
Vocational training
Fellowship of the Australian College of Rural and Remote Medicine (FACRRM)
Quality general practice experience
Fellowship of the Royal Australian College of General Practitioners (FRACGP)
Vocational recognition
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AGPT Program Endpoint Qualifications and Fellowships FACRRM qualifications (ACRRM)
Year one
Core clinical training time
FRACGP qualifications (RACGP) Possible equivalence*
12 months
+ Year two
Primary rural & remote training 2 x 6 months
Primary rural & remote training 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†
+ Note: Fourth year is for FACRRM and FARGP candidates
12 months
+
+ Year three
Hospital training time
GPT3 — 6 months Extended Skills — 6 months
FRACGP (VR) Possible equivalence*
Advanced skills training for FARGP (12 months)
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.
What is the role of the two colleges of general practice?
What are the endpoint qualifications/fellowships?
RACGP and ACRRM establish training standards, set examinations and assessments, accredit training placements and approve completion of training by registrars.
Attainment of a Fellowship of the RACGP (FRACGP) or a Fellowship of ACRRM (FACRRM) is necessary to become vocationally recognised for independent general practice in Australia under the Medicare system.
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ACRRM has specifically designed its curriculum to meet the needs of doctors practising in rural and remote settings. 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 (see page 43). You may wish to complete one, two or three qualifications (FRACGP, FACRRM and FARGP) and this can be integrated into your training course from the beginning.
Geographical classification Your training pathways and obligations are designed around the Australian Standard Geographical Classification-Remoteness Areas (ASGC-RA) system, developed by the Australian Bureau of Statistics. This classifies all Australian towns and cities on a scale of 1–5, where 1 includes major cities and 5 denotes the most remote areas. The General Practice Rural Incentives Program (GPRIP) payments are also based on the ASGC-RA system.
What are the training pathways and obligations? Before starting training in the general practice setting, you need to complete mandatory hospital rotations determined by the colleges.
If you have completed these before joining the AGPT program, you will need to apply for recognition of prior learning (RPL). You can complete the rest of your general practice training via either the general pathway or the rural pathway. Doctors from overseas who are subject to the 10-year moratorium are usually required to follow the rural pathway.
General pathway RA1–5 Registrars in the general pathway of the AGPT program can train in RA1–5 locations. Training in the general pathway does not preclude a registrar later working in rural or remote areas. General pathway registrars are required to complete 12 months of their training outside the inner metropolitan area of a capital city, or alternatively six months of training outside the inner metropolitan area of a capital city and six months of training in an Aboriginal or Torres Strait Islander health training post. There is a range of flexible options to achieve this: 1. 12 months in a rural location RA2–5 2. 12 months in an outer metropolitan location 3. 12 months in a non-capital city classified as RA1 4. Six months in any two of the above areas (12 months total) 5. Six months in one of the above areas plus six months in an Aboriginal and Torres Strait Islander health post at an Aboriginal Medical Service (12 months total).
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*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
NSW GP Synergy^
SA Sturt Fleurieu GP Education & Training
NSW WentWest ACT NSW CoastCityCountry 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
GPRAtip Recognition of prior learning Recognition of prior learning (RPL) gained in hospital before entry into GP training is possible but requires good documentation. You need to apply for RPL in your first year in the AGPT program and have full documentary evidence of your relevant experiences to qualify. Talk to your RLO and RTP early for full details.
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NSW GP Synergy* NSW GP Training Valley to Coast
NSW VIC Bogong Regional Training Network VIC Victorian Metropolitan Alliance TAS GP Training Tasmania
Rural pathway RA2–5 Rural pathway registrars are required to undertake their training in rural locations RA2–5. Eligible registrars will benefit from the Australian Government’s General Practice Rural Incentives Program, known as GPRIP (see page 133).
Personalised learning The AGPT program is personalised to meet each registrar’s individual goals and career aspirations and is a composite of in-practice learning and external education and training arranged by your RTP. Your medical educators, supervisors and mentors will help guide your learning to shape your future career.
2 Your GP training experience
Flexible aspects of training The AGPT program is known for its flexibility. Part-time training is a popular feature, especially for women having children. 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, General Practice Registrars Australia (GPRA) plays an important unifying role with its focus on the interests of the registrar.
GPRA works on behalf of GP registrars to identify and rectify any problems and inconsistencies that may occur with so many stakeholders involved in general practice training. Contributed by Dr Christine Willis, Dr George Manoliadis and Dr Jen Lonergan
Who’swho 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
Do itnow For more information about the Australian General Practice Training program, visit:
FARGP Fellowship in Advanced Rural General Practice FRACGP Fellowship of the Royal Australian College of General Practitioners
AGPT agpt.com.au
GPET
General Practice Education and Training Ltd
RACGP racgp.org.au
GPRA General Practice Registrars Australia
ACRRM acrrm.org.au Your RTP gpra.org.au/links#RTPs
RACGP Royal Australian College of General Practitioners
GPRA gpra.org.au
RLO
Registrar liaison officer
You can also speak to your registrar liaison officer (RLO). You can contact GPRA on (03) 9629 8878 or email enquiries@gpra.org.au
RTP
Regional training provider
For an expanded glossary of terms, see pages 142-145.
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Getting
more involved
As a registrar, you can play an active role in the delivery of the GP training program by seeking employment as a registrar liaison officer (RLO) or registrar medical educator. Could you be an RLO? Registrars helping registrars Want to be paid for helping your peers? Then consider being a registrar liaison officer (RLO). Each RTP employs one or more RLOs to provide pastoral care, information and support
for registrars. RLOs are registrars themselves and their RLO work can be counted towards training as a special skill. Each RLO is a member of the GPRA Advisory Council, which meets four times a year. Attending meetings may involve paid travel — a great fringe benefit. If you are interested, talk to your current RLO or RTP.
DR SOPHIE SAMUEL “By being an RL O I have met a lot of interesting peop le, discovered sk ills and talents I never knew I had and can now appreciate the bigger picture. I have satisfied my cu riosity about th e how, where and wha t of the plannin g, st rategy and structure of general prac tic e education. Plus the time was accredited to m y training, I go t to travel, and even got paid! Be an RLO, see the world!” Dr Sophie Sam uel Registrar liaison officer, Beyond Medical Education, VIC
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2 Your GP training experience
Could you be a registrar medical educator? Registrars training registrars Like the idea of teaching? Employed positions for registrar medical educators (RMEs) are available at some RTPs. Positions are part-time and involve teaching other registrars and junior doctors. In some cases, the work can be credited as a special skill in the training program. If you are interested, talk to your RTP.
DR NYOLI VALENTINE “I combine wor king one day a w eek as a registrar med ical educator w ith my clinical and acad emic work. I he lped with the develo pment of the G oi ng Places Networ k program, prom oting general practice to junior doctor s in Adelaide teachi ng hospitals th ro ugh education dinne rs and lunchtim e teaching sessio ns. I learn so m uch; the junior doct ors help make su re my knowledge st ays current.” Dr Nyoli Valent ine Registrar medic al educator, Sturt Fleurieu General Practic e Education and Tr aining, SA
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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 workforce shortages, the Australian Government has certain policies that apply to overseas-trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS).
What is section 19AB/the 10-year moratorium? Section 19AB of the Health Insurance Act 1973, also known as the 10-year moratorium, states that OTDs and FGAMS will only be issued with a Medicare provider number if they work in areas
deemed by the government to be a district of workforce shortage (DWS). This usually means a rural, remote or outer metropolitan area. GP registrars under the moratorium 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 became known as the 10-year moratorium. However, there have been recent changes that allow doctors to reduce the moratorium time by up to five years, depending on the Remoteness Area (RA) of the location where they practise. The Australian Standard Geographical Classification-Remoteness Areas (ASGC-RA) system classifies locations from RA1 to RA5 according to their remoteness, with RA1 being the most urban and RA5 the most remote. The reduction in moratorium time is dependent on the remoteness of the area in which a doctor practises.
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 38
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2 Your GP training experience
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 a doctor is registered as a medical practitioner in Australia. If a doctor has not obtained Australian permanent residency or citizenship by the end of the 10-year moratorium, they will still need a section 19AB exemption in order to continue to access Medicare benefits.
Registrar rave Dr Anne Kleinitz My training provider is Northern Territory General Practice Education (NTGPE). Registrar Rave My current post is GPT3 and an academic post. This involves teaching medical students from Flinders University in Darwin. A typical workday for me is half a day of general practice, half a day of teaching. What I love about general practice is the way you can be creative and make it into a nice mixture of all the things you enjoy.
Factfile • For more information, talk to your RTP, visit agpt.com.au or doctorconnect.org.au •
If you need detailed information about your individual circumstances, contact the Department of Health and Ageing Workforce Regulation Section —19AB@health.gov.au
A patient who inspired me was every mother who lost a child in Africa — devastated by their loss but gracious and accepting (Anne has done volunteer work in Africa). After hours I like to sing, swing dance and walk on Darwin’s beaches — but not usually all three at once. A quirky fact about me is that I can still do flips — a remnant from when I did gymnastics.
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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 and Canada.* The RACGP conjoint fellowship examinations continue to be delivered in Malaysia and Hong Kong.
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
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medicine, general surgery, emergency medicine and paediatrics) plus three hospital rotations of your choice, provided they are relevant to general practice.
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General practice placements (18 months) • — completed in RACGP-accredited
teaching practices, with a compulsory term (minimum of six months) in an outer metropolitan area or rural-remote area.
skills (six months) — can be • Extended completed in a range of RACGP-accredited
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 43. *Contact the relevant colleges for details. Contributed by the Royal Australian College of General Practitioners
2 Your GP training experience
Get RACGP OSCE exam tips For tips from registrars who have done the exams — including the new online format — see pages 118–123.
About the FRACGP examination
When can I enrol to sit the FRACGP examination?
The FRACGP examination comprises: two online written segments — the Applied Knowledge Test (AKT) and Key Feature Problems (KFP)
If the chief executive officer (CEO) or authorised senior medical educator of the registrar’s regional training provider authorises, the registrar will be eligible to enrol in the AKT only after completing six active training units. Two of these units must be GP term 1 (also known as the basic term).
•
clinical segment — the Objective • one Structured Clinical Examination (OSCE). To allow for greater flexibility, each segment can be completed and paid for separately. All three segments need to be completed within a three-year period of first passing one of the online written segments.
Am I eligible to sit the examination? 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 achieved certified competence • have in a recognised cardiopulmonary
resuscitation course (CPR) within 36 months of the opening of enrolment
• have completed the required training.
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With the CEO or authorised senior medical educator’s authority, all segments of the examination may be undertaken upon completion of eight active units of training. These units include: 1. Two basic units — GP term 1. 2. Two advanced units — GP term 2. 3. Four other units — these units may be hospital training, special skills, extended skills, subsequent time (GPT3), optional elective or mandatory elective. Recognition of prior learning may contribute up to four units. The eight active units must be completed by the date specified at the time of enrolment. Remote Vocational Training Scheme (RVTS) candidates are eligible to enrol in the FRACGP examination following satisfactory completion of 12 months in the RVTS, in addition to the standard RACGP eligibility criteria.
For more information about the FRACGP examination, visit: racgp.org.au/assessment/examination racgp.org.au/assessment
racgp.org.au/assessment/faqs or for specific questions, email fellowshipservices@racgp.org.au
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The RACGP journey towards general practice (via the vocational training route) Medical school (4-6 years)
Internship year (PGY1)
Postgraduate resident years (PGY2) (this can be completed before or during general practice training)
General practice training (3 years)
RACGP Fellowship examination
Prevocational General Practice Placements Program PGPPP (optional)
4th year additional training in advanced rural skills or advanced academic skills (optional)
Successful completion of RACGP training and assessment
RACGP Fellowship
Continuing professional development
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Fellowship in Advanced Rural General Practice (FARGP) (optional)
2 Your GP training experience
RACGP’s
Fellowship in Advanced Rural General Practice (FARGP)
The FARGP is a fellowship that offers advanced training in the skills required for rural and remote practice. It extends on the Fellowship of the Royal Australian College of General Practitioners (FRACGP). What is the FARGP?
Structure of the FARGP
The Fellowship in Advanced Rural General Practice (FARGP — pronounced ‘far-GP’) recognises the advanced rural skills and additional training undertaken by GPs in preparation for practice in rural and remote Australia.
There are five main elements of the FARGP:
FARGP enrolment information
enrolling in the fellowship, a registrar • Before or practising GP needs to be a current
financial member of the RACGP and either working towardsor intending to work towards their FRACGP.
The fellowship can be completed with or • after the FRACGP. graduate with two fellowships • Candidates — FARGP and FRACGP.
• The whole process usually takes four years. • The FARGP on its own takes 12–18 months.
1. 12 months in an accredited rural general practice post.
2. 12 months in an accredited advanced skills training post (the skill needs to be relevant to rural general practice).
3. Development of a learning plan and 160 hours of educational activities to complete the plan.
4. Completion of a core unit of activities in emergency medicine.
5. Completion of a core unit of activities working in rural general practice. The FARGP is flexible and self-paced. The educational activities have a strong practice-based focus. There is no final exam for the FARGP — it is based on a continuous assessment framework.
FARGP under review The FARGP is currently under review and the plan is to have more of the activities available online. The new FARGP will be launched early in 2012.
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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: anaesthetics 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).
• • • • • • • • • •
Contributed by the RACGP National Rural Faculty
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Learn more about the Fellowship in Advanced Rural General Practice (FARGP) from your RTP. Alternatively, email fargp@racgp.org.au, call 1800 636 764 or visit racgp.org.au/rural
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The ACRRM
Fellowship
The Australian College of Rural and Remote Medicine (ACRRM) has specifically designed its GP training program to meet the needs of the rural and remote practitioner, especially for advanced procedural skills. What is the FACRRM?
Vocational training program components
of ACRRM is an approved • Fellowship 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. (Training time is reduced where a candidate is granted recognition of prior learning, or RPL.)
training occurs on the job as a registrar • The in an ACRRM-accredited general practice,
Aboriginal Medical Service, Royal Flying Doctor Service or as a medical officer in an ACRRM-accredited hospital setting.
wishing to achieve a Fellowship • Candidates of ACRRM can apply for one of three
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training pathways: 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; or the Independent Pathway, administered by ACRRM, which is suitable for doctors with experience who prefer self-directed Visit our website — gpra.org.au
learning. For more information on which pathway is most suitable for you, contact the ACRRM vocational training team.
The ACRRM training program comprises three stages of learning and experience (see the table on page 48). Core Clinical Training — Registrars complete • 12 months of training in an ACRRM
accredited metropolitan, provincial or regional/rural hospital. This should ideally include rotations in general medicine, general surgery, paediatrics, emergency medicine, obstetrics and gynaecology, and anaesthetics.
Rural and Remote Training — • Primary Registrars undertake 24 months of training
in a combination of rural or remote ACRRM-accredited general practices/ community-based facilities, hospitals, Aboriginal Medical Services, Royal Flying Doctor Service, 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
2 Your GP training experience
by the Primary Curriculum and Procedural Skills Logbook.
Advanced Specialised Training — Registrars • undertake 12 months of training in one of
10 ACRRM-accredited disciplines listed in the table on page 48.
FACRRM assessment
Registrars must successfully complete the • following assessments: Procedural Skills
Logbook, Multi Source Feedback (MSF), Mini Clinical Evaluation Exercise (miniCEX), Multiple Choice Question (MCQ) exam and Structured Assessment Using Multiple Patient Scenarios (StAMPS), plus assessments specific to their chosen Advanced Specialised Training discipline.
is considerable flexibility in the timing • There of the assessments and registrars can opt
to undertake each assessment component in or close to their local community.
To achieve FACRRM, candidates must also • successfully complete four ACRRM online
education modules and at least two emergency skills courses approved by ACRRM (for example, EMST/ELS/PHTLS or equivalent, APLS, ALSO).
Frequently asked questions How is FACRRM integrated into the AGPT program? Registrars enrolled in the AGPT program can elect to train to either or both the FACRRM and the FRACGP. FACRRM training is open to both rural and general pathway registrars providing that they work in ACRRM-accredited training posts. 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. Registrars 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. ACRRM has a different curriculum and assessments, and has different requirements for accreditation of training posts. Candidates must train in posts accredited by ACRRM.
Contributed by the Australian College of Rural and Remote Medicine
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For more information, visit the ACRRM website (acrrm.org.au), call ACRRM on 1800 223 226 or contact ACRRM Vocational Training, training@acrrm.org.au GPRA — The future of general practice
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The ACRRM Fellowship Training Program After first completing Core Clinical Training, a registrar may complete the remainder of the training requirements in any order.
Core Clinical Training (12 months)
Primary Rural and Remote Training (24 months)
Advanced Specialised Training (12 months)
The ACRRM Fellowship begins with Core Clinical Training. This stage is 12 months working in an accredited hospital, where you complete required terms in:
Primary Rural and Remote Training comprises a total of 24 months in rural or remote settings accredited by ACRRM. These can include hospitals, general practices, Aboriginal Medical Services or the Royal Flying Doctor Service. You may choose to complete your Primary Rural and Remote Training in one or several locations. Training in a single location will enable you to build a strong relationship with colleagues and your community. However, training in several locations may better equip you to expand your posting opportunities later in your career. Primary Rural and Remote Training will build your clinical and procedural skills, and your confidence to work in rural and remote contexts.
