Explorer THE REGISTRAR GUIDE
2013
Training tips for registrars by registrars
The future of general practice
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About this guide The Explorer guide is produced by General Practice Registrars Australia (GPRA).
The name Explorer reflects the aim of this 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 guide has been produced using environmentally friendly printing techniques and paper; an approach that reflects GPRA’s ethos of supporting tomorrow’s GPs, and their families, in their quest for sustainable careers in general practice.
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Contents g tips
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About this guide
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Welcome
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A message from the GPRA Chair
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Dr Cass Wys balances practising medicine and motherhood. Read her story on page 131.
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1 GPRA and you 10
Introducing GPRA
12 With you on your journey 14 The GPRA Registrars Services team 16 The GPRA Board 19 Member benefits 22 What GPRA is doing for you 26 A year in the life of GPRA 28 Want to get more involved?
2 Your GP training experience 32 The structure of GP training 36 Getting more involved
prac tice
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Joining forces with the ADF
59
Understanding the moratorium
3 Exploring your options 60 Extend yourself with a special interest 65 A rural career takes off 68 Aboriginal and Torres Strait Islander
health training
72 Treating the whole person 74 About academic training posts 76 Food for thought 78 Travel while you train
4 Term allocation and choice 80 Choosing your practice placement 82 Your practice interview 86 If things go wrong
38 Understanding the moratorium
5 Preparing for practice
40 The RACGP Fellowship
90 Things to do before your first GP term
43 RACGP Fellowship in Advanced
94 Designing your learning plan
98 First day survival tips
Rural General Practice
46 The ACRRM Fellowship
102 GP focus in hospital
50 RVTS: An alternative pathway to fellowship
106 Going bush
2 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. 110 What every VMO should know 112 Teach while you learn as a registrar
medical educator
114 Mastering Medicare 118 Prescribing pointers
6 Exams and assessments 122 Exam survival guide
7 Keeping your balance 130 Part-time training options 131 Dr Cass Wys 132 Stress tips from GP registrars
8 Money matters 136 National Minimum Terms and Conditions 141 Incentive payments
9 The business of general practice 144 Business structures 101 148 Being the boss
10 Info file 150 Jargon buster 156 GP resources directory
Professor Murtagh is Adjunct Professor of General Practice at Monash University and Professorial Fellow in the Department of General Practice at the University of Melbourne. He practises parttime as a GP at East Bentleigh in Victoria and has teaching responsibilities at three Melbourne-based universities. He is also the author of several internationally adopted text books including the popular General Practice. Platinum sponsors: Avant Mutual Group Limited and Healthscope Medical Centres GPRA Editorial team General Manager: Sally Kincaid Editor: Jan Walker Graphic Design: Peter Fitzgerald Business Development Manager: Kate Marie Š2013 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.
Printed by Graphic Impressions
GPRA — The future of general practice
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Welcome Whether you’re a new or experienced GP registrar, the 2013 issue of Explorer will prepare you for the road ahead. Where are you heading? When will you arrive? How will you know when you get there? In this goal-orientated world, it’s easy to overlook the journey when there is so much focus on the destination. While it’s reassuring to have some sort of direction in mind, life is really all about the twists and turns along the way. There have certainly been twists and turns in GP-land recently — government funding changes, new IT initiatives, the end of divisions of general practice and the beginning of Medicare Locals. The Australian Health Practitioner Regulation Agency is settling
“In the 2013 issue, there are ideas, information and priceless insiders’ tips for both new and experienced GP registrars.” 4
Visit our website — gpra.org.au
into its new role, ACRRM is raising its profile, and the RACGP has undertaken an overhaul of the training standards that underpin GP registrar training. So while the terrain of general practice training changes around us, it’s sometimes a challenge to navigate it, let alone have time to enjoy the scenery. The Explorer registrar guide is here to help! In the 2013 issue, there are ideas, information and priceless insiders’ tips for both new and experienced GP registrars. You’ll find tips on planning your own educational journey and an expanded exam survival guide. There is a new section on the business of general practice post-fellowship and much more. All this is interwoven with intriguing stories from registrars, all with interesting and varied experiences. A big thank you to all the registrars who kindly said ‘yes’ to requests for their input and took time from busy schedules to contribute. It’s the peer-to-peer insights that make Explorer such a valuable resource. Dr Christine Willis Medical Editor Explorer 2013
Message from the GPRA Chair “Infinite diversity in infinite combinations … symbolising the elements that create truth and beauty.” Mr Spock, Star Trek GPRA is pleased to release the 2013 issue of Explorer, showcasing the rich diversity of general practice and GP training. We hope that this resource provides you with options and ideas that will help enrich and define your career. GPRA is the voice of the next generation of GPs, from medical students to new fellows. We represent the interests of GP registrars, and we support you through the training program. We strongly advocate on key issues affecting GP registrars and provide resources for exam preparation, maintenance of resilience and life beyond training as a fellowed GP. We encourage you to stay keen and get
“Use this guide to find out how you can get involved.” 6
Visit our website — gpra.org.au
involved — your input can shape the outcomes of core general practice training issues. Use this guide to find out how you can get involved. General practice allows me to be involved — involved with patient care from cradle-to-grave, in preventive medicine as well as chronic disease management. I enjoy the diversity of medicine that I practise, and I look forward to the variety of work available to me in general practice. The 2013 Explorer guide looks at the diverse opportunities that exist for us right from the start of our training. In an era when the profession is being redefined and expanded, it is an interesting time to be part of general practice. The choices are enormous, and registrars are often not aware of the possibilities available to them. Welcome to general practice — you have made the first critical choice. Let Explorer and GPRA be your guide to the infinite diversity of your profession. Dr Edward Vergara GPRA Chair
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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 RS
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Publications — GP Companion, More than Money: A Negotiation Guide for GP registrars, Explorer guide
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Professional development — finance, medico-legal, contracts National Minimum Terms and Conditions — policy document, interpretations, assistance
Visit gpra.org.au to keep up to date with how GPRA is working for you.
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GPRA and
you
GPRA
Introducing
Here’s a brief introduction to who we are and how we support you on your journey to becoming a GP. What is GPRA? General Practice Registrars Australia (GPRA) is the peak national representative body for general practice registrars in Australia. One of our most important functions is to provide resources to support you, as a GP registrar, throughout your training and represent your interests.
What GPRA does for you To keep registrars’ interests at the forefront of our work, we:
students — through the General • medical Practice Students Network (GPSN)
doctors in hospital — • prevocational 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 government to help shape the direction of general practice training.
• provide a wealth of resources to support you throughout your 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.
negotiate your pay and your conditions of employment through the National Minimum Terms and Conditions (NMTC)
for your interests and provide a direct • fight channel to raise any issues
• represent your views to the Minister for Health and other stakeholders peer-to-peer support and report on any • offer issues that require improvement. Registrar
liaison officers (RLOs) are a link between regional training providers (RTPs) 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
About GPRA’s structure Your RLO, GPRA Advisory Council, GPRA Board and management team all have a role to play. Each RTP employs one or more RLOs 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 both local and national training issues.
1 GPRA and you
Join now! GPRA also has a board of six directors who are elected from GPRA’s membership at each annual general meeting in September.
Do itnow
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 20), raising issues with your RLO or contacting us directly:
The board is responsible for:
Level 4, 517 Flinders Lane Melbourne VIC 3001
• corporate governance • financial sustainability GP registrar issues with • advancing 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.
Online gpra.org.au Email enquiries@gpra.org.au Telephone 1300 131 198
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 the National Minimum Terms and Conditions to conferences and professional development webinars. Our members only section has exam resources and more information on a range of subcommittees Visit us at gpra.org.au
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 general practice training policy
Provide services to promote general practice as a career and support future general practitioners
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Visit our website — gpra.org.au
Step 1: Medical students
General Practice Students Network
• Events – networking opportunities
– social – educational – career
Wave Scholarship • First Program — providing
early exposure to general practice
• – Publications Aspire guide – GP Companion
• Website, e-newsletters benefits, such as • Member discounts as they arise
1 GPRA and you
Step 2: Prevocational doctors
Taking a fresh look at general practice
Going Places Network
• Events – networking opportunities
– social – educational – career
• – Publications Going Places guide – Going Places magazine – GP Companion
• Website, e-newsletters • Member benefits, such as discounts as they arise
Step 3: GP registrars
Step 4: Alumni
The future of general practice
GPRA membership
and support • Advocacy during training • Negotiation of pay and conditions preparation • Exam resources including
webinars
• Professional development webinars • Publications – Explorer guide
For vocationally registered GP members Opportunities to ‘give back’ through presenting, writing, advising, mentoring Also:
• Webinars • Business advice • Discounts to CPD events • Exclusive alumni offers
– GP Companion – Negotiation guide
• Website, e-newsletters benefits, such as • Member discounts for services
and events GPRA — The future of general practice
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The GPRA
Registrars Services team Margo Field General Manager: Education and Training Margo is responsible for the overall management of GPRA’s Registrar Services and Corporate Services. This includes heading new registrar developments. Margo is also a member of the GPRA Executive.
Dr Cameron Adams Policy and Evaluation Coordinator Cameron oversees the subcommittee management, meeting coordination and resourcing and helps develop policy with research input, such as the benchmarking report and the Dr Wyse Research Project. Cameron also assists with registrar enquiries.
Nicole Bonne Registrar Services Coordinator: Member Engagement Nicole is the key point-of-contact for registrar enquiries. She also provides support to RLOs. Nicole manages the Future Series and Exam
Support webinar series and also provides leadership for the registrar e-news and publications.
Stephanie May Coordinator: Indigenous GP Registrars Network Stephanie assists in the coordination of the Indigenous General Practice Registrar Network (IGPRN) in partnership with the IGPRN Chair (Dr Angela Forrest). Her role includes advocacy and policy development, providing support and professional development to Aboriginal and Torres Strait Islander registrars and developing publications and resources, as required by the network.
Joshua Steele Registrar Services Officer (until March 2013) Josh is responsible for providing support to the Registrar Services area, including assisting with registrar enquiries, webinars and meetings. He is a key point-of-contact for RLOs and registrars and he assists with video and photo work.
GPRA — The future of general practice
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The GPRA
Board
Dr Edward Vergara — Chair
Dr Holly Deer — Vice Chair
Ed works at Westcare Medical Centre in Melton, Victoria. He has a strong interest in advocacy and a deep commitment to registrar issues. He brings a wealth of experience in corporate governance through his ongoing role as board director and member of the Finance, Audit and Risk Management Subcommittee at VMA, as well as completion of courses through the Australian Institute of Company Directors.
Holly is a senior GP registrar in the mid-north of South Australia. She has completed a Diploma in Palliative Medicine and is working towards dual training for fellowships of the RACGP and ACRRM. Holly is passionate about general practice training and the future of the profession, as well as workforce and rural health issues.
Dr Anne Kleinitz Based in Darwin, Anne works clinically and as a lecturer for the Flinders University NT Medical Program. She has worked in rural and remote
1 GPRA and you
Indigenous communities, as well as humanitarian work overseas. She is passionate about medical education and is doing an academic post looking at GP registrar attitudes towards teaching medical students.
Dr Clark Maul Dr Clark Maul is a junior doctor at Sir Charles Gairdner Hospital and Joonalup Health Campus in Perth. Before entering medical school, Clark was a lawyer in a large commercial law firm. He brings a unique perspective with his considerable knowledge of corporate and commercial law. Clark is also a former Going Places Network GP Ambassador
Dr Bennie Ng Bennie is the Deputy Director of Medical Services at Peter MacCallum Cancer Centre in Melbourne. After several years of clinical practice, he has been working in executive roles in Australia and overseas across primary care, hospital and government sectors, including as an adviser to a former federal Minister of Health and Ageing.
Dr Piotr (Peter) Swierkowski
Dr Mary Wyatt Mary is a junior doctor at Fremantle Hospital. At medical school, Mary was a GPSN Student Ambassador and the GPSN National Secretary. During her intern year she was a Going Places Network GP Ambassador. Mary is interested in fostering interaction of the general practice pathway between students, prevocational doctors and GP registrars.
Do you belong here? Could you be an RLO and sit on our GPRA Advisory Council, or join our subcommittees or GPRA Board? Develop your skills in medical management, training and politics while you build your networks. Have fun, travel and meet new people. Contact us to find out more. For further information about getting more involved, see pages 28 – 29.
Piotr is the Executive Director of Medical Services at the Sunshine Coast Hospital and Health Network in Queensland. He provides professional leadership to over 500 medical staff. Piotr is a fellow of the Royal Australasian College of Medical Administrators, a fellow of The Royal Australian College of General Practitioners, and a graduate member of the Australian Institute of Company Directors.
GPRA — The future of general practice
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Visit our website — gpra.org.au
Memberbenefits 1 GPRA and you
Being a member of GPRA is free and provides many professional and personal benefits. Core membership benefits and conditions — We negotiate your • Pay pay and conditions of employment
(see pages 135 – 140).
— We fight for your interests and • Advocacy provide a direct channel to raise any issues.
copy of the GPRA Negotiation • Online Guide, with tips on how to negotiate a
win-win contract
copy of the GPRA’s in-practice • Online teaching resource, with tips on how to get
the most from your learning plan
• E-newsletters and mailouts to keep you Personalised advice — We offer personalised • up-to-date with activities advice on the National Minimum Terms and Conditions document and what it mean • Professional development and travel opportunities through GPRA committees
for you. We also offer advice if you encounter a problem or dispute related to your training (see pages 86 – 87).
Professional development — We offer • interactive online support to help you
prepare for exams and understand the business of general practice.
Plus you receive:* exam resources developed for • Online registrars by registrars (see pages 122 – 127
for more details)
• Copy of the Explorer registrar guide copy of GP Companion, a handy • Online medical pocket reference
to Healthed seminars for GPRA • Discounts registrar members in the Australian General
Practice Training (AGPT) program
for registrars to attend the General • Discounts Practitioner Conference and Exhibition
(GPCE) Melbourne and Sydney (numbers are limited and eligibility is subject to GPCE approval) and other professional development conferences and seminars as they arise
Club membership — $200 off • Qantas original price discount for Fitness • AFirstcorporate memberships
• Competitions and other opportunities. GPRA — The future of general practice
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Joinnow Alumni and Associates membership This package is designed for new fellows who want to stay abreast of general practice issues, medical students and prevocational doctors plus any other members who want access to our resources and activities.
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 registrarenquiries@gpra.org.au Telephone 03 9629 8878
You receive:* E-newsletters and mailouts to keep you • up-to-date with activities and job listings
GPRA committees
•
Discounted access to some professional development workshops.
Explorer E
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Professional development and • networking opportunities through relevant
ars
* Specific benefits of our membership packages may vary without prior notice
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Whoknew? ia 0* ustral 0 8 , 29 in A 100 million GPs consultations between Australians and their GPs Appr each year o GP r x. 3,000 e on th gistrars progr e AGPT am in 20ad from9 new 13 0 co % o advertiser at ns f A lea ul u st t t str 0 0 ,0 0 $18 e on hei alia averag ce r G ns annual s for e m a Ps o c in a ye orking dard w ar s P G n a t s e im t l l u f 124** week average numb of patients er a sees each w GP eek
* HIA Medical **From Australian Bureau of Statistics 2009-10 Health Care Services survey
GPRA — The future of general practice
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What GPRA is doing for you GPRA’s top priority is to find new ways to support GP registrars. Here’s just some of the work we’ve been doing lately. Policy and advocacy The GPRA Policy and Evaluation Coordinator facilitates policy development through working closely with GPRA subcommittees, the GPRA Chair and CEO to author discussion papers and submissions. Some key policy and advocacy areas GPRA will be working on in 2013 include support for Aboriginal and Torres Strait Islander registrars, rural and international medical graduate issues, terms and conditions of employment, assessment and standards, and furthering recognition and support for registrar medical educators.
Subcommittees and networks GPRA subcommittees are formed 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 the future of general practice in Australia. GPRA subcommittees are working parties of the advisory council 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.
Recent significant outcomes produced by the subcommittees include the registrar medical educator job description being accepted by RTPs, the publication of a resource for registrars advising them on how to maximise their in-practice teaching experience, and the publication of a discussion paper and statement of principles on fatigue management. We have recently revamped our subcommittees to give them more scope, a better teleconference platform, and improved email and forum facilities. These changes should result in improved continuity, support and succession. GPRA’s subcommittees are looking at the following areas:
• Assessment and standards • Closing the Gap • International medical graduates • Rural issues • Terms and conditions. In addition to the subcommittees there are two networks: Indigenous General Practice • Registrars Network Practice Registrar Medical • General Educators Network.
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Visit our website — gpra.org.au
1 GPRA and you
Joining a subcommittee or network 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 and to join email subcommittee@gpra.org.au
National Minimum Terms and Conditions for registrars As part of our work to support GP registrars, we negotiate the National Minimum Terms and Conditions (NMTC) for GP registrars every two years. Additionally, indexation to salary occurs each year. The NMTC was revised in late 2012. If you would like support to negotiate your contract, we have resources to assist you. Look for our negotiation guide and contract template at gpra.org.au For more information, see pages 135 – 140.
