Explorer 2010 by Moksha Web

explorer

T H E R E GI ST RAR GU I DE

2010

Training Tips for Registrars by Registrars

EXPLORING

GPland

REGISTRAR RAVES SALARY GUIDE NEW!

PICK A FLAVOUR:

PAEDIATRICS OR 25 OTHERS

www.gpra.org.au / RRP $10.00

Why is Avant the smart choice for GP Registrars?

AB OU T T H I S

Because Avant GP Registrars are supported by: ď&#x192;źa cost effective package for GP Registrars with an annual base cost of $100*

ď&#x192;ź24/7 support from experienced medico-legal advisors

ď&#x192;źwhat we believe is the broadest insurance cover available to doctors**

ď&#x192;źpractical clinical risk management resources for your practice

ď&#x192;źunlimited private practice billings

ď&#x192;źAustraliaâ&#x20AC;&#x2122;s largest â&#x20AC;&#x2DC;in-houseâ&#x20AC;&#x2122; medical defence team

ď&#x192;źmonthly teleconferences on hot GP Registrar topics

ď&#x192;źmore than 100 years experience in managing medical claims ď&#x192;źalliances with GPRA, and GP Compass.

EXPLORER HAS BEEN PREPARED BY GENERAL PRACTICE REGISTRARS AUSTRALIA (GPRA). Explorer has been designed to assist Registrars in making informed choices about their future career directions. The guide is set out in colour-coded sections for easy navigation. Explorer has been produced using sustainable, environmentally friendly printing techniques. This reďŹ&#x201A;ects GPRAâ&#x20AC;&#x2122;s ethos of supporting tomorrowâ&#x20AC;&#x2122;s GPs and their families in their quest for sustainable careers in General Practice.

More than 55% of Australiaâ&#x20AC;&#x2122;s doctors choose Avant as their medical defence organisation. Protect your career. Call 1800 www.avant.org.au

128 268 today!

* plus the ROCS levy, GST and stamp duty of between $20 and $40 depending on the state and territory in which you practice. **IMPORTANT: Insurance policies available from Avant Mutual Group Limited ABN 58 123 154 898 (Avant) are issued and underwritten by Avantâ&#x20AC;&#x2122;s licensed subsidiary, Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. Applications for insurance are subject to approval and insurance cover is subject to the terms and conditions of the policy and policy schedule. Before deciding to purchase or continuing to hold a policy with us, you should read and consider the Product Disclosure Statement (PDS) to determine if this product is appropriate for you. The policy and PDS are available at www.avant.org.au or by contacting us on 1800 128 268.

Welcome General Practice Registrars Australia, known as GPRA, is your supporter while you train. Explorer has been designed by GPRA to be your guide and travelling companion as you explore your chosen career. It forms a continuum with the other GPRA-suppor ted guides for prevocational doctors (Compass) and medical students (Aspire). The name, Explorer, was chosen to represent the exploratory nature of GP training as you try out some of the many facets of General Practice. We are fortunate enough to work in a field that offers a myriad of possibilities for practice: in location, areas of special interest, work conditions and more. Along the way, we can each follow our own passions and travel our own distinct professional journey. Explorer aims to open your eyes to some of the many training options you can delve into during your training. The personal experience stories enclosed are written for Registrars by Registrars.

They detail just a handful of the many unique, rewarding and challenging training opportunities available in General Practice, from Paediatric Outreach in Cape York and Expedition Medicine in Greenland to teaching and research in academic practice. The Registrar Raves offer profiles of Registrars from around the country, to give you a further insight into the diversity of your Registrar peers and their experiences. Explorer also aims to give you a reference guide to establishing yourself in General Practice training, and getting the most out of your training experience. It’s a resource I have found myself turning to throughout my training for handy practical tips on getting started in practice and study as well as for inspiration for what new professional role I may turn to next. I hope you find it is as useful a reference for you on your journey.

Producing a magazine such as this requires the time and effort of a number of different people. Without them this issue would never have come to fruition. I would like to thank the many GP Registrars who have contributed so generously of their time, experience and stories to provide the bulk of the magazine’s content. The efforts of graphic designer Jo Li Tay, who is responsible for making the guide look so appealing and reader-friendly, are also greatly appreciated. Many thanks too to Amit Vohra and the GPRA staff for their ongoing work. Finally, my heartfelt thanks to Explorer’s subeditor, Jan Walker, whose steady supply of inspiration, encouragement and editorial nous navigates this production successfully through its own challenging journey from early development to final execution. Dr Kate Kelso Medical Editor Explorer 2010

Contact MDA National today and find out What’s in it for You.

Contents About this guide Welcome A message from the GPRA Chair

1 2 6 10 14 16 18 20

Change alert So... what’s changed?

General Practice training landscape The GP training landscape The RACGP Fellowship The RACGP’s Fellowship in Advanced Rural General Practice (FARGP) The ACRRM Fellowship The ADF: a force in GP training Jargon buster

31 34 38 40 44 48

Real-life GP explorers Luck of the Irish Reaching the kids Diary of a rural doc Doctor on ice Pick a flavour

54 58 60 64 68

Academic options This academic life My RRADO year Give it a go as an RLO

78 80 82

Preparing for practice

GPRA and you Your GPRA support team All about Gen X and Gen Y GP Registrars Agenda now Member benefits A year in the life of GPRA

Hot off the press Learn as you teach Class act

70 74 76

In hospital? Think General Practice Before your GP Term: get it sorted! GP Term survival tips Net gain A country practice What every VMO should know Mentally prepared The Medicare maze Prescribing and the PBS Countdown to Healthcare Identifier numbers Testing times

86 88 92 96 102 105 108 110 114 118 120

132

136

Money matters 2010 National Minimum Terms and Conditions Employee or contractor? Incentive payments $30,000 Outer Metropolitan Grants

158 160 162 164

GPRA calendar 2010 168 We want your feedback on Explorer 2010 172

GPRA would like to acknowledge the support of our patron, Professor John Murtagh, and his invaluable contribution to General Practice. Prof. Murtagh is Adjunct Professor of General Practice, Monash University and Professorial Fellow in the Department of General Practice, University of Melbourne. He practises part-time as a general practitioner at 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 GPSN Founding Sponsor: MDA National Insurance Pty Ltd

124 126 128 130

Exam preparation Top tips for exams

Pregnant pause Part-time, smart time Life as a Registrar mum Being resilient

Info file

Founding Benefactor: Dr Jerry Schwartz, The Schwartz Family Co.

Term allocation and choice The place race Facing the interview Transferring across RTPs If things go pear-shaped 10 hot questions on the 10 Year Moratorium

Keeping your balance

Co-Sponsors: Aspen Pharmacare, Australian Locum Medical Service, Commonwealth Bank of Australia, Department of Health and Ageing, Health 24/7, Independent Practitioners Network Ltd, Matraville Medical Complex, McMasters’ (Vic) Pty Ltd, Medfin Australia Pty Ltd, Medical Insurance Group Australia, Medical Recruitment Pty Ltd, More Doctors Initiative from Department of Health and Ageing, MIMS Australia, National E-Health Transition Authority Ltd, North Coast GP Training, Northern Territory General Practice Education, The Doctors’ Health Fund, Royal Australian College of General Practitioners and WentWest Limited. Business Partners: Australian Doctor, FPA Health Pty Ltd, General Practice Education and Training, Healthed Pty Ltd, Medical Observer, Ochre Recruitment Pty Ltd and Reed Medical Education. Medical Editor: Dr Kate Kelso. Subeditor: Jan Walker. Graphic Design: Marie-Joelle Design & Advertising. Marketing: Kate Marie. Printing: Fishprint. GPRA wishes to thank all the contributing authors for their work and guidance. We also thank the Commonwealth Department of Health and Ageing for their continued support and assistance.

142 148 152 154

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.

;^cVcXZ [dg <E GZ\^higVgh

A message from the

GPRA Chair

L]Zc ndj hiVgi ndjg heZX^Va^hi igV^c^c\! ndjg ZkZgnYVn a^[Z X]Vc\Zh VcY Vadc\ l^i] ^i ndjg Ă&#x192;cVcX^Va cZZYh#

Welcome to General Practice â&#x20AC;&#x201C; the most important specialty in medicine.

BZY[^c 6YkVcXZ d[[Zgh ndj [^cVcXZ [dg i]Z ejgX]VhZh ndj cZZY id bV`Z Âś Wdi] aVg\Z VcY hbVaa# L^i] heZX^Va egZ"VeegdkZY a^b^ih !

To enable us to fulfil this mission it is important to us that we hear from you. We will be conducting a number of surveys and are keen to hear about any challenges that you may face throughout your training.

BZY[^c 6YkVcXZ ^h VkV^aVWaZ ZmXajh^kZan id YdXidgh l]d VgZ XdbeaZi^c\

The health reform process in Australia has begun and the good news is that the importance of having a strong GP-led primary care system has been recognised. As GPs we are uniquely positioned to positively influence our patientsâ&#x20AC;&#x2122; and our communityâ&#x20AC;&#x2122;s health, and improve outcomes more significantly than any other profession. General Practice also offers amazing diversity and flexibility that enables you to shape your career in almost any way you choose. GPRAâ&#x20AC;&#x2122;s Explorer is designed to help you make the most of your General Practice training. Inside you will find everything you need to know about taking advantage of the different options for training as well as lots of great information on

financial issues, preparing for exams and, importantly, about looking after yourself. You can guarantee the information to be relevant because itâ&#x20AC;&#x2122;s prepared by Registrars and recent Fellows especially for you. At GPRA we are committed to our vision statement: GPRA will promote General Practice as the medical specialty of choice and improve the health care of all Australians through excellence in education and training for Registrars present and future. We are well placed to advocate for Registrars through our membership of United General Practice Australia (UGPA), consisting of RACGP, ACRRM, AMA, RDAA and AGPN, and via strong relationships with GPET, DoHA and the Minister for Health and Ageing.

i]Z^g heZX^Va^hi igV^c^c\# LVci bdgZ ^c[dgbVi^dc4 IVa` id V BZY[^c GZaVi^dch]^e BVcV\Zg idYVn VWdji BZY[^c 6YkVcXZ# E]dcZ &(%% (+& &'' dg k^h^i bZY[^c#Xdb#Vj

I would like to wish you all much enjoyment and satisfaction in your future, both personally and professionally. Dr Belinda Guest GPRA Chair 2008-2010

BZYĂ&#x192;c 6YkVcXZ ^h VkVâVWaZ id bZY^XVa YZciVa heZX^Va^hih ^c igV^c^c\ eZgbVcZci gZh^YZcih d[ 6jhigVa^V dcan# IZgbh XdcYî^dch Veean# Di]Zg [ZZh X]Vg\Zh bVn Veean# Cdi hjeea^ZY Wn BZYĂ&#x192;c# BZYĂ&#x192;c ;^cVcXZ 6jhigVa^V Ein A^bîZY 67C -. %,% -&& &)-# 6 l]daan dlcZY hjWh^Y^Vgn d[ CVi^dcVa 6jhigVa^V 7Vc` A^bîZY! VcY eVgi d[ i]Z C67 =ZVai] heZX^Va^hi Wjh^cZhh# <EG6$&% EgVXi^XZ Â&#x2122; :fjêbZci Â&#x2122; Bdidg kZ]^XaZ Â&#x2122; GZh^YZci^Va ^ckZhibZci egdeZgin 8Vh] Ă&#x201E;dl Â&#x2122; >ckZhibZci ^c hjeZgVccjVi^dc Â&#x2122; =dbZ

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

1 GPRA and you Exploring a career in General Practice as a GP Registrar is alive with adventure and possibility. It’s good to know there’s an organisation of peers that can guide you on your journey.