Advanced Specialised Training broadens your skills and capacity beyond the standard scope of general practice training. With these supplementary procedural skills, your expanded professional scope can include clinical privileging in hospitals, access to additional Medicare Benefits Scheme item numbers and contributing to the pool of medical skills in your district. Advanced Specialised Training requires a minimum of 12 months training in one of the 10 disciplines specified by the college:
• • • • • •
general internal medicine general surgery paediatrics emergency medicine
obstetrics and gynaecology anaesthetics. This training should provide you with sufficient clinical cases and opportunistic learning to form a good foundation to begin work in rural or remote practice.
• • • • • • • • • •
Aboriginal and Torres Strait Islander health adult internal medicine anaesthetics emergency medicine mental health obstetrics and gynaecology paediatrics population health remote medicine
surgery. Each Advanced Specialised Training discipline has its own curriculum and assessment requirements.
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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.
teaching visits — An experienced • On-site rural practitioner visits the registrar to
observe consultations and provide feedback.
RVTS registrars enjoy the same level of support as their big city counterparts, no matter how remote they are. 50
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workshops — Registrars • Face-to-face 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 Aboriginal and Torres Strait Islander communities. Many work in solo practice.
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 start of training.
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Applicants must provide continuing, wholepatient care. Preference is given to doctors working in solo practice and those who cannot access Australian General Practice Training (AGPT) programs. 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 the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). Twelve-month training is available in advanced skills curricula, such as anaesthetics, obstetrics and emergency medicine. Contributed by the Remote Vocational Training Scheme
Factfile What: Train for FRACGP/FARGP or FACRRM in rural or remote locations.
Who: The registrar who enjoys the independence of rural or remote practice but wants a supportive training environment.
Information: Contact RVTS on (02) 6021 6235 or visit rvts.org.au
Dr Joanna Longley A remotely supervised GP registrar working in solo rural practice by PGY3 wasn’t exactly what Dr Joanna Longley planned. “It happened by accident,” she recalled. “The senior doctor I was supposed to work with was on extended sick leave and didn’t return to the practice.” Fortunately for Joanna, RVTS was perfectly positioned to support her during the transition from junior hospital doctor to solo GP. “I don’t think I would have survived without RVTS,” she said. “It was isolating and difficult initially, but RVTS gave me the skills and confidence to work alone.” A registrar in the 2010 cohort, Joanna is now making strides towards her GP fellowship and hopes to start exams in 2012. “The best thing about RVTS is having an experienced GP at the end of the phone when you need advice,” she said. Joanna currently spends the majority of her time in solo GP practice in Springsure, Queensland, but also works in the emergency department at Emerald Hospital. She has an unpredictable and heavy workload, but she enjoys the autonomy and the generalist nature of the job.
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Joining forces with the ADF Around 2.5 per cent of GPs train in the Australian Defence Force. It’s an opportunity to develop leadership skills and specific medical skills in a challenging environment.
Training as a GP registrar in the Australian Defence Force (ADF) offers opportunities and challenges. 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.
Most ADF MOs are recruited as medical students, some from universities and others from within the services. A small number join as direct entry medical practitioners.
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Civilian and military posts 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. Generally, composite terms are accredited only after an initial full-time civilian term, usually a three-month rural term. 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. 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, medical administration, occupational medicine and sports medicine, known as the ‘force
2 Your GP training experience
protection’ specialties. Generally, the procedural specialties (surgery, anaesthetics, orthopaedics) required for providing higher level care on deployments reside within the Reserve Forces.
for remote supervision in an operational deployment environment. Those who have achieved FRACGP or FACRRM progress to CL3.
ADF medical officer recruitment
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.
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 MO’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
Remuneration
Contributed by Dr Geoff Menzies
Do itnow 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. You can speak to a member of the ADF Joint Health Command who can direct your query to a relevant person by phoning CMDR Bronwyn Ferrier, Staff Officer Medical Officers, (02) 6266 4176 or emailing bronwyn.ferrier@defence.gov.au For more information or to apply, call 13 19 01 or visit defencejobs.gov.au
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Dr Scott Hahn Earning his stripes as a military registrar Captain Scott Hahn is a GP registrar with the Army in Brisbane. For Dr Scott Hahn, military medicine has proved an exciting way to earn his stripes in general practice. Scott was introduced to military life when working in his former career as an academic in biomedical science at Southern Cross University in Lismore.
While his work as an academic involved lecturing on biomedical topics to nursing and naturopathy students, he clung to his youthful ambition to be a medical doctor and practise clinical medicine. The Graduate Medical Scheme means a full-time salary while studying at university and training as a doctor. In return, Scott will work a Return of Service Obligation (ROSO) based on the number of sponsored training years plus one.
“It’s another The Army Reserve engaged him to challenge and He is excited by the prospect work as a science officer advising on health threat assessment. adventure rolled of his career transition. “It’s another challenge and adventure Scott had an immediate affinity into one…” rolled into one,” he said. with military culture and loved the outdoor training with the Army Reserve on the weekends — a complete contrast to the indoor pursuits of academia. It was here that he became aware of the work of military doctors and the opportunity for a career change offered by the Graduate Medical Scheme with the ADF.
Based on his qualifications, skills and experience, Scott entered the ADF through the specialist services officer stream and was commissioned at the rank of Captain. He began his education as an Army officer with an intensive six-week course at Duntroon. Having finished his four-year postgraduate medical degree at the University of Queensland, Scott is now doing his junior doctor hospital training at Logan Hospital south of Brisbane where he is a GP Ambassador for the Going Places Network, which is a network for junior doctors interested in general practice and administered by GPRA. He is looking forward to starting his first general practice term soon and, further down the track, receiving his Army posting.
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3
Term
allocation and choice
Getting your practice placement Planning ahead will give you the best shot at getting the general practice placements you want. The RTPs are responsible for allocating registrars to general practices for each general practice term, and ensuring all placements are appropriate and accredited.
Consider your goals
The system of allocation is determined by the RTP and varies considerably between RTPs. Allocation systems may involve interviews with prospective practices chosen by the registrar (for interview tips, see pages 58-60). Alternatively, the RTP may determine the placement with little or no registrar input. The method of placement for the majority of RTPs lies somewhere in between these two extremes.
Clinical goals — Define the knowledge and skills you would like to focus on. At this early stage of your learning, it may be sensible to focus on areas that are lacking rather than continuing to pursue favoured areas where you already have experience. Do you want to be exposed to a great variety of medicine including procedural and emergency medicine? A rural practice with hospital rights may be an excellent choice. Do you want to gain experience in
The way terms are allocated is influenced by various factors including the range of practices available, registrar numbers, the educational and personal needs of the registrar, the location (rural versus urban), and the opportunities provided by the practice and needs of the practice. There may also be unexpected events such as a registrar or practice withdrawing at the last minute. Allocations are often complicated for RTPs, who may be unable to fulfil everyone’s requests, and can be difficult for registrars, who may need to relocate or commute long distances, or be placed in a practice that is not ideal for them.
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When choosing a practice, there are many aspects to consider. To start with, think about your goals for the term.
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3 Term allocation and choice
women’s health? Then being a male registrar in a female-dominant practice may not be the choice for you. Refer to your learning plan and assess whether the practice has special skills or interests that complement your needs. Professional goals — What type of practice •will help your professional development? Do you want to experience a busy term where you have lots of responsibility to maximise your learning and really challenge yourself? Or a flexible practice with many GPs, where you may have to share a room but you can have Fridays off? What about the structure of the practice? Is it owned by several practice principals or an independent corporation? During your training, it is useful to experience what it is like to work at different types of practices. goals — Will your supervisor •be a Mentorship strong role model or are you a more independent worker? Do you want a supervisor who inspires you with their singular dedication to the practice of medicine or their ability to maintain a harmonious balance of work and play? Life goals — What role will medicine play •in your life for the next 6–12 months? Are you feeling energised to maximise your learning by working long hours in challenging areas, or do you have interests, activities and commitments outside of medicine that you don’t want to put off?
Consider the practicalities You should also think about the practicalities. Find out what your usual hours will be. What about on-call? What about nursing homes, hospital work and home visits? How well equipped is the practice? Consider other work conditions including leave, teaching and pay (refer to the NMTC).
Know yourself Think about what aspects of the placement would suit the way you work already and what aspects would be a challenging opportunity for learning and experience. You need a balance of these two things. Most importantly, be flexible and retain a positive attitude, even though you are unlikely to always get exactly want you want. This will help you get the most out of your placement and help other people to enjoy having you there. Contributed by Dr Christine Willis, Dr Jen Lonergan and Dr Skye Boughen
GPRAtip Be proactive and get organised early. If you have certain needs or requests, let someone in your RTP know as soon as possible. This will give you the best chance of getting the placements you would prefer.
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Your practice interview You will be more confident at practice interviews armed with the right questions.
As a registrar, you may be required to participate in interviews for practice placements before your general practice terms. Once training is over, you will probably also be attending interviews for a permanent position.
Here are a few tips and questions you might like to ask.
Practice — What special interests and skills •do people in the practice have that you can learn? Will you have your own room, or will you
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need to move rooms depending on the day? Will you need any equipment (for example, a doctor’s bag or diagnostic set) or are they provided? Is there a practice nurse and, if so, what duties do they perform? What medical records system does the practice use? How does the appointment system work? Will you have internet access at the practice? If so, in every room or just one computer? Is it broadband?
3 Term allocation and choice
hours — What days and hours are •you Work expected to work? Will you be working on Saturdays? Will you be doing nursing home visits and house calls and, if so, when? What are the on-call and after-hours commitments? Hospital work — Are you expected to •undertake work in the local hospital? How are you paid for hospital work? Do you require an ABN for this? If the payments are processed through the practice, what percentage do you receive? For your hospital patients, what are the usual arrangements for the weekends you are not on call? Are the other GPs happy to cover, or would you be expected to continue their care? — Does the practice have •any Accommodation accommodation for GP registrars? How many bedrooms and other facilities? What is the rent and do you have to pay for services such as electricity and gas? Personal safety — It is the practice’s •responsibility to provide a safe working environment for registrars so you should raise this if you have any questions or concerns. Education and supervision — How does •the practice structure your in-practice teaching
supervisor take on this role? How does your supervisor like to be contacted when you need help with your patient? Leave — You are entitled to paid leave •arrangements set out under the Fair Work Act and National Employment Standards. Some practices will allow you to take study leave (unpaid unless part of your annual leave). If you have two particular weeks in mind for your annual leave, mention this at your interview. — What is the practice prepared to •pay Pay in salary or percentage of earnings for your usual hours? What is the remuneration for after-hours work? What is the bulk-billing versus private billing mix? Does the practice pay above or according to the minimum in the National Minimum Terms and Conditions (NMTC)? If they pay less, don’t sign anything! If you are unsure, ask your RLO. Frequency of billing cycle — A weekly or •fortnightly billing cycle is the most advantageous for registrars, although the NMTC states it can be up to 13 weeks. Try for a weekly or fortnightly billing cycle if possible. This minimises potential payment problems and can make it easier to calculate annual leave.
(three hours a week for GPT1 and 1.5 hours a week for GPT2)? Is there a regular time each week and, if so, when is it? Do all partners in the practice share in the education or does your
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Dr Aaron Davis My training provider is Western Australian General Practice Education and Training Registrar Rave (WAGPET). My current post is a subsequent term in Aboriginal health. A typical workday for me involves flying on Monday to Bidyadanga Aboriginal Community Clinic. On Tuesday, Thursday and Friday I have a clinic at Broome Regional Aboriginal Medical Service and on Wednesday an alcohol and drug rehabilitation clinic. What I love about general practice is the reminder of who I am, my responsibility and the opportunity to make a difference to my people. A patient who inspired me is most of them, especially when they are happy to know I am one of the first Aboriginal doctors they have met. After hours I like camping, fishing and hunting. A favourite philosophy I often turn to is: “It does not matter if you try and fail, but it matters much if you fail to try again.”
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paperwork — GPRA recommends •you Contract have a written contract at the beginning of the term to support a shared understanding of your employment. It also gives both parties recourse against breaches under contract law. Take along a copy of the current NMTC document for reference, and to compare with any contract you might be asked to sign. If offered a contract, read it carefully before signing, and don’t feel you have to sign on the spot. If there are clauses in the contract that concern you, discuss it with the practice and your RLO. Contributed by Dr Jen Lonergan and Dr Skye Boughen
GPRAtips detailed information about minimum • For salaries and conditions for registrars
according to the National Minimum Terms and Conditions (NMTC) and further negotiation tips, see pages 126–130.
a comprehensive guide to how to • For negotiate a win-win contract, download the e-book More than Money: A negotiation guide for GP registrars published by GPRA at gpra.org.au/ negotiation-guide
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If things go
wrong
If a problem or dispute arises with your training, ask for help sooner rather than later. Sometimes registrars find themselves in situations where they are unhappy about some aspect of their training. This can range from practice placement, relocation and educational issues to interpersonal problems and financial disputes. If this happens to you, don’t worry, you are not alone. There are many people involved in GP training who are specifically employed and more than happy to help you out. If you are in a fix, the best advice is to let someone know.
Talk to someone The most appropriate person to talk to depends on what the problem is and how you personally feel about dealing with it. Remember your RLO is always there in the first instance to support and advise you, no matter how big or small the problem might seem. As an example, you might try to resolve the problem with the practice or RTP directly if it is an issue regarding practice placement.
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Alternatively, you may talk to your supervisor, medical educators or director of training if you feel your educational needs are not being met. If this does not resolve the dispute, or if you feel nervous handling the problem alone, go back to your RLO. It is their job to advise registrars about how the system works and what the expectations and responsibilities of both parties are. In some circumstances, the RLO can also act on behalf of the registrar if the registrar feels unable to confront the issue themselves. In general, most problems would be resolved locally at the practice or RTP level.
Take it further to GPRA If the RLO feels out of their depth, they are able to discuss the issue confidentially (no names mentioned) with the GPRA Advisory Council. It consists of the RLOs from all RTPs across Australia, GPRA representative members on different committees and the GPRA Board and management. Sometimes issues arise that indicate a systemic problem (for example, a policy or situation that is disadvantaging a group of registrars). GPRA will then act to lobby the relevant stakeholders to review and change their policies.
3 Term allocation and choice
Registrar rave Dr Dominic Blanks GPRA is run for registrars by registrars, which creates a non-threatening source of advocacy and support. GPRA can also be contacted directly by registrars for any issues, however, it is often the RLO and their local networks who can be of the most assistance.
Dispute resolution guidelines Many RTPs are developing or have developed local documents outlining a dispute resolution process that can guide you if problems arise. Contributed by Dr Jen Lonergan
GPRAtip If you have an issue about your training, it’s best to try and resolve it by talking to the practice, your RTP or RLO. You can also contact GPRA directly at enquiries@gpra.org.au or telephone (03) 9629 8878.
My training provider is Bogong Regional Training Network. Registrar Rave My current post is at Mount Beauty and Falls Creek Medical Centres in Victoria’s high country. A typical workday for me involves a morning mountain bike ride in summer and autumn, and a ski in winter and spring. This is followed by ward rounds at a small acute-bed GP hospital, then clinic for the rest of the day. My favourite technical gizmo is the ski-doo. Who else can jump on a ski-doo to pick up the mail, do the odd home visit and mountain resuscitation? When I feel like quitting I remind myself how happy I am when compared to living in Melbourne. After hours I like to play with the kids, ride a bike and enjoy paradise. A quirky fact about me is that for an alpine doctor I am the world’s ugliest skier.
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MEDICAL
4
Preparing for practice
Things to do before your first GP term Starting your first GP term? Here’s a handy checklist of essential forms and resources you will need to organise in advance.
When do I start my term? GP terms are six months each when done full-time. They tend to run from mid-January to mid-July and then from mid-July to mid-January. You should be aware that GP term dates may differ from resident medical officer (RMO) hospital dates and between states.
What forms do I need? Your regional training provider (RTP) should help you with this list. In summary: Application for a Medicare provider number for the practice and, if applicable, the local hospital if a VMO position is attached. Allow at least eight weeks for this to be processed. Application for recognition as a general practitioner (AGPT) in an accredited training placement.
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indemnity — you must have your • Medical own indemnity to cover GP practice.
Indemnity for hospital work is a different scenario. It is a good idea to get indemnity as a GP registrar — procedural. This means you are covered for a wider scope of practice. If in doubt, speak to your own indemnity provider. Registration with the Australian Health Practitioner Regulation Agency (AHPRA), previously the state or territory medical boards. Employment contract and confirmation of employment agreement.
