Explorer Guide 2011

explorer

T H E RE GI ST RAR GU I DE

20 11

Training Tips for Registrars by Registrars

Meet deepa

TV GP

Postcards from GPland Change alert salary rise

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About this

GUide Explorer has been prepared by General Practice Registrars Australia (GPRA).

The name Explorer reflects the aim of the guide to help registrars explore their future career options during the training years. It is set out in colour-coded sections for easy navigation.

The publication has been produced using sustainable, environmentally friendly printing techniques. This reflects GPRA’s ethos of suppor ting tomorrow’s GPs and their families in their quest for sustainable careers in general practice.

More than 55% of Australia’s doctors choose Avant as their medical defence organisation.

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Welcome Welcome to general practice training and the new edition of Explorer for 2011.

W

e use the name Explorer for this guide with good reason. General practice training is a golden opportunity to explore the extraordinary breadth encompassed within our profession.

In this guide you’ll read about registrars doing posts with RFDS and on tropical islands through to research and teaching opportunities and extended skills posts in intriguing fields like forensic medicine. Your prospective training path can be as expansive and eclectic as your medical interests. I hope you will enjoy reading about the registrars we’ve featured, and in them see the personification of the variety on offer within GP training.

Whether you are working in a hospital waiting to begin your GP training, or about to embark upon your first general practice term, or nearing your

2

fellowship exams, I hope that you will find in GPRA Explorer interesting and inspiring information to assist you confidently along your path.

Much of this guide has been prepared by current and recently fellowed GP registrars, who bring together their wealth of personal experiences to help you negotiate your training with ease.

I’d like to thank those registrars who shared with us their stories of unique training placements – they truly embody all that our career can offer.

So, go forth and explore general practice! I hope you’ll find it to be as intriguing, and personally and professionally satisfying, as I have.

Dr Kirsten Patterson Medical Editor Explorer 2011

“General practice training is a golden opportunity to explore the extraordinary breadth encompassed within our profession.”

Contents On the cover Meet Deepa – TV GP Postcards from GPland

96 95

Change alert Salary rise for registrars

28 124

GPRA would like to acknowledge the support of our patron Professor John Murtagh and his contribution to general practice.

Prof. Murtagh is Adjunct Professor of General Practice, Monash University and Professorial Fellow in

About this guide Welcome A message from the GPRA Chair

1 2 6

1 / GPRA and you Your GPRA support team Agenda now Member benefits A year in the life of GPRA Who knew?

8 16 18 22 26

2 / Your GP training experience Change alert The structure of GP training Understanding the moratorium The RACGP Fellowship The RACGP’s Fellowship in Advanced Rural General Practice (FARGP) The ACRRM Fellowship RVTS: an alternative pathway to fellowship Joining forces with the ADF

28 32 40 42 46 48 54 58

3 / Term allocation and choice Finding your place Facing the interview Saving the day if things go wrong

82 85 86 90

5 / Exploring your options Destinations unlimited Postcards from GPland TV GP More about academic training posts Wings of care My island home Crime drama Ship to shore

94 95 96 98 101 106 110 114

6 / Exams and assessments Top tips for exams

118

7 / Money matters 2011 National Minimum Terms and Conditions Employee or contractor?

Incentive payments

124 132 136

the Department of General Practice, University of Melbourne. He practises part-time as a general practitioner at East Bentleigh and has teaching responsibilities at three Melbourne-based universities.

He is also the author of 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 Co-Sponsors: Allied Medical Group, Aspen Pharmacare, Australian College of Rural and Remote Medicine, Elsevier Australia, Health 24/7, Matraville Medical Complex, Medfin Australia Pty Ltd, Medical Indemnity Protection Society Ltd, Medical Insurance Group Australia, MIMS Australia, National E-Health Transition Authority Ltd, North Coast General Practice Training, Northern Territory General Practice Education, Royal Australian College of General Practitioners, The Doctors’ Health Fund, Victorian Aboriginal Community Controlled Health Organisation and Wavelength International.

Business Partners: Australian Doctor, General Practice Education and Training (GPET), Healthed Pty Ltd, Medical Observer, Ochre Recruitment Pty Ltd and Reed Medical Education.

Editor: Jan Walker. Medical Editor: Dr Kirsten Patterson. Graphic Design: Marie-Joelle Design & Advertising.

Marketing: Kate Marie. Printing: Daniels Printing Craftsmen.

GPRA wishes to thank all the contributing authors for their work and guidance. We also thank General Practice Education and Training (GPET) Ltd and the Commonwealth Department of Health and Ageing for their continued support and assistance.

Cover image: GP registrar and TV GP on The Circle, Dr Deepa Daniel. For Deepa’s full story, see page 96.

8 / Keeping your balance 62 64 66

4 / Preparing for practice The GP mindset in hospital 70 Before your first GP term: first things first! 74 GP term survival tips 78 4

Going bush What every VMO should know The Medicare maze The L plate prescriber

Part-time smart time 8 principles for being a resilient doctor

140 143

9 / Info file Learn to speak GP Net effect GPRA Calendar 2011

148 153 156

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

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A message

from the GPRA CHAIR

It has been my privilege this year to take over the Chair of GPRA and it is in this role that I welcome you to the highly fulfilling career of general practice.

I

have come into general practice in a rather circuitous way, having trained in a number of other specialty programs first. The broadbased training was useful but I do wish that I had opened my mind to general practice earlier.

“GPRA is there with you all the way as you navigate your path towards becoming a fully trained general practitioner.�

Many things attract me to general practice but if I was allowed to name only one, that one thing is the variety.

6

This truly adds spice to my professional life.

Enough about me; let me tell you about GPRA. GPRA is the peak body that represents all future general practitioners. We provide support in the form of advocacy, exam resources and resilience resources.

The negotiation of your salary and employment conditions is one of our core services. In addition, we provide feedback from you, our members, to government and professional bodies to ensure policies affecting you contain your input.

GPRA is there with you all the way as you navigate your path towards becoming a fully trained

general practitioner. You can become a member today by going to www.gpra.org.au.

There you will also find a wealth of information to help you through general practice training.

You are now at a fork in the road of your general practice career. Many different paths lie ahead. I wish you all the best in your journey and I hope that you find GPRA Explorer stimulating and informative.

Dr Wicky Wong GPRA Chair 2010-2011

1

gpra and you

1 / GPRA and You

your

GPRA support team

GPRA is the peak body for Australian GP Registrars. Here’s a brief introduction to who we are and what we mean to you as part of the next generation of GPs. Who is GPRA? GPRA stands for General Practice Registrars Australia.

We are the peak national representative body for general practice registrars in Australia. One of our most important functions is to provide resources to support you as a GP registrar throughout your training and represent your interests.

In addition to representing GP registrars, we promote general practice as the medical specialty of choice to: Medical students through the General Practice Students Network (GPSN). GPSN has student-run clubs promoting general practice in all 20 Australian medical schools.

Prevocational doctors in

the hospital environment through our initiative called the Going Places Network.

profession and the health care of all Australians.

The future of general practice

We negotiate your pay and your conditions of employment through the National Minimum Terms and Conditions.

We fight for your interests and provide a direct channel to raise any issues.

We represent your views to the Minister for Health and Ageing and other stakeholders.

We provide a wealth of resources to support you throughout your training.

We offer peer-to-peer support and report on any issues that require improvement. Registrar Liaison Officers (RLOs) are a link between the regional training providers and GPRA.

In an era 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 GP training.

We have strong links with other key organisations involved in GP education and training so we can work together for the common purpose of advancing the

What GPRA does for you

visit us @ www.gpra.org.au 8

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 RLO who is there to help you with your training.

The RLOs sit on the GPRA Advisory Council and communicate via the GPRA Advisory Council email list server, forming an Australiawide network to provide solutions to local and national training issues.

Given GPRA’s expanding role, this includes Board positions for a prevocational doctor and a medical student. The GPRA Board is responsible for: Corporate governance.

Financial sustainability.

Advancing registrar issues with appropriate organisations.

The Board relies on the GPRA 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.

DO IT NOW Get involved by becoming a GPRA member (see page 18), raising issues with your RLO or contacting us direct: Level 4, 517 Flinders Lane Melbourne VIC 3001 1300 131 198 enquiries@gpra.org.au www.gpra.org.au

GPRA also has a Board of eight directors who are elected from GPRA’s membership at each Annual General Meeting in September.

Be part of our online community. GPRA’s website puts all the information you need at your fingertips. Stay current on everything from National Minimum Terms and Conditions (NMT&C) to conferences and professional development workshops.

9

How GPRA supports the next generation of GPs  GPRA’s vision GPRA is the peak voice for the next generation of general practitioners. We improve the health care of all Australians through excellence in education and training and ensure that general practice is a medical specialty of choice.

 Provide feedback to Government and stakeholders on GP training policy  Provide services to promote general practice as a career and support future general practitioners

 STEP 1

 STEP 2

 STEP 3

medical students

prevocational doctors

GP Registrars

GENERAL PRACTICE STUDENTS NETWORK First Wave Scholarship Program – providing early positive exposure to general practice Events »»Social »»Educational »»Career Publications »»Aspire Guide »»GP Companion Website, e-newsletters Mentoring Member benefits such as discounts

GOING PLACES NETWORK Events »»Social »»Educational »»Career Publications »»Going Places Guide to GP Training »»Going Places magazine »»GP Companion Website, e-newsletters Mentoring Member benefits such as discounts

GPRA MEMBERSHIP Advocacy and support during training Negotiation of pay and conditions Member benefits such as discounts Publications »»Explorer Registrar Guide »»GP Companion Website, e-newsletters Professional development workshops Exam help »»www.onlineexamresources.org.au Self-care help »»www.rcubed.org.au

1 / GPRA and You

It’s easy GPRA management team Chief Executive Officer: Amit Vohra Senior Manager Going Places Network and Human Resources: Margo Field Business Development Manager: Kate Marie Policy and Evaluation Manager: Connie Lambrou National Manager Prevocational Doctors: Sarika Shah Communications Officer: Ruth Hyland Accounts and Administration Officer: Rebecca Qi Project Officer: Renata Schindler Project Officer GPSN & First Wave: Alex de Vos Administration Officer: Allisha Hiscock Sponsorship and Events Officer: Janice Wong Regional Project Coordinators – Victoria and Tasmania: Emily Fox Queensland: Tracey Handley South Australia: Louise Comey

Amit

Margo

Kate

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1 / GPRA and You

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Belinda

Jennifer

Lana

Mary

Emily

Bennie

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14

Insurance Policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by the Medical Defence Association of South Australia Ltd. Before you make any decisions about our Policy, please read our Product Disclosure Statement and Policy Wording and consider if our policy is appropriate for you. Call MIGA for a copy or visit our website. © MIGA November 2010

1 / GPRA and You

National Minimum Terms and Conditions for registrars

AgendaNOW After an extremely active year, these are the issues that are currently front and centre for GPRA.

GP FIRST – Fostering Interns, Registrars, Students and Trainees The last two years have seen GPRA engage in a number of new initiatives to promote general practice to students and prevocational doctors. Following an extensive external review of these initiatives, GPRA is proud to announce that we have secured ongoing funding from General Practice Education and Training Ltd (GPET) to continue this important work. The new funding allows GPRA to bring all these initiatives together under a single umbrella and promote general practice across the continuum.

As part of the new funding: The General Practice Students Network (GPSN) will continue to promote GP career options to the 20 medical schools around the country. With over 5,000 members and growing rapidly, GPSN is here to stay. The next 12 months will focus on creating more linkages with other clubs and looking at the vertical integration of students, prevocational doctors and registrars.

The First Wave Scholarship program offers early positive exposure in general practice to first and second year medical students. After a two-year pilot this program is finally becoming mainstream. The new funding will offer baseline funding for 60 scholarships in 2010-11, expanding to 80 scholarships in 2011-12 and 100 scholarships in 2012-13 across all medical universities in Australia.

The Going Places Network will be rolled out nationally to promote general practice in the hospital system after a successful pilot program last year. A peer-driven network, this will be the first of its kind in Australia and provide much needed advice to prevocational doctors considering general practice as a career option.

16

In our vision to continue to support GP registrars, GPRA has successfully negotiated the 2011 National Minimum Terms and Conditions (NMT&C) for GP registrars. The new NMT&C lifts the minimum base rate for GP registrars above national indexation for the first time in 10 years. GPRA is keen to offer more resources for registrars and will soon be producing targeted resources to help registrars negotiate contracts.

New exam resources for registrars GPRA continues to build on our services for registrars. In late 2010, GPRA successfully piloted a new exam webinar series for registrars preparing for the RACGP OSCE exams.

Following strong demand and positive feedback, this will be expanded in 2011 to become a standard feature offering support for all aspects of the exams. For more information on GPRA’s Online Exam Resources, visit www.oer.org.au.

New Policy Director role In recognition of GPRA’s increased market presence and role in contributing to national health policy, GPRA has created a new Policy Director position to help us be the voice for the next generation and ensure excellence in GP education and training. We welcome our new Policy Director Dr Emily Farrell.

GPRA Board sets new vision The GPRA Board has done a lot of work in redefining GPRA’s vision into the future and to bed down our services in line with this vision.

Our new vision and key objectives are:

GPRA VISION GPRA is the peak voice for the next generation of general practitioners. We improve the health care of all Australians through excellence in education and training and ensure that general practice is a medical specialty of choice.

KEY OBJECTIVES • Be the voice for future general practitioners.

• Develop general practice as a medical specialty of choice.

• Ensure excellence in general practice education and training.

• Ensure members have sustainable and fulfilling careers in general practice.

• Have sound governance and follow best business practices.

Moving forward, GPRA will be working hard to realign our products and services to match this vision and further build on the services we offer to registrars.

17

1 / GPRA and You

Member benefits

Being a member of GPRA costs you nothing and gives you all sorts of professional and personal perks.

Core Membership Benefits Pay and conditions.

We negotiate your pay and conditions of employment.

Advocacy. We fight for your interests and provide a direct channel to raise any issues.

Dispute resolution.

We offer personalised help for dispute resolution on any aspect of your training.

Personalised advice.

We offer personalised advice on the National Minimum Terms and Conditions document and what it means for you.

Plus you receive:* Free Online Exam Resources (OER) developed for registrars by registrars (see page 122 for more details).

Free admission to Healthed seminars for GPRA members in the AGPT program (see page 67 for more details).

Free postage and handling on books featured in the GPRA e-newsletter purchased online with Healthed. (Eligibility is subject to Healthed’s approval.)

Free copy of the Explorer Registrar Guide.

Free e-newsletters and mailouts to keep you up to date with activities and job listings.

Free copy of the GP Companion e-book.

Free professional development and travel opportunities through GPRA

committees or becoming a GPRA Mentor.

Free registration for registrars to attend the General Practitioner Conference and Exhibition (GPCE) Melbourne and Sydney 2011. (Numbers are limited and eligibility subject to GPCE’s approval).

Journal of Complementary Medicine – 10% off one-year subscription, 20% off two-year subscription.

FPA health courses (NSW only) – 10% off all sexual and reproductive health courses ($150 value per course).

Qantas Club Membership – $200 off original price.

Ramsay Books and Equipment – 15% off.

Access to specialised practice placement services through Ochre Recruitment.

Join up now if you’re not already a member.

It’s free!

Alumni & Associates Membership This package is designed for ex-general practice registrars who want to stay abreast of general practice issues, medical students and prevocational doctors plus anyone else who wants access to our national network of GP registrars.

You receive:* Free e-newsletters and mailouts to keep you up to date with activities and job listings.

Free professional development and travel opportunities through GPRA committees or becoming a GPRA Mentor.

Discounted access to professional development workshops.

Access to specialised practice placement services through Ochre Recruitment.

DO IT NOW There are three easy ways to join and start receiving all the benefits.

Online

www.gpra.org.au

Email

enquiries@gpra.org.au

Phone

1300 131 198

*The specific benefits of our membership packages may vary without prior notice.

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19

1 / GPRA and You

A Year in the life of

GPR A 2010 Breathing NEWLIFE into General Practice 2010, Canberra

22

GPRA Board Meeting 2010, Melbourne

23

1 / GPRA and You

A Year in the life of

GPR A 2010 Future Series 2010, Sydney

24

Advisory Council Meeting 2010, Alice Springs

25

1 / GPRA and You

Who knew?

55% of GP registrars are in the genera l pathwa y; 45% in the rural pathwa y

27% of GP reg ist rars are int ern ation al medical gra du at es

T he re are 90 0 pla ces availa ble in th e AG PT prog ra m in 20 11

73% of GP registrars are Austra lian medical graduates

26

G P regist ra rs are m o re likely to be femal e (65%)

2

your gp training experience

2 / Your GP Training Experience

Change alert

General practice training is an ever-changing

landscape. Here’s a rundown of the most recent changes.

General Practice Rural Incentives Program (GPRIP)

T

he new General Practice Rural Incentives Program (GPRIP) commenced from 1 July 2010. It replaced the Registrars Rural Incentive Payments Scheme (RRIPS), which applied to GP registrars in the AGPT program, and the Rural Retention program, which applied to GPs. The new GPRIP rewards doctors who stay and work in rural and remote areas for longer periods. The longer you stay, the greater the incentives. Your eligibility for incentives is determined according to a sliding scale and is based on the ASGC-RA category and the length of time in a rural location (see table below).

This means that if you are in this category, you will continue to be paid higher incentives rates for RRIPS-eligible placements up until you are a fellow, opt out of RRIPS grandfathering (which triggers an automatic switch to GPRIP) or reach the three-year RRIPS cap. 2010 rural pathway registrars are included in this group. The grandfathering arrangements will continue to be paid until the end of the 2012 training year.

For more information about GPRIP, please refer to the Doctor Connect website (www.doctorconnect.gov.au) under GPRIP FAQs. Go to “Rural Health Workforce Strategy” then “General Practice Rural Incentives Program”.

Registrars who have received payments or are qualifying for payments formerly under RRIPS prior to July 2010 will be eligible for grandfathering arrangements.

ASGC-RA classification

General pathway registrars are now given greater flexibility with how to fulfil their training pathway requirements.

You are now able to nominate how you fulfil your 12-month training pathway requirement by electing one of the following: 12 months training in a rural location classified ASGC-RA2-5.

12 months training in an outer metropolitan location.

12 months training in a non-capital city classified as ASGC-RA1.

Or 12 months training comprising two of the following: • Six months training in an outer metropolitan location.

• Six months training in a rural location classified ASGC-RA2-5.

• Six months training in a non-capital city classified ASGC-RA1.

• Six months training in an Indigenous health training post in an Aboriginal medical service.

These options will be given to registrars entering AGPT in 2011 and onwards.

However, your RTP will still need to fulfil staffing requirements for their area’s rural workforce so the choice may not be entirely yours.

If you are a continuing general pathway registrar (2010 cohort and earlier) who has not yet completed your pathway requirements, you can apply to your RTP to have all your training undertaken from 1 January 2010 recognised under these new options.