GENERAL PRACTICE STUDENTS NETWORK

A GPRA initiative

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

GPRA and You

your

GPRA and You

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 new GP generation. Who is GPRA? GPRA stands for General Practice Registrars Australia. It is the peak national representative body for General Practice Registrars in Australia. One of our most important functions is to provide resources to support you as a GP Registrar throughout your training and represent your interests.

The future of General Practice 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 profession and the health care of all Australians.

What GPRA does for you

About GPRA’s structure

We negotiate your pay and your conditions of employment. 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 provide Registrar Liaison Officers (RLOs) at all Regional Training Providers (RTPs) to offer peer-to-peer support and report on any issues that require improvement.

Your RLO, GPRA Advisory Council, GPRA Board and management team all have a role to play.

visit us @ www.gpra.org.au 10

Each Regional Training Provider (RTP) employs one or more Registrar Liaison Officers (RLOs) who are there to help you with your training. The RLOs communicate via the GPRA Advisory Council email list server, forming an Australiawide network to provide solutions to local and national training issues. GPRA also has a Board of eight directors who are elected from GPRA’s membership at each Annual General Meeting in August.

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

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. 11

GPRA and You

Medical Indemnity insurance

GPRA management team Chief Executive Officer: Amit Vohra Senior Manager: Margo Field Business Development Manager: Kate Marie Project Manager: Connie Lambrou GP Compass Project Officer: Mary Lambrou National Membership Development Manager: Georgina Johnston GPSN Project and Marketing Officer: Laura Borelli Marketing and Communications Officer: Janice Lim Accounts and Administration Officer: Rebecca Qi Administration and Website Officer: Kylie Flack

Amit

Margo

Kate

Connie

Mary

Georgina

Laura

Janice

As a young professional, you’re only as good as your reputation. Rebecca

Kylie

Protect your career

Board of directors Chair: Dr Belinda Guest Vice-Chair: Dr Danika Fietz Dr Jennifer Mooi Dr George Forgan-Smith Dr Abhi Varshney Dr Manisha Fernando Dr Bennie Ng Dr Lana Prout Ms Mary Wyatt

MIGA offers medical indemnity insurance* and personal support for doctors employed in public hospitals for matters where you may not be covered by the hospital. Belinda

Danika

Jennifer

George

This may include inquiries by the Medical Board or a health care complaints commission where you may need personal representation. Protect your most valuable asset, call us for a quote today.

Abhi

Manisha

Bennie

Lana

Practise with confidence 1800 777 156

Mary 12

•

miga.com.au

Adelaide (Head Office)

Brisbane

Melbourne

Sydney

Insurance policies available through MIGA are underwritten by Medical Insurance Australia Pty Ltd (AFSL 255906). Membership services are provided by Medical Defence Association of South Australia. 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. * Based on the Category of cover selected, cover is provided to the extent you are not otherwise indemnified. © MIGA February 2008

Dream GP jobs

GPRA and You

ALL ABOUT

Gen X and Gen Y GP Registrars AGPT’s target of 700 training places will be met in 2010 due to a record number of applications (1,007)

54% of GP Registrars are in the General Pathway; 46% in the Rural Pathway

The sky is

the limit!

Looking for a dream career in General Practice? Then consider working in partnership with Independent Practitioner Network. IPN is Australia’s premium medical centre operator and the leading provider of quality management services for Doctors and their patients. We are the preferred business partner of more than 900 independent GPs. 72% of GP Registrars are Australian medical graduates

28% of GP Registrars are international medical graduates

GP Registrars are more likely to be female (63%)

With Support Payments!

Doctors work with, not for IPN, running their own practices in the comfort of IPN’s modern, wellestablished, supportive group practices. Less than 10% of our partner-GPs are on fixed contracts. So Doctors stay with us because they choose to, not because they have to! Live your dream career by building the practice you want in the comfort of an IPN Medical Centre, with the guidance of experienced GP Mentors, and the support of IPN’s practice management and business development expertise.

The dream Work / Life balance

The dream Practice environment

s Freedom – Choose the hours you want to practice. s Flexibility – Practice in NSW, QLD, SA, VIC, TAS or WA. s High Income Potential – Bill the way you want to. Private, bulkbill or combine the two. s Individual Development – Pioneer your own GP special interests from Travel Medicine to Anti-aging, Women’s Health or Skin Checks. The sky is the limit!

s Experienced Mentors s Well-established s Friendly group practices s Modern facilities s Fully Accredited s Busy Treatment Room s Fully-computerised s IT Support s Service-focused Reception Staff s Premium Nurse Support s Progressive GP services

Realise your dream career today! Call 1300 IPN DOC (1300 476 362)

Or visit www.ipnet.com.au

GPRA and You

Agenda

NOW

GPRA has been busy working for the interests of GP Registrars and Australiaâ&#x20AC;&#x2122;s health care system. Here are a few recent achievements and projects.

GP Registrar numbers are up GPRAâ&#x20AC;&#x2122;s strategies to increase the popularity of General Practice and the number of GP Registrar training places appear to be working. The number of applications and acceptances of training places in the Australian General Practice Training program has continued a consistent upward trend that began in 2007. Applications received for the 2010 training year have set a new record of 1,007. GPRA and other peak bodies have successfully lobbied for extra training places in the AGPT program. This has resulted in available places for 2010 entry being increased to 700. 16

GPRA and You

GPSN raises profile of GP careers among medical students The General Practice Students Network (GPSN), one of our flagship programs, continues to flourish with national membership passing the 4,000 mark. The recently published evaluation survey shows a positive link between GPSN activity and increased awareness about GP career options and the GP training program itself. For details, visit www.gpsn.org.au

GPSN Schwartz First Wave Scholarship expanded The GPSN Schwartz First Wave Scholarship is in its second year pilot with 54 students across 14 universities and 12 Regional Training Providers participating in 2009-2010. A prestigious scholarship for first and second year medical students, it provides early, structured exposure to General Practice in outer metropolitan and academic settings. For details, visit www.gpsn.org.au

GP Compass for prevocational doctors launched Building on the success of GPSN, a new initiative has been launched to promote General Practice to prevocational doctors in the hospital setting. This program will build on peer-to-peer marketing and engagement strategies similar to GPSN. The inaugural magazine, Going Places, was launched in 2009 with a new website and other initiatives to follow in 2010.

New resources for Registrars We continue to focus on providing new enhanced resources for Registrars. RCUBED (see page 166), a web-based resource to promote resilience and self-care, was launched in 2009 along with new online exam resources to assist Registrars sitting the RACGP exam (see page 140). In 2010 we will continue to build on these resources and provide new learning and professional development resources via a revamped GPRA website.

RACGP exam price increase Following a large increase in the RACGP exam price for 2009, GPRA lobbied the college on behalf of Registrars and negotiated a significant rebate for 2009 and 2010 exam candidates in the form of a membership credit with the RACGP and a commitment to discuss any further increases with GPRA in the future.

GPRA and other peak bodies now a united voice GPRA continues to lobby on behalf of Registrars as part of the newly formed United General Practice Australia, a peak body formed to achieve improvements for the profession and the Australian health care system by presenting a united voice to government and other stakeholders. 17

GPRA and You

Member benefits Join up now if you’re not already a member. It’s free!

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

Basic Membership Benefits We negotiate your pay and conditions of employment. We fight for your interests and provide a direct channel to raise any issues. We offer personalised help for dispute resolution on any aspect of your training. 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 by Registrars for Registrars (see page 140 for more details)

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

Qantas Club Membership – $200 off original price

Free admission to Healthed seminars for GPRA members in the AGPT program (see page 117 for more details)

Free registration for Registrars to attend the General Practitioner Conference and Exhibition (GPCE) Melbourne and Sydney 2010 (Numbers are limited and eligibility subject to GPCE’s approval)

Avant Teleconference Series for Registrars on medico-legal issues

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

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)

Ramsay Books and Equipment – 15% off

Access to specialised practice placement services through Ochre Recruitment

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

DO IT NOW If you’re not already a member, there are three easy ways to join and start receiving all the benefits.

Online

www.gpra.org.au

enquiries@gpra.org.au

Phone

1300 131 198

GPRA and You

A Year in the life of

GPRA Breathing NEWLIFE into General Practice 2009, Canberra

GPRA and You

A Year in the life of

GPRA

Future Series 2009, Sydney

Advisory Council

GPRA Teambuilding Day, Point Lonsdale

WE CAN HELP YOU REACH YOUR CAREER TARGETS

2 Change Alert Change is par t of life for a GP Registrar. Here’s a heads up on the latest changes to the GP training program for 2010.

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

Change Alert

So... what’s changed? General Practice training is

New rules on Rural and Outer Metro Terms

Merger surge for RTPs Due to recent changes in the Budget, 2010 will see a number of RTPs merging. Institute of General Practice Education (IGPE) in Sydney will become part of GP Synergy. Other merger partners will be Victoria Felix with GPlogic, and Greater Green Triangle (GGT) with Gippsland Education and Training for General Practice (getGP).

During the first half of the year, there will be transitional arrangements leading to the completion of the mergers in the latter half of the year.

Here’s a rundown of the most recent changes.

Rural incentives change

he Registrars Rural Incentive Payments Scheme (RRIPS), which paid Registrars generous incentives of up to $90,000 a year to train in rural and remote locations, , will be no more from midyear. In its place will be the General Practice Rural Incentives Program (GPRIP), a scheme that applies equally to GPs and GP Registrars. The new scheme favours doctors who stay in rural and remote areas for the longest periods of time. If Registrars train in rural and remote locations, then stay on and practise there they will earn larger incentives.The more ASGC-RA remote the location, the classification 0.5 greater the rewards. Incentives will be paid according to a sliding scale based on the ASGC-RA category

and the length of time in a rural location (see table below). RRIPS will still be applicable for Registrars commencing the AGPT program in eligible training terms at the start of the 2010 training year, for all training undertaken before 1 July 2010. From 1 July 2010 incentive payments will be paid under the GPRIP. Training undertaken prior to 1 July 2010 will be recognised for calculating time spent in a rural location for the purposes of future payments. Period of time (years) in a rural location 1

The good news is that there will be more flexibility, but there will be an extension from a six-month to 12-month commitment. From 1 January 2010, instead of a six-month term in a rural practice, General Pathway Registrars in RA1-5 are required to fulfil a 12-month training pathway obligation.

This will bring the total of RTPs to 17.

an ever-changing landscape.

There are changes to the rules regarding obligatory terms for General Pathway Registrars.

3 - 4

RA2

$2,500

$4,500

$7,500

$12,000

RA3

$4,000

$6,000

$8,000

$13,000

$18,000

RA4

$5,500

$8,000

$13,000

$18,000

$27,000

RA5

$8,000

$13,000

$18,000

$27,000

$47,000

You can elect: 12 months training in an RRMA3-7 or RA2-5 location, or 12 months training in an outer metropolitan location, or 6 months training in an RRMA3-7 or RA2-5 location plus 6 months training in an outer metropolitan location. However, your RTP will still need to fulfil staffing requirements for their area’s rural workforce so the choice may not be entirely yours.

