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PREVOCATIONAL DOCTORS GUIDE TO GP TRAINING

2010

GPCOMPASS

GENERAL PRACTICE: TRY IT NOW! JOIN THE GOING PLACES GP NETWORK

EXPLORING

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GP Compass has been prepared by General Practice Registrars Australia (GPRA). GP Compass has been designed to assist prevocational doctors in making informed choices about their future career directions. The guide is set out in colour-coded sections for easy navigation. GP Compass has been produced using sustainable, environmentally friendly printing techniques. This reflects GPRAâ&#x20AC;&#x2122;s ethos of supporting tomorrowâ&#x20AC;&#x2122;s GPs and their families in their quest for sustainable careers in General Practice.

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Contents Produced with funding support from

About this guide A message from the GPRA Chair

1 4

Choosing a career in General Practice Why choose General Practice? GP snapshot "Why I chose General Practice" General Practice mythbusters Not just a GP

10 16 18 20 24

East Bentleigh and has teaching responsibilities at three Melbourne-based universities. He is also the author of

28 30 32 36 38

42 44 48

Real-life adventures in GPland Luck of the Irish Reaching the kids Diary of a rural doc This academic life

50 54 56 60

Money matters What you can earn Incentive payments

68 72

Keeping your balance Part-time, smart time Being resilient 2

several internationally adopted textbooks, including General Practice.

GPRA wishes to acknowledge our sponsors for supporting this publication: Platinum Sponsor: Avant Mutual Group Founding Benefactor: Dr Jerry Schwartz, The Schwartz Family Co. GPSN Founding Sponsor: MDA National Insurance Pty Ltd

Design your own GP career What kind of GP will you be? Your career your way Travel while you train

Prof. Murtagh is Adjunct Professor of General Practice, Monash University and Professorial Fellow in the Department of General Practice, University of Melbourne. He practises part-time as a general practitioner at

Exploring General Practice in hospital 5 things to do right now The Going Places GP Network – Join now! PGPPP – Try it on for size "My PGPPP experience" Turbocharge your GP career in hospital

GPRA would like to acknowledge the support of our patron, Professor John Murtagh, and his invaluable contribution to General Practice.

76 78

Co-Sponsors: Adelaide to Outback GP Training Program, Aspen Pharmacare, Australian College of Rural and Remote Medicine, Australian Defence Force, Australian Locum Medical Service, Bogong Regional Training Network, Central and Southern Queensland Training Consortium, Department of Health and Ageing, Health 24/7, General Practice Training Valley to Coast, Matraville Medical Complex, McMasters’ (Vic) Pty Ltd, Medical Insurance Group Australia, Medical Recruitment Pty Ltd, More Doctors Initiative from Department of Health and Ageing, MIMS Australia, National E-Health Transition Authority Ltd, North Coast GP Training, Northern Territory General Practice Education, Royal Australian College of General Practitioners, Rural Workforce Agency Victoria, The Doctors’ Health Fund and WentWest Limited. Business Partners: Australian Doctor, FPA Health Pty Ltd, General Practice Education and Training, Healthed Pty Ltd, Medical Observer and Ochre Recruitment Pty Ltd. Subeditor: Jan Walker. Graphic Design: Marie-Joelle Design & Advertising. Marketing: Kate Marie. Printing: Fishprint. GPRA wishes to thank all the contributing authors for their work and guidance. We also thank the Commonwealth Department of Health and Ageing for their continued support and assistance.

All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party materials, the owner of that content.You may not alter or remove any trademark, copyright or other notice from copies of the publication. All efforts have been made to ensure that material presented in this publication is correct at the time of publishing. Due to the rapidly changing nature of the industry, GPRA does not make any guarantee concerning the continued accuracy or reliability of the content.

A message

HOW MANY WAYS DO YOU LOOK AFTER YOURSELF?

from the

GPRA Chair

“Which speciality is right for me? Which direction should I take in my career? What do I really want from my work and my life in the years to come?” These are big questions we all ask ourselves as doctors in the hospital system.

This guide for prevocational doctors has been designed to help you answer such questions about your future career. The name GP Compass is an obvious reference to the search for direction at this exciting yet potentially confusing time. General Practice occurs outside of the hospital, which means that despite accounting for around 90% of patient care it often falls off the radar. At General Practice Registrars Australia (GPRA) we are passionate about promoting the amazing opportunities that General Practice can offer you. While everyone knows that achieving a good work-life balance is easier in General Practice, not everyone is aware of the other great advantages,

such as continuity and holistic care of our patients, the benefit of working in teams, the considerable professional challenge and the ability to pursue procedural or medical special interests. Bear in mind that it’s now possible to do a rotation in General Practice through many hospitals, which is a brilliant way to find out what it’s really like (see page 32). Another way to find out more about General Practice is to keep an eye out for Going Places GP Network events at your hospital this year. It’s a GPRA initiative that will set up networks in hospitals for doctors interested in learning more about General Practice (see page 30). 

Looking after you - The Doctors’ Health Fund When you’re busy living life to the full you don’t expect things to go wrong, but if the unexpected strikes, you’ll be glad you are prepared with the right health insurance so you can concentrate on enjoying life. Join your not-for-profit private health insurance fund which offers high quality health insurance with the flexibility for you to choose the hospital and extras insurance that works for you. With hospital insurance, from the very economical ‘Smart Starter’, to ‘Top Cover’ with the greatest medical benefits in Australia based on AMA List fees. The choice is yours. For all the information you need and to join visit www.doctorshealthfund.com.au. Contact us at info@doctorshealthfund.com.au or call 1800 226 126.

www.doctorshealthfund.com.au

We would like to extend our appreciation to General Practice Education and Training Ltd (GPET)* for providing financial assistance and support for this new initiative as our GP Compass founding partner. Many of the articles in this guide have been written by General Practice Registrars so it’s an authentic insider’s view of this wonderfully fulfilling yet often underrated profession. I would like to acknowledge and thank the many writers who have so freely given of their time and expertise to make this edition possible. A special thanks too to all the GPRA staff, Board and Advisory Council members for the hard work they do in supporting the future of General Practice.

If there is anything else you’d like to know please feel free to email us, or you may like to apply to have your own GP Mentor (see page 82 in the other section of this guide for details). It’s a great way to get friendly peer-to-peer advice. Dr Belinda Guest GPRA Chair 2008-2010 chair@gpra.org.au 0406 214076 *General Practice Education and Training Ltd (GPET) is the company that administers the Australian General Practice Training (AGPT) program.

Fostering Interest in General Practice GPSN’s primary role is to function as a General Practice interest group, seeking to promote the beneﬁts of a life and career in General Practice. With various programs focussed on mentoring, peer support, networking and research, GPSN aims to become the largest student network promoting General Practice. GPSN is administered by General Practice Registrars Australia (GPRA) and is supported by a funding grant from General Practice Education and Training (GPET).

1 Choosing a career in General Practice

As a prevocational doctor you’ve reached a fork in the road. Which direction will your career take? Consider the many rewards of being a “general specialist” – a great career in ever y direction.

GENERAL PRACTICE STUDENTS NETWORK

A GPRA initiative

To ﬁnd out how you can support the future of general practice, please contact us on 1300 131 198, or email us at gpsn. enquiries@gpra.org.au

Choosing a career in General Practice

Why choose

General Practice? Is General Practice the career choice for you? A newly trained GP outlines the pros and cons to help you decide. As you progress through your internship and early RMO years, a time comes when decisions have to be made about your future training and specialisation. You get exposed to most medical specialties as a junior doctor in the hospital system, but General Practice is a bit of a mystery.

What do I like about General Practice?

I love the wide variety of work, covering aspects of every specialty. I like to know a little bit about everything compared to a lot about one or two things. Over time, one can build a relationship with the patient, their family and community. Patients come back and see me “As a GP you can and bring their families. I really get to know what makes them enjoy a healthy tick and what impacts upon their lifestyle and health beyond the physical.

As a junior doctor, there are now more opportunities than before to try out General Practice via the Prevocational General Practice Placement work-life Program, commonly known as the PGPPP. (For more information about the PGPPP, see page 32.) I would recommend trying one of these terms. You may find that General Practice is for you. If not, at least you will get some idea of what the GP work environment is like, which will be useful regardless of your future specialisation.

So how do you know if General Practice is the right career for you? Here are a few questions I have asked myself and at least some of the answers.

balance.”

Early intervention and screening, and a trusting relationship, can impact upon a patient’s entire life. Being an advocate for patients is something I enjoy, especially for those with chronic conditions who have to navigate the health system. Rural medicine has additional rewarding challenges, including procedural and Accident and Emergency skills. These are all things I like about General Practice.