Webinars After reading the countless member feedback forms and surveys, GPRA now supports registrars through online web conferences on the following topics:
• Exam preparation • Negotiating employment contracts • Business development. Information on upcoming webinars is advertised through the GPRA e-newsletter and online at gpra.org.au
Future Series — business tips for new GPs GPRA’s Future Series business-focused webinars continue to be an overwhelming success. The business development webinars put registrars in touch with experts and experienced GPs who share first-hand knowledge about the business side of general practice. During 2012, 567 registrars attended live webinars, and webinars were downloaded 1,329 times after the series had finished. The Future Series covered four topics:
• Successful negotiation • Maximising your income • Making sense of GP business • Future GP opportunities. Keep an eye out for information about the 2013 Future Series in the GPRA e-newsletter and online at gpra.org.au/future-series For more information about the business of general practice, see pages 144 – 148.
GP First — working with junior doctors and medical students GPRA continues 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 44 hospital-based GP Ambassadors in 42 training hospitals. GPRA — The future of general practice
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Indigenous General Practice Registrars Network GPRA welcomes Aboriginal and Torres Strait Islander registrars. If you are an Indigenous GP registrar, we invite you to join the funded Indigenous General Practice Registrars Network (IGPRN) and meet with your colleagues for professional development and support. The primary objective of the network is to provide ongoing support for Aboriginal and Torres Strait Islander registrars. Over the past few years a group of Indigenous GP registrars has been formally meeting together, and in August 2012 GPRA received funding from GPET to become the auspice for this network. All costs associated with network meetings (flights, accommodation, meal costs) are funded for Aboriginal and Torres Strait Islander registrars. The network provides a forum for registrars undertaking the AGPT program to come together in a supportive environment to: and address issues such as professional • discuss and cultural isolation discuss and explore solutions for strengthening • communication and networking that support
Indigenous GP registrars through their training
participate in workshops and activities that • contribute to ongoing professional knowledge, 24
The network met in Alice Springs in October 2012 prior to the Pacific Region Indigenous Doctors’ Congress and plans were made for two face-toface meetings in 2013, as well as linking up via telephone, email and web meetings. The Chair of the network is Dr Angela Forrest. Angela is a descendant of the Galamai people of Western Australia. She completed her fellowship in 2009 and works in general practice in Hobart. Angela writes exam questions for the RACGP and is an examiner for the college. Angela is also the Tasmanian representative on the RACGP National Faculty of Aboriginal and Torres Strait Islander Health, which promotes culturally appropriate health systems for Aboriginal and Torres Strait Islander peoples. The network also has a part-time staff member, Stephanie May. Please feel welcome to contact the network via Stephanie, telephone 03 9629 8878 or email igprnenquiries@gpra.org.au
General Practice Registrar Medical Educators Network Registrar medical educators (RMEs) represent the future of medical education and GPRA is passionate about supporting and nurturing them. One way of doing this is through GPRA’s new General Practice Registrar Medical Educators Network (GPRMEN).
including exam support workshops and skill development in addition to supporting a healthy work-life balance. Visit our website — gpra.org.au
1 GPRA and you
The aim of GPRMEN is to provide a professional network for registrar medical educators and advocate for the role to exist in a quality framework. The network provides peer support via Here ’ achie s a snaps online discussion forums and vemen h ts fr ot of so 1. Jan m om t u a he pa e of GP teleconferencing facilities for r y guide RA’s st ye s: Ex 2012 — GP ar. plore 2. M RMEs around the country. r, G RA publ a
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A year
in the life of GPRA 2012
Take a look at what GPRA’s registrar network got up to in 2012 GPRA Board meetings 4 – 5 February and 16 – 17 June 2012, Melbourne The GPRA Board meets several times a year, including two face-to-face meetings, to can keep on top of registrar issues and continue to help steer GPRA forward. Board members also communicate via online discussion groups and webconferencing platforms.
Breathing new life into general practice 18 – 20 March 2012, Parliament House, Canberra The conference was GPRA’s sixth BNL event and the theme, ‘General practice in the HOT seat’ saw presidents of GP organisations, international speakers and key ministers take centre stage. It was a great opportunity for students, prevocational doctors and registrars to network with each other and key stakeholders. This year’s BNL event will be held on 19 March 2013.
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Visit our website — gpra.org.au
1 GPRA and you
Advisory Council meetings March and October 2012 The GPRA Advisory Council is made up of RLOs from around Australia and also includes national registrar representatives from various organisations. The group met face-to-face in March in Canberra at BNL, and in September following the GPET Convention in Melbourne. They also meet online twice a year, and have an active discussion group. The Advisory Council is the hub of GPRA’s advocacy activities. Indigenous GP Registrar Network 1 – 2 October 2012 The first GPRA Indigenous GP Registrar Network meeting was held in Alice Springs. The event was held in the lead up to the 6th Pacific Region Indigenous Doctors’ Congress conference. It provided an opportunity for Aboriginal and Torres Strait Islander GP registrars to come together to discuss issues that impact them in general practice training, and to explore solutions and ways forward. This meeting also provided an opportunity for the group to participate in workshops including exam preparation, negotiating contracts and self-care. Future Series webinars Held online, 26 June – 9 August The Future Series consisted of 15 webinars, with topics ranging from the basics of financial planning right through to buying and establishing a general practice. Other popular topics were superannuation, Medicare and locum tips. Hundreds of attendees logged on, including some from abroad. Future Series webinars, in addition to being a source of knowledge, are also a great opportunity to network with other professionals and hear personal experiences from your peers.
GPRA — The future of general practice
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Want to get more involved? As a GP registrar, you can play an active role in the delivery of the general practice training program by seeking employment as an RLO, joining a subcommittee or simply sharing your ideas. When you become a GP registrar, you enter a complicated world of training requirements, competing interests, politics and red tape. It is also a fascinating, ever-changing environment, where inspirational people continue to make changes to improve general practice training and the profession as a whole. Could you be one of these inspirational people? You don’t have to be knowledgeable about all the issues or excessively opinionated. If you are keen to contribute to better training, support current and future registrars, and learn more about the bigger picture, consider getting more involved. It’s a great way to broaden your skill set, networks and CV — and it can be very satisfying.
Could you be an RLO? Want to be paid for helping your peers? Then consider being an 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 sometimes 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.
Could you join a subcommittee? This is a great option for people short on time, or those with a specific area of interest. Usually a small group of people will meet via teleconference to work on solutions for a particular issue. For example, the Safe Hours
Dr Z ac h Ta pp en de n R eg is tr ar lia is on of fi ce r R TP : Tr op ic al M ed ic in e Tr ai ni ng Lo ca ti on : M ac ka y, QL D “I enjoy getting to know the re gistrars, making new friends and hopefully guidi ng them to be great future he alth care provide rs. There are perks — I get to travel all over Au stralia to attend meetings .” 28
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1 GPRA and you
Registrar rave Dr Casey Maddren Subcommittee completed a discussion paper that was circulated to stakeholders to raise awareness of the importance of safe working hours for GPs. It led to the development of the Fatigue Management discussion paper.
Could you be more vocal in your opinions? Just make sure you tell someone who cares, and who can do something about your concerns. Look out for emails from your RLO that may alert you to current issues and request your feedback. If you have an issue, concern or idea, don’t hesitate to raise it with your RLO. The progress of our profession relies on people to raise issues and suggest solutions. Contributed by Dr Christine Willis
Do itnow
My training provider is WentWest.
Registrar Rave
My current post is working as an academic registrar at the University of Sydney, Westmead. My research topic is GP registrars’ experience of death and bereavement care. I’m also GPET’s Registrar Research and Development Officer (RRADO) and doing some clinical work. A typical workday for me? I don’t have one! My work is varied and geographically diverse. I regularly travel to Canberra as the RRADO and work in two different areas of Sydney. The last book I read was The Help — an absolute delight with so many messages about friendship, sisterhood, equality, integrity, steadfastness and joy. Life is … such a gift. Being in general practice reinforces how blessed I am and how our time on this earth is limited.
For more information, talk to your current RLO or RTP
GPRA — The future of general practice
29
IPN: Experience the benefits of a community IPN is the largest operator of medical centres within Australia. With over ten years of experience in general practice management, you can be confident in establishing your career with us. We offer a supportive network you can rely on, within a community you can trust. For more information, visit our website at www.ipn.com.au. We look forward to working with you.
Supporting Better Medicine www.ipn.com.au
2
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
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 delivering educational activities and training material to registrars.
What is RVTS? For those who wish to train in isolated remote locations, there is an alternative to the AGPT
Other ways to fellowship There are other pathways to fellowship designed for experienced GPs. These pathways are not funded under the AGPT program and various fees are involved. For more information, visit the college websites racgp.org.au and acrrm.org.au 32
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program — the Remote Vocational Training Scheme (RVTS), which involves distance education and remote supervision (see pages 50 – 51).
What is the role of the two colleges of general practice? The RACGP and ACRRM establish training standards, set exams and assessments, accredit training placements and approve completion of training by registrars.
What are the endpoint qualifications? 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.
What is the difference between the two GP fellowships? ACRRM has specifically designed its curriculum to meet the needs of GPs practising in rural and remote settings. However, fellows of ACRRM may ultimately practise anywhere in Australia — rural, remote or urban. The RACGP 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 Fellowship in Advanced Rural General Practice (FARGP) as an additional optional qualification (see pages 43 – 44).
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
Australian General Practice Training program
Training providers
Hospital/practices
Vocational training
Fellowship of the Australian College of Rural and Remote Medicine
Quality general practice experience
Fellowship of The Royal Australian College of General Practitioners
Specialist recognition
GPRA — The future of general practice
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AGPT program endpoint qualifications and fellowships FRACGP qualifications (RACGP)
FACRRM qualifications (ACRRM)
Year one
Core clinical training time
Possible equivalence*
12 months
12 months
+ Year two
Primary rural and remote training 2 x 6 months
+ Joint training opportunities are available †
+ Year three
Primary rural and remote training 2 x 6 months
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
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.
You may wish to complete one, two or three qualifications (FRACGP, FARGP and FACRRM), and this can be integrated into your training course from the start.
Geographical classification Your training pathways and obligations are designed around the Australian Standard 34
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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
2 Your GP training experience
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) in partnership with your RTP after you have been accepted into the AGPT program. You can complete the rest of your general practice training via either the general pathway or the rural pathway. Fifty per cent of AGPT program placements must be in a rural pathway, which means RA2 and above. A rural pathway is not a reflection on the nature of your training; it only relates to the location of your training. 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).
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 141).
Rural generalist pathway The rural generalist pathway was pioneered in Queensland as a Queensland Health initiative to provide a fully supported, incentive-based career pathway for junior doctors wishing to pursue a career in rural generalist medicine, combining hospital procedural work with general practice. Rural generalist programs aim to offer opportunities for procedural skills training early in the training pathway. New rural generalist training programs are being developed all over Australia. For more information, talk to your state government health department. GPRIP incentive payments will apply to eligible registrars (see page 141). GPRA -—The future of general practice
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Northern Territory GP Education
Tropical Medical Training
WAGPET Adelaide to Outback GP Training
Queensland Rural Medical Education PLUS Central and Southern Qld Training Consortium
Central and Southern Qld Training Consortium North Coast GP Training GP Synergy New England/Northwest
Beyond Medical Education
GP Training Valley to Coast GP Synergy - Sydney Central and South/Southwest
WAGPET Sturt Fleurieu GP Education and Training
WentWest
Bogong
CoastCityCountry General Practice Training
GP Training Tasmania
Shared zone: Sturt Fleurieu and Southern GP Training
Shared/transitional zone
Southern GP Training
Victorian Metropolitan Alliance Shared zone: Southern GP Training and Victorian Metropolitan Alliance
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.
36
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Flexible aspects of training The AGPT program is known for its flexibility. Part-time training is a popular feature, especially for women with 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.
Is training funded? Training places under the AGPT program and RVTS are fully funded by the government and registrars are paid while training.
2 Your GP training experience
GPRAtip Recognition of prior learning
Can I be enrolled in another specialty program while doing the AGPT program? Yes, this is possible. It must be approved in advance by your 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 online at agpt.com.au
How GPRA helps
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
Who’swho ACRRM Australian College of Rural and Remote Medicine
With so many different entities involved, each with a slightly different focus, GPRA plays an important unifying role with its focus on the interests of the registrar.
AGPT Australian General Practice Training
Do itnow
FRACGP Fellowship of the Royal Australian College of General Practitioners
For more information about the Australian General Practice Training program, visit:
GPET
AGPT agpt.com.au RACGP racgp.org.au
FACRRM Fellowship of the Australian College of Rural and Remote Medicine FARGP Fellowship in Advanced Rural General Practice
General Practice Education and Training Ltd
GPRA General Practice Registrars Australia
ACRRM acrrm.org.au
RACGP the Royal Australian College of General Practitioners
Your RTP gpra.org.au/links#RTPs
RLO
Registrar liaison officer
GPRA gpra.org.au
RTP
Regional training provider
You can also speak to your RLO. You can contact GPRA on 03 9629 8878 or email registrarenquiries@gpra.org.au
For an expanded glossary of terms, see pages 149 – 154.
GPRA — The future of general practice
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Fellowship The RACGP
Fellowship of The Royal Australian College of General Practitioners (FRACGP) is held in high esteem around the world and certifies competence to practise unsupervised in any general practice setting in Australia. What is the FRACGP? Fellowship of the RACGP (FRACGP) demonstrates to governments, the general practice community and the Australian community that a GP has met the required level of competence to deliver unsupervised general practice services in any general practice setting in Australia — urban, regional, rural or remote. It also confers the ability to access specialist medical registration and consequently A1 rebate rates under Medicare legislation. International recognition of the FRACGP is expanding and is now recognised in New Zealand, Ireland and Canada. The RACGP also delivers conjoint fellowship exams in Malaysia and Hong Kong.
Vocational training towards FRACGP Vocational training towards FRACGP is three years full-time (or part-time equivalent), with an optional fourth year for additional skills and qualifications in rural general practice. There is flexibility in regard to when and how the essential components of training can be
40
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completed, such as the ability to complete the training on a part-time basis and/or take up to three years of leave. The essential components of vocational training towards FRACGP are: training (12 months) — Four • Hospital compulsory hospital rotations for general
practice training: general medicine, general surgery, emergency medicine and paediatrics. To complement this, you also need to complete three hospital rotations of your choice, provided they are relevant to general practice.
practice placements (18 months) • General — 18 months of general practice placements
need to be completed in RACGP-accredited teaching practices, and include a compulsory term (minimum of six months) in an outer metropolitan area or a rural or remote area.
skills (six months) — Provides an • Extended opportunity to develop your general
practice skills further and can be completed in a range of RACGP-accredited settings. Options include advanced rural skills, an overseas post, an academic post, or extended procedural skills within a hospital or practice.
2 Your GP training experience
Fourth-year additional training (optional)
rural skills — If you decide that • Advanced you want to become a rural GP or have a
strong interest in rural general practice and want to take your training and education further, you have the option to complete an additional 12 months of advanced rural skills training (ARST).
academic skills — You can also • Advanced apply for an academic term under the
RACGP pathway and work part-time in a university department and part-time in clinical general practice.
About the FRACGP exam Successful completion of the RACGP fellowship assessments is required for FRACGP. The fellowship assessment for registrars comprises two online segments: the Applied Knowledge Test (AKT) and Key Feature Problems (KFP), and a clinical segment — the Objective 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 segments. For more information about exam preparation, see pages 122 – 127.
Eligibility to enrol for the exam To be eligible to sit the fellowship assessments, all registrar candidates are required to have:
• current Australian medical registration • current financial membership of the RACGP from your RTP that you have • confirmation completed the required vocational training. Contributed by The Royal Australian College of General Practitioners
Get RACGP OSCE exam tips For tips from registrars who have done the exams — including the new online format — see pages 122–127.
Do itnow Find out more
For more information about the FRACGP exam, visit: racgp.org.au/assessment/examination racgp.org.au/assessment racgp.org.au/assessment/faqs
or for specific questions, email fellowshipservices@racgp.org.au
GPRA — The future of general practice
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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 exam
Prevocational General Practice Placements Program (optional)
Fourth year additional training in advanced rural skills or advanced academic skills (optional)
Successful completion of RACGP training and assessment
RACGP Fellowship
Continuing professional development
42
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Fellowship in Advanced Rural General Practice (FARGP) (optional)
RACGP
2 Your GP training experience
Fellowship in Advanced Rural General Practice
How far can you go as a rural GP? If you are interested in living and working in regional, rural or remote Australia, then the Fellowship in Advanced Rural General Practice (FARGP) is for you.