Geography lesson – Remoteness Areas From July 2010, the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system replaced the Rural, Remote and Metropolitan Areas (RRMA) system.

The general training pathway applies in Remoteness Areas RA1-5 locations and the rural pathway applies in RA2 - 5 locations.

Period of time (years) in a rural location 0.5

1

2

3 - 4

5+

-

$2,500

$4,500

$7,500

$12,000

RA2 (Inner Regional)

-

$2,500

$4,500

$7,500

$12,000

RA3 (Outer Regional)

$4,000

$6,000

$8,000

$13,000

$18,000

*Other

More choice on pathway requirements

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

The RA categories are defined in terms of “remoteness”. Regions that share remoteness characteristics are grouped into RA groups. RA1 is major cities and can be defined as urban locations. RA2 - 5 are grouped in progressively more remote locations, and can be defined as regional or remote. Areas such as Hobart and Darwin are now rated as RA2+, giving registrars greater choice on where to complete their training.

For more information about how the ASGC-RA categories are calculated or to look up the RA of a location, please refer to the Doctor Connect website at www.doctorconnect.gov.au.

*Payments for all eligible RA1 training placements will be made according to the category “Other”.

28

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2 / Your GP Training Experience

10-year moratorium restrictions eased RACGP membership credit Don’t forget that if you are a registrar who enrolled for their exam in 2010, you can claim $327.50 worth of membership credit, which is 50% of the fellow rate of $655.

New names for merged RTPs Following the completion of their merger, merging partners Victoria Felix Medical Education and GP Logic are now called Beyond Medical Education (BME).

In southern Victoria, merging partners Greater Green Triangle (GGT) and Gippsland Education and Training for General Practice (getGP) will be called Southern GP Training.

The total number of RTPs across Australia is now 17.

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Changes made to section 19AB of the Health Insurance Act 1973 came into effect from April 2010.

The amendments have seen restrictions lifted from New Zealand permanent resident and New Zealand citizen doctors who obtained their primary medical education either at an accredited medical school in Australia or New Zealand.

These doctors are no longer classified as an “overseas trained doctor” or “former overseas medical student”.

In another important provision in the Act, the moratorium period for overseas trained doctors will now begin when they first obtain (or obtained) their first medical registration in Australia, provided that the medical practitioner will become a permanent Australian resident during that period. Otherwise they will still require a section 19AB exemption to continue to access Medicare benefit arrangements.

Overseas trained doctors were previously required to have either Australian permanent residency or citizenship in order for their 10-year moratorium period to commence.

On 1 July 2010, moratorium scaling was also introduced.

This enables overseas trained doctors to reduce their moratorium commitments by up to five years depending on the Remoteness Area (RA) of the location where they practise. The more remote the area, the more the moratorium period will be reduced. For more information, visit www.doctorconnect.gov.au.

2 / Your GP Training Experience

structure of GP training

THE

Hereâ&#x20AC;&#x2122;s a quick overview of the who, what and how of GP training.

The GP Training Landscape

Australian Government

I

f you are a little confused about the structure of general practice training, that is probably because GP training is organised differently to any other vocational training program in Australia.

What is the difference?

Nearly all other training programs in Australia are essentially run by the colleges such as the College of Physicians, Surgeons or Emergency Medicine. The colleges select applicants, provide training material, play a part in organising educational activities (although these are primarily delivered by the relevant hospital) and set training standards and the examination. Registrars work in the hospital system under the supervision of consultants.

GP training most obviously differs in that, other than the 32

initial year of hospital terms, it often occurs in a private practice setting. What may not be as obvious is that the two colleges of general practice, the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM), are not responsible for all aspects of GP training.

Who is GPET (General Practice Education and Training Ltd)?

GPET is a wholly owned government company established in 2001 by the Commonwealth Government to fund and oversee general practice vocational training in Australia. Australian General Practice Training (AGPT) is the name of the training program for GP registrars.

GPET contracts with regional training providers (RTPs)

Australia-wide, which deliver the AGPT program to about 2,500 GP registrars.

General Practice Education and Training Ltd

Selection of candidates is initially organised by GPET in conjunction with RTPs, who interview applicants.

Australian General Practice Training Program

What are RTPs? RTP stands for regional training provider. RTPs contract with GPET and deliver the AGPT program in their designated region. Delivering the program through local providers enables a targeted response to local health workforce and health care needs.

Candidates applying for GP training are asked to nominate and rank in order of preference the RTPs in which they are willing to train.

The administration of the training program, delivery of educational activities and

Regional Training Providers

Vocational Training

Vocational Training

Fellowship of the Australian College of Rural and Remote Medicine (FACRRM)

Fellowship of the Royal Australian College of General Practitioners (FRACGP)

Vocational Recognition

33

2 / Your GP Training Experience

AGPT Program Endpoint Qualifications and Fellowships FACRRM qualifications (ACRRM) Year One

Core Clinical Training Time 12 months

FRACGP qualifications (RACGP) Possible equivalence* <=>

+ Year Two

Primary Rural & Remote Training 2 x 6 months

Year Three

2 x 6 months

Joint training opportunities are available†

Year Four

Advanced Specialised Training 12 months

GP terms GPT1 – 6 months GPT2 – 6 months

+ Joint training opportunities are available†

GPT3 – 6 months Extended Skills – 6 months

FRACGP (VR)

+ Note: Fourth year is for FACRRM and FARGP candidates

12 months

+

+ Primary Rural & Remote Training

Hospital Training Time

Possible equivalence* <=>

Advanced Skills Training (12 months) for FARGP

FACRRM (VR) * Credit given for AGPT training already undertaken towards one fellowship, prior to undertaking a second or third fellowship. † Can be achieved in dual-accredited practices or posts.

Note: Although this table is presented in a linear format, both colleges have flexible training options to enable registrars to plan their training around their own needs and interests. See the college websites for more information.

34

“Your medical educators, supervisors and mentors will help guide your learning to shape your future career.” training material are provided by the RTPs. For those who wish to train in isolated remote locations, there is another alternative to the RTPs – the Remote Vocational Training Scheme (RVTS).

What are the training pathways and obligations?

You can enrol to do the general pathway or rural pathway.

Doctors from overseas who come under the 10-year moratorium (see page 40) are obliged to do the rural pathway.

If you do the rural pathway, you are required to train in rural locations. If you do the general pathway, you are required to do 12 months of your training in a rural or outer metropolitan location, or six months in each as approved by your RTP to meet workforce needs. A temporary transfer to a rural RTP can be arranged for a rural term.

You also need to complete certain mandatory hospital

rotations (see page 71 for details). In addition, you must satisfy the requirements of the Aboriginal Curriculum Statement. Training is available in accredited Aboriginal medical service (AMS) training posts throughout Australia in urban, remote and regional settings.

Geographical classification system Your training pathways and obligations are designed around the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system, developed by the Australian Bureau of Statistics and used by many government agencies.

RA1 is major cities and can be defined as urban locations.

RA2-RA5 are grouped in progressively more remote locations spanning regional and remote.

The ASGC-RA system is also the basis for the General Practice Rural Incentives Program (GPRIP), which

DO IT NOW For more information about the Australian General Practice Training program, visit www.agpt.com.au or the college websites www.racgp.org.au and www.acrrm.org.au.

There is also lots of helpful information at www.gpra.org.au, you can phone GPRA on 1300 131 198 or send an email to enquiries@gpra.org.au.

provides incentive payments to GPs and registrars in rural locations. (For more information, see page 28.)

What is the role of the two colleges of general practice?

RACGP and ACRRM set training standards, set examinations and assessments, accredit training placements 35

2 / Your GP Training Experience

Who’s who ACRRM Australian College of Rural and Remote Medicine AGPT Australian General Practice Training program FACRRM Fellowship of the Australian College of Rural and Remote Medicine FARGP Fellowship in Advanced Rural General Practice FRACGP Fellowship of the Royal Australian College of General Practitioners GPET General Practice Education and Training Ltd GPRA General Practice Registrars Australia RACGP Royal Australian College of General Practitioners RLO Registrar Liaison Officer For an expanded glossary of terms see page 148.

and sign off on completion of training by registrars.

integrated into your training course from the beginning.

Attainment of the Fellowship of the RACGP (FRACGP) or the Fellowship of ACRRM (FACRRM) is necessary to become vocationally recognised for independent general practice in Australia under the Medicare system.

Personalised learning

ACRRM has specifically designed its curriculum to meet the needs of doctors practising in the rural and remote context. However, fellows of ACRRM may ultimately practise anywhere in Australia – rural, remote or urban.

The RACGP’s curriculum is designed to prepare GPs for practice in any setting.

Those who want to complement their FRACGP with more specialised rural and remote skills can do the RACGP’s Fellowship in Advanced Rural General Practice (FARGP).

You may wish to complete one, two or three qualifications (FRACGP/FARGP and FACRRM) and this can be

36

The AGPT program is personalised to meet the individual goals and career aspirations of each registrar and is a composite of inpractice 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.

Flexible aspects of training The AGPT is known for its flexibility. Part-time training is a popular feature, especially for women having babies.

Parental leave and other reasonable leave breaks may be negotiated. Transfers between RTPs may be possible to arrange if the registrar has a strong case.

Making the pieces fit Understanding that there are a number of entities involved in GP training may help to explain some of the paperwork. Each organisation involved in GP training is seeking feedback

registrar

GPRA TIP Recognition of prior learning Recognition of prior learning (RPL) gained in hospital prior to entry into GP training is possible but requires good documentation.

You need to apply 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.

from registrars, which should explain why there are so many surveys. Information provided to GPET may not be available to the colleges and vice versa, hence the need to sometimes supply the same information more than once.

How GPRA helps With so many different entities involved, each with a slightly different focus, it also highlights the importance and relevance of General Practice Registrars Australia (GPRA).

GPRA works hard on your behalf to identify and rectify any problems and inconsistencies that may occur when there are so many different stakeholders involved in GP training. If you feel confused or identify a problem with your training, please discuss it with your Registrar Liaison Officer (RLO), who is your link with GPRA, or contact GPRA directly.

Contributed by Dr George Manoliadis and Dr Jenny Lonergan

rave

Dr Allison Turnock My RTP is General Practice Training Tasmania (GPTT).

My current post is a part-time GPT2 post at Sorell Family Practice and a part-time extended skills post at GPTT undertaking a Registrar Medical Educator position and Registrar Liaison Officer position.

What I love about general practice is variety.

What I don’t love so much is lack of time.

After hours I love to pack in as much as I can – walking the dogs, basketball, catching up with family and friends, planning more renovations.

A quirky fact about me is I lived on a yacht at the wharf, about a block from the hospital a couple of years ago.

My favourite technical gizmo is our liquid nitrogen gun because my supervisor has written “exterminate, exterminate” on the outside and it makes me giggle.

37

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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 these workforce shortages, the Commonwealth Government has certain policies that apply to international medical graduates (IMGs) and overseas trained doctors (OTDs).

What is the section 19AB moratorium?

Under section 19AB of the Health Insurance Act 1973, medical practitioners subject to the moratorium are not able to attract Medicare benefits unless they practise 40

in locations designated by the government in rural, remote and outer metropolitan areas.

GP registrars under the section 19AB moratorium do their vocational training in the rural pathway.

How long does it last?

Originally, the geographic limitation on provider numbers lasted for 10 years, which is why the scheme was known as the 10-year moratorium.

However, there have been recent changes that allow doctors to reduce their time requirements by up to five years, depending on the Remoteness Area (RA) of the location where they practise.

The Australian Standard

Geographical Classification – Remoteness Areas (ASGCRA) system classifies locations from RA1 to RA5 according to their remoteness, with RA1 being the most urban (major cities) and RA5 (very remote) the most remote. The more remote the areas they work in, the more doctors can reduce their moratorium time.

Who is under the moratorium?

The moratorium applies to: Overseas trained doctors who did not obtain their primary qualification in Australia or New Zealand*.

Overseas doctors trained in Australia or New Zealand who began studying in Australia or New Zealand under a

temporary visa and subsequently obtained their primary qualification from an Australian or New Zealand university.

When does the moratorium start?

The period starts from the time you become registered as a medical practitioner in Australia.

DO IT NOW Find out more. For more information, visit www.agpt.com.au, www.doctorconnect.org.au or talk to your RTP. Recent changes. For more a more detailed explanation about recent changes, see page 30 of this guide.

Your personal situation. Doctors requiring detailed advice their individual circumstances should contact the Department of Health and Ageing Workforce Regulation Section – 19AB@health.gov.au.

* From 1 April 2010, doctors who were permanent residents of Australia or New Zealand at the time of commencing their primary medical training at an Australian Medical Council accredited medical school in Australia or New Zealand are no longer be subject to section 19AB of the Health Insurance Act 1973.

41

2 / Your GP Training Experience

the

RACGP

Fellowship

Fellowship of the Royal Australian College of General Practitioners certifies competence for delivering unsupervised general practice services in any general practice setting in Australia.

What is the FRACGP? Fellowship of the Royal Australian College of General Practitioners (FRACGP) is held in high esteem around the world, with successful completion certifying competence to deliver unsupervised general practice services in any general practice setting in Australia – urban, regional, rural or remote.

The international recognition of the RACGP Fellowship is expanding, and it is now recognised in New Zealand, Ireland, Canada and Singapore. The RACGP conjoint fellowship examinations continue to be delivered in Malaysia and Hong Kong.

42

Vocational training towards FRACGP Vocational training towards FRACGP is three years fulltime (or part-time equivalent), comprising: »» Hospital training (12 months) – four compulsory hospital rotations: general medicine, general surgery, emergency medicine and paediatrics; plus three hospital rotations of your choice, provided they are relevant to general practice. »» General practice placements (18 months) – completed in approved teaching practices, with a compulsory term (minimum of six months) in an outer metropolitan area or rural and remote area. »» Extended skills (six months) – can be completed in a range of RACGP approved settings, including advanced rural skills, an overseas post, an academic post or extended procedural skills.

Further training options The advanced academic term is an optional fourth year, allowing part-time work within a university department and part-time work in clinical general practice.

Optional advanced rural skills training (ARST) can be undertaken at any time during training which offers additional procedural skills in rural general practice. The RACGP also offers a Fellowship in Advanced Rural General Practice (FARGP). (For further information, see page 46.)

Contributed by the Royal Australian College of General Practitioners

GPRA TIP If the option of working overseas is important to your future career plans, the FRACGP is more widely recognised internationally than the FACRRM at this time.

About the FRACGP examination

Am I eligible to sit the examination?

When can I apply to sit the FRACGP exam?

The FRACGP examination comprises: Two written segments – the Applied Knowledge Test (AKT) and Key Feature Problems (KFP).

Plus one clinical segment – the Objective Structured Clinical Examination (OSCE).

To be eligible to sit the college examination, all registrar candidates are required to: Have current medical registration in Australia.

Be a current financial member of the RACGP. Have achieved certified competence in a recognised cardiopulmonary resuscitation course (CPR) within 36 months before enrolment.

Have completed eight active units of training in the Australian General Practice Training program or have completed at least 12 months in the Remote Vocational Training Scheme (RVTS).

Registrars must have completed eight active training units in the Australian General Practice Training program to enrol in the KFP and the OSCE. Registrars may enrol in the AKT after completing six active training units if this is supported by their medical educator, and two of these active units must be from completion of general practice term 1.

Each segment can be completed and paid for separately, so you can undertake the fellowship exams at your own pace.

Passing the AKT is a prerequisite to presenting for the OSCE. All three exams need to be completed within a threeyear period of first passing a written exam.

RVTS candidates are eligible to enrol in the college examination following satisfactory completion of 12 months in the RVTS, in addition to the standard RACGP eligibility criteria.

DO IT NOW Find out more about the college examination by visiting www.racgp.org.au/assessment/examination or www.racgp.org.au/assessment/policy.

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Committed to shaping the future of general practice As the national leader who sets and maintains the standards for quality clinical practice, the RACGP is working hard to shape a stronger general practice future.

The College has embraced the concept of e-health; is actively involved in the development of national e-health initiatives; is at the forefront of the national health reform and; continues to ensure that general practice remains a satisfying and rewarding vocation for current and future GPs. As a RACGP registrar member, you can become involved in shaping the future of general practice. Your RACGP registrar membership also provides you with the practical clinical resources and online learning tools you need to prepare for your Fellowship examination and to deliver high quality general practice care.

Join the RACGP or renew your RACGP registrar membership today www.racgp.org.au/registrar or freecall 1800 331 626

The RACGP journey towards general practice (via the vocational training route)

Medical school (4-6 years)

Internship year (PGY1)

Postgraduate resident years (PGY2) (this can be completed before or during general practice training)

General practice training (3 years)

RACGP Fellowship examination

PGPPP (optional)

4th year additional training in advanced rural skills training or an academic term (optional)

Successful completion of RACGP training and assessment

RACGP Fellowship

Continuing professional development

Fellowship in Advanced Rural General Practice (FARGP) (optional)

2 / Your GP Training Experience

The RACGP’s Fellowship in advanced rural general practice (FARGP)

DO IT NOW Find out more about the Fellowship in Advanced Rural General Practice (FARGP) from your RTP or by emailing di.schaefer@racgp.org.au at the RACGP’s National Rural Faculty, calling 1800 636 764 or visiting www.racgp.org.au/rural.

The FARGP is a fellowship that extends the FRACGP program to offer advanced training in the skills required for rural and remote practice.

What is the FARGP? The Fellowship in Advanced Rural General Practice (FARGP – pronounced “farGP”) recognises advanced rural skills and additional training undertaken by GPs in preparation for practice in rural and remote Australia.

Am I eligible to enrol in the FARGP? To be eligible for FARGP, registrars need to: Have completed (or be working towards completing) a minimum of 12 months of training in accredited rural training posts.

Hold or be enrolled in the Fellowship of the RACGP award.

Be a current financial member of the RACGP. Be a general practice registrar enrolled in the Australian General Practice Training (AGPT) program

46

or the Remote Vocational Training Scheme (RVTS).

Have completed (or be working towards completing) 12 months in an accredited advanced rural skills training post.

Can I complete the FARGP at the same time as the FRACGP? You can undertake the FARGP while completing your RACGP Fellowship, enabling you to complete two highly respected RACGP Fellowships in four years. Training to the RACGP curriculum and FARGP curriculum is closely integrated so all the requirements can be achieved concurrently.

FARGP specific educational requirements

education modules – “Working in Rural General Practice” and “Emergency Medicine”.

160 hours of elective educational activities, which can include workshops, clinical audits and online learning activities.

Submit a portfolio of educational activities for final assessment.

How flexible is the FARGP? The FARGP is flexible and selfpaced. The educational activities have a strong practice-based focus. There is no final exam for the FARGP – assessment is based on a continuous assessment framework.