The work environment, flexibility in hours and part-time options are attractive. The training environment offers so many options both during and after training, and there is financial support for training via government incentive payments. Travel, both within Australia and overseas, can be part of your training with forward planning.You can follow a love of research, complete your training part-time or pursue almost any special interest. Sports Medicine, Palliative Care, Drug and Alcohol, Psychiatry, Paediatrics, Family Planning, Obstetrics, Anaesthetics, Emergency, Antarctic Medicine and more can all be catered for. It is possible to take leave to pursue other interests such as overseas work and travel, and family time, without a significant impact upon future training. There are opportunities to run your own business in the future and to learn this during training while you are employed under protected conditions. And every day is different!

What qualifications will I end up with? There are two colleges of General Practice – the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM).

Registrars may complete Fellowship of RACGP (FRACGP) and/or Fellowship of ACRRM (FACRRM) to gain vocational registration to work unsupervised in Australian General Practice. The FACRRM course has an emphasis on the skills required for rural and remote practice so training takes place mostly in rural and remote locations but once the qualification is complete, Fellows may practise anywhere in Australia. The FRACGP curriculum covers broad General Practice with plenty of scope for special interests, including some rural medicine skills. For those doing FRACGP with an interest in obtaining additional skills to practise in rural areas, there is the option of the Fellowship in Advanced Rural General Practice run by the National Rural Faculty of the RACGP, which may be studied concurrently and awarded after completion of the FRACGP. Some Registrars choose to complete all three Fellowships, and much of the training can be undertaken concurrently. Some Registrars choose to complete just the FRACGP or ACRRM, which is all that is required for vocational registration. GP Registrars can also elect to undertake all manner of diplomas or courses in areas of special interest to them such as Obstetrics or Child and Adolescent Health. 

“I love the wide variety of work, covering aspects of every specialty. I like to know a little bit about everything compared to a lot about one or two things.” 11

Choosing a career in General Practice

10 great reasons to find yourself in General Practice Supervisors Association (NGPSA). The document stipulates the minimum salary or percentage of billings that must be paid to the Registrar for hours worked (whichever is highest). Most Registrars are able to earn more based on a percentage of billings generated once they settle into General Practice. In recent years there have been changes that make General Practice a financially attractive option. (For more information about salaries, see page 68.)

1 2

Be challenged every day. Looking for intellectual stimulation? Want to test your diagnostic skills? Want to use all the knowledge you learnt at med school, not just a little bit? You never know what is going to walk through the door in General Practice.

You’ll never be bored. Every day is different – and you can mix it up by working different sessions and following special interests.

An alternative training route for those wishing to train in Australia’s most remote locations is the Remote Vocational Training Scheme (RVTS).

Design your own career. No other specialty offers so many diverse special interests to pursue during training and practice.

(For more information about the structure of General Practice training, see page 9 in the other section of this guide.)

Develop relationships with real people. Establish ongoing relationships with families and individuals as people, not just patients.

What are the employment conditions?

Be part of a team. Develop rewarding collegiate relationships with the other GPs and allied health professionals.

Make a difference. As a GP you’re in a position to save lives through screening and early intervention.

Enjoy work-life balance. Choose the hours you work with time for family, friends and personal interests.

Train part-time or take time off for travel. Whether you want to combine starting a family with your training or take a break for travel, the flexibility of GP training and work makes it possible.

10 12

The overall vocational training program is called the Australian General Practice Training program (AGPT), which is administered by a company called General Practice Education and Training Ltd (GPET). It delivers training through a number of Regional Training Providers. (RTPs) that respond to the health care needs of various regions across Australia.

Be the doctor people see first. Everything starts with the GP or “general specialist” – the hub of the health care system. The family doctor holds a special place within a family and in the community.

General Practice training differs in that it usually occurs in a private practice environment. Remuneration for Registrars during training is protected by the National Minimum Terms and Conditions (NMT&C) document. This document is brokered by Registrar representatives from General Practice Registrars Australia (GPRA) and Supervisor representatives from the National GP

Unlike in many other training programs, the Registrar is paid to learn, with a certain number of education sessions and one-on-one teaching by the GP Supervisor at the practice included in the paid sessions. Registrars are also released from working at the practice to attend education sessions organised by their RTPs in their first 12 months of GP Terms (RACGP) or Primary Rural and Remote Training (ACRRM).

How long does it take? The Australian General Practice Training program usually takes three years for the FRACGP curriculum or four years for the FACRRM curriculum. A fourth year of Advanced Rural Skills Posts (ARSPs) may be added to the FRACGP program to attain the optional FARGP. 

Earn good money. You’ll earn a good income while training and working as a GP without the extreme hours of many other specialties. You can work for others or consider starting your own practice.

Choosing a career in General Practice

The first of these years is undertaken in the hospital and must be after the internship. However, there are ways to reduce this time. If you already have additional years of hospital experience it is possible to have these counted retrospectively by applying for Recognition of Prior Learning (RPL), enabling you to shorten your training time by a maximum of 12 months or enabling you to undertake Elective Terms rather than Hospital Terms to complete your training time. The length of training can also be extended in a number of ways. This includes part-time training, Advanced Academic Posts, mandatory Elective Terms or leave. You can tailor it to suit you.

Points to consider

Multiple stakeholders in General Practice training and ongoing changes to Australia’s health care system, which can add layers of complexity to General Practice and General Practice training. Fortunately, General Practice Registrars Australia (GPRA) advocates on your behalf for quality training and good conditions for GP Registrars. Having recently completed my training, I can say I had a great experience, was generally wellsupported and very happy with my career choice. General Practice could be just what you are looking for.

Contributed by Dr Siew-Lee Thoo and updated by Dr Jenny Lonergan, Dr Naomi Harris and Dr Jason Ong

The downsides – yes there are a few negatives – but with preparation they can be managed. The General Practice environment – adjusting to private practice, the Medicare Benefits Schedule and fee-for-service models. The effect of government legislation to address critical workforce shortages. GP Registrars must meet compulsory geographical requirements for training (rural and outer metro requirements). This most likely involves relocation once and sometimes twice during training. This can get more difficult if you have a partner, family, mortgages or other responsibilities but with forward planning stress on the family can be reduced.

DO IT NOW For more information, visit www.gpra.org.au or www.agpt.com.au

Choosing a career in General Practice

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Choosing a career in General Practice

“ Why I chose General Practice” Dr Abhi Varshney is the Royal Australian College of General Practitioners’ 2009 Registrar of the Year. But he almost never became a GP at all. As a hospital doctor, did you see yourself in General Practice? When you’re doing your training, the way you see your career heading depends very much on the people you work with. I was lucky enough to work with some people who were really passionate about Surgery and particularly Orthopaedic Surgery so that was originally what I wanted to do. I did all the compulsory terms and then all my terms after that were Surgery or Orthopaedic Surgery.

Did you initially even consider General Practice? No. When I was a medical student I went through the process of a General Practice rotation but it wasn’t a good experience. Basically I sat in the corner and didn’t do anything.

What changed your thinking? I was doing a Registrar job in Orthopaedics when I had a motorcycle accident. I was the fool who saw the trauma cases caused by motorcycle accidents but was still riding my motorcycle. 18

Fortunately, I was not badly injured but it was quite a big deal. There was ambulance, fire brigade, everything else. My bike was written off. My wife was called to the Emergency Department and she was there crying and even though they told her everything was fine she was very upset. It made me think – about the importance of spending time with the people you love. I lost the drive and desire to be at the hospital at two in the morning. Orthopaedics is very much like that.

“It made me think – about the importance of spending time with the people you love. I lost the drive and desire to be at the hospital at two in the morning.”

Abhi’s tips on choosing the right specialty There is a specialty for everyone. We are fortunate in medicine to have so many choices. There is more to life than work. Medicine is a great job but there’s more to your life than that. General Practice is a specialty that allows you to have outside interests that balance the challenges of the job. Don’t make hasty judgements. Don’t dismiss General Practice until you know something about it. Do the PGPPP. This really is a great program and an excellent way to find out what General Practice is really like. Having your own patients to manage is very different from sitting in the corner as a student. (For more information, see page 32.)

What happened next? We moved from Brisbane to Sydney for my wife’s work – she’s a university lecturer in Linguistics. I did some locum work. I did some Emergency Department work. I did some work in a psychiatric hospital. I did some work in the jails in Sydney. I guess I was trying to find the thing that I wanted to do, that would suit me.

What made you take a fresh look at General Practice? I realised I really liked having lots of contact with patients. It’s amazing the privileged position we’re in when patients will open up and tell you the most personal things that they wouldn’t tell anyone else. I realised that General Practice was the one specialty that would allow me that connection with patients.

What else did you like about the idea of being a GP?

well. I didn’t have to give up Mental Health and I didn’t have to give up the procedural things. I could do all those things in General Practice – and have the life I wanted.

Is General Practice the easy option? General Practice is a specialty in its own right. The training program is quite difficult but you’re well supported. It’s not an easy option.