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Note: Your employment is a legally binding contract about your hours and pay. Refer to the National Minimum Terms and Conditions (NMTC) document for guidance, available from GPRA’s website (go to gpra.org.au, then ‘Advocacy’, then ‘National Minimum Terms and Conditions). For more information about negotiating your contract, see page 128 or download the e-book More than Mor e th Money: A negotiation guide for GP an M oney registrars published by GPRA at gpra.org.au/negotiation-guide 2011
Experienced registrars have put together this checklist of the paperwork, equipment and resources you will need to organise up to three months before starting your first general practice term. It is important to get organised early — especially the paperwork which can involve significant lead-time.
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What organisations should I join? All are optional, and this list is not exhaustive: General Practice Registrars Australia (GPRA) — Your national GP registrar representative group — free membership. Join at gpra.org.au Royal Australian College of General Practitioners (RACGP) — You must be a member prior to exam enrolment. Joining earlier as a registrar has additional member benefits, like a subscription to check magazine and free textbooks such as Murtagh’s General Practice or AMH. Go to racgp.org.au Australian College of Rural and Remote Medicine (ACRRM) — It is best to join prior to starting your first term in general practice. Go to acrrm.org.au Australian Medical Association (AMA) — Contact your state branch. Go to ama.com.au Your local Division of General Practice or Medicare Local — Find out who to contact from your practice or RTP. Rural Doctors Association of Australia (RDAA) — Go to rdaa.com.au
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Australian Indigenous Doctors’ Association • (AIDA) — A not-for-profit organisation that
encourages Aboriginal and Torres Strait Islander people to work in medicine by supporting Indigenous students and doctors. Go to aida.org.au
What equipment will I need? Equipment: Your own stethoscope. An auroscope/ophthalmoscope (diagnostics set). Some practices have reference books, posters and models in the rooms; otherwise start collecting your own. Consider a tympanic thermometer for kids and a magnifying glass or dermatoscope for skin checks.
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using equipment you are • Consider comfortable with; for example, your own
tendon hammer, neuro exam kit and small tape measure.
Remember, most practices will have this equipment available and you should feel free to use it, at least until you decide on your personal preferences. Doctor’s bag: A doctor’s bag is useful for home visits and nursing home visits, and may be convenient to have
•
at your practice as a back-up of emergency medicines and equipment that is readily accessible to you. Although each practice should ensure a doctor’s bag is available to you, it is good to have one of your own that is familiar and tailored to your needs. PBS-listed emergency medicines are available free for your doctor’s bag. Discuss with your practice manager or RTP. See the Australian Family Physician article ‘What’s in the Doctor’s Bag?’ at racgp.org.au and the Australian Prescriber article ‘Drugs for the Doctor’s Bag’ at australianprescriber.com The local Division of General Practice or Medicare Local may have contacts to purchase these locally.
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4 Preparing for practice
What books and resources will I need? These are all optional. Your practice may already have these or provide online access. You will soon find your favourites. Journals and publications, many of which are now available online: GP Companion. A handy reference of GP clinical information. Available to GPRA members as an e-book. Go to gpra.org.au, then ‘Resources’. Australian Family Physician (AFP). Available as part of your RACGP membership. MJA (Medical Journal of Australia). Australian Prescriber, RADAR. Produced by the National Prescribing Service Ltd and available at nps.org.au Medicine Today. A publication of the AMA. Medical Observer. A weekly publication with a helpful ‘Clinical Review’ section. Australian Doctor. A weekly publication with the excellent ‘How To Treat’ section.
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Guidelines for Stroke and TIA • Clinical Management: A quick guide for
general practice.
Kidney Disease Management in • Chronic General Practice. Australian Immunisation Handbook. • The Asthma Management Handbook (2006), • nationalasthma.org.au to Prevent Cervical Cancer: • Screening Guidelines for the management of asymptomatic women with screen detected abnormalities, nhmrc.gov.au Guide to Management of Hypertension (2008), updated 2010 — National Heart Foundation, heartfoundation.org.au Other guidelines are available at racgp.org.au/guidelines Therapeutic Guidelines series, print or electronic.
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Books General Practice, Patient Education and Patient Treatment — John Murtagh, print or CD. Your favourite dermatology atlas; for example Colour Atlas and Synopsis of Dermatology — Fitzpatrick et al. Reproductive and Sexual Health: An Australian clinical practice handbook — Family Planning NSW. Contraception: An Australian clinical practice handbook — Sexual Health and Family Planning Australia. An orthopaedic/fracture management book; for example Practical Fracture Treatment — McCrae and Esser.
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Guidelines Many of these are available at practices or free with college membership. Most are available online. Hard copies may be available from the local Division of General Practice or Medicare Local.
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• Guidelines for Preventive Activities in General • Practice (The Red Book) 7th edition and Putting Prevention into Practice (The Green Book) 2nd edition. Diabetes Management in General Practice 17th edition.
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Registrar rave Dr Elly Warren My training provider is GP Synergy.
Registrar Rave
My current post is at The Village Medical Practice in Sydney. I also drive to Bathurst once a fortnight to run the GP Indigenous health clinic I helped set up during my rural placement. A typical workday for me starts with being woken up by my two-year-old son calling from his bedroom: “Mama, play trains?” Then I rush to work and rush home again to be greeted with: “Hi Mama, play trains?” My favourite technical gizmo is Evernote because being part-time I’m always changing consulting rooms and it allows me to access my internet faves from anywhere, including my phone. A quirky fact about me is that my first job after school was as a hair transplant technician.
Medicines Handbook (AMH). • Australian MIMS — a supplier of quality, • independentleading medical information to
Australian health care professionals Paediatric Pharmacopeia. Clinical Sports Medicine — Brukner and Khan. Paediatric Handbook — from Royal Children’s Hospital or Westmead. Oxford handbooks (clinical medicine, specialties). Your favourite ophthalmology atlas.
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What about other web resources? A list of your favourite websites saved to your desktop can be an invaluable information resource. Suggested useful sites are listed on pages 146 –149. Contributed by Dr Christine Willis, Dr Siew-Lee Thoo, Dr Naomi Harris, Dr Kate Kelso and Dr Kirsten Patterson
GPRAtips If you have read this and still have questions, contact:
• Your RLO or ask your RTP enquiries@gpra.org.au or telephone • GPRA: (03) 9629 8878 • Your medical educator (see your RTP) • Your supervisor
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First day survival tips
Starting your first day at a new practice? Here’s a novice’s guide to making it through those first consultations with ease.
In your room:
resource books (see the resource lists • Put on page 69 for suggestions) in your room
all the cupboards in your room on • Open if available. entering to find where everything is. where all the prescription, pathology • Locate Therapeutic Guidelines, either print • Locate and radiology forms are kept in your room, copies or on the desktop of your computer. and recommended websites and check with reception staff where the • Addtouseful your favourites or bookmarks list on
extra or infrequently used referrals and forms are kept. Work out which way the paper faces in the computer printer. Work out how to use the phone. Put labels against internal numbers if not already done. Check if there is an emergency alert button, and how to use it and turn it off. Explore where common equipment is kept: - What type of sphygmomanometer, which way the BP cuff faces and where the large cuff is kept. - What type of thermometer, and where the otoscope with different sized specula for ears and noses is kept. - What type of specula and which sizes are kept, in addition to other Pap smear equipment. - Different types of swabs (M/C/S, PCR) and specimen jars.
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your browser. Play with software. Use a fake patient to manage a condition. Every practice will have one of these on their system for you to experiment on. Locate where information leaflets are on the toolbar (especially with Medical Director). Start collecting resources that will be useful during your consulting, such as guidelines for bowel screening and a flowchart for investigating breast lumps. Keep them in an accessible place (such as a folder or file) in your room.
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In the practice:
out the treatment room, especially • Check where dressings, vaccines and needles are kept. Does the practice nurse administer vaccines? Check how to fill up and use liquid nitrogen for cryotherapy.
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4 Preparing for practice
where the resuscitation kit and oxygen • Find are kept. Ensure you know what is in the kit
and how to use it. Also find out if you have access to oxygen saturation monitors and an ECG. Make friends with the practice staff — they can make your life much easier. Be friendly and polite, and make an effort to learn their names. Offer to make coffee and bring treats for morning tea from time to time. The practice manager is a key ally and can help smooth your way into your new environment — and they know lots about Medicare! If you have a practice nurse, get to know them well. They can be very helpful and a very valuable resource. Have a say in setting up your bookings.You will almost certainly need extra time until you find your feet, so book accordingly (ideally two patients per hour when you first start, moving to three or four when you feel comfortable). Let the practice staff know the common procedures you may routinely need extra time for (for example, Pap smears, psychological intervention and care plans, skin excisions).
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including who follows up your patients’ results after you leave the practice. Establish their preferred method of being contacted for questions during consultations (for example, phone, knock on the door, internal messaging system) and after hours. If you are doing after-hours cover, make sure that a senior has been designated to back you up and that you have their contact numbers. Ask for a list of local services from your supervisor: - Pathology/radiology - Allied health - Specialists - The capabilities and specialist coverage of the local hospital - Community or domiciliary nursing services - Local audiometrists and optometrists Talk about your teaching requirements. Make sure you have sufficient designated teaching time and discuss how you would like to use this.
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• Take a deep breath, count to 10 and then call your first patient in. •
With your supervisor:
the practice booking and • Check billing system. about the practice policy on checking • Ask and follow-up of results and patient recalls,
During consultations:
a deep breath, count to 10 and then • Take call your first patient in. with open-ended questions. • Start Try to get the full list of the patient’s • complaints and needs early in the consult.
Then you can prioritise and, if required, book a second appointment to cover the list in full. GPRA — The future of general practice
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Registrar rave Dr Michael Young
to do all the work for each consult • Try (investigation requests, prescriptions,
referrals and notes) during the consultation to avoid having to hang around after hours when everyone else has gone home and when you are more likely to forget the details. Have a system for keeping track of clinical questions that arise during consults (for example, notebook on your desk, manila folder with patient consult summary printed) to ask your supervisor or look up.
My training provider is Remote Vocational Training Scheme (RVTS). Registrar Rave
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My current post is Bowen Hospital in north Queensland.
A typical workday for me is eight hours, including ward rounds, emergency and general practice in the primary care clinic then sometimes on-call at night.
Contributed by Dr Emma Ryan and Dr Kate Kelso
What I love about general practice is every day is different. My GP role model is Dr Chris Homan because he has worked for years in solo remote practice and he maintains a healthy work-life balance. An ‘aha’ moment for me was when my daughter was born. I discovered a whole new side of life. After hours I like to go fishing and cruising around the Whitsunday Islands. A quirky fact about me is I often conduct after-hours consulting in shorts and bright red Croc sandals.
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GPRAtip Once you have survived your first day, enjoy your term! Ask lots of questions, look after yourself and leave work at work. Debrief with other registrars at block releases and teaching sessions. Have fun, and if you are not enjoying work talk to someone at your RTP about it early on in your term.
DISCOVER SOMETHING NEW
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The
GP mindset in hospital
As a GP registrar, there are ways to keep focused on general practice during your hospital terms. During 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.
Learn procedural skills that may be useful in general practice: joint aspirations and injections, excision of cysts and skin lesions.
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Choose your terms Choose terms that will give you experience with common GP-managed conditions. Mandatory and other useful rotations are listed on page 78. 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 the prevocational years, doing a Prevocational General Practice Placements Program (PGPPP) term is a great asset.
Fine-tune your practical skills Ask nurses to teach you skills, such as giving vaccinations (especially to children) and dressing
4 Preparing for practice
wounds. Ensure you can place common types of plaster casts with confidence.
up-to-date guidelines and approaches to chronic disease management.
Pick up useful procedural skills
Find out who’s who
Learn procedural skills that may be useful in general practice: joint aspirations and injections, excision of cysts and skin lesions.
Identify people who may be good information sources when you are working in the community; for example, hospital registrars, consultants, CNCs.
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?
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
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.
Network with your peers Most registrar liaison officers (RLOs) and regional training providers (RTPs) have email lists enabling registrars to communicate with their RLO or other registrars in their region. Make use of this and other opportunities, such as social or educational meetings to get to know other GP registrars. Contributed by Dr Kate Beardmore, Dr Kate Kelso and Dr Kirsten Patterson
GPRAtip
Do itnow
Take care with your record-keeping to ensure you have proof of all your relevant hospital experience and copies of all term assessments to make future recognition of prior learning (RPL) easier to achieve.
For more information about compulsory hospital rotations for general practice training, visit agpt.com.au, racgp.org.au and acrrm.org.au If you have any questions or problems during hospital training, contact your RLO or GPRA directly.
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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. Refer to the college fellowship overviews on pages 40– 44 (RACGP) and pages 46 – 48 (ACRRM), and the college websites. You should also discuss requirements with your RTP. If you have completed some of these as a prevocational doctor, you may qualify for recognition of prior learning (RPL) so you can either reduce your training time or substitute terms that develop existing or new skills. Your RTP can provide further information about how to apply for RPL, which you must apply for in the first year of training. RPL may be approved for all, or part, of the requirements of the post-intern hospital year of training in Australia.
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Dr Natalie Sancandi Seeing the hospital through the lens of general practice Dr Natalie Sancandi is a resident at St George Hospital in Sydney. As she busies herself with her daily duties she has an eye to her future career beyond the hospital doors. During her intern year she did a term with the Prevocational General Practice Placements Program (PGPPP) and was smitten with general practice. Natalie says there are a number of ways she views her hospital work through the lens of general practice, and has tips for others. “When people come to hospital, ask yourself whether their problem could have been better managed in the community,” she advised. “Ensure you recognise the types of cases that definitely need hospital management so you know when to refer early as a future GP. “You should also expose yourself to the various community support services available to patients upon discharge.” Having done hospital terms in emergency, cardiology and paediatrics, and two terms at Albury Hospital, Natalie looks forward to applying her skills in general practice soon.
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Goingbush So you are about to live and work in a town you have never heard of? A group of doctors share their tips on how to get the most from your sea change, tree change or outback adventure.
Hitting the wide open road for a rural term can be daunting, especially for city types in the general pathway. But it can also be one of the most rewarding times of your training. Here are some tips.
Where am I going to live?
housing options in the town with • Discuss the current GP registrar, your future GP
with the past and current GP • Discuss registrar, your future supervisor or
• • •
supervisor or practice staff as well as the RTP, RLO and medical educators. Surf the internet for websites of real estate agents in town. Browse the internet for websites of local newspapers for their classified advertisements. Consider shared accommodation with some locals — you will get an amazing insight into the town and its people. How much financial assistance will the RTP provide for relocation? Bring along some personal items like favourite cushions and pictures that will make your new residence feel like home. Enquire about internet coverage. People often forget when relocating to the rural or remote regions of Australia that there is not always broadband internet access (or access at all) and your digital mobile phone may not have a signal. If these things are important to you, do some homework before you sign up for a six or 12-month contract.
Do your research before your rural term starts. What is the town like?
practice staff. You may temporarily transfer from your regular regional training provider (RTP) to a rural RTP. Talk to the registrar liaison officer (RLO) and medical educators at your rural RTP. The RTP should mail out a registrar information pack to you. If relocating with your partner and children, ask about employment opportunities, local schools and child care facilities. Check out the rural RTP’s website and surf the internet for information about the town. Contact the local council for an information pack to be mailed to you.
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•
4 Preparing for practice
When you arrive for your rural term, get established in your community
•
Approach your town council to request information for new residents, such as local amenities. Visit the tourist information centre to request maps, information on coming events and surrounding towns. Ask your supervisor and practice staff for suggestions of things to see and do. Get to know your neighbours and people in your street.
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• •
companies, for socialising, networking, education — and the food! Do your grocery shopping in the local supermarket. By and large, the community understands your need for privacy outside of practice opening hours, so the fruit and veg section won’t feel like a quasi-consulting room and the community will respect you for shopping locally. If they ask you to sit on the dunking machine at the local festival, take it as a compliment. Remember, it’s only water. (This actually happened to Dr Naomi Harris!)
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Get involved in your community out of your comfort zone! • Get Try new experiences. what your community can • Experience offer in dining out, music, the arts and
outdoor recreation. Sign up as a member of groups in areas of interest to you, such as sports, hobbies and church.
•
Enjoy living in your community
the temptation of returning to your • Avoid hometown every weekend. your friends and relatives to visit you in • Ask your new town instead of you returning to
your hometown to visit them.
the local continuing professional • Attend development (CPD) and educational
dinners, usually sponsored by the local Division of General Practice or pharmaceutical Dr Will Thornton divides his time between urban and bush practices.
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Registrar rave Dr Mirza Baig My training provider is General Practice Training Tasmania (GPTT). Registrar Rave My current post is a GPT3 post at the Latrobe Family Medical Practice in Latrobe, the platypus capital of the world. I also work at the Tasmanian Skin and Body Centre. What I love about general practice is that I meet wonderful people — artists, ex-pilots, fishermen, salespeople and farmers. Ordinary people with extraordinary stories. After hours I try to relax with mates and be a good dad to my eight-year-old. He reads me bedtime stories. A quirky fact about me is that if I was not a GP, I would have been the cartoon character Hagar the Horrible. Friends tell me I look like him.