The FARGP is the qualification awarded by the RACGP beyond the vocational fellowship. The FARGP recognises advanced rural skills training that develops extended general practice skills and broadens options for safe, accessible and comprehensive care for Australia’s rural, remote and very remote communities. In 2011, the FARGP was extensively reviewed for the first time since its inception in 2006. Advice was sought from RTP staff, medical educators, key stakeholders and candidates (past and present). Based on the findings and current research, the new FARGP was developed and launched in April 2012.The FARGP e-learning platform was launched in October 2012. The new FARGP:
based on contemporary thinking in adult • islearning, reflective practice, self-determined
learning and places the learner at the centre of the process
• focuses on building the specific knowledge and skill sets required by individual GPs to
meet the needs of their local community
works best if you start early and go • rural so you can complete more of the
Speak to your RTP, medical educator, visit racgp.org.au/fargp or call the RACGP National Rural Faculty on 1800 636 764 for more information on how the RACGP can meet your needs.
Pre-requisites for general practice registrars:
• membership of the RACGP • working towards FRACGP • committed to working in rural
general practice
FARGP requirements:
• completion of a learning plan and reflection • 12 months in rural general practice • 12 months of advanced rural skills training in an accredited training post • completion of a six-month ‘working in rural general practice’ community-based project
of two advanced emergency • completion skills courses and a series of emergency
medicine activities
requirements before heading into the FRACGP exams.
GPRA — The future of general practice
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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
Do itnow Find out more
Learn more about the Fellowship in Advanced Rural General Practice from your RTP/RVTS. Alternatively, telephone the RACGP National Rural Faculty on 1800 636 764 or visit racgp.org.au/fargp
44
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Building your RACGP membership value Drawing on feedback from our members, we continue to work hard to enhance the range of quality services and resources that help you deliver better patient outcomes and support your quality of life. The Royal Australian College of General Practitioners (RACGP) membership package for registrars now offers even more in value and savings. As a RACGP Registrar member, you receive complimentary access to a number of educational services, in addition to exclusive savings on local and national RACGP workshops. You can also access member only savings on a new suite of general practice business resources, plus exclusive savings and benefits in the areas of finance, travel, insurance and health/wellbeing. Supporting your Fellowship preparation and learning
Join the RACGP or renew your RACGP Registrar membership today www.racgp.org.au/registrar or freecall 1800 331 626
Your RACGP Registrar membership package enables you to access high quality services and resources to support your Fellowship preparation and learning, including a range of practical self education tools, and a unique collection of journals, databases and e-books. One of your greatest resources are other registrars and GPs, and as a RACGP member you have the opportunity to tap into a wealth of knowledge and experience of our 21 500 members across Australia and the world.
Fellowship The ACRRM
The Australian College of Rural and Remote Medicine (ACRRM) has designed its general practice training program to meet the scope of clinical skills, knowledge and values required by the rural and remote practitioner.
What is FACRRM?
For more information on the pathway most suitable for you, contact the ACRRM vocational training team.
and unrestricted general practice anywhere in Australia.
Vocational training towards FACRRM
is granted recognition of prior learning.
The ACRRM training program comprises three stages of learning and experience. After first completing Core Clinical Training, a registrar may complete the remainder of the training requirements in any order.
posts including general practices, hospitals, Aboriginal Medical Services and the Royal Flying Doctor Service.
of ACRRM (FACRRM) is an • Fellowship approved pathway to vocational registration
is a four-year integrated training program. • ItTraining time is reduced where a candidate
Training occurs on the job as a registrar • in a range of ACRRM-accredited teaching wishing to achieve the FACRRM • Candidates can apply for one of three training pathways: the Vocational Preparation Pathway delivered by RTPs 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 learning.
46
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Clinical Training — 12 months • Core working in an accredited hospital, where you
complete terms in: – general internal medicine – general surgery – paediatrics – emergency medicine – obstetrics and gynaecology – anaesthetics.
Gaps in terms may be filled during subsequent stages of training. 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.
2 Your GP training experience
Do itnow Find out more
For more information, visit acrrm.org.au, telephone ACRRM on 1800 223 226 or contact ACRRM Vocational Training, training@acrrm.org.au
• Primary Rural and Remote Training — 24 months working in facilities accredited by ACRRM, to build your clinical and procedural skills and your confidence to work in rural and remote contexts. These facilities can include general practices, hospitals, 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. While there is considerable flexibility, the experience must include a minimum of six months in a community primary care setting and a minimum of six months living and practising in a rural or remote setting. 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 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:
– Aboriginal and Torres Strait Islander health – adult internal medicine – anaesthetics – emergency medicine – mental health – obstetrics and gynaecology – paediatrics – population health – remote medicine – surgery.
To achieve FACRRM, candidates must also successfully complete four ACRRM online education modules and at least two emergency skills courses approved by ACRRM (eg. EMST/ELS/PHTLS or equivalent, APLS, ALSO).
Frequently asked questions Why would I consider training for FACRRM? Fellowship of ACRRM equips you to practise unsupervised anywhere in Australia. This gives you real freedom, independence and scope of practice throughout your career. Your general practice qualification — complemented by Advanced Specialised Training — provides the skills and confidence to practise in a broad range of geographic and clinical settings. From solo practice in small communities to leadership roles in larger hospitals, from retrieval and expeditionary medicine to GPRA — The future of general practice
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Aboriginal Medical Services or urban general practice. Achieving a FACRRM will verify that you are qualified to practise anywhere. How is FACRRM integrated into the AGPT program? Registrars enrolled in the AGPT program can elect to train to either or both FACRRM and FRACGP. FACRRM training is open to both rural and general pathway registrars, provided they work in ACRRM-accredited training posts. What is the difference between ACRRM and RACGP training pathways? The ACRRM program is an integrated program that usually takes four years post-internship. However, there can be the opportunity for some of a registrar’s PGY2 or 3 training to be assessed for RPL. ACRRM has a unique curriculum and set of assessments that reflect the broad and deep requirements of the rural and remote context. Candidates must train in posts accredited by ACRRM. Can candidates do both qualifications at the same time? Yes, but requirements for placement, duration and completion of training are different between FACRRM and FRACGP. Registrars seeking both fellowships will need to talk to their RTP about a program that complies with both colleges. It is essential to enrol with ACRRM as soon as you enrol with an RTP. Do you have to undertake all training in rural or remote locations? No, while most registrars will spend a significant amount of training in rural areas, the focus is on gaining the skills and knowledge required in rural and remote settings. Many of these skills can be 48
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developed in urban or rural facilities. However, having a good understanding of the context of rural medicine is also essential, therefore all registrars must spend a period of training living and practising in a rural or remote setting. Can you train with ACRRM then later work in an urban setting? Yes, FACRRM qualifies you for vocational registration and approval to work in unrestricted general practice anywhere in Australia. When do you undertake the assessments? Once you have met the minimum eligibility of 24 months training, or equivalent RPL, you can commence assessment. However, it is important to note that the standard for all assessments is that of a doctor practising independently and safely at fellowship level, so it is important to be well prepared. While the order is not specified, it is strongly recommended that StAMPS is left until you have had experience across the broad range of learning experiences, including community primary, emergency and hospital care, and rural or remote settings. What is available to help in preparing for ACRRM assessments? New information is being developed all the time. Check the ACRRM website for sample questions and scenarios, plus recorded virtual classroom sessions and online modules on Rural and Remote Medical Education Online (RRMEO). StAMPS preparation workshops are now offered via live virtual classroom or face-to-face at least three times a year. Contributed by the Australian College of Rural and Remote Medicine
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.
supervision — Each registrar is • Remote 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. They can be found practising as RFDS 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.
2 Your GP training experience
Applicants must provide continuing, whole-patient care. Preference is given to doctors working in solo practice and those who cannot access the AGPT program. Once accepted, the registrar remains in the same location throughout their training. Check the RVTS website for complete eligibility criteria.
The endpoint This 3 – 4 year program meets the requirements for fellowship with both the RACGP and ACRRM. Twelve-month training is available in advanced skills curricula, such as anaesthetics, obstetrics and emergency medicine. Contributed by the Remote Vocational Training Scheme
Do itnow For more information, telephone RVTS on 02 6057 3400 or visit rvts.org.au
Dr Catherine Gargan
RVTS registrar Dr Catherine Gargan enjoys the stimulation of splitting her time between Darwin and remote Indigenous communities. Mondays and Tuesdays Catherine travels to the community of Maningrida in Western Arnhem Land, population 3,200. Her focus is child health, performing well kids’ checks to identify children at risk and managing chronic diseases in children. Wednesday it’s back to Darwin to tidy up loose ends and provide support to the community from a distance. On Thursdays she travels to the Nauiyu community in the Daly River region south of Darwin, where she mainly sees adults with chronic disease, usually diabetes and renal diseases. Friday is dedicated to meetings and following up outstanding issues. Catherine graduated in 2008 and spent a year in Bendigo, Victoria, before moving north in 2010. She joined the RVTS program in 2012, a move that means she can train for fellowship in the remote locations she prefers. “There’s plenty of assistance when I need it, which allows me to practise in a challenging and rewarding environment,” Catherine says.
GPRA — The future of general practice
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Joining forces with the ADF Around 2.5 per cent of GPs train in the Australian Defence Force (ADF). It’s an opportunity to develop leadership skills and specific medical skills in a challenging environment.
Training as a GP registrar in the ADF offers opportunities and challenges. ADF GP registrars must meet the same educational requirements but there are some specific policies that relate 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 GP 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 protection’ specialties. In addition, there are
2 Your GP training experience
limited opportunities to specialise after initial service as an MO in certain procedural specialties (surgery, anaesthetics, orthopaedics) required for providing higher level care on deployment.
ADF medical officer recruitment Most ADF MOs are recruited as medical students, some from universities and others from within the services. A small number join as direct entry qualified medical practitioners. Medical students and trainees serve as ADF members and attract a salary and ADF benefits such as superannuation, allowances, medical and dental care, and accommodation options while 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 program, 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 health system.
Competency levels Clinical employment is based on progression through clinical competency levels designated as ‘medical levels’ (ML). Beginning at ML1, MOs who have completed initial courses and a period of supervised
primary care are recognised as ML2. MOs at ML2 have basic skills and are considered suitable for remote supervision in a deployed environment. Those who have achieved FRACGP or FACRRM progress to ML3.
Remuneration In return for supporting the initial medical training, the ADF requires a Return of Service Obligation (ROSO) or Initial Minimum Period of Service (IMPS). During internship and residency, The ADF continues to pay the MO a salary, while wages earned from the hospital or other employers are paid to Defence. If hospital pay exceeds military pay, the difference is paid to the MO periodically. MOs at CL2 and above are reimbursed a further $10,000 annually for continuing medical education expenses. Contributed by Dr Geoff Menzies
Do itnow GP registrars and fellows wanting to explore a career as an ADF medical officer 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 the relevant person. Contact Bronwyn Ferrier Staff Officer, Medical Officers Telephone: 02 6266 4176 Email: bronwyn.ferrier@defence.gov.au For more information or to apply, telephone 13 19 01 or visit defencejobs.gov.au GPRA — The future of general practice
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Dr Joel Hissink A recently fellowed military doctor finds satisfaction serving on land and at sea. Lieutenant Commander Joel Hissink is currently posted to the HMAS Penguin Navy establishment in Mosman, NSW. The Sydney Harbour setting is idyllic — Joel can paddle his kayak to work from his nearby home. This is the site of the Navy’s submarine and underwater medicine unit and Joel is in charge. His work centres on occupational health — keeping assorted Navy crew medically shipshape. Duties range from conducting medicals on Navy divers to formulating diving policy across Navy, Army and Air Force.
Joel is also involved in research projects in collaboration with naval and civilian diving organisations around the world. One day a week he practises at a civilian general practice in Dee Why, an activity endorsed by the Navy as part of his continuing professional development. However, as a Navy medical officer he could be deployed to an operation at any time. One such deployment remains vivid in Joel’s memory. He was a member of an ADF medical taskforce that delivered emergency relief to thousands of displaced people after the Pakistan floods of 2010, one of the world’s worst natural disasters.
“Humanitarian work is one reason why many doctors are attracted to the The unit oversees a hyperbaric chamber that treats divers military.” — both Navy and civilian — for decompression sickness, known as ‘the bends’.
“People were coming in from a nearby displaced persons’ camp and were also travelling from further afield — up to 220 km — to reach our centre,” he says. The team treated some 215 patients a day for 53 days for malaria, cholera, tuberculosis, malnutrition, skin and eye infections and diarrhoeal illnesses. “It was an amazing opportunity. Humanitarian work is one reason why many doctors are attracted to the military,” Joel reflects. Joel originally joined the Navy in a different capacity and decided to retrain as a doctor under a generous postgraduate training scheme sponsored by the ADF. . 54
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2 Your GP training experience
Understanding the moratorium Have you come to Australia from overseas? Then there may be restrictions on where you can practise.
Doctors from overseas are being welcomed to help fill Australia’s GP shortage. However, to ensure these doctors work in the geographic regions that address workforce shortages, the Australian Government has certain policies that apply to international medical graduates (IMGs), 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.
Who is under the moratorium? The moratorium applies to: overseas-trained doctors who did not obtain their primary qualification in Australia or New Zealand
•
doctors trained in Australia or • overseas 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 to continue accessing Medicare benefits.
Reduction of moratorium time RA classification
RA category
Scaling % discount
Restriction period reduced to:
RA1
Major cities
Nil
10 years
RA2
Inner regional
10%
9 years
RA3
Outer regional
30%
7 years
RA4
Remote
40%
6 years
RA5
Very remote
50%
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Factfile 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 (see table on previous page).
Moreinformation •
•
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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
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What are IMGs, OTDs and FGAMS? IMG — International medical graduate A graduate who received their primary medical degree from a medical school outside of Australia or New Zealand. OTD — Overseas-trained doctor A doctor who received their primary medical degree from a medical school outside of Australia or New Zealand, who has also undertaken at least a portion of further training outside of Australia or New Zealand. FGAMS — Foreign graduate of an accredited medical school A doctor who received their primary medical degree from an Australian or New Zealand university, but who was a temporary resident when first enrolled in that degree. For the purposes of the AGPT program, the terms IMG and OTD are often used interchangeably. What resources are available? DoctorConnect website This has some very useful information including a map showing various RA categories and district of workforce shortage locations. Medical Observer IMG Survival Guide Published annually, this is essential reading for international doctors. Register for your free copy at medicalobserver.com.au Additional material contributed by Dr Zeshan Shaikh
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Dr Zeshan With a cosmopolitan background Shaikh spanning three continents, GP registrar Dr Zeshan Shaikh is thriving on life in an Australian regional city. He grew up in Canada, he has Indian ancestry and he came to the University of Tasmania a decade ago to study medicine. Now this global GP registrar is working in a corporate practice in the regional city of Orange, NSW. Dr Zeshan Shaikh is one of the many international doctors required to work for up to 10 years in a district of workforce shortage under the government’s 10-year moratorium.
“Part of the problem is labelling ‘international doctors’ as a single category.”
“Part of the problem is labelling ‘international doctors’ as a single category. International doctors form a diverse group of people and it’s difficult to generalise,” he says. “I find it challenging when patients expect me to speak a language other than English simply because of my ethnic background. But another international doctor may relish the opportunity.” Zeshan can see the appeal of staying on in a regional city like Orange when his moratorium time is up in five years but he prefers not to plan that far ahead. “I’d just like to continue working to gain more experience then see where I go from there,” he says.
Far from seeing it as a time-serving chore, Zeshan views the experience in a positive light. “The diverse foods and cultural experiences of a big city are made up for by short commutes, lower cost of living and access to amazing procedural opportunities,” Zeshan says. Circumcisions, Implanon insertions and minor skin surgeries are among the procedures he has witnessed and assisted with. There is also plenty of general practice work, with an emphasis on mental health and occupational medicine for the mining companies in the region. So what does Zeshan view as the biggest challenge for moratorium doctors? GPRA — The future of general practice
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Sub-specialise
Extend yourself with a special interest General practice is the most flexible of medical careers — you can shape it to suit your own interests. There are many opportunities for studying a special interest and gaining additional qualifications in a sub-specialty during your training time.
Extended and advanced skills training posts (RACGP) Registrars training towards the FRACGP will complete six months training in a post that provides the opportunity to learn relevant extended or advanced skills. The training can be undertaken in general practice, hospitals, an academic post, an overseas post or other appropriate settings where registrars will learn skills of use in their future general practice careers. If you are interested in a more in-depth experience, you can do an optional fourth year in advanced academic skills or advanced rural skills training (see FARGP). For more information, see pages 40 – 41 or visit racgp.org. au/vocationaltraining
Fellowship in Advanced Rural General Practice (RACGP) The FARGP is an RACGP qualification requiring completion of a 12-month advanced rural skills training post in conjunction with other learning activities. It can be completed concurrently with general practice training. For more information, see pages 43 – 44 or visit racgp.org.au/fargp
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Advanced Specialised Training (ACRRM) Registrars training towards ACRRM complete a compulsory fourth year of training in an advanced specialised training post. For more information, see page 46 or visit acrrm.org.au/teaching-posts
Other qualifications It is feasible to consider completing additional qualifications during these special interest posts, such as the Diploma of Child Health, Diploma of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Certificate of Primary Care Dermatology and others. The options are only limited by your imagination. Well, perhaps also a bit limited by funding and red tape, but don’t let that stop you from being creative and striving for your ultimate educational experience. Your training time is the ideal opportunity to try new things, extend yourself and discover your hidden talents, as there are many generous additional supports available that won’t be on offer once you become a fellow.