Contributed by Di Schaefer, RACGP National Rural Faculty

Advanced rural skills training An important component of the FARGP is advanced rural skills training (ARST). Each ARST has its own curriculum guidelines and assessment process. Registrars may choose to complete an ARST post in an area of interest or of value to a rural community including: Anaesthesia Obstetrics Surgery Emergency medicine Mental health Child and adolescent health Adult internal medicine Small town rural general practice Aboriginal and Torres Strait Islander health Individually designed ARST (approval by the RACGP National Rural Faculty is required, after consulting your medical educator)

Registrars need to complete these FARGP specific educational requirements: Two core distance

47

2 / Your GP Training Experience

ACRRM Fellowship

The

The Australian College of Rural and Remote Medicine (ACRRM) has specifically designed their GP training program to meet the needs of the rural and remote practitioner.

What is the FACRRM? Fellowship of ACRRM is an approved pathway to vocational registration and unrestricted general practice anywhere in Australia.

It is a four-year integrated training program for registrars wanting to train for rural and remote medicine.

The training occurs in an “on the job” environment as a registrar in an accredited general practice, Aboriginal medical service, Royal Flying Doctor Service or as a medical officer in an accredited hospital setting.

Candidates wishing to achieve a Fellowship of ACRRM are able to choose from three training pathways: 48

the Vocational Preparation Pathway delivered by regional training providers with funding from GPET; the Remote Vocational Training Scheme (RVTS) for doctors working in isolated rural communities who find it difficult to leave their community to participate in training; and the Independent Pathway, administered by ACRRM, which is suitable for doctors with experience in rural and remote practice who prefer self-directed learning. For more information on which pathway is most suitable for you, see the ACRRM website.

primary rural and remote training

core clinical training

Vocational training program components The ACRRM training program comprises three stages of learning and experience (see flowchart on page 52).

Core Clinical Training.

Candidates complete 12 months of training in an ACRRM-accredited metropolitan, provincial or regional/rural hospital. This should ideally include rotations in general medicine, obstetrics and gynaecology, anaesthetics, general surgery, paediatrics and emergency medicine.

Primary Rural and Remote Training. Candidates undertake 24 months of training in a combination of rural or remote ACRRMaccredited hospitals, Aboriginal

MSF

advanced specialised training StAMPS

miniCEX medical services or general practices/community-based facilities, or a combination of these. The registrar works with increasing autonomy and manages an increasing range of conditions. The specific procedures, breadth and depth of practice are defined by the Primary Curriculum and Procedural Skills Logbook.

Advanced Specialised Training. Candidates undertake 12 months of training in one of 10 ACRRMaccredited disciplines listed in the flowchart on page 52.

Many FACRRM candidates undertake training in a procedural discipline.

MCQ FACRRM assessment Candidates must work in accredited training posts and successfully complete the following assessments: Multisource Feedback (MSF), Mini Clinical Evaluation Exercise (miniCEX), Multiple Choice Question (MCQ) exam and Structured Assessment Using Multiple Patient Scenarios (StAMPS).

There is considerable flexibility in the timing of the assessments and candidates are able to undertake each assessment component within or close to their local community.

DO IT NOW For more information, visit www.acrrm.org.au, call ACRRM on 1800 223 226 or contact ACRRM Vocational Training, training@ acrrm.org.au.

modules and at least two emergency skills courses approved by ACRRM (for example, EMST/ELS/PHTLS or equivalent, APLS, ALSO).

To achieve FACRRM, candidates must also successfully complete four ACRRM online education 49

registrar

rave

Dr Andrew Pennington My RTP is Bogong Regional Training Services.

My current post is an advanced rural skills post in obstetrics at Wodonga Hospital in Victoria.

A typical workday for me begins in the birth suite assessing women in labour or needing induction, then doing baby checks and tying up ward work before occasionally delivering a baby or two usually in the afternoon.

What I love about general practice is the flexibility and variety of work, the interpersonal relationships with your patients, the ability to make decisions and manage patients by yourself and the fact that you are not in hospital any more!

My most memorable GP moment is referring a young patient with a lesion on the hard palate who baffled me, my supervisor and three specialists before it was finally diagnosed as a sticker!

A quirky fact about me is I played Ultimate Frisbee for Australia.

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Frequently asked questions How is FACRRM integrated into the AGPT program?

Candidates enrolled in the AGPT can elect to train to either or both the FACRRM and the FRACGP. FACRRM training is open to both rural and general pathway registrars. However, general pathway candidates who wish to pursue FACRRM will need to undertake training within ACRRM-accredited training posts.

Can candidates do both qualifications at the same time?

Yes, but requirements for placement, duration of training and completion of training are different between the FACRRM and FRACGP. Candidates seeking both fellowships will need to talk to their RTP about a program that complies with both colleges.

What is the difference between the ACRRM and RACGP training pathways?

The ACRRM program is an integrated program that usually takes four years post-internship. While some posts are suitable for both ACRRM and RACGP candidates, this is not automatic and cannot be assured. ACRRM has a different curriculum and different requirements for accreditation of training posts. ACRRM candidates must train in posts accredited by ACRRM.

Contributed by the Australian College of Rural and Remote Medicine

GENERAL PRACTITIONER CONFERENCE & EXHIBITION

2 / Your GP Training Experience

Learn from the best Register and take part in interactive workshops and comprehensive seminars

The ACRRM Training Program

ACRRM Registrar Core Clinical Training (CCT)

Primary Rural and Remote Training (PRRT)*

Advanced Specialised Training (AST)†

12 months

24 months

12 months

In any of the following: • Rural hospital • Aboriginal medical service • Rural general practice • RFDS

Location is dependent on the speciality requirements

50% DISCOUNT FOR GPRA MEMBERS!

Undertaken in one discipline from the following: • Anaesthetics • Obstetrics and gynaecology • Surgery • Population health • Remote medicine • Emergency medicine • Indigenous health • Adult internal medicine • Mental health • Paediatrics

One of the best value educational opportunities available to registrars this year

In an ACRRMaccredited or Postgraduate Medical Council (PMC) hospital Terms in: • General medicine • Obstetrics and gynaecology • Anaesthetics • General surgery • Paediatrics • Emergency medicine

Training to be through ACRRM-accredited training posts

* Primary Rural and Remote Training and Advanced Specialised Training may be undertaken in any order after the Core Clinical Training year. † Primary Rural and Remote Training and Advanced Specialised Training may be undertaken in any order after the Core Clinical Training year.

52

Sydney

Melbourne

20-22 MAY 2011

11-13 NOVEMBER 2011

Sydney Showgrounds Sydney Olympic Park

Melbourne Convention & Exhibition Centre

Attend Australia’s premier primary healthcare event, which provides unparalleled access to the leading experts, medical researchers and scientists from across Australia. This scientific program - accredited by the RACGP/ ACRRM / AAPM includes a diverse range of therapeutic areas and allows delegates to attend interactive hands-on workshops as well as seminars.

The GPCE invites delegates to attend for 1, 2 or all 3 days.

To learn more call 1800 358 879 or visit www.gpce.com.au

2 / Your GP Training Experience

RVTS:

an alternative pathway to fellowship

RVTS trains GP registrars working in rural and remote locations, where accessing mainstream training is impractical or impossible.

The Remote Vocational Training Scheme (RVTS) offers GP registrars working in rural or remote locations a unique remote training experience and an alternative pathway to fellowship.

Remote training and supervision RVTS trains its registrars via distance education and provides remote supervision. No location is too remote and the program is structured to meet the needs of solo practitioners.

Education is delivered via: Teletutorials. Weekly 90-minute education sessions via teleconference.

On-site teaching visits.

An experienced rural practitioner visits the registrar to observe consultations and

54

provide feedback.

Face-to-face workshops.

Registrars meet for five days of practical training twice a year.

Remote supervision.

Each registrar is allocated a supervisor who acts as a mentor and provides clinical and educational advice.

RVTS registrars enjoy the same level of support as their big city counterparts, no matter how remote they are, and can be found practising as Royal Flying Doctors, district medical officers, with Aboriginal medical services and in private practice. They serve a variety of communities, from farming and mining towns through to remote Indigenous communities. Many work in solo practice.

Dr Vincent Cornelisse

A remotely supervised GP registrar Dr Vincent Cornelisse lives in the farming community of Biggenden, around an hour from Bundaberg. He’s the only GP in a town of 650 residents and one of only a handful of registrars in Australia training for fellowship remotely.

The Remote Vocational Training Scheme (RVTS) trains, supervises and supports Vincent from a distance. The alternative was leaving his community to access training. “RVTS is awesome, and you can quote me on that,” he says.

The challenge of solo rural practice suits Vincent perfectly. “I see and deal with a massive variety of presentations and don’t have to wrestle an army of residents and registrars to treat an interesting patient,” he says.

Vincent also works as the hospital’s medical superintendent, providing 24-hour emergency care, and also looks after inpatients and nursing home residents.

Being a solo rural GP isn’t for everyone, but it is rewarding. “I get to be a real doctor!” he says.

55

2 / Your GP Training Experience

Metropolitan GP positions for Doctors with:

General Registration & Australian Citizenship or Permanent Residency

“RVTS registrars enjoy the same level of support as their big city counterparts, no matter how remote they are.”

Eligibility RVTS is an independent, Australian Governmentfunded program with its own application process and annual intake of 22 registrars.

Applications open in May each year for training starting the following February.

Geographic location is the key eligibility requirement. To apply, applicants must be working in an eligible location, or have arrangements in place to be in an eligible location at the commencement of training.

Applicants must provide continuing, whole-patient care.

Preference is given to doctors working in solo practice and those who cannot access Australian General Practice Training (AGPT) programs.

56

Once accepted, the registrar remains in the same location throughout their training.

Check the RVTS website for complete eligibility criteria.

The endpoint This three to four-year program meets the requirements for fellowship with both RACGP and ACRRM. Twelve-month training is available in advanced skills curricula such as anaesthetics, obstetrics and emergency medicine.

Contributed by the Remote Vocational Training Scheme

Ideally suited to doctors working in the hospital system thinking about a career in general practice

FACT FILE What: Train for FRACGP/FARGP or FACRRM in rural or remote locations.

Who: The registrar who enjoys the independence of rural or remote practice but wants a supportive training environment.

For more information, contact RVTS on (02) 6021 6235 or visit www.rvts.org.au.

After-hours in-clinic approved medical deputising services in Melbourne [VIC] & Brisbane [QLD] UÊ ÝVi i ÌÊÀi Õ iÀ>Ì UÊ7 À ÊÌ Ü>À`ÃÊÞ ÕÀÊ *Ê i ÜÃ «Ê Ê ÕÀÊ>vÌiÀ ÕÀÃ V VÊÃiÀÛ ViÃÊ­ -® UÊ i Ì À }ÊEÊ «« ÀÌÕ Ì iÃÊv ÀÊ«À viÃÃ > `iÛi « i ÌÊ>ÀiÊ>Û> >L i UÊ ÊV VÃÊ vviÀÊ ÕÀÃ }Ê> `Ê>` ÃÌÀ>Ì ÛiÊÃÕ«« ÀÌ]Ê >ÀiÊvÕ ÞÊV «ÕÌiÀ Ãi`Ê> `Ê >ÛiÊiÝVi i ÌÊv>V Ì iÃÊ > `ÊiµÕ « i Ì

For further information, visit www.alliedmgp.com.au Apply to GP Relations Manager info@alliedmgp.com.au or phone 03 9525 3700

llied Medical Group Holdings Limited

2 / Your GP Training Experience

Joining forces with the

ADF

Around 2.5% of GPs train in the Australian DeFence force.

It’s an opportunity to develop leadership skills and specific medical skills IN A CHALLENGING ENVIRONMENT.

T

raining as a GP registrar in the Australian Defence Force (ADF) offers opportunities and challenges.

Generally, composite terms are accredited only after an initial full-time civilian term, usually a three-month rural term.

ADF registrars must meet the same educational requirements but there are some specific policies relating to ADF GP registrars. These include leave provisions, transfer between RTPs and modified requirements regarding work in outer metropolitan and rural areas.

Civilian and military posts

While most ADF registrars will select the general pathway, exposure to rural general practice provides valuable experience in the decision-making, leadership, teamwork and clinical skills that can be utilised for ADF clinical practice in Australia and when deployed.

Deployments may be prospectively accredited for training.

General practice terms are undertaken through a combination of civilian and military posts, known as composite terms. The unique demographic of the military necessitates concurrent exposure to the broader Australian community to ensure experience in areas such as paediatrics and geriatrics.

Initially, Medical Officers (MOs) in the ADF are encouraged to specialise in primary care.

This is important because whether in Australia or deployed, ADF personnel need access to high quality primary health care. There are also opportunities to specialise in public health,

58

Dr Alison Thomas

A GP with military precision

L

ieutenant Commander Alison Thomas has been a military doctor since 1994 after joining the Navy on a scholarship as a fourth year medical student at Monash.

“It’s a wonderful career,” she says. “I’ve done aviation medicine, spent six months in the UK, I’ve dangled out of helicopters and been ‘action stations’ in the Gulf – I’ve loved every minute of it.”

There is a focus on emergency medicine and similar skills to rural general practice

including self-sufficiency in remote locations.

Alison’s assignments have included several overseas deployments as a ship’s doctor.

She saw active service in the Gulf, which involved the memorable experience of being winched onto an American ship and taken to an Iraqi oil tanker to treat a stroke patient.

After a stint in civilian general practice, Alison returned to Permanent Navy in late 2009. She now works as a Medical Officer for Joint Health Command in Canberra.

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2 / Your GP Training Experience

medical administration, occupational medicine and sports medicine, known as the force protection specialties. Generally, the procedural specialties (surgery, anaesthetics, orthopaedics) required for providing higher level care on deployments reside within the Reserve Forces.

ADF Medical Officer recruitment Most ADF MOs are recruited as medical students, some from universities and others from within the Services. A small number join as direct entry qualified medical practitioners.

Medical students and trainees are considered ADF members and attract a salary and ADF benefits such as superannuation, allowances, medical and dental care, and accommodation options while under training. The MOâ&#x20AC;&#x2122;s primary duty is to train at medical school, then complete PGY1 and 2 prior to their first full-time posting to an ADF unit.

At the unit, the MO receives further training, in parallel with the AGPT, including officer training, early management of severe trauma (EMST), and specialist courses such as aviation medicine or underwater medicine. At the same time, the MO gets acquainted with the military medical system.

Clinical competency levels Clinical employment is based on progression through clinical Competency Levels (CL).

Beginning at CL1, MOs who have completed initial courses and a period of supervised primary care are recognised as CL2. MOs at CL2 have basic skills and are considered suitable for remote supervision in an operational deployment environment. Those who have achieved FRACGP or FACRRM progress to CL3.

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DO IT NOW Medical students, GP registrars and fellows wanting to explore a career as an ADF Medical Officer (MO) may find it helpful to speak with a current ADF registrar.

For more information or to apply, call 13 19 01 or visit www.defencejobs.gov.au.

To speak to a Medical Officer in the ADF, telephone Commander Nicole Curtis, RAN, Staff Officer Medical Officers (02) 6266 4176 or email nicole.curtis@defence.gov.au.

Remuneration In return for supporting the initial medical training, the ADF requires a Return of Service Obligation (ROSO) or Initial Minimum Period of Service (IMPS). During internship and residency, Defence continues to pay the MO a salary, while wages earned from the hospital or other employers are paid to Defence. If hospital pay exceeds military pay, the difference is paid to the MO periodically. MOs at CL2 and above are reimbursed a further $10,000 annually for continuing medical education expenses.

Contributed by Dr Geoff Menzies

3

term allocation and choice

3 / Term Allocation and Choice

place

fi n d i n g yo u r

Planning ahead will give you the best shot at getting the General Practice placements you want.

T

he regional training providers (RTPs) are responsible for allocating registrars to general practices for each relevant six-month general practice term and ensuring all placements are appropriate and accredited.

The system of allocation is determined by the RTP and varies considerably between RTPs. Allocation systems may involve interviews with prospective practices chosen by the registrar (for interview tips see page 64). Alternatively, the RTP may determine the placement with little or no registrar input. The method of placement for the majority of RTPs lies somewhere in between these two extremes.

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 62

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 large distances or be placed in a practice that is not ideal for them.

Be proactive The best advice we can give is to be proactive and plan ahead.

If you have certain needs or requests, let someone know as soon as possible.

In your RTP, this is generally your registrar support officer or medical educator. Alternatively, it may be an administrative staff member, the director of

GPRA TIP Organise yourself early and talk to your RTP. This will give you the best chance of getting the placements you would prefer.

Where should you go for…

Protection?

Support?

Advice?

training or even the CEO. Ask your RLO – they will advise you. Remember, your RTP will never be in a position to help you if they don’t know what your needs are.

In some RTPs, registrars and practices make arrangements between themselves, especially at GPT3 level or later stages of training. The RTP then assists by ensuring practices have the appropriate accreditation.

Contributed by Dr Jenny Lonergan and Dr Skye Boughen

MIPS – where members matter!

Medical Indemnity Protection Society Ltd. Call 1800 061 113 | www.mips.com.au DOCTORS FOR DOCTORS Medical Indemnity Protection Society Ltd (MIPS) is an Australian Financial Services Licensee (AFS Lic. 301912). MIPS Insurance Pty Ltd (MIPS Insurance) is a wholly owned subsidiary of MIPS and holds an authority issued by APRA to conduct general insurance business and is an Australian Financial Services Licensee (AFS Lic. 247301). MIPS arranges general insurance covers for MIPS members, including the MIPS Insurance medical indemnity policy underwritten by MIPS Insurance. Any financial product advice is of a general nature and not personal or specific.

3 / Term Allocation and Choice

Facing the interview

GPRA TIP Keep this checklist handy to prepare for your next practice interview.

You’ll be more confident at practice interviews armed with the right questions.

A

s 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 we have compiled a few tips and questions you might like to ask.

Practice. What special interests do people in the practice have (skills for you to learn)?

Will you have your own room, or will you need to move rooms depending on the day?

Will you need any particular 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?

Will you have internet access at the practice?

If so, in every room or just one computer? Is it broadband?

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Usual hours. What days and hours are you expected to work? What are the usual start and finish times? Will you be working on Saturdays?

When are you expected to perform nursing home visits and house calls?

On-call commitments. What are the on-call and after-hours commitments at your practice?

If you have hospital patients, what are the usual arrangements for the weekends you aren’t on call? (Are the other GPs happy to cover, or would you be expected to continue their care?)

Pay. What is the practice prepared to pay in salary or percentage of earnings for your usual hours? How often will the income according to percentage be calculated? (This should preferably be fortnightly or monthly, or at the very least three-monthly.) What is the remuneration for after-hours work? Does the practice pay above or according to the

minimum in the National Minimum Terms and Conditions (NMT&C) document? (If they pay less, don’t sign anything! If you are unsure, ask your RLO.) Hospital work. Are you expected to undertake work in the local hospital? How are you paid for hospital work? Do you require an ABN for this? If the payments are processed through the practice, what percentage do you receive?

Accommodation. Does the practice have any 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?

Teaching and education. How does the practice usually structure your teaching (three hours a week for GPT1 and 1.5 hours a week for GPT2)? Is there a regular time set aside 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?

Holidays. If you have two particular weeks in mind for annual leave, now would be the time to say so.