Continuing General Pathway Registrars (2009 cohort and earlier) and 2010 cohort entry Registrars who are (or will be) training with a non-capital city RTP who previously had only a six-month pathway obligation (ie no outer metropolitan requirement) will still only have a six-month obligation. All General Pathway Registrars entering the AGPT program from 2011 onwards will have a 12-month pathway obligation that can be fulfilled as outlined. Rural Pathway Registrars will still be required to undertake all of their General Practice and/or primary rural and remote training in a rural location, which will be RRMA3-7 before 1 July 2010 and RA2-5 locations from 1 July 2010.

Geography lesson From July 2010 the existing Rural, Remote and Metropolitan Areas (RRMA) system will be replaced by the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system. The ASGC-RA has been developed by the Australian Bureau of Statistics and uses 2006 Census data, and is widely used by Commonwealth and State agencies. Moving to the ASGC-RA will help attract health services to areas of genuine need. It reflects broader health reforms supporting the notion that “the more remote you go, the greater the reward”. The system classifies regions that share remoteness characteristics into RA groups. RA1 is major cities and can be defined as urban locations; RA2 to 5 are grouped in progressively more remote locations, and can be defined as regional, rural or remote.

Change Alert

Easing of the 10 Year Moratorium Proposed Government legislation will remove restrictions that apply to New Zealand permanent resident and New Zealand citizen doctors who have obtained their primary medical education either at an accredited medical school in Australia or New Zealand. Under the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009, these doctors will be removed from the classification of “overseas trained doctor” and “former overseas medical student”. Another important provision proposed in the Bill is the removal of the requirement for overseas trained doctors to have either Australian permanent residency or citizenship and medical registration in order for the 10 Year Moratorium period to commence. Without this change, some medical practitioners who were initially temporary resident doctors and who subsequently gained Australian permanent residency or citizenship, have been subject to the restrictions in section 19AB for periods significantly in excess of 10 years. This amendment proposes that the 10 Year Moratorium will commence from the time the medical practitioner is first registered as a medical practitioner in Australia and will cease after 10 years, provided the medical practitioner has become a permanent Australian during that period.

RACGP response to Registrar exam concerns During 2009 many Registrars raised concerns about the substantial fee increase for the RACGP exams. GPRA has recently negotiated a deal to soften the impact. Acknowledging the lack of advance communication prior to the restructuring of the exam and the associated increase in examination fees, the RACGP undertook discussions with GPRA to assist candidates most affected by the short notice of the fee increase. Registrars who enrolled for the first time for the RACGP exam in 2009 will receive membership credit up to the value of the new Fellow rate ($655), while Registrars who

enrol for their exam in 2010 will also be given membership credit of 50% of this amount ($327.50). The examination was restructured to provide a better and more flexible approach to achieving Fellowship. The uncoupled examination also offers the option of spreading the preparation time and cost of the exam over three years. Registrars who enrolled in the 2009 exam will have received an email letter from the RACGP with further information. You can also call the RACGP membership department on 1800 331 626 to find out more.

3 General Practice Training Landscape

The General Practice vocational training landscape is organised a little differently from other specialties. Here’s an over view.

General Practice Training Landscape

The Australian General Practice Training Program

The

GP training

landscape

Postgraduate Resident Years You must have completed at least 1 year of hospital experience before commencing training. You may apply for AGPT in your internship year.

Australian General Practice Training

Year 2

Core Clinical Training (Hospital)

Hospital Term

GP Terms

Primary Rural & Remote Training t RACGP Exam

GP Terms Year 3 Year 4 *optional

Primary Rural & Remote Training t

RACGP Fellowship (eligible for Medicare provider number)

Training towards FRACGP

tyears 2-4 of ACRRM training can be completed in any order

ACRRM Fellowship (eligible for Medicare provider number)

Training towards FACRRM

• Registrars select to train in the General Pathway or the Rural Pathway Applicants affected by the 10 Year Moratorium are required to join the Rural Pathway

• Registrars can elect to train towards one, two or all Fellowships

General Practice Education and Training Ltd information current at February 2009 General Practice Education and Training Limited ABN: 95 095 433 140

Advanced Specialised Training t

*Advanced Training

RACGP Fellowship in Advanced Rural General Practice

ACRRM Assessment

Year 1

These frequently asked questions will give you a better insight into how your GP training is structured. f you are a little confused about the structure of General Practice training, that is probably because GP training is organised very 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 from other training programs in that, other than the initial year of Hospital Terms, it occurs mostly 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 RTPs Australia-wide, which deliver the AGPT program to about 2,500 GP Registrars. Selection of candidates is initially organised by GPET in conjunction with RTPs, who interview applicants.

What are RTPs? RTP stands for Regional Training Provider. RTPs contract with GPET and deliver the AGPT program in their designated region. 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 

General Practice Training Landscape

of the training program, delivery of educational activities and training material are provided by the RTPs. For those training in isolated rural locations, there is another alternative to the RTPs – the Remote Vocational Training Scheme (RVTS).

What is the role of the two colleges of General Practice? RACGP and ACRRM set training standards, set examinations and assessments, accredit training placements and sign off on completion of training by Registrars. Attainment of the Fellowship of the RACGP (FRACGP) or the Fellowship of ACRRM (FACRRM) is necessary to become vocationally registered for independent General Practice in Australia under the Medicare system. ACRRM has specifically designed its curriculum to meet the needs of doctors practising in the rural and remote context. However, Fellows of ACRRM may ultimately practise anywhere in Australia – rural and 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). However, 32

General Practice Training Landscape

it is important to note that the FARGP is a complementary qualification not a stand-alone Fellowship for vocational registration. It is designed as a fourth year of advanced rural and remote skills for those who have completed their FRACGP.

Another point to keep in mind is that RTPs are essentially independent from each other. Although GPET sets relevant policy for RTPs, some policies may be open to interpretation. Don’t necessarily rely on advice from friends doing the training program in another RTP.

Other optional additional training for rural and remote practice is available. Registrars may be eligible for additional Emergency Skills courses. (Talk to your RTP and start to arrange these as soon as possible as courses such as EMST may have waiting lists as long as your training time!)

In such an environment, with so many different entities involved, and each with a slightly different focus on GP training, it also highlights the importance and relevance of General Practice Registrars Australia (GPRA).

You may wish to complete one, two or three qualifications (FRACGP/FARGP and FACRRM) and this can be integrated into your training course from the beginning. See the college websites for details, www.racgp.org.au and www.acrrm.org.au

Why does all this matter? Understanding the structure and the fact that a number of entities are involved in GP training may help to explain some of the paperwork and hopefully reduce confusion. Each organisation involved in GP training is seeking feedback from Registrars, which should explain why there are so many surveys. Information provided to GPET may not be available to the colleges or vice versa, hence the need to sometimes supply the same information more than once.

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 RTP Registrar Liaison Officer (RLO), who is your link with GPRA, or contact GPRA directly.

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 You can talk directly to your RTP, or their Registrar Liaison Officer (RLO). There’s 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

Contributed by Dr George Manoliadis and Dr Jen Lonergan

General Practice Training Landscape

The

RACGPFellowship How to become a general practitioner by attaining Fellowship of the Royal Australian College of General Practitioners (FRACGP). What is the FRACGP? The Royal Australian College of General Practitioners Fellowship (FRACGP) is a three-year program, comprising one year of hospital residency, 18 months of General Practice placements and six months of Extended Skills. FRACGP is granted to those who have undertaken suitable experience and/or training in General Practice and demonstrated their competence by successfully completing the college examination to achieve vocational registration. FRACGP meets the required standard for doctors wishing to practise as an unsupervised general practitioner anywhere in Australia.

FRACGP is also recognised by many overseas colleges including the General Practice/ Family Physician Colleges in New Zealand, Ireland, Hong Kong and Malaysia. (Note that some of these countries require additional assessment prior to working there.)

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 Posts (ARSPs) can be undertaken at any time during training and offer additional procedural skills in rural General Practice. Examples include Anaesthetics, Aboriginal Health, Obstetrics, Emergency Medicine and Mental Health.

The college also offers an additional Fellowship qualification – Fellowship in Advanced Rural General Practice (FARGP). (For further information, see page 38.)

About the FRACGP examination 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). You must successfully complete the three assessments within a three-year period. You may sit each segment of the exam individually at your own pace.

Am I eligible to sit the examination?

When can I apply to sit the FRACGP exam?

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

You can apply to sit the college examination while completing your General Practice training and when you meet the eligibility criteria. 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.

Be a current financial member of the RACGP. Have achieved certified competence in a recognised CPR course in the 12 months prior to enrolment. Be a General Practice Registrar undertaking Australian General Practice Training. Have completed eight active units of training in Australian General Practice Training which may include approved Recognition of Prior Learning (RPL), or at least 12 months in the Remote Vocational Training Scheme (RVTS).

Contributed by the Royal Australian College of General Practitioners

DO IT NOW For more information, visit www.racgp.org.au For further information on the examination, please visit www.racgp. org.au/assessment or contact the RACGP Assessment Department (call1800 626 901 or email assessment@ racgp.org.au). Check RACGP exam dates and fees on page 169.

However, you must sit and pass the Applied Knowledge Test (AKT) before you can continue to other assessments. 35

General practice registrar, Dr Shiromi Wimalaguna

Medical school 4â&#x20AC;&#x201C;6 years Internship year (PGY1) You can apply for general practice training in this year to commence your first year of training in your second year after graduation. Postgraduate resident years You must complete at least 1 year of hospital experience, however, many people benefit from 2 or more years experience. You can undertake as many postgraduate years as you wish before applying for general practice training.

Application for general practice training General Practice Education and Training 9GPET) is the body that selects you for the Australian General Practice Training (AGPT) program. The training is delivered by one of the Regional Training Providers throughout Australia.

General practice training (general practice registrar) 3 years comprising 1 year of hospital residency including a rotation caring for sick children; 18 months of general practice placements; and 6 months extended skills in a term of your choice. Part time training and up to 3 years leave are available. RACGP college examination

Prevocational General Practice Placements Program (PGPPP)* (optional) Work in outer metropolitan, regional, rural or remote areas and gain practical experience in general practice. *please check entrance eligibility with your state/territory as it may vary

4th year training (optional) The advanced academic terms allow you to work part time within a university department and part time in general practice. The advanced rural skills posts are designed for doctors to gain additional skills relevant to rural general practice. These may be undertaken at any time throughout your training depending on your educational needs.

As your professional college, The Royal Australian College of General Practitioners (RACGP) is committed to ensuring general practice remains a satisfying and rewarding vocation for your entire general practice career, and actively advocates on behalf of the profession.

Successful completion of RACGP training and assessment RACGP Fellowship You are now qualified to practise unsupervised as a GP. QA&CPD General practitioners undertake quality assurance and continuing professional development throughout their medical career to maintain their professional standing.

All the clinical resources, tools and support you need.

Additional eduation in rural general practice The college offers further rural education through our Fellowship in Advanced Rural General Practice (FARGP). You can work toward this qualification at the same time as you prepare for your FRACGP.