3 Exploring your options
Paediatrics and adolescent mental health
Special interest options
Dr Rebecca Jacobs RTP: Beyond Medical Education Location: Orange, NSW
Special interest posts completed by registrars include: Dr Rebecca Jacobs Aboriginal health boosted her paediatric academic medicine and research confidence in this alpine sports medicine award-winning post. anaesthetics Registrars see newborns aviation medicine to adolescents, with dermatology time divided between drug and alcohol medicine the Child and emergency medicine Adolescent Mental family planning and sexual health Health team and the paediatric “ I f o forensic medicine unit at Orange Base Hospital. und t he va could riety geriatrics be an in this emot quite post ional HIV medicine excep know roller tional what on-ca c oaste . It is goin men’s health ll, or r a s g when you n to oc or th y ever c o u e mental health u are r whe chall called enges n you or th a t are e tha doles o att musculoskeletal medicine nks y end a cents ou w birth, will t obstetrics ill get hrow from at yo a fam u occupational medicine ily.” paediatrics population medicine refugee health remote medicine Most RTPs will do their best to arrange an Royal Flying Doctor Service experience you would like to try, even it is rural generalist surgery not one of their standard offerings. In some small town rural general practice cases, it may involve a temporary transfer sports medicine to another RTP — especially for a rural surgery experience. But do get your request in early. travel medicine It is very important to talk to your RTP well tropical medicine in advance of the placement for the best women’s health chance of making it happen … plus many more!
• • • • • • • • • • • • • • • • • • • • • • • • • • • • •
GPRAtip
Contributed by Dr Christine Willis
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Anaesthetics Dr Jonathan Ramachenderan RTP: Western Australian General Practice Education and Training Location: Perth, WA Dr Jonathan Ramachenderan did a 12-month stint as a GP anaesthetic registrar at Joondalup Health Campus in Perth to prepare for the cases he would later encounter as a rural GP. He has since moved with his family to Albany on WA’s south coast.
“ “The procedural and dynamic natu re of manipulating ac ute physiology at tr acted me. I love placing IV cannulas, centra l lines, being involved in airway management and patients. I see re su sc itating sick myself as a ru ral critical care done further tr doctor, having aining in emerge ncy and critical care.”
Obstetrics and gynaecology Dr Rhiannon Smith RTP: Sturt Fleurieu General Practice Education and Training Location: Murray Bridge, SA Dr Rhiannon Smith originally had a dilemma choosing between general practice and O&G. Doing her DRANZCOG (Advanced) through the Bridge Clinic and Murray Bridge Hospital allowed her to combine two careers in one. rough her a patient th g in ee s c ti en seeing n fantas labour, th “It has bee er h g in ag ther ancy, man visor and o entire pregn . My super p u w o ll o for or f s available the baby f were alway ns ia morning. ic e tr th te GP obs ours of h y rl ” ea e my fridge! en in th photos on support, ev y ab b f o e a gallery I now hav 62
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3 Exploring your options
Sexual and reproductive health Dr Vanessa Huang RTP: Southern GP Training Location: Melbourne,VIC Dr Vanessa Huang spent a term working with Family Planning Victoria at Box Hill and Action Centre for under 25s in the Melbourne CBD. Her objective was to fine-tune her knowledge of sexual health issues.
“I was seeing cl ients wanting co ntraception advic doing up to five e, Implanon inser tions a day, ST treatment, sex I ch eck-ups and worker checkups and unplan I am now a lot ne d pr eg nancy counselli more confident ng. and competent health issues.” dealing with se xual
Do itnow For more information about the extended skills and special interest training, talk to your RTP For more information about academic training posts, see pages 74 – 77; for Aboriginal and Torres Strait Islander health, see pages 68 – 73; and for a profile of a rural-remote registrar, see pages 65 – 66
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GPs are vital to the cancer journey ...
Research
Treatment
Referral Screening
Prevention
We have the resources to support you NSW CERVICAL SCREENING PROGRAM
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www.cancerinstitute.org.au/direct
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Rural-remote posts
3 Exploring your options
A rural takes career off Rural-remote GPs are known for their wide-ranging skills. Registrar Dr Gerry Considine has similar diverse interests after hours as a pilot, blogger, rocker and a fairly ordinary footy player.
When Dr Gerry Considine was thinking of moving to a speck-on-the-map town in South Australia to further his general practice training, one thing clinched the deal. The GP who was to be his supervisor owned two planes. As someone with a longstanding ambition to learn how to fly, Gerry’s mind was made up. Wudinna it was.
“Luckily, they weren’t a result of my rough play,” he says with a grin. “If that happened and continued, I’m sure Medicare would have asked some questions.”
“After playing footy Gerry splits his time one day, I was asked between hospital and general practice work. to stitch up a lip and “There are morning afternoon general take an X-ray from and practice patients, with a couple of outpatients the game I had just usually presenting at the been in.” hospital for X-rays or suturing.”
Since then, he has earned his recreational pilot’s licence, and thrown himself into work and community life. Playing on the wing for the Wudinna B-grade footy team is a weekend ritual.
Gerry was inspired to study medicine by his grandfather, an ear, nose and throat specialist. “He has a real sense of humanity and doing something for others,” Gerry says.
“I enjoy being part of the community and improving the health of people I see in the supermarket or at the football,” he says.
“During my medical training, I had two very positive experiences in rural general practice. These cemented my plans not only to do general practice training but to head bush with it.”
One incident made Gerry realise just how private and professional lives are knitted together in a country town. “After playing footy one day, I was asked to stitch up a lip and take an X-ray from the game I had just been in,” he recalls.
Gerry is currently working towards both general practice college fellowships as well as a Diploma in Child Health. His obsession with flying continues, he is working towards getting his private pilot’s licence which GPRA — The future of general practice
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may come in handy to get around the country as a GP in the future. Other extracurricular activities include playing in an indie rock band called Stomp the Orange. He has also embraced the digital world and he blogs and tweets on everything from learning to
Factfile Rural-remote training is offered by regional training providers (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 (see page 35).
fly to medical policy issues and a miscellany of life’s little absurdities. You can visit Gerry’s blog at ruralflyingdoc.wordpress.com
Qualifications Registrars training to the RACGP curriculum have the option of concurrently training for an additional qualification that recognises advanced rural skills training (ARST) — the Fellowship in Advanced Rural General Practice (FARGP — see pages 43 – 44). The ACRRM curriculum, by definition, emphasises skills for rural and remote medicine. Rural generalist pathway The rural generalist pathway is another emerging training route pioneered in Queensland, which is now being developed in other states. For more information, talk to your RTP.
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Aboriginal and Torres Strait Islander Closing the gap between the health of Aboriginal and Torres Strait Islander peoples and 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 regional training provider (RTP). Clinical training at an Aboriginal and Torres Strait Islander health training post is optional.
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 68
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health training 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, coordinated by a chief executive officer and managed by a locally elected board of directors. In some regions, shared training positions are available that 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 35 for details).
Why take up 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.
3 Exploring your options
Cultural awareness training Before you start your post, you will typically attend a cultural awareness training course, as part of mandatory education, 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.
The GPET response to the Closing the Gap strategy 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 is being developed to enhance registrar Aboriginal and Torres Strait Islander health training in the AGPT program.
Indigenous GP registrars There are growing numbers of Indigenous doctors in Australia. GPRA helps to provide support to Indigenous GP registrars through the Indigenous General Practice Registrars Network (IGPRN) About IGPRN Indigenous GP registrars often face unique challenges. The IGPRN is a funded network for Aboriginal and Torres Strait Islander GP registrars that provides ongoing support services under the auspices of GPRA. For more information about the network, see page 24, telephone 03 9629 8878 or email igprn@gpra.org.au The Australian Indigenous Doctors’ Association also provides support for Indigenous doctors at aida.org.au Indigenous doctor and medical student stats Aboriginal and Torres Strait Islander doctors and students in Australia: GP registrars — 41 Medical practitioners — 153 Medical students — 218 Source: Australian Indigenous Doctors’ Association and GPRA
Do itnow How to find out about Aboriginal and Torres Strait Islander health training posts 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
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Aboriginal and Torres Strait Islander health
whole Treating the person Working in Aboriginal health in Melbourne, Dr Deepthi Iyer discovered the positive power of holistic medicine, being part of a workplace ‘family’, and sharing a piece of cake. Dr Deepthi Iyer RTP: Victorian Metropolitan Alliance Location: Melbourne,VIC
“Patients were warm and welcoming, and brought in food and cakes to be shared with all the staff and other patients.”
“I trained in New Zealand and always loved the holistic approach to health and wellbeing of Maori people,” Dr Deepthi Iyer reflects. “I wondered if Aboriginal people were similar in their view.”
At the clinic, Deepthi split her time between seeing booked general practice patients and working in the walk-in treatment room as the duty doctor.
So began Deepthi’s determination to “get some experience and learn about Aboriginal culture”. The Victorian Metropolitan Alliance (VMA) registrar took up a post at the Victorian Aboriginal Health Service in the inner-city Melbourne suburb of Fitzroy, and describes the experience as “life-changing”. “The staff adopted me as part of their family and looked after me as if I had always worked there,” Deepthi says.
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She soon discovered that, as with Maori people in New Zealand, the Aboriginal approach is holistic too. Appointments allowed time to get to know the patient and understand their social situation. “I had half an hour to see my patients and could have a long chat with them as well as take a detailed history and examination,” Deepthi explains. “My knowledge of chronic disease, mental health and acute medicine increased.” Deepthi found the post immensely helpful in preparing for her exams. “My clinical practice was excellent preparation and it also helped that my supervisor was enthusiastic in running through OSCE station scenarios for me,” she says. She says she appreciated being part of a close-knit team with the nurses, administration staff and Aboriginal health workers. “They often knew more about the patient’s social history,
3 Exploring your options
Registrar rave Dr Danielle Arabena home set-up and past medical history,” she says. Deepthi’s part-time job as a registrar liaison officer at VMA completes a busy and varied week. She is also an active member of Melbourne’s Indian and Hindu community, and teaches Hindu culture at a local school. So what would Deepthi say to other registrars about doing an Indigenous health post? “You have to work in one to understand that it is really very rewarding.” Deepthi’s tips on working in an Aboriginal Medical Service
•
•
•
Give it a go — try it! The community has a big heart Understand the holistic approach — focus on the physical, mental and spiritual health of the patient Get to know your colleagues — talk to the nurses and Aboriginal health workers and you will hear interesting stories about their upbringing and way of life.
My training provider is Central and Southern Queensland Training Consortium.
Registrar Rave
My current post is at the Majellan Medical Centre in Scarborough near Brisbane, a private practice that is Indigenous-friendly. As a Torres Strait Islander GP registrar, I love seeing my Indigenous patients every day. A typical workday for me involves laughing, engaging, advocating and sometimes a little cry with a patient. I am inspired by members of the Australian Indigenous Doctors’ Association and the GPRA Indigenous General Practice Registrars Network, by my mob’s journey into medicine and by the resilience that we as Indigenous medical students and doctors have — all with a desire to help our community. My biggest challenge was finishing my medical degree while being a mother. I would have to get up at 4 am to study before everyone else woke up.
For more information about doing a term in Aboriginal and Torres Strait Islander health, see pages 68 – 69.
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Academic posts
About academic training posts
What is an academic training post?
What could this post lead to?
An academic training post gives you the chance to try out research and teaching as a salaried registrar in the GP training program.
Past academic registrars are involved in university jobs, medical educator positions, higher degrees in research, medical editing, supervisory roles with medical students, and positions within the colleges and GPRA.
In the RACGP curriculum, it may be either an extended skills post, an elective extension of training or advanced rural skills post if your research is based in a rural area. Academic training posts are also available with ACRRM. To be eligible to do an academic post, you need to complete six months of full-time general practice training.
What does an academic registrar actually do? Posts involve a mix of teaching and research. It’s an opportunity to learn and refine skills like presenting, writing, curriculum development, assessment of students, lecturing and literature skills. You usually work part-time in a general practice and part-time in a university department. There is also a post available in medical editing based at the RACGP, working on Australian Family Physician (AFP). It combines time with the publication, time with a university department or other academic setting, and clinical work. GPET provides support to registrars through a series of webinars, an orientation workshop and a funded two-day workshop for academic registrars halfway through the post.
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Registrar Research Workshop 2013 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 (PHCRIS) annual research conference. The workshops are usually held 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’. Let the Registrar
3 Exploring your options
Research and Development Officer (RRADO) know you are interested or contact the Academic Support Team at academic@gpet.com.au There is a registrar research fund to support research projects and a registrar research prize. For more information, visit agpt.com.au
What is the RRADO? The 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. 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 office is required. To find out more, contact the current RRADO, rrado@gpet.com.au Below: Dr Jo-Anne Manski-Nankervis, who researched diabetes as part of her academic post, shares her experience with other doctors, including GPRA Chair Dr Ed Vergara
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. For more information about being a registrar medical educator (RME), see pages 112 – 113.
How to apply Talk to your 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. There is an application form available at agpt.com.au — follow the links to ‘Training posts’ and ‘Academic training’.
Do itnow If you are interested in doing an academic term, talking to your medical educator is a good place to start. You can also contact the Academic Support Team from GPET, academic@gpet.com.au or the current RRADO, rrado@gpet.com.au Visit researchweek.com.au — there is a recording ‘Everything I need to know about an academic post’. A brochure about academic posts is available at agpt.com.au or from your RTP. For further information about academic training posts, visit agpt.com.au then follow the links to ‘Training posts’ and ‘Academic training’.
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Academic posts
Food for thought Can food gardens in Aboriginal communities improve diets and lower disease rates? GP registrar Dr Andy Hume is working on a research project to investigate. Dr Andy Hume RTP: Northern Territory General Practice Education Location: Darwin, NT
In his big straw hat, Dr Andrew (Andy) Hume looks more like a gardener than a GP.
But when you learn that he spends much of his time visiting food gardens in remote Northern Territory Indigenous communities, it all makes sense.
“Academic general practice offers the chance to investigate and possibly alter the factors that mediate disease.”
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Andy is undertaking a research project with the nutrition team at the Menzies School of Health Research, an arm of Charles Darwin University. “I am investigating remote Aboriginal food gardens in the Northern Territory because I think horticulture in remote communities has a role to play in improving diets and reducing the burden of lifestyle diseases such as heart disease, diabetes, obesity and certain cancers,” he says. It’s hard to think of someone better qualified than Andy for such a research project. He began his university studies doing agricultural science, switched to general science then did a postgraduate medical degree, so the synergies between his interests in agriculture, horticulture and medicine are obvious.
3 Exploring your options
As a GP registrar, he enjoys the academic side of general practice as well as the clinical. “Academic general practice offers the chance to investigate and possibly alter the factors that mediate disease,” he says. “I see academic work underpinning general practice and vice-versa.” Andy has been working on the project for two years half-time. He spends the other half of his time doing clinical work in a Darwin general practice. “In 2011, my research aimed to find and document all the remote Aboriginal food gardens in the top end of the Northern Territory,” he says.
talking with a manager or a gardener about what they do, I have to remind myself that this is a job,” he concludes. In 2012, Andy moved on to a remote school gardening and nutrition pilot. Meanwhile, the desk-bound work continues as he writes up his research report, which is pending publication. To spread the word about his work, Andy has set up a website to promote the gardens and improve collaboration between gardeners. You can visit Andy’s website at ntgardens.org
Up at dawn to hitch a ride with the medical outreach service or making the long dusty road trip to far-flung communities; the days on site were long but rewarding. “I visited and documented many of these gardens, quantifying their location, size, funding, management and employment structures, and what they were growing and distributing,” Andy says. Andy also undertook qualitative research during garden visits to examine the perceived benefits, barriers and enablers to sustainable operation of gardens.
Andy’s academic term tips
“Hopefully this will help others to start and run gardens more easily,” he says. “Sometimes when I’m sitting under a tree in a remote community
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Choose the right project — find an achievable topic that really interests you. Choose the right supervisors — find supervisors you get along with. Allow time — leave plenty of time to write up your research and for publication. It takes longer than you think.
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Travel while you train Travel
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 the RACGP and ACRRM offer exciting opportunities to complete part of your general practice training overseas. Typically these are six-month full-time positions, 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 include the United Kingdom, Ireland, USA, New Zealand, China, Malaysia and the Middle East (Australian Defence Forceposts). Overseas terms are a fantastic opportunity to broaden your horizons while completing your general practice training. 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.
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.”