What’s life like now? I work from 8 till 5.30 – Monday, Tuesday, Wednesday and Friday. Every second Thursday I’m doing private assisting for an orthopaedic surgeon and on the other Thursday I’m doing preventative health care work in the corporate sector. I’m lucky to have a family that I love to spend time with. My wife is fantastic and I’ve got a three-year-old daughter and it’s very refreshing to see the world through her eyes.

It would allow me to practise in the general area of medicine and to have special interest areas as 19

Choosing a career in General Practice

General Practice

mythbusters Myth Myths abound about General Practice that just aren’t true. Here’s a reality check.

Myth

General Practice is all about coughs, colds and referrals.

General Practice is a poor cousin to the other specialties.

Training to be a GP is too easy.

 True

 False

Fact

General Practice is anything you want it to be.

General Practice is the profession of choice for variety, flexibility and work-life balance.

GP Registrars must complete three to four years of on-the-job training, exams and assessments to qualify for vocational registration.

 True

 False

Every day an amazing variety of presentations walk through a GP’s door, so life is never boring! General Practice is also unique in its flexibility. In fact, it’s the one specialty you can shape into whatever you want to do with your life. Many general practitioners supplement their everyday work with sessions in specific areas of interest (for example, Sports Medicine, Obstetrics, Forensic Medicine, education and research... the list keeps growing!)

 True

 False

In the hospital system, General Practice is often misrepresented as a fallback career for those who don’t make it into their preferred choice of specialty. Such misinformation is spread not maliciously but out of ignorance because hospital doctors traditionally have little exposure to General Practice. But all this is changing. There is now a “try before you buy” scheme called the Prevocational General Practice Placements Program (PGPPP) that allows junior hospital doctors to experience life in a private General Practice (see page 32). It’s a way to discover the true variety, flexibility and intellectual challenge of General Practice. And the joys of working regular hours instead of the mind-numbing hours of hospital shifts.

Myth

 True

 False

Since 1996, all new general practitioners must become vocationally registered. The introduction of formalised GP training has done much to recognise the need for structured postgraduate training in view of the complexities of primary care medicine. It has raised the competency of young GPs and promoted the status of General Practice as a specialty in its own right. Today, as in all other specialties, there is a defined pathway into General Practice through the two General Practice colleges – the Royal Australian College of General Practitioners (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM). Australian General Practice Training (AGPT) is delivered through a number of Regional Training Providers (RTPs) across Australia.  21

Choosing a career in General Practice

Myth

Life is tough as a GP.

You’ll never drive a Porsche as a GP.

 True

 False

Fact

You can “get a life” as a GP with parttime training options, family-friendly hours, minimal weekend work and no on-call.

As a GP you can make around $200,000 a year without sacrificing your lifestyle, working 9 to 5, five days a week.

 True

 False

As in any profession, you take the good with the bad, but the joys and rewards of General Practice are many. Having the options to train and work part-time, with no overnight on-calls and minimal weekend work is a big plus that GPs enjoy. You dictate the hours you want to work, and even the most seductive perks of other specialties, like travelling and training in exotic locations, are all possible in General Practice.

 False

You might be surprised to learn that earnings have improved for GPs in recent years. It’s possible to make up to $200,000 or more for working around 40 hours a week leaving time to have a life as well as a nice car. (For earning capacity, see page 68 or refer to the GP Australia website's GP Earning Calculator at www.gpaustralia.org.au/gpearnings/) There are also government incentive schemes for GP Registrars training in rural and remote areas and $30,000 for new GPs practising in outer metropolitan Unmet Areas of Need (see page 72).

Contributed by Dr Jason Ong, Jan Walker and Vicky Phan

Choosing a career in General Practice

Not just a GP “Do you want to be a specialist or just a GP?” It’s a question posed to most medical students – and that got Monash med student Lana Prout thinking.

hroughout my medical degree I have been asked by many people what I aspire to become after I have finished medical school. This is usually phrased in some form of “do you want to be a specialist or just a GP?”. I never used to be fazed by this question and would simply answer that I wanted to become a rural GP obstetrician. However, as I have progressed through my medical degree and become more aware of exactly what a GP does, I am now slightly angered by such a remark. “Just a GP.” It makes it sound as though medical students should either aim at becoming a specialist, or not bother at all – something that I have found to be a very long way from the truth.

Skill, knowledge and passion In my fourth year of medical school I was privileged enough to spend an entire year based in a General Practice located in rural Victoria, under the guidance of a very experienced general practitioner. During my time there I was able to both witness and experience first-hand just how much general practitioners do as well as the skill, knowledge and passion required to do so. There was never a dull moment, and every patient encounter provided a unique learning opportunity.

Endless opportunities Since before I was even born, my GP Supervisor has been delivering babies, carrying out anaesthetics, removing skin lesions, performing X-rays, attending to emergencies, running the local hospital, visiting patients in nursing homes,

“During my time there I was able to both witness and experience first-hand just how much general practitioners do as well as the skill, knowledge and passion required to do so.” managing acute and chronic disease, counselling patients, undertaking preventative health measures, investigating and diagnosing the unknown, teaching medical students and Registrars as well as being a leader within the local community, among many other things. The opportunities available to general practitioners are, clearly, endless. Nowadays if anyone asks if I want to be “just a GP” I challenge them to spend a day with my GP Supervisor and suggest to him that all he has become is “just a GP”. Funnily enough no one has yet taken me up on that challenge.

Contributed by Lana Prout

“

What I love about General Practice is not knowing who or what is going to walk through the door next. I also really appreciate the opportunity to practise every aspect of medicine.

”

Dr Don Cameron

WE CAN HELP YOU REACH YOUR CAREER TARGETS

Exploring General Practice IN HOSPITAL Whether you’ve decided to do General Practice or you’re still thinking about it, the time to act is now. While you train in hospital, there are many ways you can work towards a GP career or satisfy your curiosity about what General Practice is really like.

FIND OUT MORE www.gpra.org.au • enquiries@gpra.org.au • 1300 131 198

Exploring General Practice in Hospital

things

Curious about General Practice as a career? Or perhaps you’ve already decided that being a “general specialist” is your calling. As a junior doctor in the hospital system, there are five simple things you can do right now to get the show on the road.

Exploring General Practice in Hospital

Join the Going Places GP Network

Be part of the Going Places GP Network at your hospital. It’s a fun way to network with others with an interest in General Practice while developing your professional knowledge and credentials. Remember, membership of the Going Places GP Network doesn’t imply any formal commitment to General Practice – and the experience will be helpful whatever vocational path you ultimately follow. (For more information, see page 30.)

Apply for the PGPPP

Get a taste of General Practice as a junior doctor by doing a stint in the Prevocational General Practice Placements Program, known as the PGPPP. Even if you have not yet decided what your specialty will be, it’s a great way to gain exposure to General Practice so you can make an informed decision. (For more information, see page 32.)

to do right now

Choose the right hospital and rotations

When you apply for your hospital, select a hospital that offers more specialty than subspecialty rotations. Hospital experience in General Medicine, Surgery, Accident and Emergency, and Paediatrics is mandatory in General Practice training. So by doing these, you may be eligible for Recognition of Prior Learning (RPL) and be able to fast-track your GP training. Psychiatry, Orthopaedics, Geriatrics, Obstetrics and Gynaecology, and Anaesthetics (for rural General Practice) are also very useful for aspiring general practitioners. (For more information, see page 38.)

Find a GPRA Mentor

GPRA offers a great Mentors Program. Simply register with mentors@ gpra.org.au and you’ll be put in touch with a current GP Registrar, who will give you invaluable advice and one-onone career coaching. (For more information, see page 82 in the other section of this guide.)

Apply for General Practice training

You can apply during your internship year to enter the Australian General Practice Training program as a second year postgraduate, or apply during any following year of your hospital training. Online application forms are available at www.agpt.com.au (For more information, see page 4 in the other section of this guide.)

Exploring General Practice in Hospital

The Going Places GP Network

Join now!

“The Going Places GP Network brings the General Practice experience to you in your hospital.” There is a new junior doctors’ network on the block – it may already be at your hospital or just around the corner.The Going Places GP Network is all about helping your career to go places in General Practice while you complete your hospital training.

Ever noticed that once you’ve entered your hospital training, General Practice tends to fall off the radar? You are working in acute care and specific specialities – and you probably never hear about General Practice. But all that is changing. The Going Places GP Network brings the General Practice experience to you in your hospital. Members can explore the challenges and advantages of specialising in General Practice through hospital networking events, publications distributed in the hospital and online resources. All these member benefits are free to Going Places members. So why start a General Practice network in the hospital setting?

Filling the “black hole” in GP exposure The ongoing shortage of General Practitioners in Australia is rarely out of the headlines and the Government is constantly working on strategies to support a strong GP workforce into the future.

Among the most effective ways for young medical practitioners to consider their career options and enhance their training experience is through peer networks. For General Practice this has been proven by the peer networks of General Practice Registrars Australia (GPRA) and its GPSN university-based clubs for medical students. That’s why GPRA, with support from the government and financial assistance from General Practice Education and Training Ltd (GPET) and local Regional Training Providers, has developed the Going Places GP Network.