Your RACGP general practice registrar membership 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. Your membership also offers a confidential GP Support Program^ to assist in coping with personal and work related stress, as well as a suite of other valuable member services. ^ The GP Support Program is a confidential service provided by professional registered psychologists. It is available only to RACGP members who are Australian registered medical practitioners. www.racgp.org.au/gpsupport

$FFHVV \RXU EHQHČź WV WRGD\ Visit www.racgp.org.au/registrar or call 1800 331 626.

General Practice Training Landscape

The RACGP’s Fellowship in Advanced Rural General Practice

(FARGP)

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

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

What is FARGP?

Requirements for FARGP

Registrars have a choice of two endpoints through the RACGP – the FRACGP to achieve General Practice vocational recognition (three years) and those who want recognition of their advanced rural and remote skills may continue to train to the FARGP (four years), and attain both the FRACGP and the FARGP.

Candidates must have completed their FRACGP before they can be awarded their FARGP.

The FARGP may also be used for hospital credentialing and appointments.

Assessment for FARGP is based on a Learning and Educational Assessment Portfolio (LEAP). There is no formal final examination as the portfolio is based on continuous assessment.

However, training to the RACGP curriculum and Advanced Rural Skills Training curriculum is closely integrated, so many requirements can be achieved concurrently.

Registrars must undertake a minimum of 12 months of training in accredited Rural Training Posts, plus 12 months in an accredited Advanced Rural Skills Training Post (ARSP).

Skills curricula have been developed in consultation with the other medical specialty colleges such as the RANZCOG (for Obstetrics), ANZCA (for Anaesthetics) and RACS (for Surgery). The FARGP also includes two core distance education modules – Working in Rural General Practice and Emergency Medicine. Registrars can design a program that responds to their specific interests. If circumstances change, Registrars have the flexibility to revert to the three-year FRACGP program only.

Contributed by Di Schaefer, RACGP National Rural Faculty

Advanced Rural Skills Posts (ARSPs) ARSPs are available in: Anaesthetics Obstetrics Surgery Aboriginal Health Mental Health Paediatrics Emergency Medicine Adult Internal Medicine Small Town General Practice Advanced Rural Skills Training can also be designed to meet the needs of an individual Registrar or their community; for example, Palliative Care, Drug and Alcohol Misuse, Musculoskeletal and Expedition Medicine. Individual ARSPs must be approved by the RACGP’s National Rural Faculty after consultation with your Medical Educator.

General Practice Training Landscape

The

ACRRM

Fellowship

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.

DO IT NOW

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 which is suitable for doctors with experience in rural and remote who prefer self-directed learning. To see which pathway is most suitable for you see the ACRRM website for more information.

For more information, visit the ACRRM website (www.acrrm. org.au), call ACRRM on 1800 223 226 or contact ACRRM Vocational Training, training@ acrrm.org.au

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 Community Controlled Health 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: the Vocational Preparation Pathway delivered by Regional Training Providers with funding from 40

Vocational training program components The ACRRM training program comprises three spheres of learning and experience (see flowchart on page 42). 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 ACRRM-accredited hospitals, Aboriginal Community Controlled Health Services or General Practices/communitybased 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 ACRRM-accredited disciplines listed in the flowchart

Check ACRRM exam dates and enrolment deadlines on page 169.

on page 42. Many FACRRM candidates undertake training in a procedural discipline.

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. To achieve FACRRM, candidates must also successfully complete four ACRRM online modules and emergency courses approved by ACRRM (for example, EMST/ELS/PHTLS or equivalent, APLS, ALSO).

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 Practice Training Landscape

MEDICAL OBSERVER for

The ACRRM Training Program

REGISTRARS

BRINGS LIFE TO MEDICINE

ACRRM REGISTRAR Core Clinical Training

12 Months In an ACRRM-accredited hospital Terms: • General Medicine • Obstetrics and Gynaecology • Anaesthetics • General Surgery • Paediatrics • Emergency Medicine

Primary Rural and Remote Training

NB: Primary Rural and Remote Training and Advanced Specialised Training may be undertaken in any order after the Core Clinical Training year

Advanced Specialised Training

24 Months

12 Months

In any of the following:

One of the following:

• Rural Hospital • Aboriginal Community Controlled Health Service • Rural Generalist Practice • RFDS

• Anaesthetics • Obstetrics and Gynaecology • Surgery • Population Health • Remote Medicine • Emergency Medicine • Indigenous Health • Adult Internal Medicine • Mental Health • Paediatrics

s 0!4)%.4 (!.$/543 s '5)$% 4/ '5)$%,).%3 s %!2. #0$ 0/).43 s #/.&%2%.#% #!,!.$%2 s 2%3/52#% ,)"2!29 s ,%'!, !.$ &).!.#)!, !$6)#%

Find MO’s coverage for registrars at medicalobserver.com.au/registrar or search the registrar section at medicalobserver.com.au/advancedsearch 42

The

General Practice Training Landscape

a force in GP training

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.

raining as a GP Registrar in the Australian Defence Force (ADF) offers opportunities and challenges. ADF Registrars must meet the same educational requirements but there are some specific policies relating to ADF GP Registrars to allow for the exigencies of service. These include leave provisions, transfer between RTPs and modified requirements regarding work in outer metropolitan and rural areas.

Civilian and military posts General Practice Terms are undertaken through a combination of civilian and military posts, known as composite terms. Generally, composite terms are accredited only after an initial full-time civilian term, usually a three-month Rural Term (see the AGPT website for policies).

While most ADF Registrars will select the General stream, exposure to Rural General Practice provides valuable experience in the decisionmaking, 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. This requires consideration of the proposed learning plan, supervision arrangements and access to support, and requires liaison with the RTP Medical Educator and the State Censor. Initially, Medical Officers (MOs) in the ADF are encouraged to specialise in primary care. This is important because whether in Australia or deployed, ADF personnel need access to high quality primary health care. There are also opportunities to specialise in Public Health,

Medical Administration, Occupational Medicine and Sports Medicine, known in Defence 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 directly from universities and others from within the Services. Those recruited from within the Navy, Army or Air Force will have had a prior career in the ADF before selection for re-specialisation to MO. A small number join as direct entry qualified medical practitioners. Medical students and trainees are considered ADF members and attract a salary and

Remuneration

other ADF benefits such as superannuation, allowances, medical and dental care, and accommodation options while under training. The MO’s primary duty is to train at medical school, then complete PGY1 and 2 prior to their first full-time posting to an ADF unit. At the unit, the MO receives further training, in parallel with the AGPT, including officer training, Early Management of Severe Trauma (EMST), and specialist courses such as Aviation Medicine or Underwater Medicine. At the same time, the MO gets acquainted with the military

medical system and the environment in which they work.

Clinical competency levels Clinical employment is based on progression through clinical Competency Levels (CL). Initially 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, but at CL2, the real work of a military MO can start.

“You have the opportunity to manage young men who would normally present reluctantly in the wider community. The exposure to areas such as Sports Medicine, Travel Medicine and Occupational Medicine is significant.”

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 consolidated revenue. 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.

Scope of work ADF MOs are the primary care physicians for ADF personnel. This unique demographic necessitates concurrent exposure to the broader Australian community through civilian and composite terms. Although the exposure to Paediatrics and Geriatrics is limited within the Defence environment there are opportunities. For example, you have the opportunity to manage young men who would normally present reluctantly in the wider community.  45

General Practice Training Landscape

Unique challenges

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

The exposure to areas such as Sports Medicine, Travel Medicine and Occupational Medicine is significant.

Humanitarian efforts Additionally, ADF MOs need skills to operate at the front line wherever the ADF deploys forces or undertakes humanitarian operations such as help for the injured from the Bali bombing or tsunami disaster relief in Banda Aceh. The Defence website lists current military operations in Australia and overseas, most of which involve an MO presence. After completing their initial obligation, MOs may choose to transfer to the Reserve Forces, however some continue full-time and provide ongoing leadership in Australiaâ&#x20AC;&#x2122;s military medical services.

The RACGP also has a Chapter of Military Medicine for GPs employed in the Australian Defence Force. MOs in the ADF find opportunities to participate in diverse experiences in primary care, reflecting the diversity of General Practice overall. They operate as part of, and often lead, a multidisciplinary team in achieving visible outcomes in a field that is frequently highlighted as worthwhile and promoting Australian interests. Service as a Defence MO provides a supportive, collegiate environment, but it is not for the faint-hearted. The spectre of military discipline is actually not too far removed from other ideas of self-discipline and responsibility. Other exciting challenges include learning about the military medical system, military specialised areas such as Aviation, Underwater and Sports Medicine and the opportunity to move interstate and deploy overseas supported by the organisation.

Contributed by Dr Geoff Menzies

General Practice Training Landscape

Jargon

buster

Acronyms and abbreviations abound in the language of GP training. Crack the code here! AAGP – Australian Association of General Practitioners AAPM – Australian Association of Practice Managers ACIR – Australian Childhood Immunisation Register ACRRM – Australian College of Rural and Remote Medicine One of two General Practice colleges. Has a curriculum of educational objectives for rural GPs and a Fellowship process for vocational recognition. ADGP – Australian Divisions of General Practice The national body that represents the Divisions. Now known as Australian General Practice Network. 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. 48

AGPN – Australian General Practice Network The national body that represents the Divisions. Previously Australian Divisions of General Practice.

ARSP – Advanced Rural Skills Post

AGPT – Australian General Practice Training The training program for GP Registrars.

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.)

AIDA – Australian Indigenous Doctors Association AKT – Applied Knowledge Test A component of the RACGP Fellowship exam. 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

CMO – Career Medical Officer

DHAS – Doctors Health Advisory Service

FARGP – Fellowship in Advanced Rural General Practice FRACGP – Fellow of the Royal Australian College of General Practitioners GPET – General Practice Education and Training Limited Government limited company which funds and contracts with RTPs. GPR – General Practice Registrar; GP Registrar

DVA – Department of Veterans Affairs

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 currently free.

EBM – Evidence-based medicine

GPRIP – General Practice Rural Incentives Program

AMH – Australian Medicines Handbook

ECT – External Clinical Teacher

GPSA – General Practice Supervisors Association

AMSA – Australian Medical Students Association

FACRRM – Fellow of the Australian College of Rural and Remote Medicine

HIC – Health Insurance Commission Now known as Medicare Australia. 

AMA – Australian Medical Association An independent organisation that represents the professional interests of all doctors including political, legal and industrial.

DoHA – Department of Health and Ageing The Commonwealth Government Department responsible for health and ageing.

General Practice Training Landscape

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 10 Year Moratorium. JAC – Joint Advisory Committee JCC – Joint Consultative Committee KFP – Key Feature Problems A component of the RACGP Fellowship exam. MBS – Medicare Benefits Schedule ME and TA – Medical Educators and Training Advisors One of these people will give advice and guidance about your training. MCQs – Multiple choice questions (a component of the RACGP Fellowship exam) NGPSA – National GP Supervisors Association Not to be confused with the SLON (Supervisor Liaison Officer Network), although they are 50

General Practice Training Landscape

essentially same people. NGSPA is the GPRA equivalent for Supervisors. They undertake an advocacy role for Supervisors, particularly in terms and conditions negotiations.