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Professional support
your GP supervisor or practice staff • Ask about the availability of local community
health services, allied health professionals, dentists and access to consultants. If you have to do hospital on-call work, the local hospital will probably provide you with an orientation. Notify your ME and RLO at your original RTP of any issues that may arise. Organise regular get-togethers with other GP registrars in the region — drinks, dinners and outdoor activities. Take turns to visit each other’s towns. Take the opportunity to debrief, encourage and support one another.
•
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• •
Contributed by Dr Winston Lo, Dr Naomi Harris and Dr Kirsten Patterson
GPRAtip Make the most of all that the town offers because your rural term will fly by before you know it. For basic information, request a registrar information pack from your rural RTP.
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Sydney GPCE 18 – 20 May 2012 Sydney Showground’s, Sydney Olympic Park
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To register Call 1800 358 879 or visit www.gpce.com.au
2011-2013
VMO
What every should know Before you start work as a hospital VMO, be sure to ask the right questions.
Working as a visiting medical officer (VMO) at the local hospital is an integral part of most rural practices for GPs. It can also be a fascinating and highly instructive part of your training as a GP registrar. Different hospitals have different arrangements in relation to how you are appointed, the time commitment required, what type of work the VMO does and what kind of patients they see. Financial arrangements can vary. You can be paid for salaried sessions or fee for service. You may need your own ABN and you may also need to
be registered for GST. Before you begin, there are many questions you will need to ask. Here is a checklist to get you started.
Job application and rostering
I apply to the hospital directly to be • Do a VMO? Is it part of a pre-existing practice
arrangement or am I ‘deputising/locuming’ for my supervisor? What are the hospital rostering requirements for the working week? Do I cover the emergency department? Who is on call for the patients at weekends and after hours? How much time is generally involved?
• •
Type of work
private or public patients have their • Can choice of doctor? do the other doctors at the practice • How usually manage their hospital work?
Billing and administration
work paid as salaried sessions • Isorthefeehospital for service? Do I need my own ABN or do I use the • practice ABN? I need an ABN registered for GST • Do (required for gross billings over $50,000
•
per annum)? What is the method for hospital billings?
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4 Preparing for practice
Registrar rave Dr Nick Harrington do I keep records of patients seen? • How are the relevant item numbers? • What Who submits accounts for hospital • billings — the the practice manager or me? percentage of hospital billings am • What I entitled to? Remember to: Sign a medical indemnity agreement with the hospital. Keep good records of patients seen. Keep good records in the patient notes.
• • •
Most importantly, enjoy your VMO work. It is one of the most interesting aspects of rural practice.
GPRAtip If you are unsure about any of the items on this checklist, talk to your supervisor.
My training provider is Western Australian General Practitice Registrar RaveEducation and Training (WAGPET). My current post is Meekatharra Base Hospital with the Royal Flying Doctor Service north west of Perth. A typical workday for me involves ward rounds in the morning including discharges and acute admissions. I do a morning outpatient session, then lunch, acute presentations and ED paperwork followed by an afternoon outpatient session, more acute presentations and ED, with on-call every second night. My GP role model is Dr Bruce Chater of Theodore in Queensland because he is an absolute master of all trades in rural general practice. He showed grace under fire during the Queensland floods and inspired me to have a go at rural medicine. A quirky fact about me is that I used to be an infantry soldier in the Army.
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Medicare maze
The
As a GP, it’s your job to master ‘the system’. Here is a brief overview with some hints to help you navigate the Medicare maze. Medicare is a federally funded health system that allows all Australians, and those eligible for a Medicare card, access to medical, pharmaceutical and hospital services. This is implemented via the Medicare Benefits Schedule (MBS), which is a list of medical services and the rebates allocated for each service. As general practitioners, we rely on the smooth operation of Medicare, because much of our income is derived directly from it. However, grappling with the system can be overwhelming when starting out. Here are some helpful hints.
who entered the profession before vocational registration for general practice was required, attract a lower Medicare payment. your practice manager — Your practice • Use manager is an incredible resource person
a course (online available) — There are • Do a couple of courses available to familiarise
yourself with Medicare before you venture into general practice. If you are working in a capital city or larger regional centre, you Get to know about billing systems — General practices may bulk-bill, privately may be able to do the Medicare Australia familiarisation course, which takes a few bill or have a mixture of both. When a patient is bulk billed, it means they are only hours (ask your RTP or practice manager for details). Alternatively, for those unable charged the Medicare rebate and do not to attend in rural centres, excellent pay any extra. When a patient is privately education modules are available online: billed, they will pay the ‘gap’ or sum above the amount of the Medicare rebate, as set by Medicare and You — for new health professionals; and MBS and You — MBS the practice. As a registrar enrolled in GP training through primary care items. Visit medicareaustralia. gov.au/provider/business/education/ a regional training provider (RTP), you e-learning.jsp attract the same Medicare payments as a fellow of one the general practice colleges Read The Rainbow Book general notes — (known as vocationally registered GPs). Find the Medicare Benefits Schedule Book Interestingly, non-vocationally registered GPs, (commonly known as The Rainbow Book) who are usually very experienced doctors in your surgery and read the general
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who can fill you in on your practice billing system and commonly used item numbers.
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4 Preparing for practice
explanatory notes or check out the online version at mbsonline.gov.au, which also has a useful search function for those tricky item numbers. The list of services and rebates is updated annually.
them again — Re-read the general • Read explanatory notes. how Medicare defines a consultation • Know — You must see the patient in person for the consultation to attract a Medicare benefit. The most straightforward items on the MBS are the basic professional attendance items. These are the items we use for many everyday consultations which are graded as level A, B, C or D. You need to know how these are defined (check The Rainbow Book). As these are the item codes you will use most frequently in day-to-day practice they need to be applied appropriately.
what services do not attract benefits • Know — These include telephone consultations,
mass immunisation, medical examinations for travel, employment, insurance or any compensable injury, and issuing scripts without the patient present. Some of these services will be billed privately, meaning the patient or insurer pays the full sum for the consultation. Doctors cannot charge Medicare for services to their own family.
a list of frequently used item numbers • Have — Create a shortlist of frequently used item numbers. Most practices will have one and many local Divisions of General Practice may also have one.
Know what services • attract benefits —
These include ECGs, spirometry, office urine pregnancy tests, Centrelink paperwork, suturing, removing foreign bodies and private car licence renewal. Removing skin lesions attracts Medicare rebates according to the size, location and histopathology. This means the histopathology must be back before the item can be billed.
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familiar with bulk-billing forms — • Get Familiarise yourself with Direct Bill forms
(DB2). You may have to complete them, especially when on call. You must fill out the correct details first, get the patient to sign a completed form then give them a copy, in that order.
notes as you go — You must keep • Take adequate and up-to-date notes that
accurately reflect your consultation in order to attract payments from Medicare.
details! Referrals to specialists must • Details, be written, signed, dated and include your
provider number. They generally last for 12 months unless otherwise specified.
you get audited, don’t panic! This is a • Ifsource-based audit program and is random.
You are not that special!
• Got that? Step up to the advanced level. It’s now time you graduated to the more meaty aspects of the ‘Professional Attendances — Category 1’ section of the Medicare schedule. This covers areas such as chronic disease management, mental health care and health assessments, with item numbers for: - regular reviews for patients with diabetes and asthma
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- service incentive payments — for vaccinating children and performing Pap smears on a percentage of all eligible patients - care plans and team care arrangement items, which aim to improve co-ordination of care and allow patients greater access to allied health services - mental health care items, which provide access to subsidised psychological intervention and allow you to bill for providing mental health care - assorted health checks for Aboriginal and Torres Strait Islander patients - health checks for those aged over 75 years. Getting your head around it all can be overwhelming when you are first starting out, but it will enable you to provide better access to health services for your patients, as well as ensure you are adequately recompensed for your work. Use The Rainbow Book, MBS Online, your medical educators and supervisor to guide you along the way.
New and useful item numbers As the MBS is reviewed annually, new item numbers are introduced and others discontinued on a regular basis. Medicare Australia notifies all practitioners so look out for updates.
4 Preparing for practice
Any questions? Proceed to the top of the list! As GPs, we are the personification of ‘the system’ for our patients, so it is our responsibility to understand and utilise it for the benefit of all.
Registrar rave Dr Nina Robertson
In time, many of us will be closely involved in the administration of general practices. Our opportunity to train is now, and the Medicare scheme is an integral part of learning in general practice.
My training provider is North Coast GP Training (NCGPT). Registrar Rave
Contributed by Dr Luke McLindon, Dr Naomi Harris and Dr Kate Kelso
A typical workday for me is getting up early to walk my dogs and get my kids ready for school. Then it’s a full day of general practice and home to get ready to do it all again.
GPRAtip
What I love about general practice is the privilege of being allowed into people’s lives. There is something interesting or unexpected about every patient and every consultation if you just scratch the surface.
Don’t forget, your supervisor and practice manager have had vast experience with Medicare billing, so use their knowledge. For more information, contact Medicare Australia on 13 20 11. Or you can find a wealth of information at medicareaustralia. com.au and MBS Online at mbsonline.gov.au
My current post is a GPT2 post in Goonellabah near Lismore.
An ‘aha’ moment for me was when I was up yet again at 3am suturing a perineum — that was when I committed to general practice. After hours I like to indulge in reading trashy novels.
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Let Erik the e-Rep
service your sample cupboard Visit http://www.aspenpharma.com.au and login with the Physician password ‘healthy’ to request samples.
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Prescribing pointers
Tips to make writing any prescription all in a day’s work.
Prescribing medications makes up a significant part of a general practitioner’s workload. Yet GP registrars often have limited exposure to prescribing outside the hospital system or may have worked in health systems very different to ours in Australia. It is essential to develop an understanding of how the Pharmaceutical Benefits Scheme (PBS) works and your responsibilities in complying with prescribing legislation. Following is a brief guide to the most important aspects.
Writing PBS scripts
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You may have been offered an opportunity to attend a PBS prescriber seminar when you first obtained your prescriber number before starting work in hospital, or you may have been provided a copy of the PBS prescription writing tutorial on DVD. If neither of these apply, you can access an excellent PBS online education tutorial from Medicare eLearning.
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- PBS and You — new health professionals Go to medicareaustralia.gov.au/provider/ business/education/e-learning.jsp read the explanatory notes • Alternatively, at the front of the hard copy of the Schedule
of Pharmaceutical Benefits (also known as The Yellow Book). The section for prescribers is only a few pages long. It is very helpful and will tell you most of what you need to know, including what information to put on the script. You can download this publication at pbs.gov.au/browse/publications
prescribing an item, check if there are • When any restrictions on indications for therapeutic
use. If you are using the pharmaceutical for a different indication, you should write a private script for the item.
quantities and repeats listed are • Maximum calculated to provide one month supply
per dispensed amount, and enough repeats for a six-month supply of the usual recommended dose. If less than the maximum is required by the patient then it may be sensible to prescribe less. If the patient requires more than the usual recommended
4 Preparing for practice
dose, and thus would not get a one-month supply per dispensing/six months per script, then you can seek an authority script for increased quantities.
no prescribing of S8 drugs to new patients at first appointment, or no prescribing of S8 drugs on weekends.
Private scripts
Authority scripts
Pharmaceutical items are included on the • PBS (subsidised by the government) on the
familiar with the indications for • Become authority medications you commonly prescribe. Have any information required ready when calling the authority prescription number (1800 888 333) to avoid delays.
can use authority scripts to prescribe • You increased quantities of PBS/RPBS medications
if you are using doses that are higher, or courses that are longer, than standard. Just be sure you are still using them appropriately and safely.
Prescribing S8 drugs of addiction circumstances apply to the • Special prescription of S8 drugs of addiction. You
need to comply with the PBS requirements (outlined in The Yellow Book or at pbs.gov.au and these will be requested when you call for authorisation), but you also need to comply with the legislation for the state where you are practising. Be sure to find out what these requirements are, and that you are complying with them.
practice policies they may have. For example,
basis of efficacy and cost-effectiveness. Therefore, there will be instances where you feel a product is clinically indicated, but your patient does not meet criteria for a PBS script. For example, reduced bone density but no fractures, but you feel a bisphosphonate is appropriate; or elevated cholesterol but outside the criteria for a statin. You should still recommend appropriate treatment for your patient but you may need to explain to them that they cannot access subsidised medication for this condition and will need to pay more for a private script if they go ahead with treatment. Many private health funds will give some reimbursement for these medications.
Prescribing for travellers
travelling overseas will need to • Patients have sufficient quantities of their medication
prescribed and dispensed for the length of their trip.
It is helpful to provide patients with a letter Talk with your supervisor or practice manager • • outlining the medications they will be taking, about prescribing these medications, and any
and most medical records software will have a template for this.
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There are special rules regarding taking • PBS-subsidised medication out of Australia.
They must only be for the personal use of the traveller or someone travelling with them, and quantities may be restricted. However, these restrictions do not apply to private (non-PBS) scripts. Patients should always ensure their medications are legal in the countries to which they are travelling.
you may need to endorse the traveller’s script with ‘Regulation 24’ to allow the pharmacist to dispense sufficient medication for their travels. You can find information on Regulation 24 in the explanatory notes of The Yellow Book or at pbs.org.au
Contributed by Dr Skye Boughen
GPRAtips For more information on prescribing and the PBS, go to: Yellow Book (especially ‘Section 1— • the Explanatory Notes’) — available online pbs.gov.au/browse/publications
Australia PBS education — Regulation 24 allows the original and repeat • Medicare • online tutorial or face-to-face sessions at supplies to be dispensed all at once, and
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medicareaustralia.gov.au
• your supervisor RTP and ask them to arrange a • your session on prescribing at a workshop,
or organise a personal session with your state PBS education coordinator
local pharmacist — they are • your generally extremely helpful.
5
Exploring
your options
faces
The many of general practice Meet some real-life GP registrars and come face to face with their inspiring stories in general practice. Exploring everything general practice has to offer is what your training years are all about. The following pages feature real-life stories of GP registrars and posts that illustrate the variety and diversity of general practice as a career. These stories may inspire you to try something a little different for your next training term or inspire you to take a particular road in your future career.
GPRAtip Most RTPs will do their best to arrange an experience you would like to try, even it is not one of their standard offerings. In some cases, it may involve a temporary transfer to another RTP — especially for a rural experience. But do get your request in early. It is very important to talk to your RTP well in advance of the placement for the best chance of making it happen.
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Travel while you train Travel
5 Exploring your options
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 undertaken some training. Overseas terms can involve many locations, including the United Kingdom, Ireland, USA, New Zealand, China, Malaysia and the Middle East (Australian Defence Force posts). Overseas terms are a fantastic opportunity to broaden your horizons while completing your general practice training.
included maternal and child health and the emergency co-ordination of the cholera epidemic. The medicine was pretty mind-blowing.”
Dr Kelly Seach Irish exchange program “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.”
However, you should be aware that it takes a lot of forward planning to organise an appropriate post and ensure it meets college requirements. You are therefore advised to talk to your RTP early if you are considering a training experience overseas.
Factfile
Dr Stratos Roussos
Your RTP will be able to give you information about ‘travel while you train’ opportunities they may be able to offer you.
Médecins sans Frontiéres (MSF), Southern Sudan “As part of my training, I spent eight months in Southern Sudan with MSF. The assignment
For further information regarding overseas training posts, visit the college websites racgp.org.au or acrrm.org.au
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Aboriginal and Torres Strait Islander health training
Closing the gap between the health of Aboriginal and Torres Strait Islander peoples and other non-Indigenous Australians is a national priority. GP registrars who choose to do a post in Aboriginal and Torres Strait Islander health usually find the experience rewarding, enriching and a source of valuable general practice skills.
What compulsory Aboriginal and Torres Strait Islander health training is there in the AGPT program? The curriculum statements on Aboriginal and Torres Strait Islander health of each of the two professional colleges (RACGP and ACRRM) require all GP registrars to complete educational activities related to Aboriginal and Torres Strait Islander health, such as block release activities on cultural awareness. These education activities are a mandatory component and must be done before completion of training is confirmed by your RTP. Clinical training at an Aboriginal and Torres Strait Islander health training post is optional.
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What optional training opportunities are there in Aboriginal and Torres Strait Islander health? You can undertake almost any term of your general practice training in an Aboriginal and Torres Strait Islander health training post. The posts are mostly in Aboriginal Community Controlled Health Services (ACCHSs) or state or territory government health services. ACCHSs are primary health care services initiated, planned and managed by local Aboriginal communities. In this setting, the doctor works as a member of a skilled and enthusiastic primary health care team, co-ordinated by a chief executive officer and managed by a locally elected board of directors. In some regions, shared training positions are available and offer a combination of part-time work in a mainstream general practice and a local ACCHS. General pathway registrars can choose to do a six-month Aboriginal and Torres Strait Islander health term as part of their training obligations beyond inner metropolitan general practice (see page 33 for details).