GP Ambassadors at your hospital The Going Places GP Network appoints junior doctors in the role of GP Ambassadors in teaching hospitals throughout Australia. The GP Ambassadors help foster interest in General Practice by organising social networking events featuring GPs speaking on different aspects of General Practice for a new generation of GPs.

Join the Going Places GP Network now – it’s free! Resources include: Social networking events at your hospital organised by your hospital GP Ambassador. A regular Going Places magazine. The annual GP Compass Prevocational Doctors Guide to General Practice. A new website www.gpaustralia.org.au, being launched in March 2010, with information for junior doctors on General Practice: the training, the experience and the career. An e-newsletter with updates on training requirements and events at your hospital and local Regional Training Provider. Why not join today? To become a member, visit us at www.gpaustralia.org.au, email goingplaces@gpra.org.au or phone 1300 131 198 and we will sign you up and link you with your local Regional Training Provider.

Exploring General Practice in Hospital

PGPPP

Try it on for size

If you’re wondering whether General Practice is the right fit for you then give the Prevocational General Practice Placements Program (PGPPP) a go. The PGPPP – the Prevocational General Practice Placements Program – is a great way to experience General Practice during your hospital training years. Whether you’re seriously considering a GP career or you simply want to gain a deeper insight into primary care, it’s an experience that will enhance your medical training.

Work in a community General Practice Work as a valued colleague in a city or country practice, live in the community and experience a real change of pace from the hospital setting. The PGPPP is divided into two components: Practices in metropolitan and large regional areas that are managed by the Royal Australian College of General Practitioners (RACGP). Practices in remote, rural and regional areas that are managed by Australian College of Rural and Remote Medicine (ACRRM).

Who is eligible? The PGPPP is open to Interns and Postgraduate Year 2/3 doctors. Terms are generally equal in duration to hospital rotations. You will be well supported with defined levels of teaching and supervision in an accredited training practice.

A seamless move The PGPPP funds educational resources, travel and accommodation (conditions apply). All salaries continue to be paid while on placement, and superannuation, indemnity and industrial arrangements are managed by the hospital of origin, to ensure a seamless move from hospital to practice.

Talk to your hospital now Talk your Medical Education Officer or Director of Clinical Training about including a PGPPP rotation in your training plans.

DO IT NOW Talk to your Medical Education Officer or Director of Clinical Training about the PGPPP. Or visit www.racgp.org.au or www.acrrm.org.au

“Work as a valued colleague in a city or country practice, live in the community and experience a real change of pace from the hospital setting.”

“

What I love about General Practice is the continuity of care and relationships formed with patients and families.

”

Dr Carly Taylor

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Exploring General Practice in Hospital

“My PGPPP experience”

“Signing up for the PGPPP was an excellent learning experience both in terms of my future career planning as well as furthering my RMO education. I would strongly recommend it.”

Dr Rhutam (Raj) Mehta AS A JUNIOR DOCTOR, DR RHUTAM (RAJ) MEHTA FOUND THE BEST WAY TO EXPERIENCE GENERAL PRACTICE AND GAIN CONFIDENCE AS A DOCTOR WAS TO SEE HIS OWN PATIENTS AT A PRIVATE GP PRACTICE. Where did you do your PGPPP?

What was your experience like?

What range of work did you actually do?

I did the PGPPP as part of my PGY2 at Royal Perth Hospital. My placement was at Stirk Medical Centre in Kalamunda, a suburb in the Perth Hills.

Let me honestly say that the best way to experience General Practice is to fully immerse yourself in it. Within a week I was given my own room, complete with name plate, and started seeing patients on my own. At first this was quite daunting, however I was particularly impressed with the promptness of my GP mentors who would rush to my aid whenever I had a question regarding patient management.

I was performing procedures from the excision of moles to the drainage of a knee to relieve pain. It was also very satisfying be the first point of care and to see some true pathology that had not already been managed to some extent by others. All this meant that I felt I really was making a difference.

How did you feel about doing the PGPPP at first? Initially, I had my doubts about whether I had made a good choice. My colleagues were about to start the Community Residency Program, which includes some hospital contact as well. I was about to start a solely GP-based program.

How did your GP placement compare with hospital work? I really enjoyed the direct contribution I was able to make to people's health care. Often, in the hospital system as a junior doctor, a lot of time is spent doing "tasks" for the team.

Program highlights? The interaction with children. The kids I saw at my practice generally presented with well-defined clinical problems and I was able to help my little patients as well as reassure their parents.

DO IT NOW Talk to your Medical Education Officer or Director of Clinical Training about the PGPPP. Or visit www.racgp.org.au or www.acrrm.org.au

What advice would you give other junior doctors about the PGPPP? Signing up for the PGPPP was an excellent learning experience both in terms of my future career planning as well as furthering my RMO education. I would strongly recommend it.

Exploring General Practice in Hospital

TURBOCHARGE

your GP career in hospital

Get the latest information on the important clinical issues in Women’s & Children’s Health facing Australian GPs today. The 2010 seminars are scheduled for the following tentative dates:

As a GP Registrar, there are ways to keep your eyes on the General Practice prize during your Hospital Terms.

uring Hospital Terms, it’s easy to be occupied with the usual Resident duties of caring for too many patients and constantly being paged. Often, little time is left to think about how your hospital experience can help you as a GP in the future. Here are a few points that will help you make the most of your hospital experience. Choose the right hospital and terms. Choose a hospital and terms that will give you experience with common GP-managed conditions. Mandatory and other useful rotations are listed in the box overleaf. If a GP placement is offered at your hospital, take full advantage. (For more information, see page 32.) Fine-tune your practical skills. Ask nurses to teach you skills such as giving vaccinations (especially to children) and dressing wounds. Pick up useful procedural skills. Learn procedural skills that may be useful in General Practice; for example, joint injections.

Learn the art of referrals. Think about what information is pertinent in 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. Find out who’s who. Identify people who may be good information sources when you are working in the community; for example, hospital Registrars, Consultants, CNCs. Practise your writing. Take particular notice of writing comprehensive and prompt discharge summaries, and don’t be afraid to call GPs to tell them their patients are coming home. 

FREE for all GPRA members enrolled in the AGPT program

The Annual Hormone and Women’s Health Update Sydney, 20 February 2010

The Women’s Health Update Melbourne 1, 27 March 2010

Saturday, 8.30am-6.30pm Clancy Auditorium University of NSW, Kensington, NSW

Saturday, 8.30am-6.30pm Copland Lecture Theatre University of Melbourne, Parkville, VIC

The Women’s and Children’s Health Update Adelaide, 15 May 2010

The Women’s and Children’s Health Update Brisbane, 17 July 2010

The Paediatric Health Update Sydney, 11 September 2010

The Women’s and Children’s Update Melbourne 2, 28 August 2010

Saturday, 8.30am-6.30pm Mutual Community Lecture Theatre, University of SA, City East Campus, SA

Saturday, 8.30am-6.30pm Clancy Auditorium University of NSW, Kensington, NSW

Saturday, 8.30am-6.30pm Lecture Theatre, UQ Centre University of Queensland, St Lucia, QLD

Saturday, 8.30am-6.30pm Copland Lecture Theatre University of Melbourne, Parkville, VIC

Please note: dates and final programme may be subject to change

Register online at www.healthed.com.au or call 1300 797 794 Brought to you by Healthed – one of Australia’s most popular and respected providers of education for health professionals.

Exploring General Practice in Hospital

Choose the right rotations During hospital training there are rotations and experiences that are considered to be mandatory preparation for the Australian General Practice Training (AGPT) program. There are four compulsory rotations: Medicine (preferably General Medicine but as this is not available in some hospitals, a rotation that offers general medical experience); Surgery; Accident and Emergency; and Paediatrics. In addition, GP Registrars should obtain hospital experience in at least three other areas. Some useful rotations for General Practice are Psychiatry, Obstetrics and Gynaecology, and Anaesthetics (for rural practice). If you have completed some of these as a prevocational doctor, you may qualify for Recognition of Prior Learning (RPL) so you can either reduce your training time or substitute part of your training with educational requirements that develop existing skills or new skills. Your Regional Training Provider can provide further information about how to apply for RPL, which you must apply for in the first year of training. RPL may be approved for all, or part, of the requirements of the post-Intern hospital year of training in Australia.

3 Design your own

General Practice can take you on many special interest highways and byways. Whatever your interests, you can design your career around them in General Practice.

Network with your peers. Check to see whether the Going Places GP Network has started at your hospital and, if so, get involved in events and peer group activities (see page 30 for details). Once you have enrolled in General Practice vocational training, most Registrar Liaison Officers (RLOs) and Regional Training Providers (RTPs) have email list servers where Registrars can 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 and Dr Kate Kelso

DO IT NOW For more information about compulsory hospital rotations for General Practice training, visit www.agpt.com.au If you have any questions or problems during hospital training, contact the Registrar Liaison Officer at your Regional Training Provider or get in touch with GPRA directly.