Do itnow For further information regarding overseas training posts, visit the college websites racgp.org.au or acrrm.org.au Your RTP will be able to give you information about the ‘travel while you train’ opportunities they may be able to offer you. Southern GP Training (SGPT) in Victoria and South Australia has an Irish exchange program. Visit their website at southerngptraining.com.au
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Term
allocation and choice
Choosing your practice placement Planning ahead will give you the best shot at getting the general practice placements you want. Regional training providers (RTPs) are responsible for allocating registrars to general practices for each general practice term, and for ensuring all placements are appropriate and accredited. The system of allocation is determined by the individual RTP and varies considerably between RTPs. Allocation systems may involve interviews with prospective practices chosen by the registrar (for interview tips, see pages 82 – 84). Alternatively, the RTP may determine the placement with little or no registrar input. The method of placement for the majority of RTPs lies somewhere between these two extremes. 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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Consider your goals When choosing a practice there are many aspects to consider. To start with, think about your goals for the term. 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 women’s health? Then being a male registrar in
4 Term allocation and choice
a female-dominanted 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 (for learning plan tips, see pages 94 – 96). 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? — What role will medicine play in •your Lifelife goals for the next six or 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 home, hospital work and home visits? How well equipped is the practice? Consider other work conditions including leave, teaching and pay (refer to the National Minimum Terms and Conditions on the GPRA website).
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 if you are 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 questions and topics you might like to raise
Practice — What special interests and skills •do people in the practice have that you can
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learn? Will you have your own room, or will you 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?
4 Term allocation and choice
hours — What days and hours are •you Work expected to work? Will you be working
Leave — You are entitled to paid leave •arrangements set out under the Fair Work Act
Saturdays? Will you be doing nursing home visits and house calls and, if so, when? What are the on-call and after-hours commitments?
2009 and National Employment Standards. Some practices will allow you to take study leave (unpaid unless part of your annual leave). If you have particular weeks in mind for your annual leave, mention this at your interview.
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?
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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.
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Education and supervision — How does the practice structure your in-practice teaching (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 supervisor take on this role? How does your supervisor like to be contacted when you need help with a patient?
— What is the practice prepared to •pay Pay in salary or percentage of earnings for your ordinary 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)?
GPRAtips detailed information about minimum • For salaries and conditions for registrars
according to the NMTC and further negotiation tips, see pages 136 – 140.
a comprehensive guide on how to • For negotiate a win-win contract,
download the e-book More than Money: A negotiation guide for GP registrars at gpra.org.au
Mor e th an M oney
2011
Hospital work — Are you expected to •undertake work at the local hospital? How are
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Registrar rave Dr Ashe Nicholas My training provider is Tropical Medical Training.
Registrar Rave
My current post is GPT3, for which I’m doing a rural term in Charters Towers in north Queensland. Before that I did an extended skills post as a registrar medical educator. A typical workday for me starts with an emergency clinic, then later I see booked patients. I still work as a registrar medical educator so I often come home and do some preparation for a talk or educational program. I enjoy my current post because I see a lot of acute medicine and pathology you would not see in a larger town. An ‘aha’ moment for me was when I was accepted into general practice training — a wonderful feeling. My favourite technical gizmo is the forehead thermometer because it’s much easier to use with kids.
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If they pay less, don’t sign anything! If you are unsure, ask your registrar liaison officer (RLO) or contact GPRA’s Registrar Services team (see pages 86 – 87). 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. 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
Automatic cover for the treatment of public patients …you’re covered with MIGA
Sleeping easy is knowing you have the right cover in place. Medical indemnity policies for doctors aren’t the same and your current policy may not offer the cover you need. If you’re embarking on a GP placement call us today on 1800 777 156 or insure online at www.miga.com.au.
Call us on 1800 777 156 www.miga.com.au
Always on your side
Insurance policies available through MIGA are issued by Medical Insurance Australia Pty Ltd (AFSL 255906). MIGA has not taken into account your personal objectives or situation. Before you make any decisions about our policy, please read our Product Disclosure Statement and consider your own needs. Call MIGA for a copy or visit our website. © MIGA October 2012
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 general practice training who are specifically employed for this purpose and who are happy to help 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 registrar liaison officer (RLO) is always there in the first instance to support and advise you, no matter how big or small the problem might seem. The RLO is a registrar just like you and it is their job to help you.
As an example, you might try to resolve the problem with the practice or RTP directly if it is an issue regarding practice placement. 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.
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4 Term allocation and choice
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. This consists of 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.
GPRA can also be contacted directly by registrars for any issue, however it is often the RLO and their local networks who can help the most.
Dispute resolution guidelines Many RTPs are developing, or have developed, local documents outlining a dispute resolution process that can guide you if problems arise. Check the website of your RTP or ask your RLO. Remember, all employees are covered by national and state law regarding employment-related matters, including maternity leave, discrimination, sexual harassment, bullying prevention and more.
The GPRA Registrar Services team If matters need resolution beyond your RTP, consider involving the GPRA Registrar Services team (see page 14 and GPRA tip box below). Contributed by Dr Jen Lonergan
GPRA is run for registrars by registrars, which creates a non-threatening source of advocacy and support.
GPRAtip If you have an issue about your training or employment-related issues, it’s best to try and resolve it by talking to your practice, your RTP or RLO. You can also contact the Registrar Services Team at GPRA, registrarenquiries@gpra.org.au or telephone 1300 131 198
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What you can do
if things go wrong Do you have questions about employment and conditions?
Visit gpra.org.au Go to the National Minimum Terms and Conditions document on this website If the website does not answer your questions or you still have concerns
Do you have issues with your training or your practice
Talk to the parties involved This may include: • the practice • the RTP
If talking to the parties does not resolve the issue, or you feel uncomfortable about talking to them, contact your RLO. Your RLO is there to provide support and advice If the matter is still unresolved
GPRA Registrar Services Team
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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: for a Medicare provider number • Application for the practice and, if applicable, the local
hospital if a visiting medical officer (VMO) position is attached. Allow at least eight weeks for this to be processed.
for recognition as a general • Application practitioner (AGPT) in an accredited
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indemnity — You must have • Medical your own indemnity to cover general
practice work. 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 state or territory medical boards. Employment contract and confirmation of employment agreement.
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Note: Your employment contract 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, and visit the ‘National Minimum Terms and Conditions’ page). For more information about negotiating your contract, see pages 136 – 140 or download the e-book More than Money: A negotiation guide Mor for GP Registrars at gpra.org.au/ e th an M oney 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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Which 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 Indigenous General Practice Registrars Network (IGPRN) — A support network for Indigenous GP registrars coordinated by GPRA. Go to gpra.org.au or email igprnenquiries@gpra.org.au General Practice Registrars Medical Educator Network (GPRMEN) A network of registrars with an interest in medical education. Email gprmenenquiries@gpra.org.com.au The 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, eg. a subscription to check and free textbooks such as Murtagh’s General Practice or Australian Medicines Handbook. 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
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local division of general practice or • Your Medicare Local — Find out who to contact
from your practice or RTP Rural Doctors Association of Australia (RDAA) — Go to rdaa.com.au Australian Indigenous Doctors’ Association (AIDA) — A not-for-profit organisation that encourages Aboriginal and Torres Strait Islander peoples to work in medicine by supporting Indigenous students and doctors. Go to aida.org.au Australian Medical Association (AMA) — Contact your state branch. Go to ama.com.au
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What equipment will I need? Equipment: Your own stethoscope An auroscope/ophthalmoscope (diagnostics set) Consider a tympanic thermometer for children and a magnifying glass or dermatoscope for skin checks Consider using equipment you are comfortable with: eg. 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.
Some practices have reference books, posters and models in the rooms; otherwise start collecting your own. 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 for emergency medicines and equipment 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 this 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 Your Medicare Local may have contacts to purchase these locally.
5 Preparing for practice
What books and resources will I need? Your practice should have some basic texts in an accessible space for you to use during consultations. Many resources will be online as part of the medical software you use during consults, or on your telephone or iPad. Some texts and CDs/DVDs are available for short-term use through the RACGP John Murtagh Centre, which has a postal service. You may receive useful resources as part of your college membership, so check this before making a big purchase. Contributed by Dr Christine Willis, Dr Siew-Lee Thoo, Dr Naomi Harris, Dr Kate Kelso and Dr Kirsten Patterson
Moreinformation If you have read this and still have questions, contact:
• your RLO or ask your RTP • GPRA registrar enquiries, enquiries@gpra.org.au or telephone 03 9629 8878
• your medical educator (see your RTP) • your supervisor
Registrar rave Dr Fabian Schwarz My training provider is Beyond Medical Education.
Registrar Rave
My current post is working as a Royal Flying Doctors medical officer in Broken Hill, NSW. It involves aeromedical retrieval, remote general practice clinics, Aboriginal and Torres Strait Islander health and emergency medicine. A typical workday for me starts with coffee, followed by packing the Super King Air with the gear for the remote clinic, then sinking into the passenger seat as the aircraft takes off into the sunrise. I am inspired by people who make sacrifices for others without making a big fuss about it. A quirky fact about me is that I have a twin brother, who was born first, but is now my younger brother. How can that be? He lives in the northern hemisphere, and the time difference makes me a few hours older!
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Designing
your learning plan
Every new GP registrar needs a personalised learning plan. Here are some tips on how to develop your learning plan and get the most out of it. One of the first things you’ll need to do as a GP registrar is design your own learning plan. A learning plan is a structured tool that clarifies your learning needs and goals, and the activities you plan to undertake to achieve your goals. It is about your self-directed learning, separate from the teaching you get through your RTP at workshops and tutorials. Most RTPs have a web database designed for documenting your learning plan. It is important to find a format for your learning plan that works for you. Some registrars have found that being creative and thinking outside the box for their learning plan really works for them. You will receive information and guidance about your learning plan early on from your RTP. If you feel stuck, your medical educator or training advisor is the best person to ask. Your supervisor and registrar liaison officer (RLO) will also be able to help you.
Why is a learning plan necessary?
is how you take control of your • This own learning plan is a requirement of your • AGPlearning training
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provides a structure for your • Itself-directed learning will assist your supervisors and medical • Iteducators to help you meet your
learning needs It keeps you motivated when the work seems hard It keeps you focused when you are feeling overwhelmed.
• •
Step 1: Identify your learning gaps
is the tricky bit, but resist the natural • This inclination to keep studying things you know yourself which patients stress you the • Ask most and why (demographic or clinical presentation) Do quizzes (check, Australian Family Physician, gplearning) Discuss with your supervisor, medical educator, other registrars Take notes on questions and needs that become apparent while you are consulting each day Refer to the RACGP curriculum Your RTP may also have useful resources.
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5 Preparing for practice
Step 2: Write SMARTER goals (what you are aiming for) and strategies (what activities you’ll do to get there)
• Specific • Measurable • Achievable • Relevant • Time-framed — how will you know when you • Evaluate have achieved the goal? • Re-evaluate — learning is a lifelong process. Planning strategy activities
– audits of your prescribing, referral or investigation activities – discussion in study groups – a session with a specialist or allied health professional – your day-to-day work — choose placements that support your learning needs – videotaping your consultations – sitting in with your supervisor or other GPs in your practice to see how they approach problems – spending time with other staff in the practice such as nurses for wound care or the practice manager for the business side of medicine.
you have achieved your goal.
broadly about all the ways you learn • Think Assess which learning needs are best met by • what types of activity Step 3: Evaluate your learning Examples of include: • – reading texts,activities review your plan • Regularly guidelines, journals you include markers of success in • Ensure and magazines the planning stages so you will know when
– watching DVDs, webcasts, listening to podcasts – attending educational events – online learning (gplearning with RACGP, RRMEO with ACRRM) – completing a course — eg. APLS, EMST, Family Planning Australia – weekly supervisor teaching session (if these are planned in advance you will get more out of them) – teaching facilitated by RTPs such as workshops and tutorials
An example of an entry in a learning plan Need: To improve my ability to perform comfortable and accurate Pap smears. Goal: To ensure patients receiving Pap smears are well informed and comfortable; to utilise appropriate positioning and equipment; to perform the procedure within five minutes; to achieve 100 per cent samples containing an endocervical component.
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Registrar rave Dr Jason Agostino My training provider is Tropical Medical Training.
Registrar Rave
My current post is GP registrar at Gurriny Yealamucka Aboriginal Health Service and academic registrar at James Cook University. I enjoy the complexity of Aboriginal primary health care and working in a team environment. My research and teaching gives me time to do meaningful work without the constant pressure of sick patients. My GP role model is Dr Richard Heazlewood because he used his own initiative to improve the health care of children in Cape York instead of waiting for the government to act. After hours I like to spend time with my wife, cook pasta, bum around at the markets, ride my bike and head out to the reef. Life is … getting better every year.
Strategy activities:
the Cervical Screening Guidelines • Read within the next two weeks with the practice nurse for five • SitPapinsmears and ask the practice nurse
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to observe five of my Pap smears within four weeks Attend NSW Family Planning Association course at the next available date this year.
Evaluate progress by:
feedback (are they comfortable?) • Patient the procedure • Timing Assess accuracy • by pathology with reports provided Feedback from nurse • Assessment at NSW FPA course. • Contributed by Dr Christine Willis and Dr Emily Farrell
Do itnow For more information, see AGPT Guidelines to Assist in the Development of Learning Plan/Programs at agpt.com.au/Registrars/ GeneralInformation
New GPRA in-practice teaching resource GPRA has developed an excellent new in-practice teaching resource that can be a great help in exploring the most effective learning styles for you when designing your learning plan, available at gpra.org.au
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First day survival tips
Starting your first day at a new practice? Here is a novice’s guide to making it through those first consultations with ease. In your room
resource books (see the resource lists • Put on pages 156 – 160 for suggestions) in your
Open all the cupboards in your room to • find room if available. where everything is. where all the prescription, pathology • Locate Therapeutic Guidelines, either • Locate and radiology forms are kept in your room, print copies or put it on the desktop
and check with reception staff where the 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 telephone. 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 (MCS, PCR) and specimen jars.
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of your computer. Add useful and recommended websites to your favourites or bookmarks list on 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 with. Locate where information leaflets are on the toolbar (especially Medical Director). Start collecting resources that will be useful during 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, • Check especially 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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5 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 (eg. Pap smears, psychological interventions and care plans, skin excisions).
•
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•
With your supervisor
including who follows up your patients’ results after you leave the practice. Establish their preferred method of being contacted for questions during consultations (eg. telephone, 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. •
Check the practice booking and • billing system. Ask about the practice policy on checking • 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 Phil Deakin
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 (eg. notebook on your desk, manila folder with patient consult summary printed) to ask your supervisor or look up.
My training provider is Sturt Fleurieu General Practice Education and Training.
Registrar Rave
•
My current post is GPT2 registrar with Goolwa Medical Centre, Goolwa, SA. I’m also the registrar liaison officer for SFGPET.
A typical workday for me? Ha! No such thing! We manage everything from acute emergencies through to palliative care.
Contributed by Dr Emma Ryan and Dr Kate Kelso
I enjoy going to work each day. We have excellent supervisors, nurses, practice staff and a local community who have all made this Canadian feel right at home. An ‘aha’ moment for me was when I bragged about how much I love general practice and brought some of my hospital mates into the fold. After hours I like to head to the local beach for a surf with my wife and our new dog, Gordie.
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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
Where will you go? Ochre Recruitment is expanding our borders! As one of the leading medical recruitment agencies in the region, Ochre Recruitment has been placing doctors into locum and permanent positions throughout Australia and New Zealand for over ten years. Now, we’re taking you further than ever before - to the United Kingdom!
Work in the UK!
Call us today to make sure you’re kept up to date with the latest opportunities from the UK! And this is just the beginning! We’ll have more international placements coming soon! Stay informed on our website, Facebook or Twitter! Hobart: 03 6224 4399 positions@ochrerecruitment.com Brisbane: 07 3254 0008 Melbourne: 03 9249 www.ochrerecruitment.com
GP focus 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 104 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 wounds. Ensure you can place common types of plaster casts with confidence.
5 Preparing for practice
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 sources of information when you are working in the community, such as hospital registrars, consultants and clinical nurse consultants.
Learn the art of referral 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 up-to-date guidelines and approaches to chronic disease management.
Practise your writing Take particular notice of writing comprehensive and prompt discharge summaries, and don’t be afraid to call GPs to tell them that their patients are coming home.
Network with your peers Most RLOs and 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 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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Dr Sara Tarafi Choose the right hospital and rotations There are hospital experiences that are compulsory in general practice training. RACGP requires three relevant hospital rotations of your choice plus compulsory rotations in: general medicine general surgery emergency medicine paediatrics.
• • • •
ACRRM requires the four compulsory rotations above plus: obstetrics and gynaecology anaesthetics.
• •
For more information, see pages 40 – 44 (RACGP) and pages 46 – 48 (ACRRM), the college websites and discuss with your RTP. If you have completed some of the required hospital training 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. Ask your RTP about how to apply for RPL, which must be done in your first year of general practice training.
Making hospital a general practice launch pad Dr Sara Tarafi’s number one tip for future GPs in hospital? Be open about your career aspirations. That way, your colleagues can help you find the GP gold in the hospital wards. “As I approach each new rotation I discuss with my registrar my plans to be a GP and we talk about what parts of the specialty are important for me to focus on for general practice,” Sara says. “Every specialty will have aspects relevant to general practice because it’s the one specialty that requires basic knowledge about all specialties.” Having worked in emergency as an intern, Sara has added other rotations with a link to general practice. “So far I have chosen obstetrics and gynaecology, paediatrics, psychiatry and geriatrics,” she says. Sara is currently working with Southern Health in Melbourne, which includes various hospitals and medical centres. She has a keen interest in women’s health and paediatrics. “Paediatrics in hospital has given me a great base for treating families,” she says.