5 Exploring your options
How to find out about Aboriginal and Torres Strait Islander health training posts
Dr Margaret Neimann and friend, Cindy, who Margaret met while working in the Northern Territory
Why do an Aboriginal and Torres Strait Islander health post? Training in Aboriginal and Torres Strait Islander health ensures you gain excellent experience in cross-cultural communication skills, complex medicine, preventive health care, health promotion and population health. It’s a holistic approach to primary health care relevant to any cultural context. You also have a unique opportunity to make a difference while gaining a privileged personal insight into an ancient culture.
Cultural awareness training Before you start your post, you will typically attend a cultural awareness training course as part of a mandatory education activity to familiarise you with the broad cultural context of working with Aboriginal and Torres Strait Islander peoples. When undertaking clinical training at an Aboriginal and Torres Strait Islander health training post, a cultural mentor will usually familiarise you with the specific cultural context of the local people and community.
Most training providers have at least one accredited Aboriginal and Torres Strait Islander health training post. If you want experience in a different environment, you can apply through your RTP for a temporary transfer to another region. For a list of currently accredited Aboriginal and Torres Strait Islander health training posts in each region, visit agpt.com.au
The Closing the Gap strategy “Our challenge for the future is to embrace a new partnership between Indigenous and non-Indigenous Australians. The core of this partnership for the future is closing the gap between Indigenous and non-Indigenous Australians on life expectancy, educational achievement and employment opportunities. This new partnership on closing the gap will set concrete targets for the future: within a decade to halve the widening gap in literacy, numeracy and employment outcomes and opportunities for Indigenous children, within a decade to halve the appalling gap in infant mortality rates between Indigenous and non-Indigenous children and, within a generation, to close the equally appalling 17-year life gap between Indigenous and non-Indigenous when it comes to overall life expectancy.” Prime Minister Kevin Rudd, Apology to Australia’s Indigenous Peoples, 13 February 2008 The GPET response GPET is committed to the government’s Closing the Gap strategy in the training of GP registrars, and has set targets and key results areas in order to make a significant contribution. A range of initiatives are being developed to enhance registrar Aboriginal and Torres Strait Islander health training in the AGPT program. GPRA — The future of general practice
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General Practice Training in Indigenous Health Victoria
It is important It is challenging It is inspiring
Is it for YOU?
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 negotiating part-time or sessional arrangements whilst doing your GP training. • Experience complex medicine including chronic disease, preventive health care, health promotion and public health management. • Train under inspirational GP Supervisors, who are ACRRM and/or RACGP Fellows with years of experience and in depth knowledge of the clinical status and cultural aspects of the community. • Enjoy complete flexibility with 9-5 daily hours, leave for release sessions, conferences, study and personal life.
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
Aboriginal and Torres Strait Islander health
Community spirit Dr Stephanie Trust’s path to general practice has been a long and sometimes rough road. On returning to her Kimberley community as a GP registrar, she felt she had come full circle. When Dr Stephanie Trust first thought about being a doctor, she was 10 years old and living in a tent in Halls Creek. Her sister-in-law was an Aboriginal health worker and Stephanie would accompany her on the medication run through the town. “I really loved it,” Stephanie recalled. “I remember thinking that working in health was something I would like to do when I grew up.” Stephanie followed her childhood dream and became a nurse and then a health worker in Western Australia’s north.
“Nothing beats the feeling of graduation. It was wonderful to graduate, and more so because my mum, dad and Aunty Jane were at the graduation ceremony to see it.” 102
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Later, she set her sights on a new goal — to be a doctor. After years of study in Perth as a single mum, Stephanie recently returned to her Kimberley community as a GP registrar. “I am from the Kimberley region of Western Australia. My mother Biddy is a Gidja Jaru woman and my father Jack is a Walmajarri man. I am from a large family and have seven brothers and sisters and, like most Aboriginal families, I have a lot of cousins and uncles and aunties. I also have a son, Shannon, who is 19 now. I took a longer path than most to get into medicine. I went through primary school in
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Wyndham and Halls Creek, did Years 8–10 at Wyndham High School and then went to Perth to do Year 11 and 12 because we couldn’t do it in the Kimberley. When I finished school I went back home and trained as an enrolled nurse in the hospital system. I later converted it through additional training to qualifications as an Aboriginal health worker. I was quite happy being a health worker in the Kimberley and Pilbara, but was acutely aware of the shortage of doctors. I remember one day, about nine years ago, chatting with a friend who was also working as a child health worker, about an interest in medicine. Together we found out about pre-medicine at the University of Western Australia. We both went to medical school and both of us have since finished. In the early days I was staying on loungeroom floors trying to house-hunt so that Shannon and I had somewhere to live. There was the stress of not earning a wage, needing to apply for scholarships and finding housing. It wasn’t always easy, but I got there. Nothing beats the feeling of graduation. It was wonderful to graduate, and more so because my mum, dad and Aunty Jane were at the graduation ceremony to see it. I began working in a GP registrar position with the Ord Valley Aboriginal Health Service in
“As an Aboriginal doctor working in a community you have so much background knowledge.” Kununurra and I felt that I had come full circle — back to where I started. I always knew how important it was to have Aboriginal doctors, but it didn’t hit me until I got back home. As an Aboriginal doctor working in a community, you have so much background knowledge. Taking the time to learn about Aboriginal culture and history is important for students because it will make them better doctors.”
Factfile Aboriginal and Torres Strait Islander doctors and students in Australia GP registrars — 47 Medical practitioners — 153 Medical students — 218 Source: Australian Indigenous Doctors’ Association and GPRA For more information about Aboriginal and Torres Strait Islander health training for all registrars in the AGPT program, see pages 98 – 99.
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About academic training posts What is an academic training post? An academic post gives you the chance to try out research and teaching as a salaried registrar in the GP training program. In the RACGP curriculum it may be either a special skills post or an optional extra that extends your training time. Academic training posts are also available with ACRRM — policies are still being developed. What does an academic registrar actually do? It involves a mix of teaching, working on a research project, learning research skills and keeping up some clinical work. GPET also runs a series of webinars, an orientation workshop and a two-day workshop for academic registrars each year. What could this post lead on to? Lots of registrars end up taking on teaching roles at universities or positions as medical educators.
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How to apply Talk to your regional training provider (RTP) early. Do not wait until you have finished your training, as that will be too late. Posts begin in January and July each year. Applications are generally in March and September.
Factfile Visit agpt.com.au then follow the links to ‘Training Posts’ and ‘Academic Training’. Further information is available by contacting the current Registrar Research and Development Officer (RRADO), rrado@gpet.com.au. Your RTP can also advise you.
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Registrar Research Workshop 2012 Each year, GPET runs a Registrar Research Workshop. The workshop introduces registrars to research in the primary health care setting. It is held in conjunction with the Primary Health Care Research and Information Service’s (PHC RIS) annual research conference. The workshops are usually mid-year with applications a couple of months before. GPET pays for the travel and accommodation of successful applicants. For the latest on dates and venues, visit agpt.com.au then follow the links to ‘Training Posts’ and ‘Academic Training’ or let the Registrar Research and Development Officer (RRADO) know you are interested. There is a Registrar Research Fund to support research projects and a Registrar Research Prize.
office is required. To find out more, contact the current RRADO, rrado@gpet.com.au
Teaching opportunities: registrars as teachers You don’t need to do an academic term to get a taste of teaching. Teaching is now an important part of the RACGP curriculum, so even when you are doing a clinical placement you may be required to do some in-practice teaching as part of your training. Many RTPs offer training in teaching skills so registrars can feel more confident to perform this role. Most often, this could involve offering tutorials to visiting medical students, having the student sit in on your consultations or watching them do consultations.
What is the RRADO?
Other registrars choose to work directly for a university, running tutorial groups or case-based learning groups.
The Registrar Research and Development Officer (RRADO) is employed by GPET to promote training in research and academic general practice. The RRADO is a point of contact for registrars interested in research and academic training posts.
Some RTPs also have employed positions for registrar medical educators or junior medical educators, which means teaching other registrars (see also page 37). This work can often count towards training, but it is important to speak to your RTP before you start.
The position is also an attractive part-time 12-month post for registrars. It may be accredited as an AGPT special or extended skills post if appropriate. Regular travel to the GPET Canberra
There is an old adage that teaching someone else is one of the best ways to make sure you really understand a subject yourself. Most registrars who teach would agree.
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Academic posts
A passion for research When Dr Jo-Anne Manski-Nankervis worked in a laboratory, she had a personal eureka moment. She discovered that she wanted to work with people, not test tubes.
Dr Jo-Anne Manski-Nankervis began her path to academic general practice by a somewhat circuitous route, starting her university studies with a degree in science.
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“I have been lucky to have some fantastic mentors who have really opened my eyes about how to shape myself into the academic and doctor I want to be.” 106
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But the solitary nature of lab work set her on a new course. “After 12 months in the lab sequencing a malaria gene for my honours year I decided that I wanted to pursue my interest in science, but I wanted to work with people, not in a lab,” she said.
Jo-Anne took a career right turn and was accepted into medicine at the University of Melbourne. Today she works there as an academic registrar with a special interest in diabetes research. She is also a clinical GP registrar at a community practice. It’s proving the perfect balance — with lots of people contact. “When I started general practice training, I was really only aware of the clinical work. I had no idea of the opportunities that would be open to me in medical education, academic work and being on boards and reference groups. I have been lucky to have some fantastic mentors who have really opened my eyes about how to shape myself into the academic and doctor I want to be. Even though I enjoy clinical work, I wanted to
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“Even though I enjoy clinical work, I wanted to be able to pursue my special interest in diabetes further by doing some research.” be able to pursue my special interest in diabetes further by doing some research. I wanted some variety because at times, full-time clinical work can be quite draining, and it gave me the opportunity to teach.
positive impact on the participants — starting insulin and gaining better control of their diabetes. Organising this project involved meeting with the university and submitting a research proposal to GPET. This required a substantial investment of time before I even knew I was awarded a post, but it meant I could hit the ground running. Prior to my second academic post, I applied for, and was fortunate to receive, a GPET Registrar Research Fund Grant of $10,000. I currently have many roles. I sit on various boards and committees, I tutor medical students, I write regularly on diabetes for Australian Doctor and I’m doing further diabetes research for a master of philosophy degree, which should increase my body of published work.”
Jo-Anne’s academic term tips
I am also married with two young children and academic work gives me some flexibility.
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My first academic post involved being a team member in the chronic diseases group at the University of Melbourne’s Department of General Practice.
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I was involved in implementing a research project on insulin initiation in general practice to the community health centre where I worked, collecting this data, and then merging it with data from other centres. I also organised training sessions, and there was the clinical side as well. The thing I really loved was that I was in a team, I had great support, I learnt a lot about clinical work and research, and the project had a
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Choose well — Choose an area you are passionate about. Be aware of time — Have a project you can realistically complete in 12 months. Find the right supervisor — Seek out someone with whom you can have a good working relationship. Maximise your opportunities — Attend confer ences, develop your public speaking skills, take on extra activities, such as curriculum development. Road-test a future career — See if the academic life is the right fit for you.
For more information about doing an academic term, see pages 104 –105. GPRA — The future of general practice
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Business
Owning it
Recently fellowed GP Dr Abhi Varshney has never been happier going to work. The fact that he owns the practice has a lot to do with it.
Setting up your own practice as a newly fellowed GP would be considered a bold move by some. But Dr Abhi Varshney describes it as “one of the best decisions we have made”. Abhi took on the venture with his wife Rachel, who works as practice manager. He set up shop in the Brisbane inner-city precinct of Bowen Hills at the end of 2010. As a start-up practice there was a frenzy of activity before the doors could open — everything from finding and fitting out the premises to hiring staff and setting up systems. “It was daunting but exciting,” Abhi said. “The best thing is that we can run the practice the way we believe is best for our patients,” he added. “When we decided to set up our own practice, I was fortunate to get advice from a former supervisor who had set up a practice himself, and that was invaluable. Finding the right premises was the hardest part. Once Rachel and I found the space on the ground floor of an office building, we knocked out the interior and completely refitted it to make it a functional space for us. We hired architects with special expertise in GP clinics. It was a big expense, but worth it.
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The architects did a remarkably good job in the use of space. All the doorways are accessible for people with mobility impairments. You can get your arms under the taps in the sinks to wash them properly. We designed our own beds and had them specially built for us. There’s lots of natural light. The big advantage of owning your own practice is being able to do things your way. You can set up systems to support that from the beginning.
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The whole idea of our practice is that we want to run it the way we would want to be treated if we were patients. We have more modern surroundings than many traditional general practices. We try to book longer appointments so we can spend more time with patients. And by booking extra vacant spots we try and make sure we can see patients on the same day. I work with another GP, Dr Kate Bonehill, and the practice also employs a receptionist and nurse. We plan to take on more doctors as the clinic gets busier. The Bowen Hills Medical Centre is located in a rapidly changing part of Brisbane. It’s mainly offices now but there are a lot of new apartments going up. Most of our patients are young adults who work nearby and they seem to appreciate our focus on preventive health. On the financial side, some people say that GP practice owners can potentially earn a higher income than GP employees or contractors. But there is a lot of initial investment to set up the practice and service borrowings, and there are extra hours you have to put in for administration. Not everything is about money. As long as we are making roughly what we would make at another practice, that’s fine. I just know that from a job satisfaction point of view, we’ve never been happier going to work.”
“I was fortunate to get advice from a former supervisor who had set up a practice himself, and that was invaluable.” Abhi’s tips on setting up your own practice •
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Get advice from a mentor — See if you can find a GP colleague who has set up their own practice and is willing to share their experience. Do your research — What are the demographics of the area? Does the area need another general practice? Find the right premises — Consider exposure and accessibility to main roads, parking for staff and patients, suitability for fitout as a GP clinic and room for expansion. Be prepared to spend money on the fitout — Ask around about architects and shopfitters with experience in GP practices. Set up the right systems — You call the shots, so set up your systems to support your ideal practice.
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Rural-remote
The medical all-rounder North Queensland registrar Dr Chris Buck is called on to play many roles — emergency physician, anaesthetist, intensive care doctor, gym instructor and, once, a giant turtle!
Dr Chris Buck considers his decision to do rural-remote medicine as a “fortunate accident”. “I did the PGPPP as an intern in a small town called Oakey near Toowoomba,” he said. “This opened up a whole world I had never even considered as a career choice. All of a sudden, I realised that the country doctor was highly respected and the opportunities and people you meet certainly outweigh any isolation issues.”
“As a rural-remote GP registrar you have many life and death situations — and this is what I love the most.” Chris is now in his final year of training towards his ACRRM Fellowship as a rural generalist with Tropical Medical Training, based in the Atherton Tablelands area of north Queensland. “I currently live in Atherton and work as a proceduralist in a group of small rural hospitals and also see private patients in a community general practice. 110
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During my internship and postgraduate training, I stumbled across the rural generalist pathway. At the same time, I discovered a passion for anaesthetics and intensive care. The term rural generalist means different things to different people. Ultimately it is the highly skilled general practitioner who manages patients in locations that are lacking in specialist services. My current post involves care in its entirety — the whole cradle-to-grave medical care model. I could be delivering babies one minute and managing a roadside arrest with a paramedic team the next. My day always starts with great coffee. The Tablelands area is renowned for some of Australia’s best coffee plantations. Then I travel to either the hospital or GP practice and consult any appointments. This may be an anaesthetic list for a visiting surgeon, an antenatal clinic, coverage of an emergency department, minor surgical procedures — anything really! My best day in general practice was when I was able to manage a critically ill mother in ICU, have her baby delivered, resuscitate her, then put them both on the path to a healthy discharge.
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operational staff in emergency situations strengthens us as a team. Of course there is a lighter side to the job. I will never forget rocking up to work in Mount Isa and being told that I had to dress up as the mascot for a public health campaign — a highly trained professional in a giant turtle suit! Out of hours I am a certified Les Mills personal trainer and I teach fitness classes. I make sure that there are no late appointments that will stop me getting to the gym.
“I will never forget rocking up to work in Mount Isa and being told that I had to dress up as the mascot for a public health campaign — a highly trained professional in a giant turtle suit!” The ecstatic joy we felt as a team after that was overwhelming. As a rural-remote GP registrar you have many life and death situations — and this is what I love the most. While not always good outcomes, the bonding experienced with nursing and
I am now about to embark on a new chapter in my career, bringing together primary and critical care by doing some aeromedical retrieval and outreach clinics with the Royal Flying Doctor Service in Western Australia. This is kind of exciting because I love flying.”
Factfile Rural-remote training is offered by RTPs in rural-remote areas. A rural-remote term is also an enriching experience for urban registrars, often with more opportunities to broaden skills and gain confidence. General pathway registrars can temporarily transfer to a rural-remote RTP for a term. For rural, remote and procedural health post opportunities, talk to your RTP.