PIP – Practice Incentives Program

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

QA and CPD – Quality Assurance and Continuing Professional Development

OSCE – Objective Structured Clinical Examination A component of the RACGP Fellowship exam. OTC – Over the counter OTD – Overseas trained doctor – see IMG Also known as IMGs (international medical graduates). May be subject to the 10 Year Moratorium. PBS – Pharmaceutical Benefits Scheme/ Pharmaceutical Benefits Schedule

PGPPP – Prevocational General Practice Placement Program

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.

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 RDWA – Rural Doctors Workforce Agency RFDS – Royal Flying Doctors Service RRIPS – Registrars Rural Incentive Payments Scheme To be replaced by the General Practice Rural Incentives Program (GPRIP) from 1 July 2010. RLO – GP Registrar Liaison Officer Employed by an RTP to represent and advocate for GP Registrars. RMO – Resident Medical Officer RPBS – Repatriation Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Schedule RROC – Registrar Representative on Council  51

rave

registrar

Dr Benjamin Carew My RTP is Rural and Regional Queensland Consortium (RRQC).

My current post is at the Emu Park Medical Centre on the amazing Capricorn Coast of Queensland. I am doing an ARSP in Medical Education, am a VMO Dermatology at the local hospital and a board member at the Capricornia Division of General Practice.

A typical workday for me involves being woken by my human alarm clocks (daughters). After two or three coffees I walk 10 metres to work, nervously check how overbooked we are and plough on. After work I hurry home to my kids who just want to use me as a climbing toy.

My GP role model is Doc Martin because I wish I could say the things he does. After hours I love to listen to music. I collect vinyl.

A quirky fact about me is I played the triangle for the area band at school.

RRADO – Registrar Research and Development Officer RSRF – Registrar Scholarship and Research Fund RTP – Regional Training Provider RTPs tender for contracts from GPET to provide regionalised GP training. SBO – State-Based (Divisional) Organisation A State-funded organisation, not always directly linked to ADGP or individual Divisions. Provides some educational activities that GP Registrars can attend. SIP – Service Incentive Payment SLO – GP Supervisor Liaison Officer Employed by an RTP to represent and advocate for GP Supervisors. TGA – Therapeutic Goods Administration TMO – Trainee Medical Officer UGPA – United General Practice Australia VMO – Visiting Medical Officer VR – Vocational registration WONCA – World Organisation of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians

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

4 Real-life

GP EXPLORERS Share the real-life stories of GP Registrars who have explored GPland’s well-worn paths and roads less travelled.

Real-Life GP Explorers

Luck

DO IT NOW

of the

For further information regarding RACGP overseas training posts, visit racgp.org.au

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

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

Picturesque County Donegal I worked in General Practice for a couple of months in the town of Ballybofey in County Donegal, in the picturesque north-west of Ireland. My partner put paid work on hold and became the full-time carer of our daughter. I think we each thought we had the better deal.

The economic boom of the Celtic Tiger had drawn to a close and the recession had hit hard where I was working, with unemployment high and lots of unfinished construction in an area that was already one of socio-economic disadvantage.

Salary

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

Ballybofey and its “twin town” Stranorlar are divided by the river Finn, and famous for salmon fishing. 54

Donegal is adjacent to Northern Ireland, and has an interesting history in addition to being wet, rugged and spectacular in its geography.

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

My income was a salary paid in Australian dollars, which was unfortunate given the exchange rate

There are also overseas training posts available when training to the ACRRM curriculum, visit www.acrrm.org.au The Irish exchange program is regularly offered through getGP and may also be arranged through some other RTPs.

at the time. Sadly, the recession had not yet hit Irish food prices.

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

New ways of working Working in a new health system took a bit of getting used to. Patient presentations were, of course, similar to home, but I did come to realise how much is shaped by financing, resources and culture.

Home visits are much more common than I was used to. Out-of-hours care is provided through a co-operative, servicing a large region. A lack of trained paramedics means a lot of doctors’ time can be spent attending patients outside the surgery.

Bemused looks Quirks included calling the patients using a pushbutton system over a loudspeaker. It seemed a bit too much like a fish and chip shop to me. I endured the bemused looks of staff and colleagues and continued to walk the corridor to call each patient in person. Other differences included not having access to imaging (resulting in a lot more referrals to Consultants or Emergency than at home), 

“Needless to say, the Irish are a sociable and hospitable lot, from providing play dates for my partner and daughter to after-work dinner and drinks…” 55

Real-Life GP Explorers

“pathology collectors” not existing (nurses or doctors take all the bloods), and the astounding presence of a dot-matrix printer in my consulting room to generate both scripts and letters. The 9.30am starts were definitely a bonus.

Dinner and drinks Needless to say, the Irish are a sociable and hospitable lot, from providing play dates for my partner and daughter to after-work dinner and drinks, and culminating in a graduation party for the 2009 cohort in a “barn” belonging to one of the trainers.

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

Contributed by Dr Kelly Seach

Real-Life GP Explorers

Reaching the

kids

DO IT NOW If you are looking for a non-procedural Advanced Rural Skills Post (ARSP), why not consider Paediatrics? Talk to your RTP to find out what opportunities exist in your area. If this Paediatric Outreach job sounds ideal for you, contact TMT now.

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

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

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

The challenges There are some unique issues, such as having to apply for 20 different provider numbers for each location we visit. The role involves extensive travel by car to some local communities within a twohour drive of Cairns including Atherton, Mareeba, Innisfail and Yarrabah, as well as travel via charter 58

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

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

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

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

Contributed by Dr Aileen Underhill 59

Real-Life GP Explorers

Diary of a

6.30am

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

6.45am

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

8.35am

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

Rural Doc

And thus starts my day.

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

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

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

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

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

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

9.00am

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

“Things not going so well, Trumby?”

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

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

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

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

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

12.30pm

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

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

6.00pm

Cleaned up and on my way to squash. The nurses at the hospital know it’s squash night and the game should be finished by 7. Sure enough, at about 7.10 the phone rings.

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

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

2.00pm

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

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

“No, they’ll probably keep you in till they are sure the graft’s taken.”  61

Real-Life GP Explorers

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

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

AUST PERMANENTS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10.10pm

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

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

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

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

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

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

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

“Eventually Hully states: ‘If you don’t take my finger off I’m going to go home and chop it off myself!’ The look in his eye convinces me he is fair dinkum.” 62

I could do with an Adventure!

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

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

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

Contributed by Dr Ross Lamplugh, Ochre Recruitment

www.OchreRecruitment.com

Freecall

1800 99 22 30

Real-Life GP Explorers

Doctor ON ICE Fancy being the lone doctor in an icy, remote camp of international scientists ON THE GREENLANDIC ICE SHEET? Dr Lizzie Elliott tried it – and loved it. Waking up in a tent at sub-degree temperatures might not be the average GP’s cup of tea. To be honest, the idea did not appeal to me, but I was far too distracted about the challenge of working as a doctor in such an extreme location as the Greenlandic ice sheet to worry about ice crystals on my sleeping bag. As a final year student, I undertook a General Practice elective in Copenhagen, Denmark. Little did I know that three years down the track I would be working with the Danish University on the Greenlandic ice sheet as a Field Medical Officer. I have completed two stints now of three and sixweek placements and am keen to return for more.

Climatic research North Greenland Eemian Ice Drilling (NEEM) is a semi-permanent camp (2007-2011) set in the central North Greenlandic ice sheet with the 64

aim of drilling the ice core to bedrock (around 3,000m), allowing analysis of the ice for climatic research. It is a collaborative effort that runs during the Northern Hemisphere summer. Countries assisting the Danes are Australia, Belgium, France, Germany, Holland, Iceland, Norway, Sweden, Switzerland, UK, China, Japan, South Korea, Canada and USA. All NEEM participants undertake a similar medical check to Antarctic medicals so everyone is in good health prior to departure, and dental extractions and appendectomies are not obligatory. There can be up to 36 people living in camp – scientists, electricians, carpenters, plumbers, mechanics, cooks, mountaineers and a doctor.

Communal living There is a communal living and eating “dome”, three storeys high, where everyone gathers for

set meal times and R&R with movie nights, a soccer table and internet hub. The other means of communication is a satellite phone. People sleep in heated Weather-port tents and unheated tents, with larger Weather-ports acting as garages and a workshop. This year saw the addition of a new sauna and table tennis table in camp, which boosted morale, and many new ping-pong games were invented. Despite all the fun and games there was serious scientific work under way with firn-gas pumping, seismic recording, radar layer assessment, shallow ice coring and deep ice coring with on-site processing.

Personnel rotation The main transport to NEEM is via ski-equipped Hercules aircraft manned by the US Air Force. On site there are skidoos, tractors and a treadmodified 4WD Toyota for speedy movement

around the camp and transport of heavy items. Rotation of camp personnel occurs every three weeks or so via Hercules, when food, building materials and medical supplies are also restocked. With the changeover of doctors there are often a few hours while the plane is unloading and reloading for a medical handover.

Prince Frederik During my 2009 season I was in camp for the arrival of 20 distinguished visitors (DVs) and media, who bring greater attention to climate issues by reporting on the scientific research at NEEM. To my knowledge, none of these people had been medically screened prior to arrival so I spent the time close to the AED and oxygen apparatus! Earlier in the season NEEM was visited by HRH Prince Frederik of Denmark and the Prince and Princess of Sweden. 

“There can be up to 36 people living in camp – scientists, electricians, carpenters, plumbers, mechanics, cooks, mountaineers and a doctor.” 65

rave

registrar

Real-Life GP Explorers

Unlike Antarctica, there is no prerequisite for surgical or anaesthetic experience (although it’s beneficial). This is because the site is not as isolated as Antarctica, and air retrievals can be arranged to the nearest air base two hours away. Fortunately, there were no emergencies, mainly superficial injuries, some dental concerns, many musculoskeletal complaints and counselling. Other roles undertaken by the doctor are OH&S officer with advice on safe lifting practices and sun protection as well as hands-on public health matters such as digging new long drops (toilets) and maintaining a clean water supply through the ice melter.

Polar bears Due to the open plan design of the dome, my work area consisted of a desk, where I kept all the medical supplies, and non-intimate assessments were conducted. Quite a few people in camp had done first aid training, which was reassuring to know in case of a medical emergency. Plus the drill site for the ice core was 8m below the ice surface, which meant that the mountaineer could coordinate vertical retrieval if required. There was someone permanently on site who had access to a firearm should a polar bear wander into camp. This was unlikely due to NEEM’s distance from the coast. Phew! General Practice training has given me the ability to deal with my medical encounters on the ice, both physical and mental. The 66

Dr Kristen Gibbes

DO IT NOW If you are interested in Expedition Medicine, talk to your RTP about the options. GPTT in Tasmania has an Extended Skills Post in Expedition Medicine as well as a series of highly regarded, experiential short courses on different aspects of Expedition Medicine. CityCoastCountry offers an Expedition Skills Post in the ski fields. Visit www.ccctraining.org or www.gptt.com.au

flexibility of the training and the suppor t of staff at General Practice Training Tasmania (GPTT) have been integral in my diverse GP experiences as a Registrar.

Expedition Medicine Applying for Expedition Medicine training as an adjunct to my RACGP training through GPTT, and undertaking a week-long course at Freycinet gave me improved skills, greater knowledge and more confidence in dealing with extreme conditions and cold-related injuries (particularly as I grew up and trained in North Queensland). I look forward to gaining more experience in extreme climates, with Antarctica a future working goal.