GP CAREER

Design your own GP career

WHAT KIND OF

will you be?

No other specialty offers so many special interests to pursue during training and practice. These are just a few of the options. Aboriginal Health Academic Medicine and Research Anaesthetics Antarctic Medicine Australian Defence Force Aviation Medicine Cosmetic Medicine Dermatology Drug and Alcohol Emergency Expedition Medicine Family Planning and Sexual Health Forensic Medicine Geriatrics HIV Medicine Men’s Health Mental Health Musculoskeletal Medicine Obstetrics Occupational Medicine Paediatrics Palliative Care Royal Flying Doctor Service Sports Medicine Surgery Travel Medicine Tropical Medicine Women’s Health Plus many more 42

A match made in heaven WE FIND THE RIGHT PLACEMENT FIRST TIME EVERY TIME FREE PLACEMENTS FOR ALL DOCTORS Choose your lifestyle: • 100’s of vacancies to choose from throughout Australia • Work where and when it suits you • Travel Australia and NZ and get paid for it WHAT WE DO FOR YOU

$120 per hour We assist with: guaranteed or • Your provider numbers 65% of your • Medical registration billings, whichever • Professional indemnity is the greater • Travel and accommodation • Match your experience, interests and family needs with suitable placements

Benefit from our 25 years experience

Call 1300 137 142 www.medicalrecruitment.com.au

Design your own GP career

Your career your way Sports Medicine GP training encourages Registrars to explore the many guises of General Practice through various stimulating side trips. Many, like this trio, find their passion.

Aboriginal Health Dr Jenny Lonergan

Dr Michael McLean

boriginal Health is part of the training program for GP Registrars. Most say it’s one of the best things they’ve ever done – and for many there’s the boomerang effect.

“My involvement in Sports Medicine means getting out of the practice setting and being involved with local sport and games, from rugby league to hockey to soccer to cricket and others, usually on weekends.

Dr Jenny Lonergan was one such Registrar. While training, she spent a term at Redfern’s Aboriginal Medical Service and loved it.

Working at the AMS means an involvement in the local community – something Jenny regards as a privilege.

“When I left, the staff gave me a purple boomerang so I’d come back. So I did, and I’ve been there for six years now.” 44

“Most of my patients have a really dry sense of humour. Aboriginal people are quite resilient and they don’t tend to come in and see you unless they’re really unwell, so you do get a sense that you’re making a real difference to their health,” she says.

r Michael McLean is a GP Registrar working in Bundaberg in Queensland and also the team doctor for the Australian schoolboys rugby union team. He began his working life as a physiotherapist then enrolled in medicine in his late 30s. He is currently completing a Masters in Sports Medicine.

“When I left, the staff gave me a purple boomerang so I’d come back. So I did, and I’ve been there for six years now.”

“I see the athletes when they’re participating, and attend to them on the spot if they’re injured.

“Treating acute injury on the field, as it happens, is very different to an Emergency Department. Some injuries are dealt with on the field, but others need the protection of a safe medical environment – like a first-time dislocated patella.” By blending his allied health skills with his newlywon General Practice ones, Michael has found his true calling. 

Design your own GP career

Trust MIMS

Right Product, Right Place, Right Time

Rural Dr Scott Finlay

Right Place

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utures broking is a long way from rural medicine but Dr Scott Finlay has no regrets. After working for a large bank on Sydney’s North Shore, he became disillusioned with the world of finance and decided to pursue his childhood dream of becoming a doctor. After his second rural placement he was hooked on General Practice, and rural General Practice in particular. He currently works in Moree, and combines private consulting with on-call work at Moree Hospital.

“Over the last week, I’ve done some General Practice consulting, I’ve given general anaesthetics, delivered a baby, had inpatients at the hospital to look after...”

Right Product

Right Time

“There’s no such thing as a typical week,” he says. “Over the last week, I’ve done some General Practice consulting, I’ve given general anaesthetics, delivered a baby, had inpatients at the hospital to look after and, on Friday, I drove down to Narrabri Hospital to help out with a major motor vehicle accident involving 10 patients. “A GP mentor of mine made me realise that being a good rural GP meant having the ability to walk into any situation and offer some help – being present and effective. “The community really appreciates the skill set you bring to it.”

Monthly updates give you the surety that you are accessing current information at all times

MIMS is Australia’s most trusted medicines information, with 46 years of experience, giving you peace of mind as you work.

Design your own GP career

Travel

while you

train

4 Real-life adventures

Strap on your backpack and make the world your consulting room while you train. It’s all possible in General Practice.

in GPland

Share the real-life stories of GP Registrars who have If you enjoy travelling and are keen to gain clinical experience from another country, RACGP offers a great opportunity to complete part of your General Practice training, including Extended Skills or Advanced Skills Terms, overseas. Typically, these are a six-month full-time position, although part-time can also be arranged. Please note that there are restrictions on when the overseas training posts can be completed.

To be approved as part of your General Practice training, you need to obtain prospective approval from the RACGP Censor by completing a written application that includes your specific learning plan for the post. Your RTP will assist you in obtaining and completing the form. Following completion of the post you are required to submit a report to the RACGP of the experience and learning undertaken.

Overseas terms have been completed in many locations including the United Kingdom, Ireland, USA, New Zealand, China, Malaysia and the Middle East (Australian Defence Force posts).

The overseas terms are a fantastic opportunity to broaden your horizons while completing your General Practice training.

FACT FILE For further information regarding RACGP overseas training posts, visit www.racgp.org.au There are also overseas training posts available when training to the ACRRM curriculum, visit www.acrrm.org.au Talk to your RTP about what “travel while you train” opportunities they may be able to offer you.

explored GPland’s well-worn paths and roads less travelled.

Real-life adventures in GPland

Luck of the

My income was a salary paid in Australian dollars, which was unfortunate given the exchange rate at the time. Sadly, the recession had not yet hit Irish food prices.

Teaching and learning Dr Kelly seach experienced the Celtic charm of rural Ireland on her overseas training post.

o you like Guinness? Celtic crosses? Irish accents? Then perhaps you should consider doing what I did, and apply for the GP Registrar exchange program between Gippsland Education and Training for General Practice (getGP) and the Donegal GP Training Scheme in Ireland. And don’t let a long-haul flight with a toddler, the Irish winter, or entering your third trimester of pregnancy stop you. At least I didn’t.

Picturesque County Donegal I worked in General Practice for a couple of months in the town of Ballybofey in County Donegal, in the picturesque north-west of Ireland. My partner put paid work on hold and became the full-time carer of our daughter. I think we each thought we had the better deal. Ballybofey and its “twin town” Stranorlar are divided by the river Finn, and famous for salmon fishing. Donegal is adjacent to Northern Ireland, and has an interesting history in addition to being wet, rugged and spectacular in its geography. The economic boom of the Celtic Tiger had drawn to a close and the recession had hit hard 50

where I was working, with unemployment high and lots of unfinished construction in an area that was already one of socio-economic disadvantage.

Salary The Health Services Executive (HSE) administers the financing of health care in Ireland. Means testing divides the population into General Medical Scheme (GMS) and private patients. The former receive a medical card which entitles them to unlimited GP consultations and medication free of charge; the latter pay for both. Thus GPs’ incomes are a mixture of capitation and fee for service.

“Quirks included calling the patients using a pushbutton system over a loudspeaker. It seemed a bit too much like a fish and chip shop to me.”

With GP training in Ireland there is a full day each week devoted to teaching and learning outside the practice environment, as well as tutorials in the clinic. The quality of the teaching was excellent, and I was particularly impressed with the peer-to-peer teaching.

DO IT NOW The Irish exchange program is regularly offered through getGP and may also be arranged through some other RTPs.

New ways of working Working in a new health system took a bit of getting used to. Patient presentations were, of course, similar to home, but I did come to realise how much is shaped by financing, resources and culture. Home visits are much more common than I was used to. Out-of-hours care is provided through a co-operative, servicing a large region. A lack of trained paramedics means a lot of doctors’ time can be spent attending patients outside the surgery.

Bemused looks Quirks included calling the patients using a push-button system over a loudspeaker. It seemed a bit too much like a fish and chip shop to me. I endured 

“Needless to say, the Irish are a sociable and hospitable lot, from providing play dates for my partner and daughter to after-work dinner and drinks…” 51

Real-life adventures in GPland

the bemused looks of staff and colleagues and continued to walk the corridor to call each patient in person.

drinks, and culminating in a graduation party for the 2009 cohort in a “barn” belonging to one of the trainers.

Other differences included not having access to imaging (resulting in a lot more referrals to Consultants or Emergency than at home), “pathology collectors” not existing (nurses or doctors take all the bloods), and the astounding presence of a dot-matrix printer in my consulting room to generate both scripts and letters. The 9.30am starts were definitely a bonus.