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Sub-specialise
Special interest General practice is the most flexible of medical careers — you can shape it to suit your own interests. At any one time there are numerous GP registrars in special skills, extended skills and elective posts pursuing their interests. The GP training program offers all GP registrars an opportunity to pursue a sub-specialty of their choice. In general practice, you can follow your passions and virtually design your own career. These are just some of the directions you may wish to explore with your RTP.
care • palliative refugee health • Royal Flying Doctor Service • rural and remote medicine • sports medicine • surgery • travel medicine • tropical medicine • women’s health •… plus many more!
health • Aboriginal academic medicine and research • alpine sports medicine Refugee health • anaesthetics • Australian Defence Force + academic • aviation medicine Dr Rebecca Farley • cosmetic medicine RTP: Central and Southern • dermatology Queensland Training • drug and alcohol Consortium (CSQTC) • emergency Location: Brisbane, QLD • expedition medicine • family planning and sexual health “I w ork in a gene • forensic medicine pract ral ice th • geriatrics at ha large s a refug popul ee pat • HIV medicine ation natur ie nt b ecaus e and In ad e of it • men’s health geogr dition specia a s phic to th lised locat is, I • mental health refug ion. Healt w o e r e k h Qu healt in a • musculoskeletal medicine eensl h clin Queen and, a ic, Re s n l a d fugee n at th d, wh • obstetrics teach e Univ ere I ing an e h r sity o ave be • occupational medicine d res healt en inv f earch h car olved focu e.” • paediatrics in sed o n ref ugee • 112
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Alpine sports medicine Dr Dominic Blanks RTP: Bogong Regional Training Network Location: Mount Beauty and Falls Creek, VIC
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“My current po st is at Mount Beauty and Falls Medical Centres Creek and a small GPrun hospital. In alpine sports medicine you de al with different traumatic injur ies —wrists an d an kles for snowboarders, knees and shou ld ers for skiers. We triage the pa tients, take and process the X-rays, reduce their fractures, sew them up an then do it all ag d ain the next day. You have to be resourceful an d adaptive becaus e in an emergenc suddenly be very y it can remote with lim ited transport the Australian out. I love living Alps and having in my kids grow up and riding mount there — skiing in ain bikes in sum w int er mer.”
Procedural + RFDS Dr Samuel Goodwin RTP: Northern Territory General Practice Education (NTGPE) Location: Alice Springs, NT — delivering everything at d o go are to l doctors patients in “Many rura , admitting s ic et th s g eein g anae ents and s babies, doin h car accid it w g advanced in al an ell. I did hospital, de w as s c days a their clini orking two w w patients in no ’m . I DS aesthetics ith the RF skills in an elp out w h I d an ience.” spital e my exper week in ho c an h en ly ed to real when need
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Urban
Prized position Dr Anne Khouri, winner of the RACGP’s Edward Gawthorn Award, loves her job in a diverse urban practice near Mount Lawley’s bohemian cafe strip.
“At Lindisfarne, there is a great diversity of socio-economic backgrounds in the patients.”
It started out as just another day at the office when Dr Anne Khouri received an unexpected phone call. “The college rang me at work and I actually thought they had made a mistake,” she recalled. “Then I rang my family and burst into tears.” Not only had she passed her fellowship exams, she was the winner of the RACGP’s Edward Gawthorn Award. Her prize recognised a Western Australian candidate who passed all three examinations on first attempt and achieved the highest OSCE score. Anne modestly puts it down to regular sessions with her small study group — and “luck on the day”. Having finished her fellowship, Anne also considers she got lucky with a job she loves at an urban practice in the inner Perth suburb of Mount Lawley. “My father is an obstetrician-gynaecologist and my mother is a midwife. My parents worked in the Middle East for 30 years where I was born. We grew up on a medical compound surrounded by other medical families. Medicine was something I had always known so I decided to pursue it. I was on the emergency training program when I realised that I hated night shifts, major trauma
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“I enjoy the variety, the element of surprise, the need to think on my feet…” and not knowing what happened to my patients once they left the ED. I decided then that general practice was a better option for me, and I trained with WAGPET in the general pathway. Lindisfarne Medical Centre, a large, non-corporate GP practice in Mount Lawley, was a registrar placement that I liked so when I was offered a permanent position I jumped at it. I also work at the Sexual Assault Resource Centre (SARC) at King Edward Hospital. At Lindisfarne, there is a great diversity of socio-economic backgrounds. It covers the affluent Mount Lawley crowd, lots of immigrants and ethnic groups, people from social housing, hostels and refuges, adolescents from the nearby private girls’ college and high school, and a large number of homosexual men and women. I enjoy the variety, the element of surprise, the need to think on my feet, the relationships I develop with people and their families, and the friendships I have with the other doctors, nurse and receptionists at the practice. My interests are mental health, minor procedures, adolescent medicine and cosmetic dermatology. During my general practice training, I completed a Diploma of Child Health and my level one Certificate in Aesthetic Medicine from the American Academy of Aesthetic Medicine.
When I won the Edward Gawthorn Award I was absolutely elated. It was the best day of my life. I think the only thing that will beat it will be my wedding early this year. My fiance is a surgical registrar and when he gets his private rooms I hope to be able to do some non-surgical facial rejuvenation as part of his practice.”
Anne’s exam tips •
Get a study group together — Think small — a maximum of four. Make sure they are people you get on with as you will spend a lot of time together and go through a lot of stress and emotion. Meet weekly.
• Start early — Start studying a year before the exam.
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Break it up — Split the material that
needs covering into 11-month chunks and then divide up the work between members of the group week by week.
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Mock it up — Allocate time to do exam questions and to practise OSCEs together.
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A month to go... Use the last month before the exam to do revision and practise questions. Try not to be learning new material at this point.
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Read Murtagh, then read it again — A good tip I received when I was a registrar was that if you read Murtagh cover to cover at least twice, you would pass the exam. For more exam tips, see pages 118 –119.
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Examsand assessments
Top for tips exams Being well prepared can help you pass your FRACGP exams or FACRRM assessments with the least possible stress. Passing your fellowship exams is the final hurdle to achieving your fellowship and gaining vocational registration. The RACGP’s examination consists of three segments. There are two online written segments, the Applied Knowledge Test (AKT) and Key Feature Problems (KFP), and one clinical segment, the Objective Structured Clinical Examination (OSCE). With the FACRRM, there is a different assessment model across the duration of the training program consisting of a variety of assessments and exams.
Whichever fellowship you are working towards, you will benefit from the following tips compiled by registrars who have sat — and passed — their exams. when to sit the exam — The RACGP • Plan exams run twice a year. You can sit each
segment of the exam (AKT, KFP and OSCE) individually and at your own pace. However, you need to sit and pass the AKT before you can continue to other assessments. Check page 122 for more details and page 121 for exam dates and call the RACGP or visit racgp.org.au for an enrolment pack. Your supervisor or medical educator can advise you if they think you are ready, or if you may be best to wait another six months before you sit the exam.
With ACRRM, various assessment components are held at different times throughout the year. Eligible candidates will need to apply prior to the enrolment closing dates for each exam. See page 121 for a timetable. Candidates must complete an enrolment form for each assessment type and return it by the required cut-off date. Each component can only be attempted a set number of times so it is important to feel ready to attempt each assessment. For further information, visit acrrm.org.au
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you are eligible — To enrol for the • Distance needn’t be a problem — Face-to- • Ensure RACGP exams, you need a letter from your face study groups are ideal, but not always
RTP stating you have completed your GPT1 and GPT2. You need evidence that you have completed your basic CPR accreditation within 36 months of the opening of the enrolment period and you must also have current medical registration. Finally, you must be a financial member of the RACGP (allow two weeks for this to be processed).
ACRRM has its own set of requirements for the different assessment components. For more information, talk to your RTP or visit acrrm.org.au to your practice — If you want to • Talk arrange time off before an exam or reduce
your on-call for a while, then do it early. Try not to be covering for a principal on leave over the exam period. However, remember that seeing patients can be one of the best ways to practise for your exams.
a study group — Study groups are • Form great for keeping you motivated, pooling
resources and sharing strengths. Identify your learning styles and work with them. Will you read topics together out loud, or go through multiple choice questions (MCQs) together and discuss the answers? Working through past papers is highly recommended. (For more on study groups, see Dr Anne Khouri’s tips on page 115.)
possible. Be creative. Email resources to each other, consider an online discussion, teleconference to go through questions, hold a Skype video conference or video yourself doing a timed OSCE case on a family member and send it to your study buddy for feedback.
a study plan — Identify your strengths • Make and weaknesses, making sure you cover
the curriculum. Set a study timeline so that you don’t spend months on women’s health and only 10 minutes on respiratory problems. Set aside time to fit in with your life. Candidates with family responsibilities may need a longer lead-time.
for the RACGP examination — • Resources For the RACGP exams, Murtagh and The Red Book are your friends, as is Therapeutic Guidelines. You should be familiar with the immunisation schedule and cancer screening recommendations (The Red Book). The check program has questions that are similar to the RACGP’s KFPs. Australian Family Physician (AFP) and Medicine Today have MCQs and brainteaser questions with pictures. gplearning has lots of MCQs, KFPs and a timed practice exam. Australian Doctor’s ‘How To Treat’ summaries are evidence-based and succinct. Websites are useful (see pages 146 – 149 of this guide as a
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starting point) for up-to-date guidelines. Your practice or RTP may have the last few years of the monthly check program Australian Family Physician, or you can order them from the RACGP Library (free postage). Get good at ECGs (Hampton, 150 ECG Problems). Practise picture recognition — dermatology, ophthalmology, CXRs. For the OSCE, the marking structure and case proformas can be downloaded from the RACGP website so you can make up your own cases. In addition, GPRA’s Online Exam Resources (OER) website at oer.org.au has clinical cases for your study group.
clinical cases — Practise these to • Practise the correct times, with bells or alarms.
Make up cases for each other from your own patients. Give each other feedback on those skills you can’t learn from a book — communication, use of non-medical language, analysis of articles. Practise cases that you are not so good at — it’s better to be embarrassed in front of friends than the assessors on the day. And don’t forget your practical skills, like suturing, asthma puffers and CPR.
Attend a pre-exam workshop — These are • run by the RACGP in all states and by some RTPs. They will help you become familiar with the structure of the exam and what examiners are looking for. For dates, visit racgp.org.au
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Read information, questions and answers • carefully — You can get more questions wrong by misreading than by not knowing the answer. Don’t spend ages on a question you can’t answer; make a best guess and come back to it later if you have time. In the RACGP’s OSCE, make sure you complete the requested task. If they ask for a management plan, don’t spend seven minutes taking the history. Read all the information given to you — the answer might be on the bottom of the full blood count you requested. If you feel like you messed up a station then take a deep breath and move on — the next one is likely to get better. Agonising over it in your reading time for the next question just makes the next question harder. Tips for the ACRRM assessments and • exams — For the ACRRM assessments,
ensure you are totally familiar with the primary curriculum and fully understand the learning outcomes of each domain. Understand how the assessment blueprint links with each assessment component. Review the assessment information available at acrrm.org.au and make use of practice exams, sample questions, feedback you receive from the formative components of the assessment, and advice and resources from your supervisor and RTP. Remember all questions take into account the rural context and the implications this may have for the resources you are able to access for the management of your patient.
6 Exams and assessments
to enjoy the learning process — • Try The things you learn while studying should
be helping you to become a better doctor and feel more comfortable and competent treating people. Generally, your exams will
be very focused on things that you will come across in general practice, so use the things that worried you in your practice today to help you study tonight.
Contributed by Dr Anna Colwell and updated by Dr Kirsten Patterson
RACGP exam and assessment information Exam
Enrolments open
Enrolements close
Assessment date
Cost
AKT
19 September 2011
11 November 2011
25 February 2012
$1,620
AKT
15 March 2012
TBC
4 August 2012
$1,620
KFP
19 September 2011
11 November 2011
25 February 2012
$1,620
KFP
15 March 2012
TBC
4 August 2012
$1,620
OSCE
19 September 2011
11 November 2011
12 May 2012
$3,220
OSCE
15 March 2012
TBC
21 October 2012
$3,220
Visit racgp.org.au for further details about the RACGP assessment system. Acrrm exam and assessment information Exam
Enrolements close
Assessment date
Cost
MSF
Can enrol any time
At the registrar’s choosing
TBA
miniCEX
13 January 2012
February to July 2012
$1,700
miniCEX
8 July 2012
August to December 2012
$1,700
MCQ
5 December 2011
10 March 2012
$1,000
MCQ
6 July 2012
8 September 2012
$1,000
StAMPS
3 February 2012
19 and 20 May 2012
$1,800
StAMPS
17 August 2012
1 and 2 December 2012
$1,800
Advanced Specialised Training (Emergency Medicine)
3 August 2012
10 and 11 November 2012 (face to face)
$1,800
Visit acrrm.org.au for further details about the ACRRM assessment system.
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Dr Charles Ellis
on the RACGP’s new computer exams
computer features allow you to easily • Good mark questions to come back to later. It is easier to pace yourself due to the • ‘time elapsed’ and ‘time remaining’ features.
will no longer mark you down • Examiners because of illegibility.
•
Since the second Most people can type faster than they round of RACGP can write. examinations in 2011, The format is easier to mark so you the Applied Knowledge Ellis s e rl a h tend to get your results faster. Test (AKT) and Key Dr C Feature Problems (KFP) exams have made the Understand the disadvantages switch from paper-based to computer- based. You cannot cross out answers to multiple- The RACGP says the new technology is more choice questions (AKT) when trying to modern, reliable and user-friendly, making the deduce an uncertain answer. exam process smoother for both candidates You cannot scribble notes in the margin. and examiners.
•
•
But what do registrars say? Dr Charles Ellis, a registrar with GP Synergy, was one of the first to sit the exams online. Here is Charles’ personal take on the new format.
• • You cannot draw pictures or diagrams. may be disadvantaged if you are a slow • You or inaccurate typist.
Get familiar with the format
are vulnerable to technical failure but • You this is mitigated by the exam venue having
Before getting to the exam room, have a look at the very useful online tutorial at youtube.com/watch?v=oT03vEaEDBw
Understand the advantages
To sum up…
•
No risk of accidentally being ‘out of synch’ on your multiple-choice question (AKT) answer sheet and getting a whole bank of questions wrong because you are marking answers one question ahead or behind.
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a back-up power generator (separate to the mains), two internet connections and back- up hard drive.
Don’t focus on the fact that you are doing the exam on a computer. Do prepare as you would for any other significant assessment, confident that the new online format has been very well received by candidates.
6 Exams and assessments
GPRA’s free OSCE preparation webinars Want to know what really happens in the OSCE? Want to hear from your peers who have sat the exam — and passed? Want to ask questions about the OSCE and get some answers? This webinar presents the personal experiences of two registrars who have recently sat and passed the OSCE. If you have an internet connection and are a GPRA member, you can join in. For more information about GPRA’s OSCE webinars and how you can be involved, check for updates at gpra.org.au/exam-preparation-webinars GPRA’s online exam resources (OER) GPRA’s online exam resources (OER) consists of clinical cases perfect for your study group plus other exam tips — free to all members of GPRA. Download cases from gpra.org.au
Do itnow For details of how to enrol for exams and assessments, dates and pre-exam workshops, visit racgp.org.au and acrrm.org.au You will also find sample questions for ACRRM assessments on acrrm.org.au The programs continue to evolve, so for the latest information be sure to check the websites. You will find a summary of exam and assessment dates on page 121.
Registrar rave Dr Rebecca Farley My training provider is Central and Southern Queensland RegistrarTraining Rave Consortium CSQTC). My current post is an extended academic training post with the University of Queensland. A typical workday for me varies. I work two days a week in general practice, one in refugee health and two teaching and researching at the university. I love the way the different roles complement and enrich each other. What I love about general practice is really getting to know my patients and how best to work with them. After hours I like to do so many things, mostly spend time with friends and family. A quirky fact about me is that I love languages, but am terrible at learning them. I spent weeks in Timor-Leste asking grown men how their breastfeeding was going, while thinking I was asking about their appetite.
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7
Money matters
National
(NMTC)
Minimum Terms and Conditions One of GPRA’s main roles is to negotiate minimum pay rates and conditions for GP registrars. How much will you earn as you make the transition from the hospital system through to your GP terms and beyond? There are frameworks to ensure you are paid and treated fairly as a practice employee while you train.
What is the National Minimum Terms and Conditions document? The National Minimum Terms and Conditions (NMTC) is a document negotiated on behalf of registrars by General Practice Registrars Australia (GPRA) with the National GP Supervisors’ Association (NGPSA). It is not an award or contract in itself but a goodwill document that sets out the pay and conditions registrars should expect — as a minimum. You are free to negotiate and accept better pay and conditions.
The NMTC applies to GPT1 and GPT2 registrars but it is also a valuable reference document for GPT3 and beyond. It is reviewed in its entirety every two years, and pay rates are reviewed in line with the Consumer Price Index (CPI) every year.
How much are GP registrars paid? Under the NMTC, a registrar is paid in one of two ways — the minimum base salary or a percentage of billings, whichever is greater.
What is the minimum salary for GPT1 and GPT2 registrars? The minimum annual salary for a full-time registrar is shown in the following table. Or it can be calculated based on 45 per cent (or higher) of billings plus nine per cent superannuation.