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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 doing the general pathway. But it can also be one of the most rewarding times of your training. Here are some survival tips.
Do your research before your rural term starts. What is the town like? with the past and current GP • Discuss registrar, your future supervisor or
practice staff. You may temporarily transfer from your RTP to a rural RTP. Talk to the 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 look online for information about the town. Contact the local council for an information pack to be mailed to you.
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Where am I going to live?
housing options with the current • Discuss GP registrar, your future GP supervisor or
•
practice staff, and your RTP, RLO and medical educators. Look online for websites of real estate agents in town, and 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 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.
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5 Preparing for practice
When you arrive for your rural term, get to know your community the local council to request • Approach information for new residents, such as
local amenities. Visit the tourist information centre to request maps, information on upcoming events and surrounding towns.
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your grocery shopping at the local • Do supermarket. By and large, the community
will understand 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 appreciate you shopping locally.
Dr Will Thornton divides his time between urban and bush practices
your supervisor and practice staff for • Ask suggestions of things to see and do. to know your neighbours and other • Get people living in your street.
Get involved
Get out of your comfort zone! Try new • experiences. what your community can offer in • Explore dining out, music, the arts and outdoor recreation. Sign up as a member of groups in areas of interest to you, such as sporting, hobby and church groups.
•
Enjoy being a local
the temptation of returning to your • Avoid hometown every weekend. your friends and relatives to visit you in • Ask your new town. the local continuing professional • Attend development (CPD) and educational
dinners, for socialising, networking, education — and the food!
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Registrar rave Dr Ronda Gurney My training provider is the Remote Vocational Training Scheme.
Registrar Rave
My current post is GP registrar at Esperance Multi-purpose Health Centre in Dover, Tasmania — the most southern GP practice in Australia. The work involves general practice as well as weekly rounds at the local 16-bed nursing home. We have a community emergency room, two rural health care beds and a palliative care bed. I do community on-call every second week and weekend. I enjoy that I get to do a bit of everything — general practice, inpatient work, emergencies, palliation, procedures. There’s never a dull day. A quirky fact about me is that my husband and I did a 10,800 km round trip in our 4x4 to the equator and back in Africa to see the migration in the Serengeti.
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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 medical educator and RLO at your original RTP of any issues that may arise. Organise regular get-togethers with other GP registrars in the region. 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 Kirsten Patterson, Dr Naomi Harris and Dr Winston Lo
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
+ A
5 Preparing for practice
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
The future of general practice
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 type 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’s 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?
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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
hospital work paid as salaried sessions • Isorthefee-for-service? I need my own ABN or do I use the • Do 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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Registrar rave do I keep records of patients seen? • How What are the relevant item numbers? • Who submits accounts for hospital • billings — the the practice manager or me? percentage of hospital billings am • IWhat 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
Dr Steve Grillett My training provider is Beyond Medical Education.
Registrar Rave
My current post is at Maari Ma Aboriginal Health Service in Broken Hill, NSW. I work with other GPs, visiting specialists, nursing staff, a midwife, a psychologist and Aboriginal health workers. A typical workday for me varies. I work three days in Broken Hill, the other two days I attend outreach community clinics in Wilcannia and Menindee. It’s 8.30 am till 5 pm, no overtime, on-call or weekends, which makes me smile. I enjoy seeing the great variety of clinical cases from which to learn. Also, there are many challenges in Aboriginal health, and I enjoy a challenge. A quirky fact about me is that I was once an avid pigeon racer, which has been rudely interrupted by my studies.
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Teach while you learn as a registrar medical educator There is an old adage that teaching someone something is one of the best ways to learn about it yourself, so why not consider becoming an RME? A registrar medical educator (RME) or junior medical educator (JME) is both an educator and a learner. If you become a medical educator, you are supported to acquire the knowledge, skills and competencies required for medical education.
What does an RME do? The role includes: registrar, junior medical officer and medical student education, support and guidance networking within the education team and with other stakeholders working with the RTP to plan and deliver education, including activities such as policy and resource development undergoing professional development.
medical educators including the Australian Medical Educators Network (AMEN) workshop from GPET. Peer support is also available through the General Practice Registrar Medical Educators Network run by GPRA.
Test the waters as a medical educator
• • •
The ability to educate others is a crucial role in general practice — for patients, fellow health professionals and junior colleagues. Medical education is the basis of a sustainable, quality medical workforce, and being an educator helps you to be a well-informed and inspired GP.
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Starting as an RME is a supported way to test the waters when considering a career in medical education.
Workload and qualifications There are about 20 RMEs currently in Australia, and the number will increase as more RTPs invest in the ‘vertical integration’ model of medical education. The workload generally ranges from 1– 5 sessions a week, with 3 – 9 sessions of clinical practice to complete the working week. RMEs may work towards qualifications such as Graduate Certificate in Education or Master of Public Health. There are annual conferences for 112
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Contributed by Dr Christine Willis
.
Do itnow Ask about RME opportunities For more information, talk to your medical educator or RTP
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Registrar rave Dr Tom Rolley
Dr Ashe Nicholas Registrar medical educator RTP: Tropical Medical Training Location: Charters Towers, QLD
“I rea lly lik e the w a y you c an g et inv olved in you r own trainin g progr For m a m . e, it is inspir and a ing passio n. I l forw ook ard to a ll the I do work as an RME. ”
Join the General Practice Registrar Medical Educators Network
My training provider is North Coast GP Training.
Registrar Rave
My current post is at Mullumbimby Medical Centre, Mullumbimby, NSW. A typical workday for me is four hours of consulting, a luxurious hour and a half for lunch — if I’m on time — and the afternoon session till five. Then I drive home through the hills of the Byron hinterland. I enjoy the great family feeling in the practice and strong back-up to help with clinical decisions. After hours I like to spend time with my wonderful family, go surfing, play guitar, cook and practise qi gong. My vision for the future is integrating general practice with traditional Chinese medicine to provide holistic primary care for my patients.
The General Practice Registrar Medical Educators Network (GPRMEN) provides a professional network for RMEs. If you are an RME interested in joining GPRMEN, email registrarenquiries@gpra.org.au
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Mastering Medicare
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 GPs, 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.
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 who can
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 may be able to do the Medicare Australia Get to know about billing systems familiarisation course, which takes a few General practices may bulk-bill, privately hours (ask your RTP or practice manager for bill or have a mixture of both. When a patient is bulk-billed, it means they are only details). Alternatively, for those unable to charged the Medicare rebate and do not pay attend, excellent education modules are available online: Medicare and You — for any extra. When a patient is privately billed, new health professionals; and MBS and You they will pay the ‘gap’ or sum above the — MBS primary care items. Go to amount of the Medicare rebate, as set by medicareaustralia.gov.au/provider/business/ the practice. education/e-learning.jsp As a registrar enrolled in general practice training through an RTP, you attract the Read The Rainbow Book general notes — same Medicare payments as a fellow of one Find the Medicare Benefits Schedule Book of the general practice colleges (known as (commonly known as the Rainbow Book) vocationally registered GPs). Interestingly, in your surgery and read the general non-vocationally registered GPs, who are explanatory notes or check out the online usually very experienced doctors who version at mbsonline.gov.au, which also has a
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fill you in on your practice billing system and commonly used item numbers.
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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 prescriptions 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 Medicare Locals 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. GPRA — The future of general practice
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a list of frequently used item numbers • —HaveCreate a shortlist of frequently used item
numbers. Most practices will have one and many Medicare Locals may also have one.
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Get familiar with bulk-billing forms — 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 • Details, must 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.
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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 – Service Incentive Payments (SIPs) 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 coordination 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 more than 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.
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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.
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. In time, many of us will be closely involved in the administration of general practice. Our opportunity to train is now, and the Medicare scheme is an integral part of learning in general practice. Contributed by Dr Luke McLindon, Dr Naomi Harris and Dr Kate Kelso
Do itnow For more information, talk to your supervisor and practice manager Do an in-person course or online course at medicareaustralia.gov.au/provider/business/ education/e-learning.jsp Telephone Medicare Australia on 13 20 11 or visit medicareaustralia.com.au and MBS Online at mbsonline.gov.au
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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 GP’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 prescribing the medication for a different indication, you should write a private script for the item.
Maximum quantities and repeats listed are • 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
5 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.
Authority scripts
•
Become familiar with the indications for 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,
no prescribing of S8 drugs to new patients at first appointment, or no prescribing of S8 drugs on weekends.
Private scripts
items are included on the • Pharmaceutical PBS (subsidised by the government) on the
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 with your supervisor or practice manager • • Talk 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 the patient’s 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
Do itnow 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 — • Medicare Regulation 24 allows the original and repeat • 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 can be • your very helpful
6
Examsand assessments
Exam survival guide If you’ve come this far in medicine, exams are nothing new. But as a GP-to-be, your final RACGP exams or ACRRM assessments have special significance. These valuable tips can help you prepare — and pass! The RACGP exam consists of three segments: 1. Applied Knowledge Test (AKT) — Features 150 single best answer (multiple choice) or extended matching questions, over four hours online. To assess the breadth and application of contextual knowledge required for certification to enter unsupervised general practice.
The AKT is a prerequisite for the OSCE. At the time of enrolment candidates are able to apply to enrol simultaneously in both the AKT and OSCE. 2. Key Feature Problems (KFP) — Features 26 case scenarios with a series of questions requiring short answers, over 3.5 hours online. To assess clinical decision making skills in general practice cases. A ‘key feature’ is a critical step in the resolution of a clinical problem in the context of everyday general practice. A KFP question consists of a clinical case scenario followed by questions that focus only on those critical steps. 3. Objective Structured Clinical Examination (OSCE) — 14 stations of either eight minutes or 19 minutes. Most are role-plays with patients; the eight-minute stations being clearly focused and the 19-minute stations resembling a long case. Some of the eight-minute stations will be vivas or Q&As with the examining doctor. You need to pass the AKT before sitting the OSCE. For more information on the RACGP exam, visit www.racgp.org.au
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6 Exams and assessments
The ACRRM exams have more flexibility in the timing and location of the exams: 1. Multiple Choice Question exam (MCQ) — Three hours, 125 questions, online. There are practice questions, preparation tips and an online recording through RRMEO available on the ACRRM website. You are eligible to enrol after 12 months training or RPL. 2. Mini Clinical Evaluation Exercise (miniCEX) — Features at least six observed consultations marked on communication skills, history taking, physical examination, clinical management and judgement, rural and remote context/ organisation/efficiency and overall clinical competence. You are eligible to enrol after two years of training or RPL. 3. Structured Assessment Using Multiple Patient Scenarios (StAMPS) — A blend of OSCE and viva stations. Eight scenarios, 10 minutes duration, with five minutes between. You are eligible to enrol after two years of training or RPL. For ACRRM assessments, 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. There is an excellent ACRRM assessment handbook at acrrm.org.au/assessment
Useful tips from registrars and GPs who have passed the exams
when to sit the exam — The RACGP • Plan exams are run twice a year. You can sit the
AKT and KFP on the same day, or separately. All three segments need to be completed within three years of passing the first written exam.
ACRRM exams are also run twice a year, but the miniCEX date is flexible. There are two enrolment cut-off dates a year for each exam.
For exam dates, see page 127. Note: Information may have been updated since this guide was printed so you should also check the college websites racgp.org.au and acrrm.org.au
As the number of times a registrar can sit the exams is limited, and they cost a lot of money, it is worthwhile thinking carefully about whether you will be ready to sit. Some people suggest six to 12 months of focused study prior to sitting the exam. Discuss your readiness with your medical educator.
Ensure you are eligible — Both colleges • require:
– evidence of completion of the required training time for the particular exam (as outlined in the exam descriptions)
– current AHPRA registration
– current college membership.
The RACGP no longer requires evidence of basic CPR training at the time of enrolment. GPRA — The future of general practice
123
It is a requirement of fellowship that AGPT registrars complete ALS (including CPR) during training. (For more information, see racgp.org.au/ assessment/policy) your college website and documents • Read — Both colleges have exam advice,
resources and policies on their websites. Read these early on, and again, later on.
to your practice — With your practice, • Talk discuss study leave or reduced on-call 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, especially the OSCE.
a study group — Study groups • Form are great for keeping you motivated, pooling
• 124
resources and sharing strengths. Identify your learning styles and work with them. Small numbers of between two and four are good. 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. If possible, start meeting 12 months ahead of the exams and increase your meeting frequency to weekly (or more) closer to the date. Study groups are especially valuable for OSCE or StAMPS preparation to practise the case scenarios. Distance needn’t be a problem — If you can’t meet face-to-face, be creative. Email resources to each other, consider an online Visit our website — gpra.org.au
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 group for feedback.
learning gaps — Refer to the • Identify curriculum and your learning plan. Identify your gaps early on to avoid the natural tendency to study things you enjoy or see a lot. Completing quizzes such as those in check, Australian Family Physician (AFP) and Australian Doctor will help you discover your strengths and weaknesses. a study plan — Set a study timeline • Make so that you don’t spend months on women’s
health and only 10 minutes on respiratory problems. Try to be realistic with your study goals and ensure some time for relaxation, family, friends and fun. If you have to cut back on activities, consider starting with those that are more ‘mastery’ than ‘pleasure’ (eg. committee meetings, extracurricular but work-related activities) so that your spare time is relaxing during the stressful study period.
your resources — The resources • Gather you use in your day-to-day practice are also
the most useful for your exams.
For the written exams Murtagh’s books and RACGP guidelines such as the ‘red book’ are your friends, as is Therapeutic Guidelines. Be familiar with the National
6 Exams and assessments
Immunisation Program Schedule. Address your identified learning gaps by studying clinical updates and review articles from AFP, Medicine Today and Australian Doctor. Multiple-choice questions can also be sourced in those publications. The check program has short answer questions resembling the RACGP KFP exam, and is available online and in hard copy from the RACGP. It is worth getting five years of past check programs from people you know or the college (for purchase or library loan). Get better at ECGs (Hampton, 150 ECG Problems). Practise picture recognition — dermatology, ophthalmology, chest X-rays. You can find complete online learning modules at gplearning (RACGP) and RRMEO (ACRRM).
For the OSCE and StAMPS The marking structure and case proformas for the OSCE can be downloaded from the RACGP website so you can make up your own cases. Susan Wearne’s Clinical Cases for General Practice Exams is invaluable. Murtagh’s Patient Handouts are useful to read and remember for stations requiring patient education. There are also practice cases on the GPRA website at oer.org.au written questions — Gather as • Practise many practice questions as possible. Ask
other registrars and recent fellows, search the college website, write your own. Practise any past papers to time. In your study group, read topics together out loud, go through practice questions, quiz each other
on guidelines, write your own practice questions. OSCE/StAMPs cases — Don’t • Practise just read through the cases you find; ensure
you practise them under exam conditions with at least one other person with the stopwatch on and bells or alarms. In your study group, give each other feedback on those skills you can’t learn from a book — communication, use of non-medical language, analysis of research 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.
Don’t forget your practical skills, like suturing, asthma puffers and CPR. Generally, your exams will be very focused on problems that you will come across in general practice, so use the things that worried you in your practice today to help you study tonight.
pre-exam courses — Courses run • Attend by the colleges or your RTP are likely to be
very useful in becoming familiar with the structure of the exam, helping to plan your preparation, gauging the level of difficulty, identifying learning gaps and practising your techniques. Attend an OSCE or StAMPS mock exam. Do a dress rehearsal to check your clothing is comfortable enough.
month to go — Aim to devote the last • Amonth before the exam to doing revision
and practising questions. GPRA — The future of general practice
125
the day — written — Read information, • On 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.
the day — OSCE or StAMPS — Wear • On professional, comfortable clothing. If you
feel as though you messed up a station, ensure you let it go immediately. Take a deep breath and move on without letting the stress of the previous station influence your subsequent performance. If you have a rest station, try to use it wisely; for example, practise relaxation techniques, think positive thoughts that give you confidence and help your performance. Avoid ruminating over previous stations.
the exams — What if I fail? After • After you have sought the appropriate solace with 126
friends and family, and turned to whatever helps you cope with such disappointing and Visit our website — gpra.org.au
stressful circumstances, look into the official processes available to you on the colleges’ websites. Don’t delay as there may be time pressure if, for example, you wish to appeal the decision. Talk to your medical educator for further information about implications for your training and the remediation available. Your RLO is also available if you need to talk, have questions, or don’t know where to turn. Contributed by Dr Christine Willis
GPRA’s 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 GPRA’s online exam resources (OER) consist of clinical cases, perfect for your study group, plus other exam tips — free to all members of GPRA. Download cases from gpra.org.au
6 Exams and assessments
RACGP exam and assessment information Exam
Enrolments open
Enrolements close
Assessment date
AKT
17 September 2012
14 December 2012
9 February 2013
AKT
12 March 2013
14 June 2013
10 August 2013
KFP
17 September 2012
14 December 2012
9 February 2013
KFP
12 March 2013
14 June 2012
10 August 2012
OSCE
17 September 2012
15 March 2013
11 May 2013
OSCE
12 March 2013
30 August 2013
27 October 2013
Visit racgp.org.au for further details about the RACGP assessment system. Acrrm exam and assessment information Exam
Enrolements close
Assessment date
miniCEX
14 January 2013
February to July 2013
miniCEX
5 July 2013
August to December 2013
MCQ
4 January 2013
9 March 2013
MCQ
5 July 2013
7 September 2013
StAMPS
1 February 2013
20 and 21 April 2013
StAMPS
19 July 2013
12 and 13 October 2013
Advanced Specialised Training (emergency medicine)
3 May 2013
20 and 21 July 2013
Visit acrrm.org.au for further details about the ACRRM assessment system.