My RTP is Valley to Coast, although I completed the first half of my training with SIGPET (GP Synergy).

My current post is temporarily on hold. I am on maternity leave but next term will return to my post at Umina Surgery on the Central Coast.

A typical workday for me consists of seeing patients from 8 till 5.30, with a 1.5 hour lunch break for catch up, lunch and paperwork. As a Registrar, I have a varied caseload.

What I love about General Practice is the variety of clinical presentations, the constant learning, getting to know my patients and feeling I’m really helping them. I also appreciate the flexible work arrangements for a sustainable work-life balance.

After hours I love to walk to the beach with my husband and son.

My favourite medical TV show is Scrubs because it’s hilarious and I love the way it pokes fun at the hospital hierarchy.

Contributed by Dr Elizabeth Elliott 67

Real-Life GP Explorers

Pick a flavour Have you tried these training term flavours yet? Discuss these training and career options with your RTP.

5 Academic OPTIONS From research to teaching, from education

Aboriginal Health Academic Medicine and Research Anaesthetics Australian Defence Force Aviation Medicine Dermatology Drug and Alcohol Emergency Expedition Medicine Family Planning and Sexual Health Forensic Medicine Geriatrics HIV Medicine Men’s Health Mental Health Musculoskeletal Medicine Obstetrics Occupational Medicine

Paediatrics Palliative Care Royal Flying Doctor Service Sports Medicine Surgery Travel Medicine Tropical Medicine Women’s Health Plus many more

management to the medical media, the academic side of General Practice offers many exciting options.

Academic Options

academic life

Academic Options

This

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

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

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

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

Why do an Academic Term?

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

What is an Academic Post? Basically, an Academic Post is an opportunity to spend a term of your General Practice training involved in research and teaching. It can be completed as an Extended Skills Term, over six months full-time or 12 months part-time. Registrars are usually supervised by a university’s Department of General Practice, or a rural clinical school. You should have the opportunity to get involved in the academic life of the university you are based at. This could mean attending meetings, sitting on curriculum committees, or just talking to other people about the research they are doing. You will also get to be involved in the teaching activities of 70

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

DO IT NOW When can you do an Academic Post?

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

How do you apply?

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

For more information

Check out www.agpt.com.au and follow the links to Training Posts then Academic Training or contact the RRADO. The RRADO is a Registrar hired part-time to help support others with a research interest. Contact the current RRADO at rrado@gpet.com.au (The RRADO position is actually a great job as part of your training if you are interested in Academic General Practice – see page 74.)

rave

registrar

Academic Options

Dr Carly Taylor

You will get to meet some amazing inspiring people, both medical and non-medical.

My RTP is Western Australian

You will become an expert in an area – something unusual in General Practice.

General Practice Education and Training (WAGPET). at FPWA Sexual Health Services.

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

A typical workday for me is only

Other tips

My current post is Extended Skills

half a day, two or three days a week.

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

What I don’t love so much is being called “just a GP”.

My GP role model is GP obstetrician Dr Greg Caddy because of the dedication and care shown to his patients. After hours I love to spend time with my two-year-old daughter and husband, mostly gardening and renovating at the moment.

You will be paid at “base rates” to do an Academic Term and your income is likely to drop. If this is an issue, consider doing your term part-time over 12 months and supplementing your income with some extra clinical work or teaching.

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

Registrar Research Workshop 2010 The 2010 workshop will be held between May and July (with applications a couple of months before). Check the website for the latest at 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.

Take note of when applications are due. They are due earlier than you think and will take longer to put together than you anticipate. Allow plenty of time. The best thing about Academic General Practice for me? It makes me feel like I can be a better doctor for my patients. And I know that by combining teaching and research with my clinical work I will always feel energised by a career that offers me something different every day.

Contributed by Dr Adrienne Burchard with Dr Rachel Lee

My favourite travel destination is home. A quirky fact about me is that when I was on maternity leave I started The Green Nappy Company. I’m passionate about looking after the environment. 72

Academic Options

RRADO year

The Registrar Research and Development Officer (RRADO) role with GPET is a great gig for Registrars interested in Academic General Practice says Dr emily farrell.

hat is the RRADO you may ask? The RRADO is the Registrar Research and Development Officer. This is a part-time position with General Practice Education and Training (GPET) held by one Registrar per year interested in Academic General Practice and education. The position combines very nicely with clinical work and can count as an Extended Skills Term for FRACGP candidates.

What is involved? To give you an idea of what is actually involved, I would like to share my typical week. On Monday I work in GPland as a Subsequent GP3 Registrar. On Tuesdays and Wednesdays I work from home with fast broadband, a laptop and mobile phone, all supplied by GPET. On Thursdays I work again in clinic and Fridays are meant to be for me but I usually spend a few hours doing RRADO work. I also keep a check on my RRADO emails most evenings and weekends.

“Once a month I would travel. This may be to the GPET office in Canberra for valuable face-to-face time with colleagues, or to present a workshop or attend a conference.”

Travel

Workshops

Once a month I would travel. This may be to the GPET office in Canberra for valuable faceto-face time with colleagues, or to present a workshop or attend a conference. I also attend regular teleconferences for the RACGP National Research and Evaluation Ethics Committee (every six or eight weeks) and face-to-face meetings for the RACGP National Standing Committee – Research (about four times a year).

The biggest activities are organising the three-day Registrar Research Workshop and two one-day Academic Registrar Workshops. The RRADO also organises RLO Workshops twice a year. This covers setting the program, finding speakers, developing resources, leading the events of the day and follow up such as evaluation.

Areas of responsibility The main areas of responsibility are the promotion and development of academic Registrars and posts and the professional development of Registrar Liaison Officers (RLOs). I have also had input into GPET policy and activities. Generally, my day-to-day work involves answering questions about the Academic Posts from the GP Registrars, RTPs and universities, promoting the Academic Terms, supporting Registrars doing Academic Terms and organising workshops.

There is also the opportunity to do a small research project and you sit on the GPRA Advisory Council.

Critical thinking and research You will also get to provide GPET management with your unique insight into Registrar professional development, especially the promotion of critical thinking and research within AGPT.

All in all, it’s a wonderful job and really extends your leadership skills and exposes you to the world of Academic General Practice and education management like no other opportunity as a GP Registrar.

Contributed by Dr Emily Farrell

DO IT NOW To find out more about this position, contact the current RRADO, rrado@gpet.com.au

Wonderful job Don’t worry about being an instant expert, you will have great support from a project officer and the GPET education team. 75

rave

registrar

Academic Options

Give it a go

as an

RLO

Being an RLO will add variety to your week, broaden your skills and open doors for you personally and professionally, says Dr Tim Francis.

ant to be paid for helping your peers? Like to enjoy all expenses paid trips around Australia for meetings and other assignments? Then consider becoming an RLO.

choose to take on further roles within the RTP with medical education, exam preparation and RTP board representation common choices.

Registrar Liaison Officers (RLOs) are employed by each Regional Training Provider (RTP) to provide pastoral care and advocacy support for their Registrars. They are often a first point of call for Registrar concerns and queries regarding National Minimum Terms and Conditions.

Each RLO is a member of the GPRA Advisory Council. They represent the Registrars from their RTP at the GPRA level,

RLOs are acutely aware of the broader issues affecting Registrars at any given time because they are still Registrars themselves. Depending on the RTP, most RLOs work around 10 hours per week, all of which can be counted towards training as a Special Skill. Some RLOs 76

GPRA Advisory Council

and they also represent GPRA to their fellow Registrars. The GPRA Advisory Council is a collection of national RLOs that meets every six months to discuss current and ongoing Registrar issues and assist in directing GPRA attention to matters where it is needed most.

DO IT NOW If you are looking to add something extra to your General Practice experience and gain valuable skills for your future career by becoming an RLO, speak to your current RLO or your RTP. We look forward to meeting you.

When they are not meeting face to face, the GPRA Advisory Council is in constant communication through a list server. This allows GPRA to address issues, queries and opportunities as they arise. While any member of GPRA can become a GPRA Board member, many RLOs have taken on Board positions as a result of their time working on the Advisory Council.

Developing new skills For me, working as an RLO has meant adding variety to my working week while meeting many new people and opening the door to a range of different career pathways for general practitioners. I have gained greater insight into the General Practice training landscape and become actively involved in the promotion and direction of General Practice training in Australia while also developing skills in business management, medical education, negotiation and communication.

Contributed by Dr Tim Francis

“Depending on the RTP, most RLOs work around 10 hours per week, all of which can be counted towards training as a Special Skill.”

Dr Elaine Tho My RTP is Gippsland Education and Training for General Practice (getGP).

My current post is at Wonthaggi Medical Group as part of the Rural Pathway. A typical workday for me kicks off with a ward round of my inpatients at the local hospital, a strong latte from the clinic’s coffee machine, four hours of clinic patients, an hour’s lunch in the park and finally three and a half hours of clinic patients. I then destress at the beach or gym. Every fortnight I visit the local nursing home and occasionally the hospital Emergency Department for patient admissions. What I love about General Practice is the diverse clinical presentations and ability to specialise to your heart’s content.

What I don’t love so much is the frustrations sometimes associated with acquiring specialist advice. After hours I love to stroll along the beach and watch the sunset with my Paulie, pump iron or do any form of activity to raise the heart rate. 77

Academic Options

DO IT NOW If you would like to apply, contact the AFP medical editor Jenni Parsons to express your interest. The AFP will work out who they want to support and you apply for an Academic Post through the central GPET process. You can get the inside scoop from Dr Kate Kelso at AFP in early 2010, or the new Registrars from February.

Ever considered being a medical journalist or editor? Dr rachel lee recommends a stint with a leading GP journal one day a week.

f you fancy trying something a little different, a new Medical Editing Post for Registrars with leading GP journal Australian Family Physician (AFP) may be for you. The post is one day a week and offers a chance to try out your medical editing and writing skills with great support. You write the clinical challenge quiz, send manuscripts off for peer review, edit submitted articles and commission articles for some of the theme issues. You also get to write editorials, and shaping articles on a particular topic for a GP audience is a great way to refine your knowledge.

How did the position start?

What it’s been like for me

2010 AFP positions

The AFP Registrar position started when a GP Registrar had an idea. She wanted to strengthen her medical writing so she approached the AFP editor. They hatched a plan, she applied for an Academic Post and created the first Registrar Medical Editing Post.

This year has been a great experience – I think doing the combined post provides the best of both worlds.

There will be two AFP Registrars in 2010, one at the AFP office in Melbourne and the other in Canberra with some commutes and remote work. (The joys of the internet – all manuscripts are processed via an online system so you can do it from anywhere.)

How I got involved I was the third Registrar to take on the post. I found out about it by meeting Kath the trailblazer at the annual Registrar Research Workshop. I stewed on the idea for some time then decided to apply for an Academic Post, combining the AFP position with work at Melbourne University.

“The AFP role has given me great insight into the breadth of academic work and improved my reviewing and writing skills.” 78

For more general information about Academic Posts contact the Registrar Research and Development Officer (RRADO) on rrado@gpet.com.au

The university part allowed me to hone my tutoring skills and grapple with my own qualitative research project with fantastic supervision, and introduced me to a dynamic academic unit. The AFP role has given me great insight into the breadth of academic work and improved my reviewing and writing skills. The AFP team are a friendly bunch and writing the clinical challenge is a great way to revise the theme each month. (It’s the perfect exam preparation job.)