Minimum salary for GPT1 and GPT2 Registrars 2012 Annual salary
Weekly salary
Superannuation
GPT1 or equivalent
$71,400
$1,369
Plus 9% superannuation
GPT2 or equivalent
$85,845
$1,646
Plus 9% superannuation
Note: These are minimum rates only and higher rates can be negotiated. The pay scale is reviewed annually.
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7 Money matters
For GPT1 and GPT2, most practices will pay the minimum salary set down by the NMTC, at least to begin with. When the registrar gains experience and sees more patients, they will usually move to a percentage of billings which should increase their income.
Payment by billings for GPT1 and GPT2 Higher incomes become possible when 45 per cent of a registrar’s billings for the practice exceed the NMTC minimum wage. Typically, the transition point comes when you are seeing an average of three patients per hour doing eight or more sessions a week. However, other factors, such as whether the practice bulk-bills or charges higher private patient rates, are also important. A higher percentage of billings rate also makes a substantial difference to income. Forty five per cent of billings plus nine per cent superannuation is the minimum rate for GPT1 and GPT2 according to the NMTC, but some registrars are on 50 per cent of billings or more. This may be negotiable, and having more experience or special skills are good reasons to negotiate for a higher rate.
GPT3 and beyond payment basis Registrars at GPT3 and beyond who work in a private practice are usually able to negotiate market rates and are typically paid a percentage of their billings. This would normally be better than the GPT2 minimum rate.
Know your value While private GP clinics provide a community service, they are also businesses so there is scope to negotiate the terms and conditions of your employment based on the value you bring to the practice. Once you have settled in, it’s worth increasing your awareness about how a practice runs as a business and your contribution to it. If the practice is agreeable, request a fortnightly or monthly statement of the income you generate
What can you earn? Calculate your income online! If you would like a rough estimate of what your income based on billings may be, GPRA’s online calculator is a useful tool at gpra.org.au/earningscalculator. GPRA — The future of general practice
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from all sources: standard patients seen in the rooms, medical and insurance reports, hospital patients, on-call and nursing home. It is important to get an idea of how much income you generate and where it comes from to know your value.
Download Go online for the National Minimum Terms and Conditions at gpra.org.au
2011
GPRA has developed a 50-page publication about how to negotiate a win-win contract called More than Money: A negotiation guide for GP registrars. You can Mor e th download it by visiting an M oney gpra.org.au/negotiation-guide AN
EGO TIAT
ION
GUID
E FO
Secu re y our winwin cont ract
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RG
P REG
ISTR
ARS
Why you need a written employment contract GPRA recommends that registrars have a written employment contract with their practice employer for each GP term. This ensures clarity between employee and employer, and gives both parties recourse against any breaches under contract law. Do not assume that your supervisor or practice manager has read the NMTC any more carefully than you have! Even if you simply agree on the minimum terms in the NMTC it is important for you and the practice to develop a shared understanding of what you have agreed to in writing.
Securing a win-win contract
For many registrars, negotiating an employment contract can be a challenging process.
7 Money matters
When negotiating, it is wise to think about the big picture. Earning a reasonable income is necessary for most of us, but there are considerations beyond money and essentially your years as a registrar are a learning experience. Other aspects may include the availability of training in the areas that interest you, a willingness by the practice to fit in with the days you want to work or the ethos and values of the practice and its people. These will differ from registrar to registrar, but finding a practice that suits you should be highly valued.
Your negotiating checklist This checklist is a summary of key topics that may be covered and documented in your employment contract.
• Work hours - Hours, sessions and locations, educational release time, administration time
- On-call and after-hours
- Number of patients per hour
• Education and supervision
- In-practice teaching
- Educational release time
- Supervisor obligations
• Remuneration - Base salary or percentage of billings plus nine per cent superannuation (minimum)
- Pay for ordinary hours
- Pay for off-site work including hospital VMO, nursing home and home visits
- Pay for after-hours and on-call work
- On-call percentage — on premises and off premises
- Frequency of billing cycles
- Payment for working on public holidays
- Payment for annual leave
- SIPs and PIPs payments (if paid a percentage)
Calculate your income gpra.org.au/earnings-calculator Our online GP Earnings Calculator allows you to estimate your individual earning potential based on the kind of GP you want to be.
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Registrar rave Dr Samuel Goodwin
- Any accommodation subsidies
- Any other allowances and expenses
• Leave - Annual leave and method of annual leave calculations
My RTP is Northern Territory General Practice Education Registrar Rave(NTGPE).
- Personal/carers leave (includes sick leave)
- Compassionate leave
My current post is at Central Clinic and Alice Springs Hospital.
- Study leave
- Parental leave
A typical workday for me is largely unpredictable.
• Other matters
- Medical indemnity insurance
- Personal safety
What I don’t love so much is being pigeonholed as “just a GP.”
- Restrictive covenants
- Renegotiation
My GP role model is my own GP, Dr Liam Barry, because he puts me at ease.
- Dispute resolution
- Termination of employment
My favourite technical gizmo is the switchboard because they know everything.
• Contract paperwork
What I love about general practice is my options.
A patient who inspired me was — pretty much most of them. After hours I like to garden. A favourite philosophy I often turn to is: “Could be worse.”
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Complete your written contract and ensure it is signed and dated by you and your
employer.
Employee to contractor
7 Money matters
GP registrars start their careers as employees, although once qualified GPs, more employment options become available to them.
As a GP registrar, you will be classified as an employee, even if paid by percentage. Later as a fully-qualified GP, you may be offered the choice of being a contractor or consider a trust, company or partnership. Each of these structures provides slightly different benefits, mainly surrounding tax and asset protection should one be sued. Most tax advantages associated with these structures relate to the business. A GP who does not own a practice will find far fewer tax advantages in these structures.
What are the advantages of being an employee? As employees, registrars and GPs have a number of entitlements including:
• a paid minimum rate • paid annual and public holiday leave • paid sick leave superannuation contributions • employer of nine per cent of salary WorkCover/worker’s compensation • provisions
• tax is organised and paid for you.
What is a contractor? In general, a contractor receives money only when they work. There is therefore no sick leave, annual leave or public holiday pay. Because of this arrangement, contractors are likely to have income protection insurance. They also carry their own professional indemnity and public liability insurance. As far as the Tax Office is concerned, the onus is on the person paying you money to prove whether you are a contractor or an employee. If a practice incorrectly pays you as a contractor then it is the practice that is responsible. A contractor also receives all money that they earn. It is then the responsibility of the contractor to pay tax on this money and to organise their own superannuation. The Superannuation Guarantee Contribution (SGC) rate is nine per cent. However, contractors do not always have to pay their own superannuation. Please check with your accountant. As a contractor, there are specific anti-taxavoidance provisions that state income earned from personal effort must be taxed as income of that individual. Please check the anti-taxavoidance provisions with your account.
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So what are the advantages of being a contractor? Greater flexibility to: a higher or lower percentage of your • pay earnings into superannuation more or less annual leave (without pay, • take of course). It is also possible to create your own company and become the employee of this company. The company you own then provides GP services to the practice where you work. As a company employee, you can then obtain a company car and there may be some asset protection advantages to this structure. The tax advantages of a company car must be weighed against the additional costs of running a company.
Can I be a contractor as a GP registrar? No. Legal advice obtained by a working party between GPRA, the National General Practice Supervisors’ Association (NGPSA) and the ACE group clearly indicates that under law the relationship between a training practice and a GP registrar is that of an employer and employee. Under both industrial relations law and taxation law, the relationship would not be recognised as that of a principal and independent contractor. Even if payment arrangements are set up on the basis of contracting, if the matter came before a court of law, this arrangement would be considered invalid and would be deemed to be that of an employer and employee. This applies to all terms undertaken by GP registrars. A GP registrar entering into a contractor arrangement exposes themself to some risk. The contracting arrangement could call into question the cover of their own professional indemnity 132
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insurance if their category was that of a GP registrar rather than an independent GP. If the registrar does not have an adequate understanding of their legal obligations under a contracting arrangement there are also risks associated with failure to comply with, or adequately plan for, taxation and GST liabilities. If the registrar does not take out appropriate insurance in the absence of employer workers compensation insurance cover there are risk associated with injury, illness and loss of income. There may be exceptional circumstance where the legal position is different. We recommend that anyone who considers their circumstances to be exceptional to obtain clear legal advice supporting that position before entering into a contracting arrangement. We would advise that any GP registrar wishing to work as a contractor in private general practice seek independent legal and accounting advice. Disclaimer: This information is GPRA’s recommendation after seeking legal and tax advice.
GPRAtip GPRA’s Future Series webinars provide advice and information about your employment options once you are a fully-qualified GP. To find out more, visit gpra.org.au/future-series Recruitment services Ochre Recruitment, Allied Medical Group, Beat Medical, Health 24-7 Medical Recruitment Australia, Medacs Healthcare, Medic Oncall Recruitment, Medipeople Medical Recruitment, Charterhouse Medical, CM Medical, Pulse Staffing, Wavelength International.
Incentive payments
7 Money matters
In addition to your salary, you may be able to claim other financial incentive payments as a GP registrar. If you are working as a GP registrar, you may be eligible to receive a range of financial incentives and reimbursements on top of your regular salary. Most of these are offered by the Department of Health and Ageing (DoHA) to encourage more GPs to practise where they are most needed, such as in 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) is a DoHA scheme that applies to registrars and general practitioners (both locally and overseas-trained) working in rural and remote areas. 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). Visit doctorconnect.gov.au for more information.
Table 1 - General Practice Rural Incentives Program (GPRIP) Practice time (years) in a rural and remote location RA location
0.5
1
2
3-4
5+
RA2 (Inner regional)
-
$2,500
$4,500
$7,500
$12,000
RA3 (Outer regional)
$4,000
$6,000
$8,000
$13,000
$18,000
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
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HELP/HECS Reimbursement Scheme The HELP/HECS Reimbursement Scheme applies to Australian graduates who completed their medical degree in the year 2000 or later. Participants in the scheme have a proportion of their HELP/HECS fees reimbursed for each full-time year of medical training undertaken or
service provided in areas designated as Australian Standard Geographical Classification RA2–5. These reimbursements are scaled to reward doctors working in the most remote areas who receive a higher level of reimbursement and recover their fee payments over a shorter period of time (see Table 2).
Table 2 - HELP/HECS Reimbursement Scheme ASGC-RA classification
2
No. of years to receive full reimbursement 5 years
GPRAtip Ask your RTP about the financial incentives you may be able to claim in addition to your salary or visit gpra.org.au Look up your state rural workforce agencies as they often advertise financial incentives. Visit racgp.org.au/foundation/grants for research grants
3
4
5
4 years
3 years
2 years
More Doctors for Outer Metropolitan Areas Relocation Incentive Grant This is another DoHA program for GP registrars on the general pathway who have completed their training and are prepared to work in an outer metropolitan area for two years. Newly fellowed general practitioners must apply within three months of receiving their fellowship and are eligible for a total payment of up to $30,000, paid in three instalments of 40 per cent, 40 per cent and 20 per cent. For those who further commit to outer metropolitan areas by setting up their own practice and staying for three years, there is a total of $40,000 available. For more information, visit health.gov.au/outermetro
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8
Keeping
your balance
Stress less six tips and tricks from GPs
Many GPs have developed their own practical and sometimes idiosyncratic ways of dealing with the pressures of the job — from lying down to lathering up.
GPs regularly see patients with health problems due to stress. But when it comes to managing their own stress, many choose to tough it out — which can result in burnout or worse.
2. Use humour
Self-care is essential for doctors if they are to enjoy a sustainable career in medicine.
“As a GP, I have to wash my hands many times each day at work. I find it helpful to imagine that I am washing away any ‘negative energy’ from the last patient as I wash my hands.
Following is a list of simple strategies practised by GPs from GPRA’s R-cubed website — Real Resilience Resources (r-cubed.org.au). Try a new one each day and see what works for you.
1. On the couch “Doctors can use the examination couch too! After any particularly stressful interaction with a patient (or practice staff for that matter) I have always found it helpful to ‘get horizontal’. Climb up on the examination couch, lie there staring at the ceiling for a minute or two, let go of the angst and when you hop up, you’ll feel refreshed and ready for your next encounter. I do this after all my ‘heartsink patients’. It wipes the slate clean and it’s much less painful than banging my forehead on the back of the door when they leave.”— Dr E.
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“I use humour. So when it all goes pear-shaped I say, ‘that went well!’, and laugh.”— Dr D.
3. Wash the negativity away
This is a simple exercise that helps me to finish with one patient and prepare for the next.” — Dr H.
8 Keeping your balance
4. Exercise! “I try to exercise every day after work — I do a different thing on each day. This keeps me interested and breaks up the exercise routine. It also helps me to prescribe specific exercises to my patients, as I have first-hand experience in what has worked for me. Mondays — walk at the beach and watch the waves, surfers and swimmers, and feel the sea breeze. (Great for stress management and when I am feeling lazy.) Tuesdays — high intensity cycle class and sweat out all the frustrations of the day. (Good for cardio and weight loss.)
sure I go for a walk, even just for 15 minutes, to get some sunshine, fresh air and exercise. I have really found that helps to clear my head from the challenges of the morning, and reinvigorate me for the afternoon session. Even if I then have to stay 15 minutes later in the evening to finish off the paperwork I left at lunchtime, it is worth it.” — Dr J.
6. Catch-up time “Call or email a few colleagues and plan an enjoyable activity together — coffee, dinner at a pub, a cards night or a movie night. You will be able to relax while also having the opportunity for peer support.”— Dr S.
Wednesdays — core stability class. (Enables me to share tips with back pain sufferers.) Thursdays — muscle strengthening with light weights. (Osteoporosis prevention and weight loss.) Fridays — yoga, pilates and balance class with meditation. (Reduces my anxiety levels and helps me wind down.) I find I am a more credible prescriber of SNAP (S – quit Smoking, N – better Nutrition, A – moderate Alcohol, P – more Physical activity) having practised what I preach.”— Dr J.
5. Take a lunchtime walk “Previously I used to spend my lunch break going through paperwork while simultaneously eating my lunch. Recently I have taken to making
real resilience resources You can find more tips and strategies about being a resilient doctor on the R-cubed website— a GPRA initiative to give GP registrars, prevocational doctors and medical students real resources to build resilience. Check out other ideas like one-minute meditations, phone coaching and selfexpression through art, writing, music and creative interests. You can also find news of the latest research into ways to manage busy lifestyles and work. Visit rcubed.org.au
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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 an RLO or an academic registrar. When thinking about part-time training, consider the following:
Part-time training is anything less than 38 hours. Anything less than 38 hours (i.e. part-time) will be pro-rata and affect GPRIP payments if applicable.
•
To remain within the AGPT program, registrars need to undertake a minimum of nine patient contact hours per week.
should negotiate • You the amount of
practice-based teaching 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. enry on and H tt o C x le The RACGP states that general practice Dr A All components of the training program, with experience gained while working part-time is valuable and likely to be worth more than an the possible exception of hospital time, can estimation of time alone would indicate. be undertaken on a part-time basis. This is why acceleration of part-time training to As you start training as a registrar, you need ‘half-time’ training is available. It basically means to apply for part-time training to your RTP that in order to have a 12-month term counted and have it approved by your RTP before you as the equivalent of six months full-time you begin working part-time. need to ‘accelerate’ your training with a set of Full-time is considered to be 38 hours per log diaries. These log diaries show that the week, which includes all consultation time.
•
• •
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8 Keeping your balance
GPRAtips
want to apply for parental leave • Ifandyouenquire about part-time training number and range of patients seen are giving you adequate experience.
Taking parental leave All parental leave is unpaid by employers in • the AGPT program but you may be eligible
opportunities, talk to your RTP and your practice well in advance of your baby’s arrival.
in touch, consider applying for an • ToRLOkeepposition with your RTP. This offers a
great opportunity to network and travel to meetings and education sessions.
for paid parental leave from the Australian Government. You need to apply to your RTP for parental • leave — it is up to their discretion to grant
it or not.
Applications must be made in writing to • the RTP at least three months before the
expected date of leave.
primary caregiver is eligible for leave of • The up to 12 months following the live birth,
adoption or assumption of guardianship of the child or children.
The idea of a healthy work-life balance is part of the appeal of general practice. Further information: Please see the AGPT Full-Time Equivalent Policy 2010 at agpt.com.au/ Policies/Policies
Dr Alex Cotton Practising medicine and motherhood ‘Having it all’ — career, marriage and babies — remains a tricky balancing act for many women. For GP registrar and new mum Dr Alex Cotton, the part-time training and work arrangements available in general practice have proved a big help. “General practice allows you to have it all and feel as though you can do it well — most of the time!” Alex said. “My husband Pete works full-time so if I were to work full-time too it would put a lot of extra pressure on both of us.” Her first baby Henry’s entry into the world was well timed — the last day of GPT2. Alex was able to take six months parental leave to bond with her new son then return to the consulting room two days a week. Alex is doing GPT3 at the Orange Aboriginal Medical Service as well as studying for her fellowship exams.