Campervan touring

Dinner and drinks Needless to say, the Irish are a sociable and hospitable lot, from providing play dates for my partner and daughter to after-work dinner and

Three weeks touring Ireland in a campervan as the first flush of spring crept across the country rounded out our stay. My daughter had seen her first snow and learned to enjoy Sesame Street in Irish. My partner had refined his photography and campervan driving skills. I learned how to pronounce Irish names, appreciate potatoes five ways and work in a different health care system. In all, I loved my Irish exchange. Why not try your Irish luck and give it a go?

Contributed by Dr Kelly Seach

Real-life adventures in GPland

Reaching the

kids

Flying visits to see kids in remote communities are all in a day’s work for Dr Aileen TRAVES in Paediatric Outreach.

o one can say that a travelling job isn’t interesting. Exhausting, maybe, but never boring. For anyone who has worked with kids in General Practice we know they can also be a big challenge. So for an extra challenge I thought I would combine the two – travel and kids’ health.

The job The Paediatric Outreach Program provides a travelling service from Cairns Base Hospital to the Atherton Tablelands, Cape York and the Torres Strait so that kids in those areas do not have to travel to Cairns as often. GP Registrars are lucky to be able to get specialist experience in Paediatrics with this service, and I am currently undertaking the job as a 12-month Advanced Rural Skills Post through Tropical Medical Training, with a Diploma of Child Health through the Children’s Hospital at Westmead.

The challenges There are some unique issues, such as having to apply for 20 different provider numbers for each location we visit. The role involves extensive travel by car to some local communities within a twohour drive of Cairns including Atherton, Mareeba, Innisfail and Yarrabah, as well as travel via charter 54

plane either on day trips or overnight trips to Cape York communities or four-day trips to the Cape and Torres Strait.

The work The work is very varied, from obesity to failure to thrive, congenital heart disease, rheumatic fever, foetal alcohol syndrome, ADHD, autism, developmental delay, child abuse and neglect, and everything else paediatric. The outreach clinics are held in conjunction with the outreach physician clinics, and also often include an occupational therapist or speech pathologist from the Childhood Development Unit in Cairns.

The highlights This year has brought many adventures so far, from spotlighting for green snakes in Lockhart River, to falling from the sky when we lost the right engine of the plane, and being flooded in and evacuated due to tropical cyclones. It is certainly anything but dull and I would highly recommend it if you would like to further your experience in Paediatrics – and travel!

“This year has brought many adventures so far, from spotlighting for green snakes in Lockhart River, to falling from the sky when we lost the right engine of the plane, and being flooded in and evacuated due to tropical cyclones.”

Contributed by Dr Aileen Traves 55

Real-life adventures in GPland

Diary of a

6.30am

Wake up to the squawk of cockatoos sitting on the power line outside my bedroom window. Better than any alarm clock I know.

6.45am

Yell at cockatoos to “shuddup!” Has the same effect as every other morning – none.

8.35am

Walk the 200 metres from my house to the hospital. No traffic jams here, no parking problems either. As I wander up I see old Trumby sitting on the front step patiently waiting. Had to remove some gidgee from a leg wound last week. Silly old bugger was out catching goats to supplement his diminishing income during the drought. Nasty stuff that gidgee – can get infected really easily.

Rural Doc

And thus starts my day.

GP-anaesthetist and Director of Ochre Recruitment, Dr Ross Lamplugh, shares a typical day in his life as a rural doc in the “back of Bourke”.

I stroll back to the Gecko Cafe for a bite. As I wander home, Trev catches me.

“Got a few up here waiting for you when you’re ready.”

“G’day, doc,” he starts. “Are you still on for a game tonight?”

The kid with the temp, the lady with a rash and Suzanne looking for a bit of reassurance are easily dealt with.

you told me about really works.You know, doc, I thought you had half a chance of fixin’ me leg, but didn’t expect you could help me catch goats. I’ll drop you in a bit of pork when I shoot me next pig.” I stop in at the hospital to see my inpatients: a three-year-old with gastro; Mike with epigastric pain after one too many – again; Ben whose unstable angina seems to have settled today; and Suzanne whose diabetic leg is finally improving. As usual, the nurses have it all sorted – a list of jobs for me and the coffee pot on.

9.00am

I stroll up to the surgery about 300 metres the other way. Old Cat Kendal is leaning on the front rail.

“Things not going so well, Trumby?”

“G’day, doc,” he says, the standard greeting from everyone in town.

“Not at all, doc – leg’s great. Just wanted to say thanks for those tips on catching goats.That hook

“G’day, Cat,” I return. “Come on in and wait inside, I’m sure the girls will have a pot of coffee on.”

“I enjoy the unpredictability of rural practice, from dealing with an infarct and motor vehicle accident to giving an emergency GA for a cord prolapse, all in the space of an hour.”

A procession of the normal, the weird and the delightfully wonderful traipse across my floor from 9 to 12.30.There is old Cat in for his flu shot.Young Tracy who’s trying hard to have her first child. And the regular visit from Aunt Beryl, the town gossip, who comes in more for the chat really.

12.30pm

I think the only reason I am on the local squash team is to make everyone else look good but it is a great night out followed by a few beers.

with me since the start and her kids babysit mine. The coffee keeps coming and today we have scones. Yes, really!

6.00pm

Cleaned up and on my way to squash. The nurses at the hospital know it’s squash night and the game should be finished by seven. Sure enough, at about 7.10 the phone rings.

“Sure, Trev, so long as I don’t get called up by the hospital.” Over lunch I get my first hospital call. I am on call today so have to manage pretty much whatever comes in. Sounds impressive, but with the other doctors in town ready to lend a hand and the telephone as my best friend there really is help whenever I need it. Funny thing about working in Bourke, everyone in the city thinks you’re mad so I have never had a specialist not bend over backwards to lend assistance when I ring. Luckily, I can deal with this one by phone.

However, just as I am about to leave, an old cocky, Hully, comes in after catching one of his fingers in a chain on his tractor. The finger is degloved but functional. It is salvageable so I call a plastic surgeon in Sydney who accepts the transfer. I go back to deliver the good news.

2.00pm

“Will I be back at work tomorrow?” Hully asks.

Back to the surgery. Much like a city surgery afternoon, but with a bit more pathology and a lot more coping skills. The banter in the surgery is fantastic. Gay has been

“No, they’ll probably keep you in till they are sure the graft’s taken.”  57

Real-life adventures in GPland

DO IT NOW “No way! I’ve got the shearing team coming tomorrow so I need to be home.” I had done some plastic surgery in my surgical training, and thought that with a bit of advice from my friendly plastic surgeon I can probably do a graft on him in Bourke if really forced.

For more information about Rural Terms, talk to your RTP. AUST LOCUMS

AUST PERMANENTS

GP/Emergency Northern WA (C-0180) Jan–Aug 2010, 1 month min $1400.00 per day

GP/Emergency Nelsons Bay, NSW (C-0529) Start March 2010, $300,000 package Car and Accommodation

Emergency NSW (C-0471), Jan–Dec 2010 10–14 hour shifts (no on-call) $1000–$1450 per day

GP/Emergency Boggabri, NSW (C-0007) Start Feb/Mar 2010,$300,000 package Car and Accommodation

GP/Emergency Barham, NSW (C-0118) March onwards, 1 in 2 on-call $1143 plus per day

GP/Emergency Barham, NSW (C-0118) Start Feb 2010, $300,000 package Car and Accommodation

GP/Emergency Nelsons Bay, NSW (C-0529),March onwards Required to cover 24 hour shift $2000.00 per day

GP/Emergency Tasmania (C-0480) Start April 2010, $280,000 package Car and Accommodation

GP/Emergency Central QLD (C-0012) March onwards, 2 week blocks $1300–$1800 per day

GP/Emergency Coonamble, NSW (C-0005) Start Jan/Feb 2010, $280,000 package Car and Accommodation

About two weeks later at the hospital, one of the nurses warns me that the chap whose finger I amputated is back to see me. I am more than a bit concerned, wondering whether he regrets his decision and wants to have a shot at me for doing it.

GP only Darwin, NT Feb–Dec 2010, 2 week blocks $9000 per week

GP only Brisbane, QLD (C-0572) Start March 2010 65% billings, Brand new clinic

GP/Emergency Island, SA (C-0245) Various dates 2010, On-call only $1000.00 per day

GP only Outer Melb (C0569) Immediate start 65% billings, DWS available

I wander out the front. There he is, holding up his hand to show me the result of the amputation.

GP/Emergency Central, SA (C-0157) Various dates 2010, Iconic location $1000.00 per day

GP only NE Central NSW (C-0571) Immediate start 65% billings, DWS available

10.10pm

I explain the procedure to him. “I’ll wrap you up and you’ll still have your right arm for shearing all week.”