Your contract. Take along a copy of the current NMT&C 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 it on the spot. If there are clauses in the contract that concern you, or you don’t agree with, discuss it with the practice or your RLO.

Contributed by Dr Jenny Lonergan and Dr Skye Boughen 65

3 / Term Allocation and Choice

Saving the day

if things go wrong

Get the latest information on the important clinical issues in Women’s & Children’s Health facing Australian GPs today.

The 2011 seminars are scheduled for the following tentative dates:

If a problem or dispute arises with your training, ask for help sooner rather than later. ometimes 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.

S

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 happens to you, don’t worry, you are not alone. There are many people involved in GP training who are specifically employed and more than happy to help you out. If you are in a fix, the best advice we can give is to let someone know.

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.

Talk to someone The most appropriate person to talk to depends a bit on what the problem is and how you personally feel about dealing with the problem.

Remember your RLO is always there in the first instance to support and advise you, no matter how big or small the problem might seem.

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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.

FREE for all GPRA members enrolled in the AGPT program

The Annual Women’s Health Update Sydney, 19 February 2011

The Women’s Health Update Melbourne 1, 12 March 2011

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 Update Adelaide, 28 May 2011

The Women’s and Children’s Update Brisbane, 30 July 2011

The Women’s and Children’s Update Perth, 13 August 2011

The Women’s and Children’s Update Melbourne 2, 27 August 2011

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

Saturday, 8.30am-6.30pm Elizabeth Jolley Lecture Theatre Curtin University, Bentley, WA

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.

registrar

rave

Dr Belinda Guest

My RTP is General Practice Training Valley to Coast (GPTVTC).

GPRA TIP If you have an issue about your training, it’s best to try and resolve it by talking to the practice, your RTP or RLO. You can also contact GPRA directly at enquiries@gpra.org.au or telephone 1300 131 198.

My current post is my fourth general practice term in Newcastle, NSW.

A typical workday for me depends on the day. I work in general practice two days a week, one day in family planning and one day for GPRA. I love the variety!

What I love about general practice is working out tricky medical problems, getting to know my patients and empowering them to make decisions about their health.

What I don’t love so much is how busy it can be and the paperwork.

My GP role model is Michael Kidd because he is an effective leader while being incredibly generous and humble.

After hours I love to go for a run or veg out with a book.

A quirky fact about me is I played for Australia in the senior women’s Oztag team.

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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. The GPRA Advisory Council consists of the RLOs from all RTPs across Australia, GPRA representative members on different committees and the GPRA Board and management.

Sometimes issues arise that indicate a systemic problem (for example, a policy or situation that is disadvantaging a group of registrars). GPRA will then act to lobby the relevant stakeholders to review and change their policies.

GPRA is run for registrars by registrars, which creates a non-threatening source of advocacy and support.

GPRA can also be contacted directly by registrars for any issues, however it is often the RLO and their local networks who can be of the most assistance in the first instance.

Dispute resolution guidelines Many RTPs are developing or have developed local documents outlining dispute resolution that can help guide you if problems arise.

Contributed by Dr Jenny Lonergan

4

preparing for practice

4 / Preparing for Practice

the gp mindset

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

D

uring hospital terms, it’s easy to be occupied with the usual duties of caring for too many patients and constantly being paged. Often, little time is left to think about how your hospital experience can help you as a GP in the future.

Here are a few points that will help you make the most of your hospital experience.

Choose your terms. Choose terms that will give you experience with common GP-managed conditions. Mandatory and other useful rotations are listed in the box opposite. General terms such as general medicine and general surgery may be more relevant than superspecialised placements. Accident and emergency terms are always a great opportunity to experience a wide range of presentations and to learn acute care skills, timely management and referral. Any experience with skin, ears and eyes will stand you in good stead. During your prevocational years, if a Prevocational General Practice Placements Program (PGPPP) term is offered at your hospital, take full advantage.

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Fine-tune your practical skills. Ask nurses to teach you skills such as giving vaccinations (especially to children) and dressing wounds.

Ensure you can place common types of plaster casts with confidence.

Pick up useful procedural skills. Learn procedural skills that may be useful in general practice; for example, joint aspirations and injections, excision of cysts and skin lesions.

Learn the art of referrals. Think about what information is pertinent on a referral letter sent with a patient to emergency. Discuss the referral process with consultants. What do they like in a referral? What tests should be ordered prior to referral? How urgently do they need to see particular cases?

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

GPRA TIP 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 RPL easier to achieve.

Choose the right hospital and rotations Choose a hospital and terms that will give you experience with common GP-managed conditions. There are rotations and experiences that are considered to be mandatory preparation for the Australian General Practice Training (AGPT) program.

There are four compulsory rotations: Medicine (preferably general medicine but as this is not available in some hospitals, a rotation that offers broad medical experience) General surgery Accident and emergency Paediatrics In addition, each college requires certain other hospital terms and particular courses to be completed. Refer to the college websites and discuss with your RTP. If you have completed some of these as a prevocational doctor, you may qualify for recognition of prior learning (RPL) so you can either reduce your training time or substitute terms that develop existing or new skills. Your RTP can provide further information about how to apply for RPL, which you must apply for in the first year of training. RPL may be approved for all, or part, of the requirements of the post-intern hospital year of training in Australia.

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registrar

rave

Dr Jeremy Keh

My RTP is GP Synergy.

My current post is Wattle Grove Family Medical Practice (actually in Holsworthy).

A typical workday for me tends to include looking in kids’ ears and pretending I can see their parents on the other side. (Old joke, but it still gets a good laugh.)

What I love about general practice is that most days it doesn’t feel like work at all. I love being able to simply talk to patients and interact with kids.

What I don’t love so much is

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.

Network with your peers. Most Registrar Liaison Officers (RLOs) and regional training providers (RTPs) have email lists enabling registrars to communicate with their RLO or other registrars in their region. Make use of this and other opportunities such as social or educational meetings to get to know other GP registrars.

Contributed by Dr Kate Beardmore, Dr Kate Kelso and Dr Kirsten Patterson

repeatedly trying to convince people they don’t need antibiotics for a cold.

My GP role model is Dr Frank Keh because, well, he’s my father!

After hours I love to spend time with my wife and friends, go to the gym, or simply repair my boat. (It’s been a few years, but it’ll be buoyant one day.)

A quirky fact about me is I love to breakdance.

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DO IT NOW For more information about compulsory hospital rotations for general practice training, refer to www.agpt.com.au, www.racgp.org.au and www.acrrm.org.au.

If you have any questions or problems during hospital training, contact your RLO or GPRA directly.

4 / Preparing for Practice

Before your first GP term:

first things first!

If you’re getting ready to start your first GP Term, here are a few things you’ll need to organise.

E

xperienced registrars have put together this handy checklist of the paperwork, equipment and resources you’ll need to think about before you begin.

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.

Note: GP term dates may differ from RMO hospital dates and between States. Make sure you have arranged leave to start your GP term on time.

Gpra tip If you’ve read this and still have questions, contact: Your RLO or ask your RTP. GPRA: enquiries@gpra.org.au or telephone 1300 131 198.

Your medical educator (see your RTP).

Your supervisor.

What forms do I need?

Your regional training provider (RTP) should help you with this list. In summary: Application for a Medicare provider number for the practice and, if applicable, the local hospital if a VMO position is attached. Allow at least six to eight weeks for this to be processed.

What organisations should I join?

Your local Division of General Practice.

Find out who to contact from your practice or RTP. Rural Doctors Association of Australia (RDAA). Go to www.rdaa.com.au.

All are optional and this list is not exhaustive:

Application for Recognition as a General Practitioner (AGPT) in an accredited training placement.

General Practice Registrars Australia (GPRA). Your national GP registrar representative group – free membership. Join at www.gpra.org.au.

Medical indemnity – you must have your own indemnity to cover GP practice. Indemnity for hospital work is a different scenario. (It is a good idea to get indemnity as a GP registrar – procedural. This means you are covered for a wider scope of practice. If in doubt speak to your own indemnity provider.)

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, such as a subscription to check magazine and free textbooks such as Murtagh’s General Practice or AMH. Go to www.racgp.org.au.

Registration with the Australian Health Practitioner Regulation Agency (AHPRA), previously the State or Territory medical boards.

Australian College of Rural and Remote Medicine (ACRRM). Go to www.acrrm.org.au.

Employment Contract and Confirmation of Employment Agreement.

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Note: This is an important, legally binding contract about your hours and pay. Refer to the National Minimum Terms and Conditions document for guidance. See page 124 or go to www.gpra.org.au.

Australian Medical Association (AMA).

Contact your State branch. For details, go to www.ama.com.au.

Australian Indigenous Doctors Association (AIDA). A professional organisation for Indigenous medical students and graduates.

Go to www.aida.org.au.

What equipment will I need?

Equipment: Your own stethoscope.

An auroscope/ophthalmoscope.

Some practices have reference books, posters and models in the rooms, otherwise start collecting your own.

Consider a tympanic thermometer for kids and a magnifying glass or dermatoscope for skin checks.

Consider using equipment you are comfortable with (for example, your own tendon hammer and neuro exam kit, small tape measure, etc).

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4 / Preparing for Practice

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.

Australian Doctor, a weekly publication with the excellent “How To Treat” section.

Doctor’s bag:

General Practice, Patient Education and Patient Treatment (print or CD-ROM) – John Murtagh.

Your favourite dermatology atlas (eg Colour Atlas and Synopsis of Dermatology – Fitzpatrick et al.).

Reproductive and Sexual Health: an Australian Clinical Practice Handbook – Family Planning NSW. Contraception: an Australian Clinical Practice Handbook – Sexual Health & Family Planning Australia.

Therapeutic Guidelines – print or electronic.

An orthopaedic/fracture management book (for example, Practical Fracture Treatment – McCrae and Esser).

Australian Medicines Handbook .

MIMS. Paediatric Pharmacopeia.

Clinical Sports Medicine – Brukner and Khan.

Paediatric Handbook – from Royal Children’s Hospital or Westmead.

Oxford Handbooks (clinical medicine, specialties).

Your favourite ophthalmology atlas.

It is always good to have a doctor’s bag of your own, especially for house calls.

Some practices may have one for you to use.

Talk to your supervisor and RTP as they can generally assist.

AFP has published a number of useful articles about stocking a doctor’s bag.

Often the local Divisions would have contacts to purchase these locally.

If all else fails, Google will give you plenty of online providers.

What books and resources will I need?

These are all optional. Your practice may already have these or provide online access. You will soon find your favourites.

Journals and publications, many of which are now available online: GP Companion, a handy reference of GP clinical information available as an e-book by logging on at www.gpra.org.au.

Australian Family Physician (AFP), check, both available as part of your RACGP membership.

MJA (Medical Journal of Australia).

Australian Prescriber, RADAR, both produced by the National Prescribing Service Ltd and available at www.nps.org.au.

Medicine Today, a publication of the AMA. Medical Observer.

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Books

What about web resources?

A list of your favourite websites saved to your desktop can be an invaluable information resource. Suggested useful sites are listed on page 153.

Contributed by Dr Siew-Lee Thoo, Dr Naomi Harris, Dr Kate Kelso and Dr Kirsten Patterson

4 / Preparing for Practice

GP term survival tips Starting your first day at a new practice? here‘s A novice’s guide to making it through those first nerve-wracking consultations with ease.

In your room: Open all the cupboards in your room on entering to find where everything is.

Locate where all the prescription, pathology and radiology forms are kept in your room, as well as checking with the reception staff where the extra or infrequently used referrals and forms are kept.

Work out which way the paper faces in the computer printer.

Find out how the phone works. Put labels against internal numbers if not already done.

Check if there’s 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 is the otoscope with different sized specula for ears and noses.

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»» What type of specula and which sizes are kept, in addition to other Pap smear equipment. »» Different types of swabs (M/C/S, PCR) and specimen jars.

Put resource books (see the resource list on page 76 for suggestions) in your room if available.

Locate Therapeutic Guidelines, either print copies or on the desktop 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 on.

Locate where information leaflets are on the toolbar (especially with Medical Director).

Start collecting resources that will be useful during your consulting, such as guidelines for bowel screening, flowchart for investigating

breast lumps. Keep them in an accessible place (such as a folder, concertina file) in your room.

In the practice: Check out the treatment room, 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.

Find where the resuscitation kit and oxygen 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 – 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.

“Take a deep breath, count to 10 and then call your first patient in.”

Have a say in setting up your bookings. You will almost certainly need extra time until you find your feet, so book accordingly (ideally two patients per hour when you first start, moving to three or four when you feel comfortable).

Let the practice staff know the common procedures you may routinely need extra time for (for example, Pap smears, psychological intervention and care plans, skin excisions).

With your supervisor: Check the practice booking and billing system.

Ask about the practice policy on checking and follow up of results and patient recalls.

Establish their preferred method of being contacted for questions during consultations (for example, phone, knock on 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.

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4 / Preparing for Practice

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.

GPRA TIP 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.

During consultations: Take a deep breath, count to 10 and then call your first patient in.

Start with open-ended questions.

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.

Try to do all the work for each consult (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’re more likely to forget the details.

Have a system for keeping track of clinical questions that arise during consults (for example, notebook on your desk, manila folder with patient consult summary printed) to ask your supervisor or look up.

Contributed by Dr Emma Ryan and Dr Kate Kelso

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4 / Preparing for Practice

Going bush GPRA TIP 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.

So you’re about to live and work in a town you’ve never heard of? HERE’S How TO make the experience an enjoyable one.

H

itting the wide open road for a rural term can be daunting, especially for city types on the general pathway. But it can also be one of the most rewarding times of your training.

Here are some insider’s tips.

Do your research before your rural term starts. What is the town like?

Where am I going to live?

Discuss housing options in the town with the current GP registrar, your future GP supervisor or practice staff as well as the RTP, RLO and MEs. Surf the internet for websites of real estate agents in that town.

Discuss with the past and current GP registrar, your future supervisor or practice staff.

Surf the internet for websites of local newspapers for their classified advertisements.

Talk to the rural RLO and medical educators at your rural RTP. The RTP should mail out a registrar information pack to you.

Consider shared accommodation with some locals – you’ll get an amazing insight into the town and its people.

If relocating with partner and children, ask about employment opportunities, local schools and child care facilities.

How much financial assistance will the RTP provide for relocation?

Check out the rural RTP’s website and surf the internet for websites about that town.

Contact the local council for an information pack to be mailed out to you.

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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.

When you arrive for your rural term, get established in your community Approach your town council to request information for new residents such as local amenities.

Visit the tourist information centre to request maps, information on coming events and surrounding towns.

Ask your supervisor and practice staff for suggestions of things to see and do.

Bring along some personal items like favourite cushions and pictures that will make your new residence feel like home.

Get to know your neighbours and people in your street.

Enquire about internet coverage. People often forget when relocating to the rural or remote regions of Australia that there is not

Get out of your comfort zone! Try out new experiences.

Get involved in your community

Experience what your community can offer in dining out, music, the arts and outdoor recreation.

Sign up as a member of groups in areas of interest to you such as sports, hobbies and church.

Enjoy living in your community Avoid the temptation of returning to your hometown every weekend.

Ask your friends and relatives to visit you in your new town instead of you returning to your hometown to visit them.

Attend the local CPD and educational dinners, usually sponsored by the local Division of General Practice or pharmaceutical companies, for socialising, networking, education – and the food!

Do your grocery shopping in the local supermarket. By and large, the community understands your need for privacy outside of practice opening hours, so the fruit and veg section won’t feel like a quasi-consulting room.

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registrar

rave

Dr Yvonne Wang

My RTP is CoastCityCountry Training/GP Synergy.

My current post is an academic post at Westmead Hospital, Western Clinical School of the University of Sydney.

WHAT EVERY VMO should know The community will respect you for shopping locally and might even learn a few healthy purchasing habits from you!

If they ask you to sit on the dunking machine at the local festival, take it as a compliment. Remember, it’s only water.

(This actually happened to Dr Naomi Harris!)

Professional support Ask your GP supervisor or practice staff about the availability of local community health services, allied health professionals, dentists and access to consultants.

A typical workday for me varies.

On my academic days, I arrive at 9am and relax in the office, do some literature search, mark some medical student assignments and give lectures to the medical students. On my clinical days, it’s typical general practice, going to work at 8.30 and finishing at 6.

Organise regular get-togethers with other GP registrars in the region – drinks, dinners and outdoor activities.

What I love about general practice is the flexibility in lifestyle and

Take turns to visit each other’s towns. Take the opportunity to debrief, encourage and support one another.

family friendliness, and being able to sit down all day.

My most memorable GP moment is when I saw that I passed the

If you have to do hospital on-call work, the local hospital will most likely provide you with an orientation.

Notify your ME and RLO at your original RTP of any issues that may arise.

Contributed by Dr Winston Lo, Dr Naomi Harris and Dr Kirsten Patterson

Before you start work as a hospital VMO, be sure to ask the right questions.

Working as a Visiting Medical Officer (VMO) at the local hospital is an integral part of most rural practices for GPs. It can also be a fascinating and highly instructive part of your training as a GP registrar.

Different hospitals have different arrangements in relation to how you are appointed, the time commitment required, what type of work the VMO does and what kind of patients they see.

Financial arrangements can vary.

You can be paid for salaried sessions or fee for service.

You may need your own ABN

FRACGP exams. No more exams!

A quirky fact about me is that I was born in Taiwan and had already lived in five different countries by the time I was 18.

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GPRA TIP If you are unsure about any of the items on this checklist, talk to your supervisor.

and you may also need to be registered for GST. Before you begin, there are many questions you will need to ask.

Here is a checklist to get you started:

Job application and rostering Do I apply to the hospital directly to be 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?

Do I need my own ABN or do I use the practice ABN? Do I need an ABN registered for GST (required for gross billings over $50,000 per annum)?

What is the method for hospital billings?

How do I keep records of patients seen?

What are the relevant item numbers?

Who submits the accounts for hospital billings – the practice manager or myself?

What percentage of hospital billings am I entitled to?

Remember to:

Type of work

Sign a medical indemnity agreement with the hospital.

Keep good records of patients seen.

Keep good records in the patient notes.

Can private or public patients have their choice of doctor?

How do the other doctors at the practice usually manage their hospital work?

Most importantly, enjoy your VMO work. It is one of the most interesting aspects of rural practice!

Billing and administration

Contributed by Dr Siew-Lee Thoo

Is the hospital work paid as salaried sessions or fee for service?

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4 / Preparing for Practice

The Medicare maze As a GP, it’s your job to master “the system”. Here’s a quick 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), a list of medical services and the rebates allocated for each service.

As general practitioners, we rely on the smooth operation of the Medicare scheme, as 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.

Get to know about billing systems. General practices may bulk-bill, privately bill or have a mixture of both. When a patient is bulk-billed, it means they are only charged the Medicare rebate and do not pay any extra. When a patient is privately billed, they will pay the “gap” or sum above the amount of the Medicare rebate, as set by the practice. As a registrar enrolled in GP training through an RTP, we attract the same Medicare payments as a fellow of one the general practice colleges (known as vocationally registered GPs). Interestingly, nonvocationally registered GPs, who are usually very experienced doctors who entered the 86

profession before vocational registration for general practice was required, attract a lower Medicare payment.