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
GPRA — The future of general practice
127
“Test, Check, Save and Go” Test yourself Check the answer, explanation and link Save the references to read later All while on the GO “I’m happy with Available on Android & Apple
Practise, practise, practise is the best way to prepare for the fellowship written examination. Dr. MCQ is a medical multiple choice questions (MCQ) app developed by Sturt Fleurieu.
the app. It’s easy to navigate and it’s a great way to make good use of short snippets of study time. The questions are challenging, which motivates me to study certain topics further.” Dr. M
With 60 MCQs written and extensively reviewed by a group of Australian general practitioners and medical educators, it is a reliable resource for examination preparation. Its mobile format enables you to make the most of your precious time wherever you may be. At any stage, Dr. MCQ is a great study motivator. It may be used for self-review or in a study group. Dr.MCQ is useful whether you are just starting your studies or even when the examination date is looming.
During the very early part of your preparation, Dr.MCQ gives an indication of question structure and allows you to “Dr. MCQ is an develop an effective approach to MCQs. Whilst in the excellent study tool for midst of preparations, Dr.MCQ can supplement your both GP trainees but also for studies with its explanations and live links to a range any medical based person of general practice references. wanting to extend their knowledge. I believe the app is an invaluable The readings can even be saved, emailed or study tool and would recommend printed for review later. Closer to the examination it to anyone, but especially those date, Dr.MCQ can be used to gauge your level of wanting to pass the GP written learning. The categorised results helps you make examinations...buy it now to sure you have covered all of the important topics. see what all the fuss is about!” Dr. C
www.sfgpet.com.au/drmcq
7
Keeping
your balance
Part-time training options 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 registrars 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: of the training program, with • allthecomponents possible exception of hospital time, can
be undertaken on a part-time basis
•
as you start training as a registrar, you need to apply for part-time training to your regional training provider (RTP) and have it approved by your RTP before you begin working part-time must work between 3 – 8 sessions • registrars per week to qualify as part-time. Please
contact your RTP and relevant college censor for further information
remain within the AGPT program, • toregistrars need to undertake a minimum
130
of nine patient contact hours per week
Visit our website — gpra.org.au
should negotiate the amount of • you 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. The RACGP states that general practice experience gained while working part-time is valuable and likely to be worth more than an estimation of time alone would indicate. This is why acceleration of part-time training to ‘half-time’ training is available. It basically means that in order to have a 12-month term counted as the equivalent of six months full-time, you need to show that the 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 for paid parental leave from the Australian Government. leave is managed by your RTP. • Registrar You should apply for leave as early as possible.
leave entitlements may vary by RTP. • Parental Many offer up to 12 months parental leave.
7 Keeping your balance
Dr Cass Wys Practising medicine and motherhood “Being a parent is a full-time job in itself,” declares Dr Cass Wys, a Cairns-based GP registrar who had her first baby a couple of years ago with partner Matt Cooper. She knows all too well the intricate, sleepdeprived juggle of the working mother but says the flexibility of general practice eases the way. “The flexibility of part-time work and training in general practice means you can maintain a healthy balance,” she says.
ssa ys and Aly Dr Cass W
Do itnow For more information, see the AGPT Full-time Equivalence Policy 2010 at agpt.com.au/Policies/Policies
Cass left work to have Alyssa towards the end of her first GPT1 and returned to complete the post when her baby was just under five months old. “My supervisors and the staff at the practice were exceptional,” she says, as she tells of the understanding she received if Alyssa was sick or she came to work bleary-eyed after a night of broken sleep. Now that Alyssa is older, Cass works two and a half days a week in general practice.
GPRAtips
want to apply for parental leave • Ifandyouenquire about part-time training
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
She is also able to pursue her special interest in sports and acute injury management by working in a new post, especially created for her, at an acute orthopaedic injury clinic with an orthopaedic surgeon. In addition, Cass spends four hours a week as an RLO for her RTP, Tropical Medical Training, a post that underscores another of her interests, medical education and training. “I absolutely love Alyssa, but I also enjoy my career, and I am so lucky that I can have the best of both worlds,” she says.
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Stress tips from GP registrars
Achieving work-life balance can be an elusive goal for GPs and GP registrars. With competing demands at work and home you need to nurture your own mental health so you can provide care to others. Four registrars share their best stress management strategies.
Dr Ja so n Ag os ti no R TP : Tr op ic al M ed ic al Tr ai ni ng Lo ca ti on : Ca ir ns , QL D I achieve worklife balance by knowing what m priorities are. No y thing is more im portant than m and my family. y wife I’ve got the ba lance wrong at but knowing wha tim es t’s important m akes readjusting things easy. St renuous physic al exercise help relax. I love cy s m e cling. My top tip for registrars When I was re cently overwhe lmed by things com It provide I found getsom s guided medita eheadspace. tio n and mindfulnes I’m no hippie, s in book and on but I’m a lover line form. of Headspace.
132
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7 Keeping your balance
Dr Cas ey Mad dre n RTP : We ntW est Loc atio n: Syd ney , NSW
that helps to keep me My husband is non-medical — identity. I love to grounded. Medicine isn’t my main o. I play and sing, cook and I also play the pian ng into the and I find when you put everythi away. music the stress just falls
My top tip for registrars t a holiday planned or some even Have a mentor at work. Have of tea cup A ll acts of self-care. to work towards. Practise sma e. can make the world a better plac
Dr R on da G ur ne y R TP : R em ot e Vo ca ti on al Tr ai ni ng Sc he m e Lo ca ti on : Do ve r, TA S I try to leave w ork at work, ev en if I have to few minutes la stay a ter to get thing s done. I also some fresh air aim for and exercise ev ery day, and plan something like a picnic, outing or meal with fr most weekends iends when I’m not on-call. If I do plan to do it, it’ n’t s too easy not do the fun thing s. My top tip for registrars Don’t let things pile up, then yo u won’t have a next challenge backlog when th hits. e
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Feelingstressed? If you have concerns about your health, or feel you aren’t coping with things, who can you turn to? own GP. It is really helpful to have • Your your own GP to talk things over with RLO. Always feel free to speak to • Your your RLO confidentially. They may be able
to offer support, suggestions or provide you with details of someone else who can help
Support Program. A free counselling • GP service provided by registered psychologists
to RACGP members who are registered medical practitioners. 1300 366 789 (business hours),1800 451 138 (traumatic incidents or crisis situations), racgp.org.au
Support Line. A free telephone • Bush counselling service for remote health
workers and their families run by psychologists who have a strong understanding of the realities of rural and remote practice, 1800 805 391, bss.crana.org.au
Health Advisory Service. • Doctors’ Visit doctorshealth.org.au for helplines
134
in all states
Visit our website — gpra.org.au
Dr Fab ian Sch war z RTP : Bey ond Med ical Edu cat ion Loc atio n: Bro ken Hil l, NSW a tool Cognitive behaviour therapy is you are y Wh . set I use most days t, even stressed? Think about the it and the emotion it triggered. Did ose make you happy? If not, cho no have you another emotion. If rest, any rest inside, you cannot give . peace or hope to your patients My top tip for registrars oring Lap swimming can be super-b en the — a good time to reflect. Wh ss stre the is so swimming is done, or issue.
Do itnow 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 Visit rcubed.org.au
8
Money matters
National
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 general practice 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 table below. Or it can be calculated based on 45 per cent (or higher) of billings plus nine per cent superannuation. Please note that this will change after 1 July 2013 in line with changes to the superannuation legislation. Please refer to the table below. 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 the percentage (as per the table on next page) of
Minimum salary for GPT1 and GPT2 Registrars 2012 GPT1 or equivalent
Annual salary
Weekly salary
Superannuation
$72,760
$1,399.39
Plus 9% superannuation
GPT2 or equivalent $87,475 $1,682.23 Plus 9% superannuation Note: These are minimum rates only and higher rates can be negotiated. The pay scale is reviewed annually. All employees also accrue 4 weeks annual leave per year 136
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8 Money matters
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.
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/earnings-calculator
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.
Period From
Percentage of billings
Rate of superannuation
30/06/2013
45.00 %
9.00%
1/07/2013
30/06/2014
44.90%
9.25%
1/07/2014
30/06/2015
44.79%
9.50%
To
Note: The above calculation is based on ensuring that the gross percentage of the registrar remains constant at 49.05% so as to not disadvantage either the registrar or the supervisor in light of the changes to the superannuation legislation GPRA — The future of general practice
137
GPT3 and beyond payment basis
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 download it by visiting e th an M oney gpra.org.au/negotiation-guide AN
EGO TIAT
ION
GUID
E FO
Secu re y our winwin cont ract
138
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RG
P REG
ISTR
ARS
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 from all sources: standard patients seen in the rooms, medical and insurance reports, hospital patients, on-call and nursing home visits. It is important to get an idea of how much income you generate and where it comes from to know your value.
8 Money matters
Why you need a written employment contract GPRA recommends that registrars have a written employment contract with their practice employer for each general practice term. This ensures clarity between employee and employer, and gives both parties recourse against any breaches under contract law.
Your negotiating checklist This checklist provides 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
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.
– On-call and after-hours
– Number of patients per hour.
Securing a win-win contract
• Education and supervision
– In-practice teaching
– Educational release time
– Supervisor obligations.
For many registrars, negotiating an employment contract can be a challenging process. 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.
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
GPRA —The future of general practice
139
• Remuneration
• Leave
– Base salary or percentage of billings plus nine per cent superannuation (minimum)
– Annual leave and method of annual leave calculations
– Personal/carers leave (includes sick leave)
– Compassionate leave
– Study leave
– Parental leave.
– 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)
• Other matters
– Medical indemnity insurance
– Personal safety
– Restrictive covenants
– Renegotiation
– Dispute resolution – Termination of employment.
– Any accommodation subsidies
– Any other allowances and expenses.
• Contract paperwork Complete your written contract and ensure it is signed and dated by you and your employer.
140 Visit our website — gpra.org.au
Incentive payments
8 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 regional training provider (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 The General Practice Rural Incentives Program (GPRIP) is a DoHA scheme that applies to registrars and GPs (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). For more information, visit doctorconnect.gov.au Note that you must have a Medicare provider number to be eligible for GPRIP payments.
Table 1 — General Practice Rural Incentives Program 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
Part-time registrars are paid pro-rata.
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HELP/HECS Reimbursement Scheme The 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 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
142
Visit our website — gpra.org.au
3
4
5
4 years
3 years
2 years
More Doctors for Outer Metropolitan Areas Relocation Incentive Grant This is another DoHA scheme 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 GPs 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
9
The
business
of general practice
101
Business structures
One thing they don’t teach you at medical school is the business side of being a doctor. Jeff Wain and Joseph Portelli, financial planners to the medical profession, introduce you to some of the basics. When you start working as a fellowed GP after your extensive training, an important issue to consider is the structure under which you practise. The business set-up and planning process can be quite complex and differs depending upon your individual circumstances and objectives. There are many traps and pitfalls for the uninitiated, and accordingly good advice from a trusted professional is essential to ensure that an appropriate structure is established. Before considering alternatives, you need to understand some of the basic concepts associated with business structures. It is also important to distinguish between the various types of commercial and economic arrangements that can be entered into when providing services as a GP.
Seeking advice There are several alternatives available for GPs, including companies, trusts, partnerships and operating as a locum. Each structure has its own merits — such as asset protection, tax efficiency, flexibility and scope for effective insurance and estate planning — as well as pitfalls that require consideration. It is prudent that early in the process you take the time to seek advice from a suitably qualified and experienced professional. 144
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While consideration of an appropriate structure is not a costless exercise, it is preferable to vet the alternatives at the outset. The costs of unwinding an inappropriate structure, as well as the potential taxation implications, can be significant and generally outweigh the costs of undertaking an initial review.
Commercial arrangements The simplest structure is that of an employee/ locum. However, there are a number of other alternatives including contractor, associate, or partner/director of a medical practice. It is these Dr Abhi Varshey and his daughter celebrate the opening of his practice (see page 148).
9 The business of general practice
latter commercial arrangements that may also provide an opportunity to establish a particular business structure.
1. Discretionary trust
The most appropriate structure will depend on each individual’s unique circumstances, the legislative requirements that provide for (or alternatively constrain) the ability to use a particular structure, and an assessment of the trade-offs. Key factors for GPs to consider are:
degree of simplicity or complexity of • the each business structure
•
the cost of establishing and maintaining the arrangement
importance or otherwise of issues such • the as asset protection, tax efficiency and the
degree of flexibility to modify or adapt to changes in the future.
Formal documents In each case you should expect to have a formal document (partnership agreement, trust deed or company constitution) that sets out the rules of operating the business, including capital contributions, voting rights, rules of admission and dismissal, powers and duties, income distribution policy, method of keeping accounts and records, and a mechanism for dispute resolution.
Frequently used vehicles Two frequently used vehicles in a medical practice are a discretionary trust and a company. Some common features of these are as follows:
protection can potentially be achieved • Asset as capital is removed from an individual’s name and placed in the name of the discretionary trust.
is flexibility to distribute income • There across a number of beneficiaries. This can
reduce the amount of tax payable compared to an asset owned in the individual’s name.
are estate planning benefits as assets • There can remain within the trust for an extended
time, rather than being subject to distribution to beneficiaries upon death.
2. Company ability to retain profits within the • The business at a 30 per cent tax rate. are estate planning benefits as • There assets can remain within the company,
rather than being required to be distributed to beneficiaries upon death. (The transfer of the shares in the company needs to be considered.)
is limited to the underlying assets • Liability of the company. The table on the following page provides a brief overview of the types of issues to be considered and highlights the key pros and cons of each commercial arrangement.
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GP business structures — pros and cons Employee/ locum Pros – Simplicity
– Security of income
– Super paid
Contractor
Associate
Practice partner
– No buy-in costs
– Own your individual practice and patient records
– Ability to build equity
– Higher earnings potential
– Tax deduction options
– Flexible work hours – Co-locate and share expenses to minimise – Own patient records – Tax withheld costs (tax deduction – Annual leave – Highest potential to options) – Flexible work hours structure/stream – Sick leave – Exposure to multiple – Potential to structure/ income stream income – Insurance costs paid business models – Reduced principal dependency – Potential to structure – Flexible work hours – Employment laws stream income – No personal liability – SME CGT for other associates concessions – Tax deduction options
Cons – Lower percentage of billings
– No scope to structure/stream income
– Increased admin — pay tax, super and GST
– Need to operate your own small business
– Liable for acts of other partners
– Significant – Need to maintain commitment your own accounting required records for both – Less security of – Limited tax – Career moves from income and expenses tenure deductibility medicine into – Need to prepare and business – Employer does not – Annual leave, sick maintain your own leave and insurance have to pay super – Broad-based advice invoices and stationery not funded above $15,775 pa required in several – No-one to share areas – Work at one practice – Contract legal advice CEO duties with as required only so limited there is in a exposure to other partnership business models – Need to buy-in
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– No sale potential (no equity)
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9 The business of general practice
Combination of vehicles It is worthwhile noting that many GPs structure their business and personal situation using a combination of vehicles simultaneously, depending on their circumstances. The choice of the most appropriate business structure may evolve and change over the course of a medical career as circumstances warrant.
Broad consequences Finally, an understanding of your business structure has broad consequences when making decisions about insurance, superannuation, asset protection and estate planning. Again, this is because the distinction between ownership and control of assets can have wide-ranging legal ramifications. For example, the assets held within a discretionary trust, company or superannuation fund are not automatically covered by a person’s will and need to be considered in a broader context. While the issues raised can be quite complex, the rewards are there for those who apply a methodical approach and obtain quality advice before committing to a business structure. Contributed by Jeff Wain (Australian Private Wealth) and JosephPortelli (Stewart Partners)
Dr R ay m on d Ch an Fi rs t- ye ar R AC G P Fe llo w Lo ca ti on : M el bo ur ne , VI C “I changed to contractor stat us as soon as I finished my training. There are tax benefits an d it releases the flexibility in your income bu t it’s important to do what you ar e comfortable w ith. At the mom ent I’m working in a fiv e-doctor practic e and enjoying it huge ly. I found the GPRA webinars on tax and accounting very helpful.”