I reckon I’ve finally earned that beer so I wander down to the Oxford to see if it’s still open, and the squash team is there. Gary looks up from wiping down the bar and greets me. “G’day, doc.”

Still, that isn’t good enough. “Look, doc, you’re not listening to me. I need to have this hand working tomorrow to shear. I can’t shear one-handed. I really just came to get you to take the finger off.”

I enjoy the unpredictability of rural practice, from dealing with an infarct and motor vehicle accident to giving an emergency GA for a cord prolapse, all in the space of an hour.

Given that the finger is salvageable – and probably would get near full function back – I argue for a long time.

Not looking forward to being on call tonight though – don’t really enjoy getting up in the middle of the night. Luckily, the nurses screen things and it only happens once in a blue moon.

Eventually Hully states: “If you don’t take my finger off I’m going to go home and chop it off myself!” The look in his eye convinces me he is fair dinkum. So after filling out the most longwinded consent form I can devise (I have a terrible feeling this could come back to haunt me) I amputate his finger.

“Eventually Hully states: ‘If you don’t take my finger off I’m going to go home and chop it off myself!’ The look in his eye convinces me he is fair dinkum.” 58

I could do with an Adventure!

Ochre Recruitment is one of Australasia’s most respected medical recruitment companies who specialise in both Permanent and Locum placements. If you are looking to make the transition from your GP registrar position to a new role as a fellow qualiﬁed doctor or wish to take a break and combine some travel with work then we have some fantastic opportunities for you.

“Shearing went really well,” he beamed. “I had no problems with the hand and it’s healed well. Good on ya, doc.”

positions@ochrerecruitment.com GPO Box 2071, Hobart Tasmania 7001

Contributed by Dr Ross Lamplugh, Ochre Recruitment

www.OchreRecruitment.com

Freecall

1800 99 22 30

Real-life adventures in GPland

academic life

Real-life adventures in GPland

This

“You should have the opportunity to get involved in the academic life of the university you are based at.”

Teaching and research can expand your career path in General Practice.

the department and to work on a research project of your own. You will also be required to continue doing some clinical work during this time.

I love being a GP Registrar. I love seeing patients – hearing their stories and learning from them.

Why do an Academic Term?

But every now and then, I crave something a little bit different – something that challenges me on a different level. That is why I have chosen to do an Academic Post as part of my training.

What is an Academic Post? Basically, an Academic Post is an opportunity to spend a term of your General Practice training involved in research and teaching. It can be completed as an Extended Skills Term, over six months full-time or 12 months part-time. Registrars are usually supervised by a university’s Department of General Practice, or a rural clinical school. You should have the opportunity to get involved in the academic life of the university you are based at. This could mean attending meetings, sitting on curriculum committees, or just talking to other people about the research they are doing. You will also get to be involved in the teaching activities of 60

Personally, I don’t know why you would not do an Academic Term. You can choose what you want to research, so you can be involved in something that fascinates you. Over six months, you can potentially start to develop some research that is really groundbreaking and exciting – you might even get published. It gives you flexible work hours. It gives you variety in your days and a break from the demands of clinical work. It encourages you to develop a different and valuable skill set. It gives you a “foot in the door” to the world of Academic General Practice.

FACT FILE When can you do an Academic Post?

You can start an Academic Term at any time after completing your first General Practice Term (or equivalent).

How do you apply?

If you are interested, let your training provider know as soon as possible as the application process can be a little complex – but very doable. You’ll need to get a Supervisor, usually at a university or rural clinical school. If you are doing research, you can come up with your own research question or join a project that’s already running. It’s a great way to try out research and can be a stepping stone to an academic career or a higher degree.

For more information

Check out www.agpt.com.au and follow the links to Training Posts then Academic Training or contact the Registrar Research and Development Officer (RRADO). The RRADO is a Registrar hired part-time to help support others with a research interest. Contact the current RRADO at rrado@gpet.com.au

It encourages you to think about best practice and evidence-based medicine. 

Real-life adventures in GPland

You will get to meet some amazing inspiring people, both medical and non-medical. You will become an expert in an area – something unusual in General Practice.

“

I combined working at a city GP practice with doing research at the University of Adelaide and teaching undergraduates. There are as many different ways to be a general practitioner as there are general practitioners.

You will be involved in the teaching and examination of medical students, which is an invaluable experience if you plan to sit the RACGP exam soon.

Other tips You will be paid at “base rates” to do an Academic Term and your income is likely to drop. If this is an issue, consider doing your term part-time over 12 months and supplementing your income with some extra clinical work or teaching. Take note of when applications are due. They are due earlier than you think and will take longer to put together than you anticipate. Allow plenty of time. The best thing about Academic General Practice for me? It makes me feel like I can be a better doctor for my patients. And I know that by combining teaching and research with my clinical work I will always feel energised by a career that offers me something different every day.

Interested in research? Let’s workshop it! Attending the Registrar Research Workshop is highly recommended, preferably before you start your Academic Term. It’s a three-day intensive workshop designed to explain the steps involved in undertaking a research project. The academic researchers are inspirational, and you will make valuable contacts with other like-minded Registrars. Oh – and GPET pays all your travel expenses.

Have you ever considered being… A media GP? Could you be the next Dr Norman Swan or Dr Cindy Pan? There are opportunities out there for GPs with great communication skills who can explain complex medical topics in soundbites the average person can understand. A medical editor or journalist? Consider a training post with Australian Family Physician (AFP) where you can develop your writing and editing skills for the medical media. An in-practice teacher, junior Medical Educator or university lecturer?

Could you teach medical students or other GP Registrars? Explaining concepts to others is a great way to learn yourself. There are endless ways to combine General Practice with the world of media, communication and education.

Contributed by Dr Adrienne Burchard with Dr Rachel Lee

”

Dr Kirsty Anderson

www.gpaustralia.org.au

5 Money MATTERS As a GP or GP Registrar, you are well paid without the extreme hours of some other specialties. Check the salar y over view on the following pages for facts Everything you've ever wanted to know about being a GP but were afraid to ask.

Produced with funding support from

and figures. Plus you may be able to claim extra government incentives while you train.

Money Matters

What you

can earn

What do GP Registrars and GPs earn? What are the hours? Here are some financial facts and figures.

he earning power GP Registrars and GPs is excellent when you consider the flexibility and work-life balance of the profession.

GP Registrar salaries Full-time GP Registrars work a minimum of 38 hours a week. This includes education time and administration time. The actual hours of consulting (seeing patients) are usually between 27 and 33 hours a week. This can vary, especially in rural areas. Remuneration is really determined by how many patients are seen and whether there is bulk-billing or private billing. The GP Registrar can negotiate an hourly rate of pay and/ or a percentage of gross billings generated.

Minimum terms and conditions During the first two GP Terms (or ACRRM equivalent), GP Registrars are guaranteed minimum terms and conditions of employment as agreed by GPRA and the National General Practice Supervisors Association (NGPSA). For each stage of training, there is a minimum salary or hourly rate of pay or the Registrar is paid a minimum of 45% of gross billings (whichever is greater). 68

Training stage

Location

Practice style % of billings paid

GP Term 1 (or equivalent)

Any

As per NMT&C

GP Term 2 (or equivalent)

Remote

GP Term 3 (or equivalent)

Some Registrars work in salaried practice, especially ADF Registrars, those in Aboriginal Medical Services and some rural and remote hospitals that also provide GP services to the community. It is important to note that working in rural areas, doing procedural work and working as a hospital VMO tend to attract significantly higher incomes.

Improved income Changes to Medicare rebates have improved GP incomes. Once established, a GP Registrar may bill anywhere from about $100 -$240 per hour of patient consulting. They would then be entitled to receive 45% of billings = $45 -$108/hr = $1,215 -$2,916/wk. As an employee, the GP Registrar is also entitled to 9% superannuation and four weeks paid annual leave.

Different remuneration systems

On-call

Average patient consultations (hours/week)

Hourly ($)

Weekly ($)

Annual ($)

N/A

28-30 hrs plus education time

$37

$1,262

$65,613

Salaried hospital based Medical Officer, procedural work

1 in 2 -3 days

60-80 hrs

N/A

$2,658

$138,216

Rural

50% mix billing, hospital admitting rights, procedural work (Anaesthetics)

1 in 6 days

28-30 hrs

$66

$2,670

$138,840

Locum (immediately after completing training)

Rural

60% mix billing, hospital admitting rights

N/A

38-40 hrs

$90

$3,600

$187,200

Established GP (busy practice)

Rural or urban

65% private billing, hospital admitting rights

N/A

45 hrs

$115

$5,175

$269,100

Those GP Registrars who do on-call and hospital VMO work should earn a minimum of 55% of the hospital billings.

However, even in urban areas GP Registrars often earn more than what is stipulated in the National Minimum Terms and Conditions (NMT&C) document.  69

For GP Registrars and GPs practising in rural areas, incentive payments are available on top of a regular salary. (For more information, see page 72.)