Use your practice manager. Your practice manager is an incredible resource person who can fill you in on your practice billing system and commonly used item numbers.

Do a course. There are a couple of courses available to familiarise yourself with Medicare before you venture into GPland. If you are working in a capital city or larger regional centre, you may be able to do the Medicare Australia familiarisation course, which takes a few hours (ask your RTP or practice manager for details). Alternatively, for those unable to attend or in rural centres, two excellent education modules are available online – “MBS and You – for New Health Professionals” at www.medicareaust.com/generalandspecific/ M01/index.htm and “MBS and You – MBS Primary Care Items” at www.medicareaust. com/generalandspecific/M08/index.htm.

Read The Rainbow Book general notes. Find the Medicare Benefits Schedule Book (commonly known as The Rainbow Book) in your surgery

medicare

GPRA TIP Don’t forget, your supervisor and practice manager have had vast experience with Medicare billing, so use their knowledge.

For more information, contact Medicare Australia on 13 20 11.

Or you can find a wealth of information at www.medicareaustralia.com.au and MBS Online at www.mbsonline.gov.au.

and read the general explanatory notes or check out the online version at www.mbsonline.gov.au, which also has a useful search function for those tricky item numbers. The list of services and rebates is updated annually.

Read them again. Re-read the general explanatory notes.

Know how Medicare defines a consultation.

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 and they need to be applied appropriately.

Know what services do 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.

Know what services do not attract benefits.

These include telephone consultations, mass immunisation, medical examinations for travel, employment, insurance or any compensable injury and issuing scripts without the patient present. Some of these services will be billed privately (meaning the patient or insurer pays the full sum for the consultation). Doctors also cannot charge Medicare for services to their own family.

Have a list of frequently used item numbers.

Create a shortlist of frequently used item numbers. Most practices will have one and many local Divisions may also have one.

Get familiar with bulk-billing forms.

Familiarise yourself with Direct Bill forms (DB2).

You may have to complete them, especially 87

4 / Preparing for Practice

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 this order).

Take notes as you go. You must keep adequate and contemporaneous notes that accurately reflect your consultation in order to attract payments from Medicare.

Details, details. Referrals to specialists must be written, signed, dated and include your provider number. They generally last for 12 months unless otherwise specified.

If you get audited, don’t panic. This is a source-based audit program and is random.

You are not that special!

Got that? Step up to the advanced level.

It’s now time you graduated to the more meaty aspects of the “Professional Attendances – Category 1” section of the Medicare schedule.

This covers areas such as chronic disease management, mental health care and health assessments, with item numbers for: »» Regular reviews for patients with diabetes and asthma. »» Service incentive payments – for vaccinating children and performing Pap smears on a percentage of all eligible patients. »» Care plans and team care arrangement items, which aim to improve coordination of care and allow patients greater access to allied health services. »» Mental health care items, which provide access to subsidised psychological intervention, 88

and allow you to bill for providing mental health care. »» Assorted health checks for ATSI patients, those aged over 75 years and more.

Getting your head around it all can be daunting when you’re 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, Medicare Online, your medical educators and supervisor to guide you along the way.

New and useful item numbers. As the MBS is reviewed annually, new item numbers are introduced and others discontinued on a regular basis. Medicare Australia notifies all practitioners so be on the 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 practices.

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

4 / Preparing for Practice

The

plate prescriber Tips to make writing any prescription all in a day’s work.

P

rescribing medications makes up a significant part of a general practitioner’s workload. Yet GP registrars often have limited exposure to prescribing outside the hospital system or may have worked in health systems very different to that found 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 You may have been offered an opportunity to attend a PBS prescriber seminar when you first obtained your prescriber number prior to commencing 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 may like to access two of the excellent PBS online education tutorials prior to commencing your GP term: »» “PBS and You – Training for New Health Professionals” at www.medicareaust.com/ pbsandyou/M01/index.htm.

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»» “PBS and You – Prescribing in Private Practice” at www.medicareaust.com/ pbsandyou/M05/index.htm.

Alternatively, read the explanatory notes 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. This information is also available online at www.pbs.gov.au/html/healthpro/info/ prescribing?ref=section1– prescribingmedicines.

Fortunately, prescribing software helps us out.

When prescribing an item, check if there are any restrictions on indications for therapeutic use. If you are using the pharmaceutical for a different indication, you should write a private script for the item.

Maximum quantities and repeats listed are calculated to provide one month supply per dispensed amount, and enough repeats for six months 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 dose, and thus would not get 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.

You can use authority scripts to prescribe 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 Special circumstances apply to the prescription of S8 drugs of addiction. You need to comply with the PBS requirements (outlined in The Yellow Book or at www.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.

Talk with your supervisor/practice manager about prescribing these medications, and any 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 Pharmaceutical items are included on the 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 91

4 / Preparing for Practice

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 Patients travelling overseas will need to have sufficient quantities of their medication prescribed and dispensed for the length of their trip.

It is helpful to provide patients with a letter outlining the medications they will be taking, and most medical records software will have a template for this.

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.

Regulation 24 allows the original and repeat supplies to be dispensed all at once, and you may need to endorse the traveller’s script with “Regulation 24” to allow the pharmacist to dispense sufficient medication for their travels.

Information on Regulation 24 is found in the explanatory notes of The Yellow Book or at www.pbs.org.au.

Contributed by Dr Skye Boughen 92

GPRA TIP For more information on prescribing and the PBS, go to: The Yellow Book (especially “Section 1 – Explanatory Notes”) – available online www.pbs.gov.au.

Medicare Australia PBS education – online tutorial or face-to-face sessions www.medicareaust.com.

Your supervisor.

Ask your RTP to arrange a session on prescribing at a workshop, or organise a personal session with your State PBS education coordinator.

Speak to your local pharmacist – they are generally extremely helpful.

5

exploring your options

5 / Exploring your options

Destinations unlimited

d n la P G m o r f s Postca rd

General practice gives you the freedom to follow your passions, sub-specialise and virtually design your own career. Here are just some of the directions you may wish to explore with your RTP.

Aboriginal health Academic medicine and research Anaesthetics Australian Defence Force Aviation medicine Dermatology Drug and alcohol Emergency Expedition medicine Family planning and sexual health Forensic medicine Geriatrics HIV medicine Men’s health

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Mental health Musculoskeletal medicine Obstetrics Occupational medicine Paediatrics Palliative care Royal Flying Doctor Service Rural and remote medicine Sports medicine Surgery Travel medicine Tropical medicine Women’s health Plus many more

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Most RTPs will do their best to arrange an experience you would like to try even if it’s not one of their standard offerings. In some cases, it may involve a temporary transfer to another RTP – especially for a rural experience.

But do get your request in early.

It is very important to talk to your RTP well in advance of the placement for the best chance of making it happen.

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5 / Exploring your options

The segment on The Circle is about making health accessible to viewers.

If it means they’re going to go to their GP and ask about the topic we’ve discussed then I think that’s what matters.

Dr Kelly ??? experienced the Celtic charm of rural Ireland on her overseas training post.

TV GP media + academic + clinical

Dr Deepa Daniel

Flick on the TV before Dr Phil and Oprah and you may catch Melbourne GP registrar Dr Deepa Daniel giving health advice on The Circle.

So how did she get the gig? It all started when The Circle contacted the AMA’s public affairs department seeking a young female doctor for a medical segment. Having previously been involved at AMA Victoria’s Section of General Practice, Deepa was known to the AMA team. She auditioned – and won the role.

Deepa sees her media work as an interesting side project and a chance to air important public health messages.

The rest of her week is devoted to her academic registrar position, which combines teaching and research at Melbourne University, medical editing at the RACGP’s Australian Family Physician journal and clinical work at her mother’s general practice.

The producer gives me the topic a few days beforehand. On the morning of the shoot I go into the Channel 10 studios in South Yarra and talk to the producer about any last minute things. Usually I’ve got one or two key messages that I’m trying to get across.

Then I’ll go into hair and makeup and wait in the greenroom. I often get to meet a celebrity or two. During the election campaign I met Bob Brown, the Greens leader, and lots of other politicians.

I’ve covered topics such as influenza vaccines, men’s and women’s preventive health, and sleep deprivation in early parenting.

Our contraception segment was the funniest because I had all sorts of props but through our humorous approach we were able to tell people about the risks of STDs. My segment on The Circle is only one Wednesday morning a fortnight, so my main focus this year is my academic registrar position.

I’m doing a special skills academic year funded by GPET that gives me a day at a university, a day at Australian Family Physician doing medical editing and three days in clinical general practice.

Typically I spend Mondays at AFP, and we get manuscripts coming in for peer review.

My Wednesdays are usually spent at the Department of General Practice at Melbourne University. I’m doing a research project in vitamin D and its association with chronic muscle pain. I spend some of my time doing that and some of my time teaching medical students doing general practice rotations.

I spend the other three days in a small bulk-billing clinic my mum set up in 1980 or so, where she still works.

The clinic is in a lower socioeconomic area with quite a high migrant population, particularly African immigrants.

I like trying to deal with social issues as well as physical complaints for my patients.

I really grew up at my mum’s practice in a lot of ways. I went there after school and I worked there as a receptionist on Saturday mornings for a long time so I already knew a lot of the patients.

Note: Dr Deepa Daniel’s role as a media GP on The Circle is an extracurricular role and is not officially part of her GP training.

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5 / Exploring your options

More about academic Registrar Research training posts Workshop 2011 What is an academic training post?

An academic post gives you the chance to try out research and teaching as a salaried registrar in the GP training program. In the RACGP curriculum it may be either a special skills post or an optional extra that extends your training time. Academic training posts are also available with ACRRM – policies are still being developed.

What does an academic registrar actually do?

It involves a mix of teaching, working on a research project, learning research skills and keeping up some clinical work.

What could this post lead on to?

One way to make sure you really understand something is to teach it to someone else.

Teaching is now an important part of the RACGP curriculum, so even when you’re doing a clinical placement you may be

For the latest on dates and venues, visit www. agpt.com.au then follow the links to “Training Posts” and “Academic Training” or let the Registrar Research and Development Officer (RRADO) know you’re interested.

How to apply

What is the RRADO?

Talk to your RTP early. Do not wait until you have finished your training as that will be too late. Applications are generally in March and September.

The Registrar Research and Development Officer (RRADO) is employed by GPET to promote training in research and academic general practice. The RRADO is a point of contact for registrars interested in research and academic training posts.

Further information is available by contacting the current RRADO, rrado@gpet.com.au.

Your RTP can also advise you.

You don’t need to do an academic term to get a taste of teaching.

The 2011 workshop will be held between May and July with applications a couple of months before.

A Registrar Research Fund to support research projects and a Registrar Research Prize are also offered.

Visit www.agpt.com.au then follow the links to “Training Posts” and “Academic Training”.

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Attending the Registrar Research Workshop is 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.

GPET pays your travel expenses.

Lots of registrars end up taking on teaching roles at universities or positions as medical educators.

More information

Other teaching opportunities: registrars as in-practice teachers

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The position is also an attractive part-time 12-month post for academic registrars. It may be accredited as an AGPT special/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.

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required to do some in-practice teaching as part of your training.

Most often, this could involve offering tutorials to visiting medical students, having the student sit in on your consultations, or watching them do consultations.

Some RTPs also have employed positions for registrar medical educators or junior medical educators, which means teaching other registrars.

Many RTPs offer training in teaching skills so registrars can feel more confident in performing this role.

Need clinical information fast?

Ask your companion.

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Dr Katie Williamson grew up on Sydney’s northern beaches with no plans to be a doctor, much less a rural GP literally out the back of Bourke.

Armed with a degree in forensic science and having already taken one career detour from lab work to pharmaceuticals account manager in an advertising agency, she became disenchanted with her job in her mid-20s.

She was browsing through the medical trade press on behalf of her pharmaceutical client one day when a thought suddenly struck her: “I could be a doctor!”

She successfully applied to do a postgraduate degree in medicine at the University of Sydney and says she has loved medicine ever since.

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5 / Exploring your options

“When you’re working for the RFDS you can see that you’re saving lives – that the guy who’s fallen off his motorbike with the fractured femur would die.”

I wanted to work with the Royal Flying Doctor Service to throw myself in the deep end. I was a GP registrar and did the RFDS term as my advanced rural skills post for my Fellowship in Advanced Rural General Practice with RACGP. It involved a temporary transfer from my regular RTP, North Coast GP Training, to a regional one, Beyond Medical Education.

With the on-call side of things we’d get phone calls from the outlying communities and stations, probably about 30 to 50 a shift.

I was based at Broken Hill and about half was clinic work and half was on-call and retrieval.

When people drive through or live in the outback there’s no ambulance service. If you have a car accident, if you hit a kangaroo or roll your car, if you ring triple 0 there’s no one there. So the RFDS has the contract to provide the emergency services.

On clinic days we’d fly out to remote towns like Tibooburra, Hungerford, Menindee and White Cliffs. Some weren’t even towns, they were someone’s house, and people in surrounding stations would come in.

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A lot would be phone advice. Patients would have their own medicine chest and we could often prescribe over the phone. Once or twice every shift we would get a call that would result in a retrieval flight.

FACT FILE The Royal Flying Doctor Service has positions for registrars on an ongoing basis Australia-wide.

For more information, visit www.flyingdoctor.org.au, “Contact Us/ Career Enquiries” section.

Or talk to your RTP.

We would have calls from patients who may have been hit by a bull or come off their motorbike or had a car accident or a mother with a sick child. I would decide whether an ambulance should be sent from say Broken Hill or whether we needed to send a plane.

In the team you have the doctor, the flight nurse and the pilot. The flight nurses are fantastic.

They would organise all the equipment and a ventilator if I said the patient may need intubation and they would get the pilot to organise the flight.

People are so appreciative. You can work even in country towns and you don’t seem to be doing a lot of saving lives. You probably are when you’re managing chronic diseases, but when you’re working for the RFDS you can see that you’re saving lives – that the guy who’s fallen off his motorbike with the fractured femur would die.

I met my partner David through RFDS – he’s an RFDS flight nurse and a country boy – and we’ve settled in Mudgee now. I work at a local practice and he’s still flying with the RFDS. I love the rural lifestyle and the diversity of rural general practice.

As a registrar if it was something I felt I wasn’t capable of handling, I could always ask my supervisor to come with me.

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General Practice Training in Indigenous Health Victoria

What are you doing about Indigenous Health?

Indigenous health is a national priority, with Aboriginal and Torres Strait Islander Australians still dying years earlier than other Australians and suffering from a wide range of preventable diseases and treatable illnesses.

As a GP working in Indigenous health, you are likely to make a bigger difference to health outcomes than in any other area of medicine in Australia today!

• Practice a holistic approach to primary health care in a cultural context by training at an Aboriginal Community Controlled Health Service (ACCHS).

• Get an appetite for Indigenous health by negotiating part-time or sessional arrangements whilst doing your GP training.

• Experience complex medicine including chronic disease, preventive health care, health promotion and public health management.

• Train under inspirational GP Supervisors, who are ACRRM and/or RACGP Fellows with years of experience and in depth knowledge of the clinical status and cultural aspects of the community.

• Enjoy complete flexibility with 9-5 daily hours, leave for release sessions, conferences, study and personal life.

It is important It is challenging It is inspiring

Is it for YOU?

Are you interested in Indigenous Health?

Contact the GP Education and Training Officer at VACCHO. 5-7 Smith St, Fitzroy VIC 3065 P: (03) 9419 3350 E: enquiries@vaccho.com.au W: www.vaccho.com.au

Victorian Aboriginal Community Controlled Health Organisation

5 / Exploring your options

My island home

Indigenous + remote + retrieval + tropical I’m doing first year general practice training with ACRRM through Tropical Medical Training but I’ve already done some anaesthetics and intensive care training during my hospital time.

The job is really that of a rural generalist.

Obviously it’s mainly an Indigenous population so you have all the typical chronic health problems like diabetes and kidney disease. That’s overlaid with acute emergency cases and retrieval because of the remoteness and also some unusual infectious and tropical diseases other GPs would rarely see.

Dr Alex Kippin

It’s a vision that will stay with Dr Alex Kippin forever.

As the helicopter blades whirred, the sun danced on the idyllic turquoise ocean reefs and islands laid out in breathtaking splendour below. And there he was sitting in the chopper hand-ventilating a critically ill child.

“It was such a surreal mismatch of experiences,” he reflects. But then

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everything about working as a doctor on Thursday Island is unique.

Thursday Island lies off Cape York at the northern tip of Australia. As the administrative capital of the Torres Strait Islands, its 3,500 inhabitants are a mix of local Indigenous people and public servants.

Getting there involves a two-hour flight from Cairns, plus a ferry or helicopter ride from the airport on neighbouring Horn Island. The narrowness of Thursday Island means it has no airport of its own.

This extreme remoteness makes the evacuation of acute cases challenging. But Alex loves a challenge.

No other job has that level of helicopter retrievals and critical medicine as well as infectious diseases, tropical diseases, chronic disease and general practice.

There isn’t really a typical day. I spend my time between the local Thursday Island Hospital doing emergency work, general practice clinical work at a community primary care clinic on Thursday Island and then clinic work and retrieval work on the other islands.

Every three weeks I’ll go out in a helicopter and do a three-day fly-in fly-out clinic on a couple of the other islands. It’s an idyllic, pristine part of the world. When I’ve finished work I’ll get to go spearfishing.

The next week I’ll be giving paediatric anaesthetics for a dental case or flying out in a chopper in the middle of the night to resuscitate and intubate a child who’s acutely ill on one of the outer islands to bring them back for an air transfer. It’s really quite amazingly dynamic.

There is a team of 12 doctors who service all the islands, but only a couple of us do anaesthetics so there’s a lot of on-call.

In one incredible week you wouldn’t believe the cases I saw. A two-week-old baby with focal seizures from bacterial meningitis, an 18-month-old with sepsis from an infected V-P shunt stabilised and sent south, a child with shigella dysentery with severe dehydration and close to death – we were able to resuscitate him. I had a middle-aged lady with necrotising fascitis and organ failure who we sent down to the ICU unit in Cairns, I had a four-kilo baby with bilateral pneumonia and respiratory failure who I managed to not intubate and get away with bubble C-PAP. I can work a lot of hours but I love it.

One of my most memorable moments was when one of the locals taught me how to spear a fish.

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5 / Exploring your options

FACT FILE Tropical Medical Training offers posts at Thursday Island Primary Health and Thursday Island Hospital suitable for registrars in GPT1, GPT2, GPT3 and rural terms. Visit www.medicaltraining.com.au.

Your Five Essential Brain Foods

For other remote, procedural and Indigenous health post opportunities, talk to your RTP. 5

â&#x20AC;&#x153;No other job has that level of helicopter retrievals and critical medicine as well as infectious diseases, tropical diseases, chronic disease and general practice.â&#x20AC;?