The Cotto n
family
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5
3
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 fix for rural docs. 5 Australian Doctor Education Seminars developed by GPs for GPs.
Check out www.australiandoctor.com.au for more information
9
Info file
Learn to speak GP Acronyms and abbreviations abound in the language of GP training. Crack the code here! AAGP — Australian Association of General Practitioners AAPM — Australian Association of Practice Managers ACIR — Australian Childhood Immunisation Register ACRRM — Australian College of Rural and Remote Medicine One of two general practice colleges. ACRRM has a curriculum of educational objectives for rural GPs and a fellowship process for vocational registration. AFP — Australian Family Physician The official journal of the RACGP. AGPAL — Australian General Practice Accreditation Ltd. This organisation completes accreditation of practices throughout Australia. Speak to your practice manager for further information. AGPN — Australian General Practice Network The national body that represents the local divisions of general practice, some are now called Medicare locals. Previously Australian Divisions of General Practice. AGPT — Australian General Practice Training The training program for GP registrars. AIDA — Australian Indigenous Doctors’ Association 142
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AKT — Applied Knowledge Test A component of the RACGP Fellowship examination. A computer-based exam in multiple-choice format. AMPCo — Australian Medical Publishing Company Register with them to get a free subscription to Medicine Today, Australian Doctor and Medical Observer. To arrange this, visit ampco.com.au AMA — Australian Medical Association An independent organisation that represents the professional interests of all doctors, including political, legal and industrial. AMH — Australian Medicines Handbook AMSA — Australian Medical Students’ Association ARST — Advanced rural skills training ASGC-RA — Australian Standard Geographical Classification — Remoteness Areas This is the Australian Bureau of Statistics model by which all cities and towns in Australia are assigned a number between RA1–5. This is used to calculate incentive payments to doctors outside metropolitan areas. RA1 — Major cities RA2 — Inner regional RA3 — Outer regional
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RA4 — Remote RA5 — Very remote A map of Australia showing these classifications is available at doctorconnect.gov.au CMO — Career medical officer CPD — Continuing professional development Divisions of General Practice — Federally funded to provide support and educational activities to GPs and local primary care services within their division (local area); for example, diabetes nurse educators. Find out which division your practice belongs to and join. GP registrar membership is free in some regions. DHAS — Doctors’ Health Advisory Service DoHA — Department of Health and Ageing The Commonwealth Government department responsible for health and ageing. DVA — Department of Veterans’ Affairs EBM — Evidence-based medicine ECT — External clinical teacher
FGAMS — Foreign graduates of an accredited medical school May be subject to the 10-year moratorium (see also IMG and OTD). FRACGP — Fellowship of the Royal Australian College of General Practitioners GPET — General Practice Education and Training Limited A government limited company that funds and contracts with RTPs to provide general practice education to registrars and prevocational doctors. GPR — General practice registrar, GP registrar GPRA — General Practice Registrars Australia Ltd Represents GP registrar issues to AGPT, RACGP, ACRRM, DoHA and other bodies involved in training. Membership is free. GPRA has a board of nine directors, an advisory council made up of RLOs from every RTP and is staffed by a team of professional employees. GPRIP — General Practice Rural Incentives Program
ESP — Extended skills post A component of AGPT comprising a six-month training post in either general practice or an area of relevant skills; for example obstetrics and gynaecology, accident and emergency.
GPT1, GPT2, GPT3 — General practice terms 1, 2 and 3 Part of the RACGP curriculum.
FACRRM — Fellowship of the Australian College of Rural and Remote Medicine
IMG — International medical graduate May be subject to the 10-year moratorium (see also FGAMS and OTD).
FARGP — Fellowship in Advanced Rural General Practice
HMO — Hospital medical officer
JAC — Joint Advisory Committee JCC — Joint Consultative Committee GPRA — The future of general practice
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KFP — Key Feature Problems A component of the RACGP Fellowship examination. A computer-based exam in short and long answer. MBS — Medicare Benefits Schedule ME and TA — Medical educators and training advisors One of these people from your RTP will give advice and guidance about your training.
OSCE — Objective Structured Clinical Examination A component of the RACGP Fellowship exam comprising multiple stations similar to an MSAT or viva voce examination. OTC — Over the counter OTD — Overseas-trained doctor May be subject to the 10-year moratorium (see also FGAMS and IMG).
NGPSA — National General Practice Supervisors’ Association Not to be confused with the SLON (Supervisor Liaison Officer Network), although they are essentially the same people. NGSPA is the GPRA equivalent for supervisors. It undertakes an advocacy role for supervisors, particularly in terms and conditions negotiations.
PBS — Pharmaceutical Benefits Scheme/ Pharmaceutical Benefits Schedule
NMTC — National Minimum Terms and Conditions A document prepared for GP registrars in their first and second general practice terms that outlines the requirements of employment contracts between registrars and practices.
RACGP — Royal Australian College of General Practitioners One of two general practice colleges. Has a fellowship process for vocational registration. RACGP also offers a Fellowship in Advanced Rural General Practice (FARGP).
NPS — National Prescribing Service A Commonwealth Government-funded organisation that provides independent information on the prescription and use of various medications. Lots of resources and case studies for GP registrars can be found at nps.org.au
RACGP Library — RACGP members can access the full suite of services provided by the RACGP John Murtagh Library. Non-members can access some services for a fee. Visit racgp.org.au/library
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PIP — Practice Incentives Program PGPPP — Prevocational General Practice Placements Program QA and CPD — Quality assurance and continuing professional development
RACGP state censor — A fellow of the RACGP in each state who checks that the GP registrar has completed the training requirements for fellowship.
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RDAA — Rural Doctors Association Australia Has state branches. Represents rural doctor issues to government and other organisations. RDL — Registrar-directed learning RDNA — Rural Doctors Network Australia RFDS — Royal Flying Doctor Service RLO — Registrar liaison officer A registrar employed by an RTP to represent and advocate for GP registrars and liaise with GPRA. RMO — Resident medical officer RPBS — Repatriation Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Schedule RROC — Registrar Representative on Council A GP registrar who sits on the council of the RACGP to represent registrar concerns. RRADO — Registrar Research and Development Officer The RRADO is a registrar employed part-time by GPET to promote training in research and academic general practice. RRF — Registrar Research Fund A pool of funding maintained by GPET to fund GP registrar research projects. RTP — Regional training provider RTPs tender for contracts from GPET to provide regionalised GP training.
SBO — State-Based (Divisional) Organisation A state-funded organisation, not always directly linked to ADGP or individual divisions. Provides some educational activities that GP registrars can attend. SIP — Service Incentive Payment SLO — GP supervisor liaison officer Employed by an RTP to represent and advocate for GP supervisors. 10-year moratorium The 10-year moratorium requires some doctors originally from overseas (see OTDs, FGAMS and IMGs) to train and practise in designated areas of need such as rural and outer metropolitan areas for up to 10 years, although it is now possible to reduce this time by practising in more remote areas. TGA — Therapeutic Goods Administration TMO — Trainee medical officer UGPA — United General Practice Australia VMO — Visiting medical officer VR — Vocational registration Wonca — World Organisation of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Contributed by Dr Siew-Lee Thoo, Dr Naomi Harris, Dr Kate Kelso and Dr Kirsten Patterson
RVTS — Remote Vocational Training Scheme Provides distance vocational training to doctors already working in rural and remote locations where on-site supervision is not available. GPRA — The future of general practice
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GPweb directory Popular websites where GPs go to get their information. Organisations
Courses
Department of Health and Ageing (DoHA) health.gov.au
Sexual Health and Family Planning Australia courses shfpa.org.au
The Federal Government’s health department website includes information on the latest public health campaigns, key policies, services, important forms and links to other relevant websites. See also your state or territory health department website. Medicare Australia (for providers) medicareaustralia.gov.au/provider/index.jsp GPET agpt.com.au
Advanced Life Support in Obstetrics (ALSO) also.net.au Advanced Paediatric Life Support (APLS) apls.org.au Diploma in Child Health (The Children’s Hospital at Westmead) chw.edu.au/about/jobs/cro/dch/
Online learning
GPRA gpra.org.au
gplearning Online (An RACGP initiative) gplearning.com.au
RACGP racgp.org.au
ThinkGP thinkgp.com.au
ACRRM acrrm.org.au
Rural Health Education Foundation rhef.com.au
AMA ama.com.au
PrimEd primed.com.au
Rural Health Workforce Australia (RHWA) rhwa.org.au
PrimEd is a series of online professional development programs — under redevelopment at time of writing.
A not-for-profit organisation dedicated to making primary health care more accessible for communities in rural and remote Australia.
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Reference and evidence-based medicine databases PubMed (US National Library of Medicine) pubmed.gov PubMed consists of more than 19 million citations for biomedical articles from MEDLINE and life science journals. PubMed also has full-text articles and links to other resources. The Cochrane Library cochrane.org.au The Cochrane Library provides visitors with the option of searching through thousands of clinical reviews assessing the effectiveness of treatments from a selection of databases. The library can be accessed through the Australasian Cochrane Centre website. The Australasian Cochrane Centre is one of a number of centres established internationally to assist in the co-ordination of The Cochrane Collaboration’s activities. The Cochrane Collaboration is an international non-profit organisation that provides up-to-date information on the effects of health care. The international site (cochrane.org) has top links for GPs and podcasts on reviews for your commute to work. Bandolier medicine.ox.ac.uk/bandolier Bandolier is a key source for high quality information on evidence-based health care in the UK. It is also known for its award-winning electronic version at ebandolier.com, which reportedly receives almost 90,000 visitors to its pages every week.
RADAR (Register of Australian Drug and Alcohol Research) radar.org.au RADAR is a project of the Alcohol and other Drugs Council Australia. The register contains the latest records of current and recently completed research projects with details of published research. UpToDate uptodate.com This US-based website contains peer-reviewed and regularly updated review articles on an extensive range of clinical topics. It has a subscription fee.
Journals and publications The Medical Journal of Australia (Journal of the AMA) mja.com.au The Medical Journal of Australia (MJA) is Australia’s leading peer-reviewed journal of medical practice and clinical research. Australian Family Physician Online racgp.org.au/afp Australian Family Physician (AFP) is the official peer-reviewed journal of the Royal Australian College of General Practitioners.
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Medical Observer medicalobserver.com.au
Guidelines and clinical information
The Medical Observer website has excellent links to GP resources and patient handouts. It also has a useful ‘Clinical Review’ tab to keep you updated on medical news. To access content, you have to be a registered medical practitioner or health care professional and log in.
GP Psych Support (An RACGP initiative) psychsupport.com.au
Australian Doctor australiandoctor.com.au The Australian Doctor website has many resources for clinicians, leading you to respected journals from Australia and around the world. It also features ‘How To Treat’, a review article written by experts. Medicine Today medicinetoday.com.au Medicine Today is a free, peer-reviewed journal with clinical feature articles, updates and Continuing Professional Development (CPD) activities. Journal Watch globalfamilydoctor.com The Wonca (World Organisation of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) website scans the internet for journal articles and medical literature from across the world in its Journal Watch section. It includes synopses and directs you to the relevant websites.
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GP Psych Support is a service that offers GPs patient management advice from psychiatrists within 24 hours.You must be registered to use the service. National Prescribing Service (NPS) nps.org.au The National Prescribing Service is an independent non-profit organisation that aims to provide accurate, balanced evidence-based information about medicines. The website contains sections for consumers, health professionals and other members and stakeholders. Therapeutic Goods Administration (TGA) tga.gov.au The Department of Health and Ageing’s Therapeutic Goods Administration website provides information on the Australian Register of Therapeutic Goods. The TGA monitors and assesses therapeutic goods in Australia, ensures they are of an acceptable standard and ensures that any therapeutic advances are readily available to the Australian public. Pharmaceutical Benefits Scheme (PBS) health.gov.au/pbs This Australian Government website has information on the Pharmaceuticals Benefits Scheme and now also includes the Schedule of
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Pharmaceutical Benefits, which lists all medicines under the PBS. Australian Prescriber australianprescriber.com The Australian Prescriber is an independent publication offering information on drugs and therapeutic goods. It is run by the National Prescribing Service. Full-text articles are available free of charge. MIMS Australia mims.com.au MIMS Australia supplies Australian health professionals with products and publications that assist GPs to make decisions in the clinic. Australian Drug Foundation adf.org.au The Australian Drug Foundation works to educate the community on the problems associated with drugs and alcohol. Activities include conducting research, holding seminars and undertaking community development work. Clinical Practice Guidelines NHMRC nhmrc.gov.au/publications/subjects/clinical.htm This is a clearinghouse of clinical guidelines from the Australian Government’s National Health and Medical Research Council (NHMRC). Royal Children’s Hospital Guidelines (Paediatric) rch.org.au/clinicalguide
Patient information Better Health Channel betterhealth.vic.gov.au The Better Health Channel offers GPs consumerbased information that is checked on a regular basis. It has useful handouts for patients. My Dr (MIMS Australia) mydr.com.au The My Dr website contains a range of consumerfriendly tools — quizzes, calculators, a medical dictionary and information on medications. HealthInsite healthinsite.gov.au HealthInsite is an Australian Government initiative that aims to provide patients with the latest information on health and wellbeing. It has links to health services across the states and territories. GPnotebook gpnotebook.co.uk GPnotebook is an encyclopaedia of medicine updated on a continual basis. It has over 26,000 pages of information. The website now has a subscription fee. Parent handouts rch.org.au/kidsinfo/factsheets.cfm This is a series of handouts for parents and patients from the Royal Children’s Hospital.
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GP TRaining options... During your training with the Australian General Practice Training (AGPT) program, talk to your regional training provider (RTP) about options for: • • • •
an academic training post a registrar research workshop the registrar research and development officer (RRADO) Aboriginal and Torres Strait Islander health training posts.
Talk to your RTP or go to: www.agpt.com.au
GPRAcalendar 2012 Important conferences and meetings Healthed The Annual Women’s Health Update, Sydney
18 February 2012 (Sat)
RACGP Applied Knowledge Test (AKT) & Key Feature Problems (KFP)
25 February 2012 (Sat)
ACRRM Multiple Choice Question Assessment
10 March 2012 (Sat)
GPRA Breathing NEWLIFE into General Practice, Canberra
17 – 20 March 2012 (Sat – Tues)
GPET RLO Workshop and GPRA Advisory Council Meeting, Canberra
17 – 20 March 2012 (Sat – Tues)
RACGP Objective Structured Clinical Examination (OSCE)
12 May 2012 (Sat)
General Practitioner Conference and Exhibition (GPCE), Sydney
18 – 20 May 2012 (Fri – Sun)
ACRRM Structured Assessment using Multiple Patient Scenarios (StAMPS) 19 – 20 May 2012 (Sat – Sun) WONCA Asia-Pacific Conference, Korea
24 – 27 May 2012 (Thur – Sun)
Healthed The Women’s and Children’s Health Update, Adelaide
26 May 2012 (Sat)
RACGP Applied Knowledge Test (AKT) & Key Feature Problems (KFP)
4 August 2012 (Sat)
Healthed The Women’s and Children’s Health Update, Perth
11 August 2012 (Sat)
Healthed GP Education Day, Melbourne
25 August 2012 (Sat)
GPRA AGM and Advisory Council Meeting, Canberra
September 2012
GPET Convention, Victoria
5 – 6 September 2012 (Wed – Thur)
ACRRM Multiple Choice Question Assessment
8 September 2012 (Sat)
Healthed GP Education Day, Brisbane
15 September 2012 (Sat)
RACGP Objective Structured Clinical Examination (OSCE)
21 October 2012 (Sun)
RACGP GP12 Conference, Gold Coast
25 – 27 October 2012 (Thur – Sat)
Australian General Practice Network National Forum, Adelaide
7 – 10 November 2012 (Wed – Sat)
General Practitioner Conference and Exhibition (GPCE), Melbourne
16 – 18 November 2012 (Fri – Sun)
ACRRM Structured Assessment using Multiple Patient Scenarios (StAMPS) 1 – 2 December 2012 (Sat – Sun) RDAA & ACRRM Rural Medicine Australia Conference,
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With you on your journey At General Practice Registrars Australia (GPRA), we support our members throughout their general practice journey. We are with you through medical school and your hospital internship, right up until when you negotiate your first employment contract. We then provide resources to help you make the most out of your career and be a resilient GP. Students
Junior doctors
Registrars
GPs
General Practice Students Network gpsn.org.au
Going Places Network gpaustralia.org.au
General Practice Registrars Australia gpra.org.au
R-cubed – wellbeing for doctors rcubed.org.au
With you on your journey Students
Junior doctors
Registrars
Self-care
General Practice Students Network gpsn.org.au
Going Places Network gpaustralia.org.au
General Practice Registrars Australia gpra.org.au
R-cubed – wellbeing for doctors rcubed.org.au
General Practice Registrars Australia (GPRA) Level 4, 517 Flinders Lane, Melbourne Victoria 3001 Phone: 03 9629 8878