Contributed by Dr Rachel Lee

The only tricky thing is fitting it all in so keep your research project and teaching commitments manageable!

Academic Options

Learn teach as you

One way to find out if you really know something is to try to teach it to someone else. So why not make teaching part of your vocational training?

eaching reinforces your own knowledge while helping someone else to learn. And it can be lots of fun too! Teaching is now an important part of the RACGP curriculum, teaching opportunities for Registrars are increasing and lots of RTPs are offering training in teaching skills so you can feel more confident to try it out. GPRA is keen to encourage as much support as possible for Registrars who teach.

Do in-practice teaching Many practices that offer placements for GP Registrars are also involved in medical student teaching. GP Registrars are in a great position to be involved with the students, either in offering tutorials, having the student sit in your consultations, or watching them doing a consultation. The level of your involvement should be within your comfort zone as in-practice teaching can be 80

challenging – although like any new skill it gets easier.

Teach medical students Universities are always looking for new tutors and examiners. Lots of Registrars get involved in these tutorials – it’s a great supported way to start teaching. Teaching medical students communication skills and examination techniques is also a great refresher for the GP exams. Examining is highly recommended – it’s excellent exam preparation to see what it’s like on the other side of the fence. Tutoring adds variety to the week and is quite social – the meeting with the other tutors before each tute is a great networking experience.

Be an academic Registrar Academic Posts are usually based in the General Practice department of a university. A combination of research and teaching offers a taste of a career as an academic GP.

DO IT NOW Talk to your Supervisor, contact your RTP or university and take the opportunity to be involved in teaching.

Be a Registrar Medical Educator Some RTPs have employed positions for Registrar Medical Educators (MEs) or junior MEs. This provides experience in teaching other Registrars, while having direct input into what we as Registrars need to learn.

Contributed by Dr Rebecca Quake and Dr Rachel Lee

Academic Options

Class act

Many Registrars enjoy treating children and adolescents. If you’re comfortable fielding the odd curly question, then why not take your interest into the classroom, suggests Dr Don Cameron. Many of the Divisions of General Practice run Doctor in the Classroom programs that are great to be involved with. These generally entail being put in contact with teachers at local primary and secondary schools and visiting the students in the classroom. This gives you great latitude to provide presentations to a range of age groups.

to defuse anxieties and get kids familiar with the basic medical equipment such as stethoscopes, otoscopes and tongue depressors. Listening to their own hearts or their friends’ hearts never ceases to generate great excitement and creates opportunities for some introductions to their own bodies.

I have enjoyed being involved in my local program in Adelaide for some time and I find it a rewarding opportunity to hone my child and youth communication skills.

Listening to the breath sounds of their classmates is a good time to reinforce the dangers of smoking. Gratifyingly, most children are already quite toxic about cigarettes from a very early age.

Younger children

Almost every child has a story about going to the doctor that they are happy to share. It’s always interesting how many children have family members with a chronic illness that they can 

Children in the early years are often just interested in what a doctor does and what a visit to the doctor entails. This is a great opportunity 82

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

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

Benefit from our 25 years experience

Call 1300 137 142 www.medicalrecruitment.com.au

Academic Options

tell you about in remarkable detail. These stories obviously require some sensitive handling but can provide some remarkable insights.

Older children Older children often have a specific issue they want to explore. For example, one class I met with wanted to know about “germs”. After talking about good and bad bacteria and where they lived we had a great time gowning and gloving some of the class while providing some important hygiene messages.

“Interacting with children and teenagers in schools is fun and challenges you to be flexible and really develop your teaching and communication skills.” Teenage students will be looking for more information-intensive sessions that link to their science and biology studies. Demonstrating how we test vision, coordination and reflexes is fertile ground. Sessions with senior students often revolve around sexual health and are a good time to reinforce some important public health messages. The Dr Yes initiative in Western Australia is a great example of this. Adolescents really appreciate non-judgmental, straight talk with someone from outside their immediate world. 84

DO IT NOW If you would like to find out more about participating in Doctor in the Classroom, contacting your local Division is a great place to start. Note: There are no formal credits for being part of this program but you get paid and can add it to your training portfolio.

P R E PA R IN G

for practice

From handy checklists to help you get ready for your Fielding questions Interacting with children and teenagers in schools is fun and challenges you to be flexible and really develop your teaching and communication skills. Questions can come right out of left field. I vividly recall an 11-year-old asking in front of the whole class how he would know if he was gay. So, if you enjoy interacting with your younger patients and are looking for a break from your clinical routine – get into the classroom!

Contributed by Dr Don Cameron

first GP Term to mapping the Medicare maze, here’s how to prepare yourself for practice.

Preparing for Practice

in hospital?

Think General

Practice

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

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

Here are a few points that will help you make the most of your hospital experience as a GP Registrar. Choose your terms. Choose terms that will give you experience with common GPmanaged conditions. Mandatory and other useful rotations are

listed in the box below. Any experience with skin, ears and eyes will stand you in good stead. If a GP placement is offered at your hospital, take full advantage. Fine-tune your practical skills. Ask nurses to teach you skills such as giving vaccinations

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

(especially to children) and dressing wounds. Pick up useful procedural skills. Learn procedural skills that may be useful in General Practice; for example, joint injections. Learn the art of referrals. Think about what information is pertinent on a referral letter sent with a patient to Emergency. Discuss the referral process with Consultants. What do they like in a referral? What tests should be ordered prior to referral? How urgently do they need to see particular cases? Be curious about management decisions. In addition to the acute management decisions you will have made in the hospital setting, as a GP you will also be initiating and monitoring long-term management of chronic conditions. Talk to your Consultants and Registrars about up-to-date guidelines and approaches to chronic disease management.

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 list servers where Registrars can communicate with their RLO or other Registrars in their region. Make use of this and other opportunities such as social or educational meetings to get to know other GP Registrars.

DO IT NOW For more information about compulsory hospital rotations for General Practice training, refer to the Policy on Compulsory Components of AGPT at www.agpt.com.au If you have any questions or problems during hospital training, contact your RLO or GPRA directly.

Contributed by Dr Kate Beardmore and Dr Kate Kelso

Preparing for Practice

Before your GP Term:

Get it sorted! DO IT NOW If you’re getting ready to start your GP Term, here are a few things you’ll need to organise.

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

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.)

When do I start my term?

State Medical Board registration in the State or Territory where you intend to practise.

GP Terms are six months each when done fulltime. They tend to run from the start of February to the start of August and then from the start of August to the start of February. Note: GP Term dates may differ from RMO hospital dates. Make sure you have arranged leave to start your GP Term on time.

Employment Contract and Confirmation of Employment Agreement. 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 142 or go to www.gpra.org.au

What forms do I need?

What organisations should I join?

Your Regional Training Provider (RTP) should help you with this list. In summary:

All are optional and this list is not exhaustive:

Application for an HIC provider number. Allow at least six weeks for this to be processed. Application for Recognition as a General Practitioner (AGPT). Medical indemnity – you must have your own indemnity to cover GP practice. Indemnity for hospital work is a different scenario. (It is a 88

General Practice Registrars Australia (GPRA), your national GP Registrar representative group – free membership. Join at www.gpra.org.au or ask your Registrar Liaison Officer (RLO) for a membership form. Royal Australian College of General Practitioners (RACGP). You must be a member prior to exam enrolment. Joining earlier has

If you’ve read this and still have questions, contact: Your RLO (see page 76 or visit www.gpra.org.au for contact details) or ask your RTP GPRA: enquiries@gpra.org.au or telephone 1300 131 198 Your Medical Educator (see your RTP) Your Supervisor

member benefits, such as a subscription to check magazine. Go to www.racgp.org.au Australian Medical Association (AMA). Contact your State branch. For details, go to www.ama.com.au Your local Division of General Practice. Find out who to contact from your practice or RTP. Australian College of Rural and Remote Medicine (ACRRM). Go to www.acrrm.org.au Rural Doctors Association (RDAA). Telephone (02) 6273 9303 or go to www.rdaa.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 and equipment in the rooms, otherwise, start collecting your own. Consider an ear thermometer for kids and magnifying glasses. Consider using equipment you are comfortable with (for example, your own tendon hammer and neuro exam kit, your own glucometer, etc). Remember, most practices will have this equipment available, at least until you decide what you would like to use.

Doctor’s bag: 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 have it online. You will soon find your favourites.  89

Preparing for Practice

Journals and publications Australian Family Physician (AFP), check (Both available as part of your RACGP membership) MJA Australian Prescriber, RADAR. Produced by the National Prescribing Service Ltd www.nps.org.au Medicine Today Medical Observer Australian Doctor Forms for free subscriptions to these are available from the Australasian Medical Publishing Company (02) 9562 6666 or www.ampco.com.au

Books 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.) Clinical Practice Guidelines – FPA Health Therapeutic Guidelines – print or electronic An orthopaedic/fracture management book (eg Practical Fracture Treatment – McCrae and Esser) Australian Medicines Handbook MIMS Paediatric Pharmacopeia Imaging Guidelines – RANZCR Clinical Sports Medicine – Brukner and Khan Paediatric Handbook – from Royal Children’s Hospital or Westmead Oxford Handbooks (Clinical Medicine, Specialties) Your favourite Ophthalmology atlas Medical and Surgical Specialists Referral Directory (ask your practice) 90

ACRRM PDA Clinical Guidelines (free to ACRRM members) Access to Tele-derm Tele Medicine Module (free to ACRRM members) Access to Tele-tox Tele Medicine Module (free to ACRRM members) Access to Radiology Tele Medicine Module (free to ACRRM members)

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 96.

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

Preparing for Practice

GP Term

Survival Tips

In the practice:

Starting your first day at a new practice? This essential checklist of survival tips is an idiot-proof guide. In your room: Open all the cupboards in your room on entering to find where everything is. Locate where all the 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. Work 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 equipment. »» Which way the BP cuff faces, where the large cuff is kept. »» How to use speculums (different types). »» How to set up carbon dioxide snow or, if liquid nitrogen, how to fill the canisters. Put resource books (see the resource list on page 90 for suggestions) in your room if available. 92

Locate Therapeutic Guidelines on the desktop of your computer. Add useful and recommended websites to your favourites or bookmarks list on your browser (see the resource list on page 96 for suggestions). Play with software. Use a fake patient to manage a condition. Locate where information leaflets are on the toolbar (especially with Medical Director).

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

Check out the treatment room, especially where dressings, vaccines and needles are kept.

DO IT NOW

Find where the resuscitation box and oxygen is kept. Ensure you know how to use what is in the box.

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.

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. If you have a practice nurse, get to know them. They can be very helpful. 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, complex medical problems).

From 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. Ask for a list of local services from your Supervisor. »» Pathology/Radiology »» Allied health »» Specialists »» Division »» Local hearing test/optometrists Talk about your teaching requirements. Make sure you have sufficient designated teaching time and discuss how you would like to use this.

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.  93

rave

registrar

Dr John Cass-Verco My RTP is GP Synergy. My current post is at Glebe Family Medical Practice, Sydney. A typical workday for me is busy but satisfying, never procrastinating, sometimes infuriating, never dull.