3

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1 Australian Doctor Website and e-newsletter Daily breaking news and chat.

Visit www.australiandoctor.com.au 2 Australian Doctor Everything you need, every week.

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3 How to Treat Weekly clinical update, CPD and annual yearbook.

4 Rural Doctor The monthly fi x for rural docs.

5 Australian Doctor Education Seminars developed by GPs for GPs.

5 / Exploring your options

Crime drama Forensic medicine

Dr Tristan Crowe

I had just come back from a stint in Indonesia as a Medical Officer on remote mine sites and I wanted to continue the theme of doing things that were a little bit different. I saw this ad for forensic medicine in Melbourne and put my hand up. The fact that it was at Southbank was a bonus because I was keen to work in the city.

The Victorian Institute of Forensic Medicine is part of the Department of Justice. It’s a separate entity to the police although they work with the police. As Forensic Medical Officers we tried to keep ourselves at arm’s length.

A phone call at 3am. A dead body in a foggy woodland clearing. The forensic doctor, clad top to toe in biohazard overalls, busily examines the deceased and gathers evidence.

Cut to the same body on the mortuary slab and the same doctor with scalpel poised.

Popular forensic crime TV shows, from Silent Witness to CSI, make such plot lines familiar.

But how does it compare to real life?

Registrar Dr Tristan Crowe spent a term at the Victorian Institute of Forensic Medicine and says his role was not quite like the TV scenario. “No dead bodies! That’s the forensic pathologists downstairs,” he says.

Instead, Tristan worked in the clinical forensic medicine unit as a Forensic Medical Officer – a resource that assists police to gather evidence by clinically examining alleged victims and assailants.

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There were three main day-to-day jobs relating to sexual assault, physical assault and fitness for interview.

With sexual assault you could be called out in the middle of the night because DNA and semen evidence deteriorates quickly with time.

The alleged victim would see a counsellor first, then you would see them, explain the process and do the forensic medical examination. If it was a penile-vaginal rape, you’d take the appropriate swabs. If there were any bruises or bite marks, you’d take photographs. You get taught how to use an SLR camera.

If there was a question of someone having their drink spiked or something like that you’d take a blood or urine sample and send it to pathology.

“There were three main day-to-day jobs relating to sexual assault, physical assault and fitness for interview.”

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5 / Exploring your options

Physical assaults were less urgent. Bruises are still going to be there in the morning. You would photograph and describe the injury. Certain patterns of injury indicate certain things – four small bruises together can suggest someone being firmly grasped. If there were fractures, we would use the X-rays ordered by the emergency physicians in our report and we would also interpret a surgeon’s report if applicable.

The third main task was fitness for interview.

When the police arrest someone, if they are unsure of their state of mind, or an illness, they may not be capable of being interviewed. In those circumstances, they would call an MO out to assess the patient.

We were also asked to give the police phone advice about a certain medical condition that an alleged assailant or victim may have.

Writing medico-legal reports is central to the job, and you have to appear in court. I enjoy the theatre of court.

I was really impressed that I got the opportunity to work there. They’re high calibre intellectuals and they’re really striving to do a good job.

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FACT FILE The Victorian Metropolitan Alliance regularly offers forensic medicine terms. For more information, contact the Victorian Institute of Forensic Medicine on (03) 9684 4480.

Other RTPs may be able to offer similar posts at similar local organisations.

5 / Exploring your options

Ship to shore Ship’s doctor

Dr Marisa Magiros

Dr Marisa Magiros has a passion for travel so when a friend told her about a position as a ship’s doctor with P&O in the UK, it sounded like a dream job.

Her friends imagined a leisurely life treating mild seasickness and sunburn followed by cocktails at the captain’s table, but it was far more challenging than that.

Marisa had to manage many serious cases, from heart attacks to asthma, and there were a number of evacuations of critically ill patients, like the elderly woman who broke her hip and was disembarked by sea plane in Fiji.

She says doctors at sea need skills in accident and emergency, intensive care, public health, occupational health and safety, general practice and are also responsible for managing the ship’s nursing staff and floating medical centre.

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Note: Dr Marisa Magiros worked on cruise ships prior to commencing her GP training but her experience demonstrates a role that is open to general practitioners.

The way I got the job was serendipity. I had been working in London and Dublin hospitals, doing mainly emergency work. I heard about the opportunity and it was a way to work and travel and get paid.

The cruise ships have sophisticated medical centres staffed by a doctor and two nurses on the smaller ships and two doctors and three or four nurses on the bigger ships.

You’ve got a resuscitation room like a hospital, ward beds with monitoring, a lab so you can take blood tests, you can take X-rays, and there’s a pharmacy. You don’t have specialist staff to do any of that, you do it yourself. You have an orientation to learn those skills.

Before starting, adult ALS is compulsory, and paediatric ALS and EMST are desirable.

You have two types of patients – the passengers who pay privately and the crew who receive free medical care. In terms of

the kind of cases you see, it ranged from simple things like running out of medication to serious cases like heart attacks, treating pneumonias, sending them off for operations. Gastro is a big public health issue. You’ve got all ages, from children to elderly. We’ve actually had people die – we had a morgue.

We’d have inpatients. If they were quite sick and we were away from land, the nurses would do 12-hour shifts, giving them medicine and monitoring them until we could get them off.

You do a morning clinic and an afternoon clinic every day, and then you’re on call 24/7 for the entire contract. Each contract is four months, then you’d have two months off.

I got to go to Alaska, the Caribbean, French Polynesia, the South Pacific. I sailed up the Amazon, which was amazing, through the Panama Canal, up to the Baltics and to Russia, the Mediterranean. When you’re a

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5 / Exploring your options

crew member, often you get to do tours for free. I’ve been to 95 countries – many as a doctor at sea.

Being a ship’s doctor definitely improved my clinical skills. The experience also influenced my decision to train in general practice when I came back to Australia.

I experienced what it was like having continuity of care with the crew and seeing how their problems resolved, and that’s something you get in general practice.

I also enjoyed the autonomy, the same as you have in general practice, and then you call on a team to help you.

After working continuously for four months on the cruise ships, I also came to appreciate how work-life balance is really important.

I’m now training with GP Synergy in Sydney and loving it. I look forward to more travel, but this time it will be on holiday.

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FACT FILE Cruises are one of the fastest growing sectors of the travel industry and cruise ship companies are constantly recruiting medical staff. Marisa worked for Carnival, which owns a fleet of cruise ship brands, from P&O Australia to the ultra-luxury Cunard. A search of the net will reveal many others.

“Being a ship’s doctor definitely improved my clinical skills. The experience also influenced my decision to train in general practice when I came back to Australia.”

6

exams and assessments

6 / Exams and Assessments

Top tips for exams

DO IT NOW For details of how to enrol for exams and assessments, dates and pre-exam workshops, visit www.racgp.org.au and www.acrrm.org.au.

You will also find sample questions for ACRRM assessments on www.acrrm.org.au.

The programs continue to evolve so for the latest information be sure to check the websites.

Successful candidates for the FRACGP exams and FACRRM assessments advise careful planning, teaming up with study buddies and making time to laugh.

T

he exam is often the final hurdle to achieving your FRACGP and gaining vocational registration. However, it can be a stressful time.

With the FACRRM, there is a different assessment model across the duration of the training program consisting of a variety of assessments and exams.

Whichever fellowship you’re working towards, you’ll benefit from the following tips.

Plan when to sit the exam. The RACGP exams run twice a year. The RACGP college examination was recently “uncoupled”. This means that while you still have three years to successfully complete the three assessments, you are now able to sit each segment of the exam (AKT, KFP and OSCE) individually and at your own pace. However, you need to sit and pass the AKT before you can continue to other assessments. Call the RACGP or visit www.racgp.org.au for an enrolment pack; it 118

includes the examination handbook which outlines the rules and regulations. Your supervisor or medical educator can advise you if they think you are ready, or if you may be best to wait another six months before you sit the exam.

With ACRRM, various assessment components are held at different times throughout the year.

Eligible candidates will need to apply prior to the enrolment closing dates for each exam.

(See page 157 for a timetable.) Candidates must complete an enrolment form for each assessment type and return it by the required cut-off date. ACRRM candidates should be aware that each component can only be attempted a set number of times so it is important to be prepared and feel ready to attempt each assessment.

For further information about the components of the ACRRM assessment process as well as exam enrolment and assessment dates, visit www.acrrm.org.au.

You will find a summary of exam and assessment dates on page 157.

Ensure you are eligible. To enrol for the RACGP exams, you need a letter from your RTP stating you have completed your GPT1 and GPT2. You need evidence that you have completed your Basic CPR Accreditation within 36 months of the opening of the enrolment period and you must also have current medical registration. Finally, you must be a financial member of the RACGP (allow two weeks for this to be processed).

ACRRM has its own set of requirements for the different assessment components. For more information, talk to your RTP or check the ACRRM website www.acrrm.org.au.

Talk to your practice. If you want to arrange time off before an exam or reduce your oncall for a while, then do it early. Try not to be covering for a principal on leave over the exam period. However, remember that seeing patients can be one of the best ways to practise for your exams.

Form a study group. Study groups are great for keeping you motivated, pooling resources and sharing strengths. Identify your learning styles and work with it. Will you approach it by gathering together to read topics through out loud, each bringing a topic summary to share or by going though MCQs together and discussing the answers?

Distance needn’t be a problem. Face-to-face study groups are ideal, but not always possible.

Be creative. Email resources to each other, consider an online discussion, teleconference to go through questions, hold a Skype video conference or video yourself doing a timed OSCE-case on a family member and send it to your study buddy for feedback.

Make a study plan. Identify your strengths and weaknesses, making sure you cover the curriculum. Set a study timeline so that you don’t spend months on women’s health but 10 minutes on respiratory problems. This will stop

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6 / Exams and Assessments

you getting bogged down in itsy-bitsy details.

Set aside time to fit in with your life. Candidates with young children, elderly parents or other responsibilities will probably need a longer lead time than those who have time to study every night.

exams, sample questions, feedback you receive from formative components of the assessment, advice and resources from your supervisor and RTP. In addition, the Online Exam Resources (OER) from GPRA are a useful resource.

Remember new evidence can change treatments. Keep in mind that answers change over the years as new evidence is found so learning someone else’s answer by heart may be fraught with danger.

Use available resources. For the RACGP exams, Murtagh and The Red Book are your friend. The check program has questions that are similar to the RACGP’s KFPs. Australian Family Physician (AFP) and Medicine Today have MCQs and brainteaser questions with pictures. gplearning has lots of MCQs, KFPs and a timed practice exam. Australian Doctor’s “How To Treat” summaries are evidence-based and succinct.

Use GPRA’s Online Exam Resources and new webinars. GPRA’s Online Exam Resources (OER) can provide you with cases to practise. GPRA has also recently introduced an innovative new exam preparation tool in the form of webinars which are proving very popular and useful for our members. (For more information, see page 122.)

Attend a pre-exam workshop. These are run by the RACGP in all States and by some RTPs. They may involve a cost and have restrictions on the numbers. They will help you become familiar with the structure of the exam and what examiners are looking for. For dates, visit www.racgp.org.au.

Websites are useful (see page 153 of this guide as a starting point) for up-to-date guidelines.

Your practice or RTP may have the last few years of check/AFP, or you can order them from the RACGP Library (free postage). For the OSCE, the marking structure and case proformas can be downloaded from the RACGP website so you can make up your own cases. For the ACRRM assessment, ensure you are totally familiar with the primary curriculum and fully understand the learning outcomes of each domain.

Understand how the assessment blueprint links with each assessment component.

Review the assessment information available at www.acrrm.org.au and make use of practice

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Practise clinical cases. Practise these to the correct times, with bells. Make up cases for each other from your own patients. Give each other feedback on those skills that you can’t learn from a book – communication, use of nonmedical language, analysis of articles. Use all the knowledge you have crammed in your head and look up the things you have forgotten.

Practise cases that you are not so good at – it’s better to be embarrassed in front of friends than on the day in front of assessors. And don’t forget your practical skills like suturing, asthma puffers and CPR. With 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 and the management of your patient.

Read information, questions and answers carefully. You can get more questions wrong by misreading than by not knowing the answer.

Don’t spend ages agonising over a question you can’t answer; make a best guess and move on.

Mark it and come back to it later if you have time. There are other questions in there you do know and will get points for – as long as you have time to answer them.

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. Try and forget you are in an exam and pretend it’s just a morning in the surgery.

Practise on the people around you. Practise examinations on your children, on your spouse, on your mate’s bung knee. Ask your supervisor to role-play some cases with you.

Try to enjoy the learning process. The things you learn while studying should be helping you to become a better doctor and feel more comfortable and competent in treating people.

Generally, your exams will be very focused on things that you will come across in general practice, so use the things that worried you in your practice today to help you study tonight.

Contributed by Dr Anna Colwell and updated by Dr Kirsten Patterson

In written exams or assessments make sure you write legibly – there are no marks for what the examiner can’t read. In the RACGP’s OSCE, make sure you complete the requested task (written on the door before you go in and on the desk in front of you when inside). 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.

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registrar

rave

Dr Suzanne Huxley My RTP is Central and Southern Queensland Training Consortium (CSQTC).

My current post is in St George, Western Queensland.

A typical workday for me starts with a hospital ward round then down to the practice seeing patients from 8:30am. Home for lunch at 1pm, then back for the second session till 5pm.

What I love about general practice is the range of different people I see.

What I don’t love so much is discussing the management of constipation with a patient at 1am when I’m on call.

My GP role model is my supervisor Dr Pam Turnock because she is a legend and the most tolerant person I have ever met.

After hours I love to spend time with my mad kelpie Zach and go horse riding.

A quirky fact about me is I line my cutlery up in the drawer so it all faces the same direction.

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GPRA’s Online Exam Resources (OER) www.oer.org.au GPRA’s Online Exam Resources (OER) consists of clinical cases perfect for your study group – and it’s free to all members of GPRA. Download cases from www.oer.org.au.

Introducing new OSCE webinars New from GPRA – OSCE webinars, or online seminars. If you have a computer, an hour or so and you’re a GPRA member, you can join in. A pilot of this concept received an excellent response. It allows you to run through sample OSCE cases with registrars who have done the exam in real time, ask questions and share tips.

For more information about GPRA’s new OSCE webinars and how you can be involved, check for updates at www.oer.org.au.

7

money matters

7 / Money Matters

2011 National Minimum Terms and Conditions

Salary guide – big increase in new 2011 pay rates These are the new minimum salary rates negotiated on your behalf by GPRA. For the first time ever, GPRA has successfully negotiated a salary increase significantly above the CPI for GPT1 registrars, which is great news. Make sure your practice is aware of these new rates which apply from the 2011 training year.

Annual salary

Weekly salary

Superannuation

GPT1 or equivalent

$70,000

$1,342.53

Plus 9% superannuation

GPT2 or equivalent

$84,162

$1,614.15

Plus 9% superannuation

Or 45% of in-hours gross billings, plus 9% superannuation, calculated over a three-month cycle – whichever is greater.

One of GPRA’S main roles is to negotiate minimum pay rates and conditions for GP Registrars.

When talk turns to money and working conditions, it helps if you and your training practice are on the same page.

That “page” is the National Minimum Terms and Conditions (NMT&C) document. It has been designed to provide a baseline set of conditions for employment as a GP registrar. It covers GPT1 and GPT2, or their ACRRM equivalent, and the transition from hospital-based salaried employment to a “fee-for-service” environment.

The NMT&C document does not constitute an award, nor is it a contract in itself. It is a goodwill document agreed upon by GPRA and NGPSA (National GP Supervisors Association).

The document is reviewed and updated every two years. The current version is the 2011 NMT&C.

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Before you sign Familiarise yourself with the document to ensure that any employment contract you sign with a practice is consistent. In addition, it should help you to cover the relevant issues in subsequent stages of your training, when you will have to negotiate your own terms and conditions.

Some RTPs and practices have developed their own document. In doing so, they have to ensure that they meet the minimum terms and conditions contained in the NMT&C. Any registrar can negotiate terms and conditions above this minimum and there are a number of areas where GPRA would encourage this. It is important that you discuss the terms and conditions with your supervisor and practice manager prior to the start of term and clarify any issues.

Note, these are minimum rates – you are free to negotiate higher rates.

You can view the 2011 National Minimum Terms and Conditions now at www.gpra.org.au.

GPRA recommends that all GP registrars sign some form of contract as it ensures clarity between employee and employer. Note that the NMT&C also provides for a review of terms and conditions after three months, so it is worth scheduling a date to see that this happens.

to RMO1 and RMO2 rates.) The good news is that you can increase your earnings by becoming more efficient and seeing patients rather than having to work more hours. However, you need to be aware of your entitlements and some issues that might impact on your earnings.

Negotiating your employment contract – GPT1 and GPT2 or equivalent

Pay cycles for calculations of 45% of gross billings

There are some issues to consider discussing with your supervisor before the term starts, and once agreement is reached you should include the detail in your employment contract. Some of the following items relate to NMT&C clauses, but there are other issues that fall outside its ambit.

This is currently three months (NMT&C clause 6.1.4 (b)), but many practices will do this fortnightly, weekly or monthly if you ask.

Often it suits them as this is what they do for other doctors they employ. It might not be an issue when you first start work, but you can renegotiate so that the reconciliation is done more frequently.

Registrars moving from hospital terms to GP terms will find that initially their income drops significantly unless they continue to do overtime work. (Note that the base pay rates are similar

Your ability to earn a percentage will fluctuate depending on the hours allocated to patient 125

7 / Money Matters

contact in any period. If you are at educational release days or on leave, the effect of your billings will be reduced by the hours of nonbilling time. A three-month pay cycle results in an averaging of high and low billing periods. A shorter pay cycle means that registrars are paid appropriately for educational release time and annual leave.

Practice billing policy A related issue is the ability you have to charge your patients for your services. You should find out how your practice bills patients – private or bulk-bill. This will have a significant impact on your income because for the same amount of time spent with a patient you can earn about $35 for a bulk-billed patient compared with $50-$70 for a private-billed patient.

has such a policy. You will note, too, that the practice is also missing out on billings you could generate for them, so this is worth discussing.

Does the hospital pay an on-call allowance? If so, are you only going to get 55% of it, or do you want to ask for the whole amount?

Overtime According to NMT&C clause 6.2, overtime can be paid at 150% of the ordinary time rate, or taken as time in lieu. You should make an agreement with your supervisor prior to any overtime being worked.

Are the hours you are doing this work comparable to other doctors in the practice?

Are there any safety issues? Note, your supervisor is supposed to be contactable for you during your after-hours work, so make sure you know how to contact them.

Safe working hours

Paid educational release time

The importance of safe working hours when determining registrar rosters is reflected in a clause of the document. This is in line with current practice in other hospital-based specialist training programs.

Note that in some RTPs there are educational release sessions outside of normal work hours, such as on weekends.

Service Incentive Payments

There are various models, including: • All patients privately billed.

• All patients bulk-billed.