Do itnow Join GPRA’s Future Series webinars GPRA’s Future Series webinars offer valuable tips about the business side of general practice for those planning their future career. For news of the 2013 series, check the GPRA e-newsletter and gpra.org.au/future-series Consult an expert The following advisors specialise in financial advisory services for doctors: Wain, Australian Private • Jeff Wealth, Melbourne at
jwain@australianprivatewealth.com.au
Portelli, Stewart Partners, Sydney • Joseph at joseph@stewartpartners.com.au Agarwal, Mediq, Melbourne at • Ravi r.agarwal@mediqfinancial.com.au
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Being
the boss
Last year we reported on Dr Abhi Varshney, who set up his own practice as a newly fellowed GP with his wife Rachel. Since then, more doctors have joined him and his practice is thriving. Here he shares his essential tips. Abhi’s tips on setting up your own practice
Dr Abhi Varshney RACGP Fellow Location: Brisbane, QLD “Setting up my own practice was a great decision. It was daunting but exciting. I was fortunate to get advice from a former supervisor who had set up a practice himself.”
advice from a mentor — See if you • Get can find a GP colleague who has set up
their own practice and is willing to share their experience.
your research — What are the • Do demographics of the area? Does the area
need another general practice? the right premises — Consider • Find exposure and accessibility to main roads, parking for staff and patients, suitability for fit-out as a GP clinic and room for expansion.
to spend money on • Betheprepared fit-out — Ask around about rating ey celeb
Varshn Dr Abhi tice rac p of his
148
iversar y
the ann
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architects and shopfitters with experience in general practices.
systems — You call the • Setshots,upsothesetright up your systems to support
your ideal practice.
10
Info file
Jargonbuster Acronyms and abbreviations abound in the language of general practice training. Crack the code here! AAPM — Australian Association of Practice Managers ACCHO — Aboriginal Community Controlled Health Organisation ACCHS — Aboriginal Community Controlled Health Service 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 AGPAL — Australian General Practice Accreditation Ltd This organisation completes accreditation of practices throughout Australia AGPT — Australian General Practice Training The training program for GP registrars
AMA — Australian Medical Association An independent organisation that represents the professional interests of all doctors, including political, legal and industrial AMG — Australian medical graduate AMLA — Australian Medicare Local Alliance A network funded by the federal government to manage national programs for Medicare Locals AMS — Aboriginal Medical Service AMSA — Australian Medical Students’ Association ARST — Advanced rural skills training ASGC-RA — Australian Standard Geographical Classification-Remoteness Areas 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
AHPRA — Australian Health Practitioner Regulation Agency
RA2 — inner regional
AIDA — Australian Indigenous Doctors’ Association
RA4 — remote
AKT — Applied Knowledge Test A component of the RACGP Fellowship exam. A computer-based exam in multiple-choice format ALMA — Australian Lesbian Medical Association 150
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RA3 — outer regional RA5 — very remote A map of Australia showing these classifications is available at doctorconnect.gov.au AST — Advanced specialised training A 12-month training post required for ACRRM fellowship
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
The future of general practice
CMO — Career medical officer CPD — Continuing professional development DHAS — Doctors’ Health Advisory Service DoHA — Department of Health and Ageing The federal government department responsible for health and ageing DVA — Department of Veterans’ Affairs EBM — Evidence-based medicine ECT — External clinical teacher ESP — Extended skills post A component of AGPT comprising a six-month training post in either general practice or an area of relevant skills; eg. obstetrics and gynaecology, accident and emergency FACRRM — Fellowship of the Australian College of Rural and Remote Medicine
GPRA — General Practice Registrars Australia Ltd Represents GP registrar issues to GPET, RACGP, ACRRM, DoHA and other bodies involved in training; promotes general practice as the medical specialty of choice to medical students and prevocational doctors; provides support to GP registrars. Membership is free GPRIP — General Practice Rural Incentives Program GPRMEN — General Practice Registrar Medical Educator Network GPSN — General Practice Students Network GPT1, GPT2, GPT3 — General practice terms 1, 2 and 3 Part of the RACGP curriculum HMO — Hospital medical officer
FARGP — Fellowship in Advanced Rural General Practice
IGPRN — Indigenous General Practice Registrars Network
FGAMS — Foreign graduate of an accredited medical school May be subject to the 10-year moratorium (see also IMG and OTD)
IMG — International medical graduate May be subject to the 10-year moratorium (see also FGAMS and OTD)
FRACGP — Fellowship of The Royal Australian College of General Practitioners
JCC — Joint Consultative Committee
GPET — General Practice Education and Training Ltd A government limited company that funds and contracts RTPs to provide general practice education to registrars and prevocational doctors GPR — General practice registrar, GP registrar
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JAC — Joint Advisory Committee KFP — Key Feature Problems A component of the RACGP Fellowship exam. A computer-based exam in short and long answer Medicare Locals Organisations established to coordinate primary health care delivery, including general practice and allied health services. More than 60 have been established across Australia to date
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MBS — Medicare Benefits Schedule MCQ — Multiple choice question A component of the ACRRM Fellowship exams and assessments ME and TA — Medical educators and training advisors One of these people from your RTP will give advice and guidance about your training miniCEX — Mini Clinical Evaluation Exercise A component of the ACRRM Fellowship exams and assessments
OSCE — Objective Structured Clinical Examination A component of the RACGP Fellowship exams comprising multiple stations similar to an MSAT or viva voce exam OTC — Over-the-counter OTD — Overseas-trained doctor May be subject to the 10-year moratorium (see also FGAMS and IMG) PBS — Pharmaceutical Benefits Scheme/ Pharmaceutical Benefits Schedule
NACCHO — National Aboriginal Community Controlled Health Organisation
PCEHR — Personally Controlled Electronic Health Record
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
PGPPP — Prevocational General Practice Placements Program
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 NPS — National Prescribing Service A federal 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
PIP — Practice Incentives Program QICPD — Quality improvement and continuing professional development RACGP — The Royal Australian College of General Practitioners The largest of the of two general practice colleges. Has a fellowship process for vocational registration. The RACGP also offers a fellowship in Advanced Rural General Practice (FARGP) RACGP state censor A fellow of the RACGP in each state who checks that the GP registrar has completed the training requirements for fellowship of the RACGP 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 GPRA — The future of general practice
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RFDS — Royal Flying Doctor Service
SIP — Service Incentive Payment
RLO — Registrar liaison officer A registrar employed by an RTP to represent and advocate for GP registrars and liaise with GPRA
SLO — GP supervisor liaison officer Employed by an RTP to represent and advocate for GP supervisors
RMO — Resident medical officer
StAMPS — Structured Assessment using Multiple Patient Scenarios A component of the ACRRM Fellowship exams and assessments
RPBS — Repatriation Pharmaceutical Benefits Scheme RPL — Recognition of prior learning RROC — Registrar representative on council A GP registrar who sits on the council of the RACGP to represent registrar concerns. RROB — Registrar Representative on Board GPET Board representative 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 are contracted by GPET to provide regionalised general practice training 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
10-year moratorium The 10-year moratorium requires some doctors originally from overseas (see FGAMS, IMGs and OTDs) to train and practise in districts of workforce shortage 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 A group of six key medical groups who work together on key health policy areas: RACGP, ACRRM, AMA, GPRA, AGPN and RDAA 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
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A healing journey in general practice
Have you ever given thought to working as a GP registrar in an Aboriginal and Torres Strait Islander health training post? These posts can be undertaken as part of the Australian General Practice Training (AGPT) program. Talk to your local regional training provider today for more information or go to: www.agpt.com.au
GPresources directory Some handy GP resources and how to get them.
Textbooks and pocket guides Murtagh’s General Practice, Patient Education, Practice Tips
GP Companion — a handy reference of general practice clinical information available to GPRA members as an e-book: gpra.org.au/gp-companion
Australian Medicines Handbook — (available online, CD, mobile, hard copy): shop.amh.net.au
See a recommended reading list from ACRRM: acrrm.org.au/assessment (scroll down and click on ‘Recommended reading list’).
MIMS — (available online, mobile, hard copy): mims.com.au
Guidelines
Sara Bird’s Medico-Legal Handbook for General Practice — free for members of MDA National
There are many guidelines available from the RACGP: racgp.org.au/guidelines. Some important ones are:
Paediatric Pharmacopoeia — rch.org.au Fitzpatrick’s Colour Atlas and Synopsis of Dermatology Reproductive and Sexual Health: An Australian clinical practice handbook — Family Planning NSW Contraception: An Australian clinical practice handbook — Sexual Health and Family Planning Australia
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, 2011/2012 Clinical Guidelines for Stroke and TIA Management: A quick guide for general practice
Practical Fracture Treatment — McCrae and Esser
Chronic Kidney Disease Management in General Practice — 2nd edition, 2012
Clinical Sports Medicine — Brukner and Khan
Other important guidelines:
Paediatric Handbook — from Royal Children’s Hospital or Westmead
Asthma Management Handbook — (2006): nationalasthma.org.au
Oxford handbooks (Clinical Medicine, Clinical Specialties)
Screening to prevent cervical cancer: Guidelines for the management of asymptomatic women with screen detected abnormalities — nhmrc.gov.au
The ECG Made Easy — Hampton, 7th edition Fast Facts series — fastfacts.com
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Guide to Management of Hypertension (2008) updated 2010 — National Heart Foundation: heartfoundation.org.au
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Therapeutic Guidelines (TG or eTG, available online, CD, hard copy) — an invaluable resource: tg.org.au Australian Immunisation Handbook — (online or hard copy) health.gov.au/internet/immunise/ publishing.nsf/content/handbook-home You can find more lists of guidelines at: Medical Observer has compiled an extensive list, which includes the RACGP guidelines: medicalobserver.com.au/about/guide-toguidelines
Courses ALSO (Advanced Life Support in Obstetrics) — also.net.au APLS (Advanced Paediatric Life Support) — apls.org.au ARC (Australian Resuscitation Council, NSW branch) — arcnsw.org.au Clinical Emergency Management Program — racgp.org.au/cem DCH (Diploma in Child Health) — chw.edu.au
NHMRC guidelines have been developed and endorsed by the Australian Government National Health and Medical Research Council: nhmrc.gov. au/guidelines
EMST (Early Management of Severe Trauma) — surgeons.org
Online learning and resources
Reference and evidence-based medicine databases
gplearning — RACGP: gplearning.com.au RRMEO (Rural and Remote Medical Education Online) — ACRRM: rrmeo.com PrimaryCare Sidebar — a resource that works alongside your clinical desktop from the RACGP: racgp.org.au/ehealth/primarycaresidebar ThinkGP— thinkgp.com.au Rural Health Education Foundation — rhef.com.au GP Psych Support — psychsupport.com.au A government-funded service that provides patient management advice to GPs from psychiatrists.You need to register before you can access this service
Sexual Health and Family Planning — shfpa.org.au
PubMed — US National Library of Medicine — pubmed.gov — a database of journal articles including MEDLINE The Cochrane Library — cochrane.org.au — a database of clinical reviews. 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 — a UK-based independent journal of evidencebased health care UpToDate — uptodate.com — a US-based website that contains peer-reviewed and regularly updated review articles on an GPRA — The future of general practice
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extensive range of clinical topics. It has a subscription fee RCPA Manual — the Royal College of Pathologists of Australasia. Outlines appropriate tests for a clinical problem, interpretation of test results and more, rcpamanual.edu.au GPnotebook — gpnotebook.co.uk — an encyclopaedia of medicine updated on a continual basis. Has a subscription fee
Topic-based websites Anatomy — anatomyatlases.org Arthritis — arthritisaustralia.com.au Asthma — nationalasthma.org.au Cardiology — The Heart Foundation, heartfoundation.org.au COPD — copdx.org.au Dermatology — There are two Dermnets and both are useful, dermnet.com and dermnetnz.org Drug and alcohol — Australian Drug Foundation adf.org.au Conducts research and education on illicit drugs and alcohol. Their website: druginfo.adf.org.au has information for health professionals, courses and podcasts
Men’s health — Andrology Australia has great tools for prostate screening, male infertility assessment and more: andrologyaustralia.org Mental health — beyondblue: beyondblue.org.au; Black Dog Institute, blackdoginstitute.org.au Paediatrics — Children’s Hospital Westmead: — chw.edu.au; Royal Children’s Hospital Melbourne: rch.org.au Sexual health — Australasian Society for HIV Medicine: ashm.org.au; Melbourne Sexual Health Centre: mshc.org.au Women’s health — including unplanned pregnancy counselling, termination, contraception: mariestopes.org.au; childrenbychoice.org.au
Organisations Department of Health and Ageing (DoHA) — health.gov.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 — medicareaustralia.gov.au/provider; MBS Online: mbsonline.gov.au; PBS: pbs.gov.au
Gastroenterology — Gastroenterological Society of Australia: gesa.org.au
Pharmaceutical Benefits Scheme (PBS) — health.gov.au/pbs
Haemochromatosis — Resources for GPs: haemochromatosis.org.au/GPResources.htm
NPS — the National Prescribing Service is an independent non-profit organisation that aims to provide accurate, balanced evidence-based information about medicines: nps.org.au
Immunisations — Australian Government Immunise Australia Program — immunise.health.gov.au 158
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Therapeutic Goods Administration (TGA) — the regulatory body for therapeutic goods in Australia: tga.gov.au
Wonca (World Organisation of National Colleges, Academies and Academic Associations of Family Physicians) — globalfamilydoctor.com
GPRA: gpra.org.au
check — an independent learning program for GPs (free with RACGP membership): racgp.org. au/education/courses/check
Going Places Network: gpaustralia.org.au GPSN: gpsn.org.au GPET: agpt.com.au
Rural Health Education Foundation — learning resources for GPs: rhef.com.au
RACGP: racgp.org.au
Medical apps for phone or iPad
ACRRM: acrrm.org.au AMA: ama.com.au Rural Health Workforce Australia (RHWA): rhwa.org.au — a not-for-profit organisation dedicated to making primary health care more accessible for communities in rural and remote Australia
Journals, magazines and periodicals Most are available online and in print. Australian Doctor — especially its ‘How to Treat’ articles: australiandoctor.com.au Australian Family Physician — (free with RACGP membership) — racgp.org.au/afp Australian Prescriber — australianprescriber.com and other NPS publications: nps.org.au Medical Observer — especially its ‘Clinical review’ feature: medicalobserver.com.au Medicine Today — medicinetoday.com.au Medical Journal of Australia (free with AMA membership) — mja.com.au
Drug Doses — very useful in calculating paediatric doses for various medications Medical Observer — a useful calculator for a range of assessments: eg. Ottawa knee and ankle rules, Wells score MBS Search — includes various item numbers, Medicare rebates and allows you to save your favourite item numbers Pedi Safe — a useful app that gives you normal values (HR, BP, RR, fluid resuscitation rates, values for sedation medication) based on weight iAnatomy — shows you CT scans and how to identify the structures in them. Includes a quiz mode Stethoscope — allows you to listen to real chest sounds including murmurs, lung sounds and bowel sounds, and gives you information about how to use a stethoscope. Good practise for OSCEs How to Treat from Australian Doctor — includes quizzes on various conditions to test your knowledge. Very useful for the AKT exams GPRA — The future of general practice
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Podcasts Available from iTunes store: Australian Family Physician The Health Report with Norman Swan Instant Anatomy Listen to the Lancet The Merck Manual of Patient Symptoms MedPod101 — entertaining, but some reviewers have reported it to be offensive Other podcasts Annals of Internal Medicine — annals.org/multimedia.aspx Cochrane Library — cochrane.org/podcasts/ Drug Info — druginfo.adf.org.au NHMRC — nhmrc.gov.au/media/podcasts/index.htm Johns Hopkins Medicine News Roundup — hopkinsmedicine.org/news/audio/podcasts/ Podcasts.html Journal of American Medical Association Weekly — jama.jamanetwork.com/multimedia. aspx#Weekly New England Journal of Medicine Weekly Audio Summary — nejm.org
Patient information Better Health Channel — betterhealth.vic.gov.au — offers GPs consumer-based information that is checked on a regular basis. It has useful handouts for patients 160
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My Dr (MIMS Australia) — mydr.com.au — contains a range of consumer-friendly tools including quizzes, calculators, a medical dictionary and information on medications HealthInsite — healthinsite.gov.au — 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. Parent handouts — rch.org.au/kidsinfo/factsheets. cfm — a series of handouts for parents and patients from the Royal Children’s Hospital, Melbourne Patient pictures — patientpictures.com — a series of patient handouts with graphics to explain procedures and diseases
Access to resources There are many resources available free online or from organisations. There may be some at your practice already. Some subscriptions, such as eTG, may be available through your RTP, practice or hospital. Some resources are free from the RACGP with membership. In the past, free resources have included Murtagh’s texts and subscriptions to AMH or eTG. The RACGP John Murtagh Library lends to all members. This is a great service with the books posted to your door, racgp.org.au/library. Ask your RTP about nearby libraries that may hold relevant texts or DVDs Contributed by Dr Christine Willis
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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 P 03 9629 8878 W gpra.org.au