“

You make a good living – not that of an interventional cardiologist – but you have a heck of a better lifestyle. You’re not in the hospital at 3am putting catheters in people.

”

Dr Stuart Anderson

What established GPs earn Established GPs can earn good money, with the actual amount dependent on the nature of the practice and hours worked. In addition, there is the opportunity to run your own medical practice if you choose. All this with flexible hours and choice of practice style!

Contributed by Dr Siew-Lee Thoo, Dr Naomi Harris and Dr Jason Ong

Calculate your income online www.gpaustralia.org.au/gpearnings Our online GP Earning Calculator allows you to estimate your individual earning potential based on the kind of GP you want to be.

Money Matters

incentive

payments

In addition to your salary, you can claim an array of other financial sweeteners as a GP Registrar.

hen working as a GP Registrar, there are a few financial incentives and reimbursements to be aware of. These government incentives encourage more GPs where they are most needed, such as rural, remote and outer metropolitan areas. More details are available via the GPRA website www.gpra.org.au

General Practice Rural Incentives Program (GPRIP) The new General Practice Rural Incentives Program (GPRIP) will commence from 1 July 2010. The program will provide a consistent set of incentive payments that applies on an equal basis for GPs and Registrars in rural locations. The scheme favours doctors who stay in rural and remote areas for the longest periods of time. If Registrars train in rural and remote locations, then stay on and practise there they will earn larger incentives. The more remote the location, the greater the rewards. Incentives will be paid according to a sliding scale based on the Australian Standard Geographical Classification â&#x20AC;&#x201C;

Remoteness Areas (ASGC-RA) category and the length of time in a rural location (see table on page 74).

Accommodation Each RTP will have different accommodation and relocation subsidies for GP Registrars undertaking rural training. This can include free accommodation, mortgage/rent subsidy and some furnishings. Subsidies may be greater for the first years of General Practice training.

HECS Reimbursement Scheme The HECS Reimbursement Scheme applies to graduates who have graduated in 2000 or later only. Participants will have one fifth of their HECS fees reimbursed for each ď ľ

Money Matters

ASGC-RA classification

Period of time (years) in a rural location 0.5

3 - 4

RA2

$2,500

$4,500

$7,500

$12,000

RA3

$4,000

$6,000

$8,000

$13,000

$18,000

RA4

$5,500

$8,000

$13,000

$18,000

$27,000

RA5

$8,000

$13,000

$18,000

$27,000

$47,000

full-time year of medical training undertaken or service provided in areas with Remoteness Areas classifications RA2-5. This means that over five years of working or training in these areas you could have all of your HECS fees for the study of medicine reimbursed.

More Doctors for Outer Metropolitan Areas Program GP Registrars who have completed their training and are prepared to work in an outer metropolitan area for two years are eligible for payments up to $30,000. For those prepared to set up their own practice and stay for three years, there is a total of $40,000 available.

YOUR BALANCE

Medicare Plus Rural and remote Registrars (and Tasmanians and those in areas of medical need) can use item number 10991 instead of 10990 for every item bulk-billed for pensioners, concession cardholders and children under 16. This gives you a rebate of $9.80 instead of $6.50 for each item. Doesn’t sound much, but it is probably enough to get you over the hurdle from being salaried to receiving 45% of your billing much earlier than you otherwise would.

Contributed by Dr Stuart Anderson, Dr Siew-Lee Thoo, Dr Luke McLindon and Dr Tim Francis

6 Keeping

DO IT NOW Ask your Regional Training Provider about the financial incentives you may be able to claim in addition to your salary or visit www.gpra.org.au

General Practice gives you the flexibility to balance your personal life with your working life. Par t-time training? Parental leave? Family-friendly hours? It’s all possible in General Practice more than any other specialty.

Keeping your balance

Part-time, smart time and that it is 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 fulltime you need to “accelerate” your training with a set of log

Dr Sarah Bailey believes wholeheartedly in the part-time training options available to GP Registrars.

art-time training is often considered the only option for those of us who are having babies or raising small children. However, part-time training is an attractive option for many Registrars, allowing them the freedom to take up other opportunities such as becoming an RLO or an academic Registrar. The flexibility of General Practice when it comes to the hours that we work is one of the reasons many people choose it as their career path. The training program has the same flexibility.

When thinking about part-time training, consider the following: All components of the training program can be undertaken on a part-time basis. You need to apply for part-time training and have it approved before you begin working part-time. Part-time is considered to be between three and eight sessions a week; a session being between three to four hours long. Minimum hours are 10.5 hours a week over two days.

You should receive the same amount of practice-based teaching during a term as a Registrar completing it full-time. For example, a part-time GPT1 Registrar (FRACGP) should have 1.5 hours a week over 12 months and a full-time Registrar three hours a week for six months. 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 

diaries. These log diaries show that the number and range of patients seen are giving you adequate experience. Working for two or three days a week could be just the change you need to explore new opportunities or enjoy family life.

Contributed by Dr Sarah Bailey

DO IT NOW Talk to your RTP about the part-time training opportunities for GP Registrars.

Keeping your balance

Being resilient Learning to look after yourself is as important as being able to look after your patients, yet it is a skill that is usually not taught. Burnout is an important issue in the medical community. Research has shown that over 50% of Australian GPs have considered leaving General Practice at some time because of stress. Our profession generally entails more than a “9-to-5” job, with long hours, weekend work and on-call the norm. Added to this are increased organisational, financial and legal pressures in the medical professional environment. Doctors tend to be perfectionists, and our selection and training encourages us to be 78

conscientious, reluctant to delegate and unwilling to take time off when unwell. As Registrars, we have additional sources of pressure, often juggling the usual work and family commitments with study and exam preparation. It is important that we as Registrars take the time to look after ourselves, and seek help and support when it is needed. GP Dr Hilton Koppe has developed a useful wellbeing checklist for doctors:

Physical wellbeing. How is your health? Do you have a regular GP, and when did you last have a check-up, or seek advice for a health problem? Are you prescribing your own medications? Do you eat well and take regular exercise? Mental wellbeing. This doesn’t just mean depression and anxiety, but habitual thought patterns, which may include negative patterns such as “I never have enough time”, or “I’m no good at …” Identifying these thoughts may help you to make changes in your life to improve your wellbeing. Spiritual wellbeing. This will mean different things to different people, but having a “world view”, or thoughts about meaning in life can help prevent burnout. Relationships. Which ones are important to you, and how are they going? Remember, relationships take time, effort and care. Do you have a close friend or mentor with whom you can discuss events at work and in your life, to “debrief ” with? Activities. Do you have at least one nonwork activity each week that you look forward to? How is your work-life balance going?

DO IT NOW If you have concerns about your health, or feel you aren’t coping with things, who can you turn to? Your own GP. It is really helpful to have your own general practitioner to talk things over with. Your RLO. Always feel free to speak to your RLO confidentially. They may be able to offer support, suggestions, or provide you with details of someone else who can help. Doctors Health Advisory Service. www.doctorshealth.org.au Helpline (02) 9437 6552 (24 hours) or see website for numbers in other States. www.rcubed.org.au. A website developed by GPRA to give GP Registrars, prevocational doctors and medical students real strategies to build resilience.

Environment. What are your work and home environments like? Are these environments contributing to your levels of stress and discontent? Or do they help with your feelings of wellbeing and contentedness?

Useful books. Clode, D. 2004, The Conspiracy of Silence: Emotional Health among Medical Practitioners, Royal Australian College of General Practitioners, South Melbourne.

Use this checklist to identify areas in your life that might need some “maintenance”. Get into good habits early on in your training so that you can have a long, fruitful and enjoyable career. 

Koppe, H. 2002, “Self Care Strategies for Doctors – Making Changes” in Australian Family Physician (AFP), 33: 569-572.

Keeping your balance

Real Resilience Resources

“There is an expectation that doctors should be superhuman and cope with anything. The reality is, we are human, and have rates of mental health disorders and suicide at least equal to that of the general community. Our aim with this website is to promote self-care in a dynamic and fresh way that brings its significance into the consciousness of our members.” Dr Belinda Guest, GPRA Chair

What is RCUBED? RCUBED is a GPRA initiative that combines the best resilience resources in one website. Resilience means the ability to bounce back after inevitable demands. The easy-to-use resources can also be used for patients: Meditations – for example, mini meditations to listen to. Self-talk strategies. Tips to manage your own health. Time management. Goal setting. Physical fitness ideas. Inspiration. Fun stuff.

RCUBED includes an e-newsletter as a reminder to you as a busy Registrar to make your own health a priority. If you are a GPRA member, look for the regular RCUBED e-newsletter in your inbox.

www.rcubed.org.au

g. au

Check out our online resources for GPs...

or . ra p .g w u ww a . org . n s p www.g www.oer.org . au ww w .rcu be d.o rg u .a Coming soon... www.gpaustralia.org.au