• Only patients on health care cards or under 16 bulk-billed (as they attract an extra rebate).

• Some combination of these with the doctor’s individual discretion at the time of consultation (for example, bulk-bill the patient coming back for frequent reviews of the same illness).

There is an information sheet on this on the GPRA website (PIPs and SIPs). Essentially, these can be paid directly to you by Medicare if you give them your bank account details. Under the NMT&C, they are included in your gross billings, but many supervisors are willing to let you receive them directly. If not, bear in mind that the practice will likely receive payment for them many months after you have left the practice.

It has been noted that some practices ask their registrars to bulk-bill all patients even in a private billing practice. You might be happy to do this, but keep in mind that it could have a significant impact on your earnings, and it would be worth discussing with your supervisor why the practice

After-hours and on-call

126

Do you want to ask for a higher percentage than 55%? Some practices will offer higher percentages as they feel this is fair since any on-call work you do for them is time they are able to take off.

You need to clarify with your supervisor how many days worth of education time you are entitled to (for example, for GPT1 or equivalent full-time it’s one session per week, which adds up to 12 days per six-month term).

You need to tell them the dates you expect to be at educational releases.

If any sessions are not in working hours, you should try to agree with your supervisor in advance how you will be paid for this education time. Time in lieu? Paid the extra amount for that week? Always paid a 38-hour week, but only have 35 contact hours usually?

In-practice teaching In general, two-thirds of this should be scheduled one-to-one teaching time (though it

Negotiating at a glance Read and understand the NMT&C document. You can download it at www.gpra.org.au.

Use the NMT&C document as a basis to negotiate and sign a contract.

Don’t assume that your supervisor or practice manager has read any more of the NMT&C than you have!

Ask questions of your RLO or GPRA. Give GPRA your feedback for the next round of negotiations.

Remember, your remuneration and pay cycles should be reviewed after three months of employment (NMT&C clause 6.1.6). This would be the time to reconsider any of the issues outlined.

may include observation by your supervisor), while the rest of the time might cover corridor consultations. You should discuss when this teaching time will be scheduled and if possible have some plan about the content.

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7 / Money Matters

Paid annual leave Note in the NMT&C that annual leave should be paid at the rate of your average weekly earnings since the beginning of your term. If you have been consistently earning higher than base salary, your annual leave pay should reflect this.

A negotiation option worth discussing is an overall higher percentage, a shorter pay cycle, or the leave period being taken out of calculations of the 45% of gross billings in exchange for being paid annual leave at the base rate. This might benefit both the registrar and the practice and is simpler to work out.

Know your value Request that the practice prints you a fortnightly or monthly statement of income generated from all sources: standard patients seen in the room, medical and insurance reports, hospital patients, on-call and nursing home. It is important to get an idea of how much income you generate and where it comes from to know your value.

Accommodation There are a number of different models across the RTPs. In essence, the rural GP registrar should expect the provision of accommodation that meets the minimum standards outlined in GPET’s guidelines.

Some RTPs assist the GP registrar to find accommodation and then contribute to ongoing costs. The accommodation offered should be a consideration as to whether you accept

128

employment. If there are any concerns, liaise with your RLO or GPRA.

Restrictive covenant/restraint of trade

Hot topics

This refers to a limitation of where you can practise in the future when you finish your training term. Most practices would request that the doctors they employ agree to a restrictive covenant in their contract as they could lose business if you moved next-door.

These are some of the questions registrars ask us most often at GPRA. To assist you, we have prepared information resources that you can access on our website. Go to www.gpra.org.au, click on “Advocacy” then “2011 National Minimum Terms and Conditions”.

However, GP registrars are subject to training requirements; a registrar cannot obtain an unrestricted provider number and open their own general practice. Registrars must undertake training at two different practices. In small rural towns, it may be difficult to find practices far enough apart. In normal commercial situations, the Trade Practices Act has defined a threekilometre limit on geographic restraint of trade.

What are PIPs and SIPs and should I be paid for them?

It is important to discuss the issue of restrictive covenant with your practice, but any mutual agreement should not impair your ability to complete your training. You may be interested to know that a recent case has set a precedent that tests the validity of such clauses. In a recent case before the Supreme Court it was found that the practice could not apply the restrictive covenants. More details about this can be found on GPRA’s website.

How is my annual leave calculated?

The NMT&C document includes some examples of how to calculate leave.

Medicare Australia provides financial incentives to eligible practices and GPs to achieve certain health outcomes. Practice Incentive Payments (PIPs) are paid to the practice; Service Incentive Payments (SIPs) may under certain circumstances be paid to GPs or GP registrars. The general rule is did you actually deliver the service yourself? If yes, then you should get at least part of this payment. If other practice staff were involved then it is likely to be shared. For further information, see our document “SIPs and PIPs Explained – Information for Registrars” in the “Members Only” section of our website.

Should I be an employee or contractor?

GPT1 and GPT2 (or equivalent) registrars must be employees. A subsequent term registrar may sometimes have the option of being a contractor or an employee. (Different RTPs and practices offer different arrangements.) However, GPRA recommends employee arrangements even for subsequent term registrars in most cases. Should you wish to investigate contractor arrangements, seek advice from your accountant. For more information, see our documents “Distinguishing Features for Employees and Independent Contractors” and “Lawyer Advice – Employment Status of Registrars” in the “Members Only” section of our website. See also the article on page 132.

Exit clauses Rarely, a GP registrar may not be able to fulfil the full six-12 months of their training term.

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registrar

rave

Dr Brinthan Kathirgama Kanthan

My RTP is Central and Southern Queensland Training Consortium (CSQTC).

My current post is a subsequent registrar at Cooroy Doctors Surgery on the Sunshine Coast.

A typical workday for me starts with a run along the river in Noosa, a quick drive up to Cooroy past Lake Macdonald.

It’s a beautiful drive. Then seeing patients ranging from antenatal care to paeds to men’s health.

What I love about general practice is the flexibility. I love my three-day weekends and finishing work at 5pm.

What I don’t love so much is the paperwork and after-hours on-call.

After hours I love to go to the beach in Noosa.

A quirky fact about me is that my parents are Sri Lankan, I was born in Glasgow, lived in England, trained in Tasmania, and now I’m a GP on the Sunshine Coast. Plus I’ve got an identical twin brother.

130

D ISCOVER SOMETHING NEW

GP registrars have to meet training time requirements, so any problems with the practice placement need to be discussed early with your RTP and RLO to ensure there is an appropriate education and training environment.

Nevertheless, your employment contract should include a suitable period of notice of termination; for example, four weeks notice for a six-month contract.

Contributed by Dr Annabel Kain, Dr Luke McLindon, Dr Siew-Lee Thoo and Dr Tim Francis

iPhone app Available on the

Calculate your income online www.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.

App Store or call 1800 800 629

GET MORE

7 / Money Matters

Employee

or

or t c a r t n o c

?

ONLINE

Todayâ&#x20AC;&#x2122;s e-news delivered to you Now with greater frequency, more useful features and online-only content, each MO e-newsletter includes the dayâ&#x20AC;&#x2122;s vital news, plus unique themed features.

MONDAY The latest news, with news focus

THURSDAY The latest news, with gp life

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TUESDAY The latest news, with clinical review

As you gain experience in your chosen career you will discover there are different ways of working, each with pros and cons.

Under tax and corporate law there are a number of ways to structure a small business. This may be via a trust, a company or a partnership.

What is an employee?

Each of these structures provides slightly different benefits, mainly in the areas of tax and asset protection should one be sued.

As employees, we have a number of entitlements including: â&#x20AC;˘ Paid annual and public holiday leave. â&#x20AC;˘ Paid sick leave. â&#x20AC;˘ Employer superannuation contributions of 9% of salary. â&#x20AC;˘ WorkCover/workerâ&#x20AC;&#x2122;s compensation provisions.

Most tax advantages associated with these structures relate to the business. A GP who does not own a practice will find far fewer tax advantages in these structures.

GPT1 and GPT2 registrars are classified as employees, even if paid by percentage. Only GP registrars in GPT3 and beyond may sometimes be offered the choice of being contractors.

Later, as a fully qualified GP, the option may come up again.

132

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An employee is the basis upon which all of us are employed within the hospital system.

What is a contractor?

This is a rather tricky definition, but it essentially involves a person working with greater autonomy.

As far as the Tax Office is concerned, the onus is on the person paying you money to prove whether you are a contractor or an employee.

PLUS: Registrar online t Registrar stories t Guide to guidelines t Patient handouts t Ask An Expert medicalobserver.com.au/registrar

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7 / Money Matters

“There is some concern that due to the supervised nature of GP registrar work, we cannot really be considered an independent contractor.”

If a practice incorrectly pays you as a contractor then it is the practice that is responsible.

A contractor receives money only when they work. There is therefore no sick leave, annual leave or public holiday pay. Because of this arrangement, contractors are likely to have income protection insurance. They also carry their own professional indemnity and public liability insurance.

A contractor also receives all money that they earn. It is then the responsibility of the contractor to pay tax on this money and to organise their own superannuation.

Note: Contractors do not always have to pay their own superannuation. The Superannuation Guarantee Contribution (SGC) rate is 9%. Check with your accountant.

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As a contractor, there are specific anti-tax avoidance provisions that state income earned from personal effort must be taxed as income of that individual. There is a misconception that it is somehow possible to reduce tax by splitting income with family members or to be taxed at the lower company tax rate. This is not possible for the income a contractor earns from personal effort.

So what are the advantages of being a contractor?

Greater flexibility to: • Pay a higher or lower percentage of your earnings into superannuation.

• Take more or less annual leave (without pay, of course).

It is also possible to create your own company

GPRA TIP GPRA does not recommend GP registrars work as independent contractors.

For further information, talk to your accountant.

and become the employee of this company. The company you own then provides GP services to the practice where you work.

We would advise that any GP registrar wishing to work as a contractor in private general practice seek independent legal and accounting advice.

As a company employee, you can then obtain a company car and there may be some asset protection advantages to this structure. The tax advantages of a company car must be weighed against the additional costs of running a company.

Disclaimer: This information is a GP registrar’s understanding of the system and should be used as a general guide rather than relied upon as definitive knowledge.

Can I be a contractor as a GP registrar?

GPRA does not recommend GP registrars work as independent contractors. There is some concern that, due to the supervised nature of GP registrar work, we cannot really be considered an independent contractor. There is some very complex superannuation, tax and corporate law involved.

GPRA would like to thank Mr Mick Saunders and Mr Warwick Hough from the Federal AMA for assisting us to understand this complex topic.

Contributed by Dr George Manoliadis and Dr Jenny Lonergan

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7 / Money Matters

Incentive

payments

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

W

hen working as a GP registrar, there are a few financial incentives and reimbursements to be aware of. Several of these are Federal Government incentives through the Department of Health and Ageing (DoHA) to encourage more GPs where they are most needed, such as rural, remote and outer metropolitan areas.

Accommodation Each RTP has an individual policy regarding accommodation and relocation subsidies for GP registrars.

This may include subsidised rental accommodation in rural areas. Please ensure you check directly with your RTP prior to making any decisions and financial commitments regarding rural accommodation.

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General Practice Rural Incentives Program (GPRIP) The new General Practice Rural Incentives Program (GPRIP) commenced on 1 July 2010. It replaced two previous programs – the Registrars Rural Incentive Payments Scheme (RRIPS), which applies to GP registrars in the AGPT program commencing in 2010 and earlier, and the Rural Retention Program, which applies to general practitioners working in rural and remote areas. The new incentives program provides a consistent set of incentive payments that applies on an equal basis for GPs and registrars (both locally and overseas-trained) working in rural locations.

Payments are on a sliding scale calculated using the Australian Bureau of Statistics’ Australian

Standard Geographical Classification – Remoteness Areas (ASGC-RA) system.

The more remote the area and the longer a doctor stays there, the higher the rewards.

(See Table 1.)

HELP/HECS Reimbursement Scheme The HELP/HECS Reimbursement Scheme also underwent changes from 1 July 2010. It only applies to Australian graduates who completed their medical degree in the year 2000 or later. Participants in the scheme will have a proportion of their HELP/ HECS fees reimbursed for each full-time year of medical training undertaken or service provided in areas designated as Australian Standard Geographical Classification

Table 1 – General Practice Rural Incentives Program (GPRIP) Period of time (years) in a rural location

ASGC-RA classification

0.5

1

2

3 - 4

5+

-

$2,500

$4,500

$7,500

$12,000

RA2 (Inner Regional)

-

$2,500

$4,500

$7,500

$12,000

RA3 (Outer Regional)

$4,000

$6,000

$8,000

$13,000

$18,000

*Other

RA4 (Remote)

$5,500

$8,000

$13,000

$18,000

$27,000

RA5 (Very Remote)

$8,000

$13,000

$18,000

$27,000

$47,000

*Payments for all eligible RA1 training placements will be made according to the category “Other”.

Table 2 – HELP/HECS Reimbursement Scheme ASGC-RA classification

ASGC-RA1 (Major Cities)

ASGCRA2 (Inner Regional)

ASGC- RA3 (Outer Regional)

ASGC- RA4 (Remote)

ASGCRA5 (Very Remote)

Period of reimbursement

Not eligible

5 years

4 years

3 years

2 years

– Remoteness Areas (ASGCRA) 2 to 5. This replaces the RRMA classification system.

These reimbursements are scaled to reward doctors working in the most remote areas who will receive a higher level of reimbursement and recover their fee payments over a shorter period of time.

(See Table 2.)

More Doctors for Outer Metropolitan Areas Program This is another DoHA program applicable to GP registrars on the general pathway who have completed their training and are prepared to work in an outer metropolitan area for two years. Newly fellowed general practitioners must apply within

three months of receiving their fellowship, and are eligible for a total payment of up to $30,000, paid in three instalments of 40%, 40% and 20%. For those prepared to 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 137

registrar

rave

Dr Candice Kay My RTP is Central and

Southern Queensland Training Consortium (CSQTC).

My current post is Emerald Medical Group.

A typical workday for me starts with going to the gym at 6 then freshening up and starting work by 8am. I see a wide variety of patients throughout the day, and in between seeing them I check emails and results.

What I love about general practice is building relationships with my patients, being excited when they have good news and being there when there is bad news.

What I donâ&#x20AC;&#x2122;t love so much is when the patients are running late.

My favourite technical gizmo is the cryotherapy canister because it can be used for so many different things.

After hours I love to jog, scrapbook and go fishing.

A quirky fact about me is I grew up in the city and canâ&#x20AC;&#x2122;t get enough of the country.

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www.gpra.org.au or to see a map of eligible areas go to www.health.gov.au/outermetro.

Medicare Plus Medicare Plus offers rural and remote registrars (and Tasmanians and those in areas of medical need) the opportunity to use item number 10991 instead of item 10990 to receive a greater rebate. Ask your practice manager for further details.

GPRA TIP Ask your RTP about the financial incentives you may be able to claim in addition to your salary or visit www.gpra.org.au.

8

keeping your balance

8 / Keeping your Balance

Part-time smart time the part-time training options and parental leave available to GP Registrars make General practice training very flexible and family-friendly.

The flexibility of general practice when it comes to 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 with parental leave and part-time training an attractive offering.

Of course, part-time training is especially attractive for those having babies and raising young children. However, the part-time option can also give other registrars the freedom to take up opportunities such as becoming an RLO or an academic registrar.

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When thinking about part-time training, consider the following: All components of the training program, with the possible exception of hospital time, can be undertaken on a part-time basis.

You need to apply to your RTP for part-time training and have it approved by your RTP before you begin working part-time.

Full-time is considered to be 38 hours per week, which includes all consultation time, education and program activity.

Anything less than 38 hours will be pro-rata and affect GPRIP payments if applicable.

Dr Jemima Grant

Dr Mum Minimum part-time is considered to be 10.5 clinical hours a week.

Minimum hours are 10.5 hours a week over two days.

You should negotiate the amount of practice-based teaching with your RTP during a term as a part-time registrar.

You must attend educational activities that are required of you by your RTP. Most training usually occurs on weekdays. Check with your RTP. The RACGP states that general practice experience gained while working part-time is

O

ne day, Dr Jemima Grant was consulting with a patient and suddenly became aware of an extra nipple in her bra. It was the dummy she had put there during the frenetic morning rush hour with her two young boys, aged two and four.

days for the local council then stays home and looks after the children for the rest of the week while Jemima works three and a half to four days at the local Aboriginal medical service and also works as an RLO. To top it off, she’s currently studying for her fellowship exam.

It’s at moments like these that she is acutely aware that life as a GP registrar mum can verge on chaos – but she wouldn’t have it any other way.

Jemima began part-time general practice training as a mother of one then took nine months parental leave after the birth of her second child before resuming part-time training. “For me, the part-time training has been wonderful. The lifestyle flexibility is why I did general practice,” she says.

Jemima and her husband, Damian, share work and parenting. Damian works three

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8 / Keeping your Balance

8 principles

for being a resilient doctor “For me, the part-time training has been wonderful.” valuable 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 diaries. These log diaries show that the number and range of patients seen are giving you adequate experience.

Taking parental leave All parental leave is unpaid.

You need to apply to your RTP. Applications must be made in writing to your RTP in accordance with your RTP’s policies and procedures.

The idea of a healthy work-life balance is part of the appeal of general practice so feel free to explore the flexibility available to you.

Contributed by Dr Sarah Bailey

GPRA TIP

If you want to apply for parental leave and enquire about part-time training opportunities, talk to your RTP and your practice well in advance of your baby’s arrival.

To keep in touch, consider applying for the RLO position in your RTP, which offers a great opportunity to network and travel to meetings and education sessions.

(Very child-friendly!)

If medical practitioners are to provide good care to patients, they need to look after themselves.

Professor Leanne Rowe and Professor Michael Kidd share their eight principles FoR building resilience.

In any demanding career, it is essential to have a quiet sanctuary away from work.

Medicine is a rewarding and endlessly challenging career, and hanging in there for the long haul requires the ability to transcend adversity.

By caring for our families and friends, we create a welcoming sanctuary at home – a place to relax and restore ourselves and our loved ones.

When we consider all the complex issues we juggle every day, sometimes it seems easier to try to ignore the frustration and just get on with the job.

But chronic states of stress can catch up with us.

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Outlined here are some of principles we have learned about developing resilience.

1

Make home a sanctuary

We can proactively choose partnerships and friendships which energise us and provide mutual love and support.

2

Value strong relationships

Strong doctors have strong relationships.

As doctors, we face excessive demands on a daily basis. To get the job done, many of us try to manage each day by unsuccessfully attempting to complete endless “tick lists” at the expense of our professional and personal relationships.

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8 / Keeping your Balance

We also need to take time every day to nurture healthy relationships with our family and friends, our patients, our colleagues, our physical environment and ourselves.

Sometimes our patients, particularly those with special needs, benefit from a multidisciplinary team approach rather than the services of a single doctor working in isolation.

or violence in the workplace. We need to be aware of how our own behaviours are perceived and strive always to behave in an appropriate professional manner.

first do no harm {first do no harm}

being a resilient doctor in the 21st century

LEANNE ROWE AND MICHAEL KIDD Foreword by John Murtagh

Anyone with the right training and experience can become an excellent technician. What sets excellent doctors apart are their strong, caring relationships with people.

3

Have an annual preventive health assessment

As doctors, we each need our own doctor, someone we trust for our own medical care and advice.

If we are going to prevent our own major health problems, we must attend our own doctor for regular evidence-based preventive health assessment to allow early identification and management of the symptoms and signs of any physical or mental illness.

Organise for a check-up today with a trusted colleague.

4

Control stress, not people

As doctors, we tend to have reputations for being controlling. Whether this is true or not, many of us tend to develop driven personalities as an adaptation to the demands of work.

We need to accept that other people can’t be controlled, and allow others to learn from the consequences of their actions. We need to learn to delegate and share care more effectively.

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5

Recognise conflict as an opportunity

This is not about seeking or avoiding conflict.

It’s about managing conflict maturely when it inevitably arises. In order to deal effectively with conflict, we can recognise it as an opportunity to build stronger relationships with people.

If we have ever had a calm debate with someone over an important issue that concludes in a negotiated solution, we will recognise that our relationship with that person has become stronger.

If we have ever amicably agreed to disagree with someone over an issue, we will recognise that the ability to have an open debate, even without resolution, has strengthened our relationship with that person.

On the other hand, avoiding conflict, nonassertiveness, hyper-sensitivity to criticism, refusing to listen or angrily squashing another person’s point of view can be destructive to relationships. We can learn how to deal with criticism constructively.

6

Manage bullying and violence assertively

Bullying and violence are not acceptable behaviours and must not be tolerated. As doctors, we must know our responsibilities as employers in addressing cases of bullying

Medical practitioners must become skilled in ways of assertively managing patient-initiated violence and violent behaviour must always be reported to the police. Failure to do this often results in the violence being deflected onto another colleague or onto the wider community.

7

Make our medical organisations work for us

Our medical organisations are charged with the responsibility of advocating about many of the issues that affect our ability to deliver a high quality service to our patients.

By becoming involved in our membership organisations, even in a limited way, we can gain peer support, develop areas of special interest and learn how our organisations work and how they can provide us with ongoing support and advice.

8

Create a legacy

We can be proud of our profession. Each of us has the potential to be a role model for future doctors and contribute our own lasting legacy through the examples we set in the way we live our lives and practise medicine.

This article is an edited extract from the book First Do No Harm – Being a Resilient Doctor in the 21st Century by Adjunct Associate Professor Leanne Rowe AM and Professor Michael Kidd AM. Both authors are general practitioners, and are a Past Chair of the R ACGP Victoria and a Past President of the R ACGP respectively.

Both authors are also involved with GPR A and GPSN – Adjunct Assoc. Prof. Rowe as patron of RCUBED, the GPR A self-care initiative for GP registrars, and Prof. Kidd as patron of General Practice Students Network (GPSN).

First Do No Harm ($35) is published by McGrawHill Australia and is available from medical bookstores. Royalty payments are shared with the Karmel Trust of Flinders University and the National Research Centre for the Prevention of Child Abuse at Monash University.

In closing…

While “first do no harm” has long referred to protecting our patients, in the 21st century its meaning needs to be expanded to also include protecting our families, our colleagues, our environment and ourselves.

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8 / Keeping your Balance

9

Gpra tip 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.

GP Support Program. A free counselling 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), www.racgp.org.au.

Bush Support Line. A free telephone counselling service for remote health workers and their families by psychologists who have a strong understanding of the realities of rural and remote practice. 1800 805 391.

Doctors Health Advisory Service. Visit www.doctorshealth.org.au for helplines in all States.

RCUBED. A website developed by GPRA to give GP registrars, prevocational doctors and medical students real resources to build resilience. Visit www.rcubed.org.au.

Real Resilience Resources

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www.rcubed.org.au

info file

9 / Info File

Learn to speak GP Acronyms and abbreviations abound in the language of GP training. Crack the code here!

AAGP Australian Association of General Practitioners AAPM Australian Association of Practice Managers

Previously Australian Divisions of General Practice.

AGPT Australian General Practice Training The training program for GP registrars.

AIDA Australian Indigenous Doctors Association

ACIR Australian Childhood Immunisation Register ACRRM Australian College of Rural and Remote Medicine One of two general practice colleges. Has a curriculum of educational objectives for rural GPs and a fellowship process for vocational recognition.

AFP Australian Family Physician The official journal of the RACGP. AGPAL Australian General Practice Accreditation Ltd This organisation completes accreditation of practices throughout Australia. Speak to your practice manager for further information.

AKT Applied Knowledge Test A component of the RACGP Fellowship exam in multiple-choice format.

AMPCo Australian Medical Publishing Company Register with them to get a free subscription to Medicine Today, Australian Doctor and Medical Observer. To arrange this, visit www.ampco.com.au.

AMA Australian Medical Association An independent organisation that represents the professional interests of all doctors including political, legal and industrial.

AMH Australian Medicines Handbook AMSA Australian Medical Students Association

AGPN Australian General Practice Network The national body that represents the Divisions.

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ARST Advanced rural skills training

ASGC-RA Australian Standard Geographical Classification – Remoteness Areas This is the Australian Bureau of Statistics model by which all cities and towns in Australia are assigned a number between RA1-5. This replaces the RRMA classification scheme and is used to calculate incentive payments to doctors outside metropolitan areas. The ASGC-RA is as follows: • RA1 – Major cities • RA2 – Inner regional • RA3 – Outer regional • RA4 – Remote • RA5 – Very remote A map of Australia with the above classifications is available at www.doctorconnect.gov.au.

CMO Career Medical Officer Divisions of General Practice Federally funded to provide support and educational activities to GPs and local primary care services within their Division (local area); for example, diabetes nurse educators. Find out which Division your practice belongs to and join. (GP registrar membership is free in some regions.)

DHAS Doctors Health Advisory Service DoHA Department of Health and Ageing The Commonwealth Government department responsible for health and ageing.

DVA Department of Veterans Affairs EBM Evidence-based medicine ECT External clinical teacher ESP Extended skills post A component of AGPT comprising a six-month training post in either general practice or an area of relevant skills; for example obstetrics and gynaecology, accident and emergency.

FACRRM Fellowship of the Australian College of Rural and Remote Medicine FARGP Fellowship in Advanced Rural General Practice FRACGP Fellowship of the Royal Australian College of General Practitioners

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GPET General Practice Education and Training Limited Government limited company that funds and contracts with RTPs to provide general practice education to registrars and PGPPP doctors.

JCC Joint Consultative Committee

OTC Over the counter

KFP Key Feature Problems A component of the RACGP Fellowship exam, In short and long answer, extended match format.

OTD Overseas trained doctor â&#x20AC;&#x201C; see IMG Also known as IMGs (international medical graduates). May be subject to the section 19AB moratorium.

GPR General practice registrar, GP registrar

MBS Medicare Benefits Schedule

GPRA General Practice Registrars Australia Ltd A Board of eight directors and an Advisory Council made up of RLOs from every RTP. Represents GP registrar issues to AGPT, RACGP, DoHA and many other bodies involved in training. Membership is free.

GPRIP General Practice Rural Incentives Program GPSA General Practice Supervisors Association, G eneral Practice Student Ambassador GPT1, GPT2, GPT3 General practice terms 1, 2 and 3 Part of the RACGP curriculum.

HIC Health Insurance Commission Now known as Medicare Australia.

ME and TA Medical educators and training advisors One of these people from your RTP will give advice and guidance about your training.

NGPSA National GP Supervisors Association Not to be confused with the SLON (Supervisor Liaison Officer Network), although they are essentially same people. NGSPA is the GPRA equivalent for supervisors. They undertake an advocacy role for supervisors, particularly in terms and conditions negotiations.

NMTC National Minimum Terms and Conditions A document prepared for GP registrars in their first and second general practice terms that outlines the legal requirements of contracts between registrars and practices.

HMO Hospital Medical Officer IMG International medical graduate Also known as OTDs (overseas trained doctors). GP registrars who are IMGs/OTDs may be subject to the section 19AB moratorium which requires them to practise and train in designated areas of need such as rural and outer metropolitan for up to 10 years, although it is now possible to reduce this time period by practising in more remote areas.

JAC Joint Advisory Committee 150

NPS National Prescribing Service A Commonwealth Government-funded organisation that provides independent information on the prescription and use of various medications. Lots of resources and case studies for GP registrars can be found at www.nps.org.au.

OSCE Objective Structured Clinical Examination A component of the RACGP Fellowship exam comprising multiple stations akin to an MSAT or viva voce examination.

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

PBS Pharmaceutical Benefits Scheme, Pharmaceutical Benefits Schedule PIP Practice Incentives Program PGPPP Prevocational General Practice Placements Program

RFDS Royal Flying Doctor Service RLO Registrar Liaison Officer A representative of GPRA and employed by an RTP to represent and advocate for GP registrars.

RMO Resident Medical Officer

QA and CPD Quality Assurance and Continuing Professional Development RACGP Royal Australian College of General Practitioners One of two general practice colleges. Has a fellowship process for vocational recognition.

RACGP also offers a Fellowship in Advanced Rural General Practice (FARGP).

RACGP Library RACGP members can access the full suite of services provided by the RACGP John Murtagh Library. Non-members can access some services for a fee. Visit www.racgp.org.au/library.

RACGP State Censor A fellow of the RACGP in each State. Checks that the GP registrar has completed training requirements for the awarding of fellowship of the RACGP.

RPBS Repatriation Pharmaceutical Benefits Scheme, Repatriation Pharmaceutical Benefits Schedule RROB Registrar Representative on Board A GPRA-nominated registrar who sits on the board of GPET to represent registrar concerns.

RROC Registrar Representative on Council A GP registrar who sits on the council of the RACGP to represent registrar concerns.

RRADO Registrar Research and Development Officer RRF Registrar Research Fund A pool of funding maintained by GPET to fund GP registrar research projects.

RTP Regional Training Provider RTPs tender for contracts from GPET to provide regionalised GP training.

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registrar

rave

Dr Christel Smit

My RTP is Remote Vocational Training Scheme (RVTS).

My current post is Barham NSW on the Murray River.

A typical workday for me can start with either a morning round at the hospital or dropping my kids off at school. Then I have a GP session, plenty of lunchtime meetings and another session in the afternoon. Being an RVTS registrar I receive my training remotely, so two evenings a week I join in on teletutorials.

My favourite technical gizmo is my stethoscope. I ordered a personalised one that’s bright pink and very groovy. It’s a fantastic ice-breaker with younger patients.

My favourite novel is Samuel Shem’s The House of God. After hours I love to do many things but mainly spend time with my four children.

A quirky fact about me is that I am about to start a TAFE course in beekeeping.

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Net effect

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.

SBO State-Based (Divisional) Organisation A State-funded organisation, not always directly linked to ADGP or individual Divisions. Provides some educational activities that GP registrars can attend.

Here are some popular websites where GPs go to get their information.

SIP Service Incentive Payment SLO GP Supervisor Liaison Officer Employed by an RTP to represent and advocate for GP supervisors.

TGA Therapeutic Goods Administration TMO Trainee Medical Officer UGPA United General Practice Australia

Searching through vast amounts of information on the net can be time-consuming. But the internet can be used as a great source of knowledge for general practice.

Here are some reputable sites as listed by a few GPs we consulted.

Medicare

VMO Visiting Medical Officer

Medicare Australia (for providers) http://www.medicareaustralia.gov.au/provider/ index.jsp

VR Vocational registration

Evidence-based medicine/research

WONCA World Organization 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

a selection of databases. The library can be accessed through the Australasian Cochrane Centre website. The Australasian Cochrane Centre is one of a number of centres established internationally to assist in the coordination of The Cochrane Collaboration’s activities. The Cochrane Collaboration is an international notfor-profit organisation, which provides up-to-date information on the effects of health care. As a note of interest, the international site (www.cochrane.org) has top links for GPs and podcasts on reviews for your commute to work.

PubMed (US National Library of Medicine) www.pubmed.gov Consisting of more than 19 million citations of biomedical articles from MEDLINE and life science journals, PubMed also has full text articles and links to other resources.

Bandolier www.medicine.ox.ac.uk/bandolier Bandolier is a key source for high quality information on evidence-based health care information in the UK. It is also known for its award-winning electronic version at ebandolier.com, which reportedly receives almost 90,000 visitors to its pages every week.

The Cochrane Library www.cochrane.org.au The Cochrane Library provides visitors the option of searching through thousands of clinical reviews assessing the effectiveness of treatments from

RADAR – Register of Australian Drug and Alcohol Research www.radar.org.au RADAR is a project of the Alcohol and other Drugs Council of Australia. The register contains the latest 153

9 / Info File

records of current and recently completed research projects with details of published research.

Journals MJA – The Medical Journal of Australia (Journal of AMA) www.mja.com.au Australia’s leading peer-reviewed journal of medical practice and clinical research.

Australian Family Physician Online (Journal of Australian Doctor) www.racgp.org.au/afp The Australian Family Physician is the official peerreviewed journal of the Royal Australian College of General Practitioners.

JournalWatch www.globalfamilydoctor.com The WONCA (the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) website scans the internet for journal articles and medical literature from across the world in its Journal Watch section. It includes synopses and directs you to the relevant websites.

Medical Observer www.medicalobserver.com.au The Medical Observer website has excellent links to GP resources and patient handouts. It also has a useful Clinical Review tab to keep you updated on medical news. To access content, you have to be a registered medical practitioner or health care professional to log in.

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Australian Doctor www.australiandoctor.com.au The Australian Doctor website has many resources for clinicians, leading you to respected journals from Australia and around the world.

Online learning platforms GPs looking to update their skills can easily access these professional development platforms.

GP Learning Online (a RACGP initiative) www.gplearning.com.au PrimEd (online professional development programs) www.primed.com.au

Patient-friendly information Better Health Channel www.betterhealth.vic.gov.au The Better Health Channel offers GPs consumer based information, which is checked on a regular basis and has useful handouts for patients.

My Dr (MIMS Australia) www.mydr.com.au The My Dr website contains a range of consumerfriendly tools: quizzes, calculators, a medical dictionary and information on medications.

Health Insite www.healthinsite.gov.au Health Insite is an Australian Government initiative, which aims to provide patients with the latest

information on health and wellbeing and has links to health services across the States and Territories.

GP Notebook www.gpnotebook.co.uk An encyclopaedia of medicine, the GP Notebook is updated on a continual basis and has over 26,000 pages of information.

Medications/therapeutic information GP Psych Support (an RACGP initiative) www.psychsupport.com.au/default_home.asp GP Psych Support is a service that offers GPs patient management advice from psychiatrists within 24 hours.

National Prescribing Service Limited www.nps.org.au The National Prescribing Service is an independent not-for-profit organisation whose aim is to provide accurate, balanced evidence-based information about medicines. Their website contains sections for consumers, health professionals and other members and stakeholders.

Therapeutic Goods Administration (TGA) www.tga.gov.au The Department of Health and Ageing’s Therapeutics Goods Administration website provides information on the Australian Register of Therapeutic Goods. The TGA monitors and assesses therapeutic goods in Australia, ensures they are of an acceptable standard and ensures that any therapeutic advances are readily available to the Australian public.

Pharmaceutical Benefits Scheme www.health.gov.au/pbs The Australian Government website has information on the Pharmaceuticals Benefits Scheme and now also includes the Schedule of Pharmaceutical Benefits, which lists all medicines under PBS. Australian Prescriber www.australianprescriber.com The Australian Prescriber is an independent publication offering information on drugs and therapeutic goods. It is run by the National Prescribing Service. Full-text articles are available free of charge.

MIMS Australia www.mims.com.au MIMS Australia supplies Australian health professionals with products and publications that assist GPs to make decisions in the clinic.

Australian Drug Foundation www.adf.org.au The Australian Drug Foundation works to educate the community on the problems associated with drugs and alcohol. Their activities include conducting research, holding seminars and undertaking community development work.

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GPRA Calendar 2011

Important GPRA Functions Function

Dates

WONCA Asia-Pacific Conference, Philippines

21- 24 February 2011 (Mon -Thu)

National Rural Health Conference, Perth

13 -16 March 2011 (Sun - Wed)

GPET RLO Workshop and GPRA Advisory Council Meeting, Canberra

23 - 26 March 2011 (Wed - Sat)

GPRA Breathing NEWLIFE into General Practice, Canberra

RACGP Exam Dates Exam

Enrolments open

Enrolments close

Assessment dates

Cost

AKT

18 October 2010

10 December 2010

5 March 2011

$1,570

AKT

21 March 2011

13 May 2011

23 July 2011

$1,570

KFP

18 October 2010

10 December 2010

5 March 2011

$1,570

KFP

21 March 2011

13 May 2011

23 July 2011

$1,570

OSCE

18 October 2010

10 December 2010

7 May 2011

$3,125

OSCE

21 March 2011

13 May 2011

23 October 2011

$3,125

Visit www.racgp.org.au for further details regarding the RACGP examination system.

ACRRM Assessment Dates Exam

Enrolments close

Assessment dates

Cost

24 March 2011 (Thu)

MSF

Can enrol any time

At the registrar’s choosing

$500

Conference and Exhibition (GPCE), Sydney

20 - 22 May 2011 (Fri - Sun)

miniCEX

7 January 2011

February to July 2011

$1,295

GPET Convention, Canberra

7 - 8 September 2011 (Wed -Thu)

miniCEX

8 July 2011

August to December 2011

$1,295

GPET RLO Workshop, Canberra

9 September 2011 (Fri)

MCQ

7 January 2011

12 March 2011

$620

GPRA AGM and Advisory Council Meeting, Canberra

10 -11 September 2011 (Sat - Sun)

MCQ

15 July 2011

10 September 2011

$620

RACGP GP11 Conference, Hobart

6 - 9 October 2011 (Thu - Sun)

StAMPS

25 February 2011

7 and 8 May 2011

$1,170

GPRA Future Series and GPSN Council Meeting, Melbourne

15 -16 October 2011 (Sat -Sun)

StAMPS

6 May 2011

23 and 24 July 2011

$1,170

RDAA Rural Medicine Australia Conference

28 - 30 October 2011 (Fri - Sun)

StAMPS

23 September 2011

3 and 4 December 2011

$1,170

General Practitioner Conference and Exhibition (GPCE), Melbourne

11-13 November 2011 (Fri - Sun)

Visit www.acrrm.org.au for further details about the ACRRM assessment system.

Australian General Practice Network National Forum, Melbourne

16 -19 November 2011 (Wed - Sat)

156

157

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We want your feedback on Explorer 2011

We aim to continually improve the support we offer GP registrars and we value your opinions and constructive comments.

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Please send us your feedback by email publications@gpra.org.au or by phone 1300 131 198

GENERAL PRACTICE REGISTRARS AUSTRALIA T: 1300 131 198 www.gpra.org.au E: enquiries@gpra.org.au