What I love about General Practice is the chance to look after a family.

What I don’t love so much is the time pressure, the breadth at times (although this makes for an interesting day) and WorkCover. My GP role model is John Murtagh. Thanks for the book! After hours I love to hang out with my wife, family, friends and go surfing.

My favourite travel destination is anywhere with great surf, interesting culture and lots of natural beauty. Too many awesome spots to single one out.

A quirky fact about me is that my first word was “flower”.

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

Preparing for Practice

www.omnus.com.au www.reutershealth.com www.nhmrc.gov.au www.healthinsite.gov.au www.healthfirst.net.au www.gpnotebook.co.uk

The internet has revolutionised fast access to information for medicos. Here are some favourites for GP Registrars. Every year we include a list of useful resources that are available to help us in practice. Each year we expand and refine our list with the help of many current and past GP Registrars to make it as up to date and useful for you as possible.

Web-based databases/EBM Proquest-RACGP Library www.racgp.org.au Cochrane www.cochrane.org.au Bandolier www.ebandolier.com CIAP www.clininfo.health.nsw.gov.au Pubmed www.pubmed.gov Dynamed evidence-based database available to RACGP members www.racgp.org.au/library Clinical Evidence clinicalevidence.bmj.com/ceweb/ index.jsp

Journals AFP www.racgp.org.au/publications/afp_online.asp Postgrad Med www.postgradmed.com JournalWatch www.globalfamilydoctor.com American Academy of Family Physicians www. aafp.org/afpsearch.xml MJA www.mja.com.au BMJ www.bmj.com 96

New England Journal of Medicine www.nejm.org The Lancet www.thelancet.com Medical Observer www.medicalobserver.com.au Australian Doctor www.australiandoctor.com.au

Online learning platforms Rural and Remote Medicine Education Online (ACRRM) www.rrmeo.com gplearning www.gplearning.com.au PrimEd www.primed.com.au Genesis www.genesised.com.au/education

Organisations GPRA www.gpra.org.au RACGP www.racgp.org.au ACRRM www.acrrm.org.au AGPN www.agpn.com.au AMA www.ama.com.au RDAA www.rdaa.com.au GPET www.agpt.com.au DHAS (Doctors Health Advisory Service) www.dhas.org.au

General medical information www.myDr.com.au www.betterhealth.vic.gov.au

General topics (alphabetical order) Aboriginal Health www.winnunga.org.au www.healthinfonet.ecu.edu.au

Aged Care Alzheimer’s Australia www.alzheimers.org.au Dementia Helpline 1800 839 331 (good for patients without internet access)

Asthma and Allergy Asthma Action Plan www.rch.org.au/clinicalguide/ forms/asthmaPlan.cfm www.nationalasthma.org.au www.asthmaaustralia.org.au Australian Society of Clinical Immunology and Allergy www.allergy.org.au Anaphylaxis Australia www.allergyfacts.org.au

Cancer US National Cancer Institute (great for info on any type of cancer) www.cancer.gov Cancer Council of Australia www.cancer.org.au National Breast and Ovarian Cancer Centre www.nbocc.org.au

Cardiology Heart Foundation www.heartfoundation.com.au

Dermatology NZ Dermatology www.dermnetnz.org Dermatology Atlas www.dermatlas.com Dermis www.dermis.net/dermisroot/en/home/ index.htm

Diabetes Diabetes Management Handbook – Diabetes Australia www.diabetesaustralia.com.au Diabetes information www.diabetesnsw.com.au

Fitness to Drive Assessing fitness to drive www.austroads.com.au

Interpreters TIS 13 14 50 or www.immi.gov.au/tis www.healthtranslations.vic.gov.au

Medicare Medicare item numbers www.health.gov.au/ mbsonline

Medications/Complementary Medicines National Prescribing Service www.nps.org.au Australian Prescriber www.australianprescriber.com Australian Medication Handbook www.amh.net.au MIMS www.mims.com.au PBS www.pbs.gov.au/html/healthpro/home Merck Manual www.merck.com US National Centre for Complementary and Alternative Medicine www.nccam.nih.gov Prescription Shopping Info Service www.medicareaustralia.gov.au Doctor Shopping Hotline 1800 631 181 

Preparing for Practice

Mental Health

Paediatrics and Adolescent Health

Beyond Blue www.beyondblue.org.au Depression tools www.bluepages.anu.edu.au CBT self-help www.moodgym.anu.edu.au Black Dog Institute www.blackdoginstitute.org.au GP Psych Support www.psychsupport.com.au Mensline 1300 789 978 or www.menslineaus.org.au Lifeline 13 11 14 Kids Help Line 1800 551 800 Reachout see Paediatrics and Adolescent Health Centre for Eating Disorders www.cedd.org.au Multicultural Mental Health Australia www.mmha.org.au Crufad UNSW/St Vincent’s Hospital/WHO collaboration www.crufad.com Information for doctors about treatment of anxiety and depression plus their latest research

Westmead Children’s Hospital www.chw.edu.au/parents/factsheets Royal Children’s Hospital www.rch.org.au American Academy of Paediatrics www.aappolicy.org Centre for Advancement of Adolescent Health www.caah.chw.edu.au Children’s BMI chart www.cdc.gov/growthcharts/ ParentLink (02) 6207 1039 or www.parentlink.act.gov.au Immunisation information www.racgp.org.au/guidelines/immunisation Periods of exclusion for infectious diseases www.lbcma.org.uk/newsArticles/exclusion.asp (02) 6205 2155

Men’s Health Andrology Australia www.andrologyaustralia.org St Vincent’s Prostate Centre www.prostate.com.au

Quitline 13 18 48 or www.quit.org.au Australian Nutrition Foundation www.nutritionaustralia.org

Opthalmology

Renal Medicine

www.nei.nih.gov www.rbs.org.au www.ranzco.edu www.theeyeinstitute.com.au www.eyeatlas.com

Kidney Health Australia www.kidney.org.au

Osteoporosis www.osteoporosis.org.au WHO fracture risk tool www.shef.ac.uk/FRAX/index.htm www.bonehealthforlife.org.au www.toneyourbones.org

Preventative Health

Sexual Health and Family Planning Handouts www.shfpact.org.au Family Planning Australia www.fpahealth.org.au Genital herpes (pharma site) www.thefacts.com.au Shine SA www.shinesa.org.au Faculty of Sexual and Reproductive Healthcare (UK) www.fsrh.org Melbourne Sexual Health Centre (good factsheets) www.mshc.com.au Marie Stopes www.mariestopes.com.au 

Moving practices? Take your web resources with you It can be frustrating to build a good list of useful web resources only to have to start again when you move to a new practice. There are a couple of ways around this problem. One is to export your “bookmarks” or “favourites” list (called by different names depending on your browser) to a file on a USB memory stick and then import them on your new computer. Another way is to set up a Google account: www.google.com/accounts/ManageAccount and make your own Google homepage: www.google.com.au/ig?hl=en Next, load your bookmarks onto Google. You can then add a Google “gadget” to your homepage that contains all your bookmarks neatly organised any way you want: www.google.com.au/ig/directory?q=google+bookmarks&hl=en&root=%2Fig&dpos=top This way your bookmarks are available wherever you are and whatever computer you are using. This also helps in practices that don’t like you loading things onto their computers. If your browser has the Google toolbar: www.google.com.au/intl/en/options/ Once you have logged onto your homepage you can access, organise and add to your bookmarks directly from the toolbar. For more information visit: www.google.com/bookmarks/ www.ehow.com/how_2172112_save-bookmarks-google.html

Preparing for Practice

Sports Medicine/Musculoskeletal Chronic condition advice www.physsportsmed.com Sports Medicine Australia www.sma.org.au Knee sports www.kneesports.com.au www.worldortho.com www.wheelessonline.com

Travel www.travelclinic.com.au www.smarttraveller.gov.au www.who.int www.hsagroup.com.au www.traveldoctor.com.au www.travelvax.com.au www.masta.edu.au www.cdc.gov/travel

Women’s Health Jean Hailes 1800 151 441 or www.jeanhailes.org.au HRT information www.nhmrc.gov.au Antenatal guidelines www.3centres.com.au Pregnancy and baby health www.marchofdimes.com The Women’s Hospital www.thewomens.org.au

Miscellaneous Pathology tests for any condition www.rcpamanual.edu.au National Continence Helpline 1800 330 066

Contributed by Dr Skye Boughen, Dr Siew Lee Thoo, Dr Naomi Harris, Dr Anna Colwell, Dr Rob Wiles, Dr Don Cameron and Dr Kate Kelso

100

DO IT NOW If you have a favourite resource you think should be listed in next year’s guide, please send it to GPRA by addressing an email to: enquiries@gpra.org.au, titled “GPRA TRG feedback – web resources”

Preparing for Practice

country Practice

So you’re about to live and work in a town you’ve never heard of. How do you make the experience an enjoyable one? Hitting the wide open road for your Rural Term can be daunting, especially for city slickers doing General Pathway. But it can also be one of the most rewarding times of your life. 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.

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 12month 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.

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.

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

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.

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

If relocating with partner and children, ask about employment opportunities, local schools and childcare 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.

102

Bring along some personal items like favourite cushions and pictures that will make your new residence feel like home. Enquire about internet coverage. People often forget when relocating to the rural or remote regions of Australia that there is not always

Get to know your neighbours and people in your street.

Get involved in your community Get out of your comfort zone! Try out new experiences. Experience what your community can offer in dining out, music, the arts and outdoor recreation. Sign up as members 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 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 the end of your term it may turn the fruit and veg section into a consulting room but the community will respect you for shopping locally and it is also a good opportunity to see your patients outside the clinic. 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 health services and access to Consultants.  103

rave

registrar

Dr Nyoli Valentine My RTP is Sturt Fleurieu. My current post is a half-time Academic Term doing diabetes research and a half-time general rotation at Nairne and Mount Barker South, South Australia.

A typical workday for me varies – that’s what I love about it. On my research days I read articles, write education programs on diabetes, teach medical students, attend grand rounds, prepare presentations, and try to understand my statistics. On clinic days I see lots of kids, women, chronic disease, emergencies – everything really!

What I love about General Practice is the interaction with patients and their families and the reward of seeing them come back.

What I don’t love so much is the pressure of time. You have to learn to prioritise a patient’s issues and deal with them over several visits if need be, which I am still bad at doing.

After hours I love to travel and see more of the world.

104

Preparing for Practice

What every

VMOshould know DO IT NOW 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.

If you have to do hospital on-call work, the local hospital will most likely provide you with an orientation. Notify your RTP’s ME and RLO of any issues that may arise. Organise regular get-togethers with other GP Registrars – drinks, dinners and outdoor activities. Take turns to visit each other’s towns! Take the opportunity to debrief, encourage and support one another.

Contributed by Dr Winston Lo and Dr Naomi Harris

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 rural training as a GP Registrar. Different hospitals have different arrangements in relation to how you are appointed, the time commitment required, what type of work the VMO does and what kind of patients they see. Financial arrangements can vary. You can be paid for salaried sessions or fee for service. You may need your own ABN and you may also need to be registered for GST. Before you begin, there are many questions you will need to ask. Here is a checklist to get you started:

Job application and rostering 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?

Type of work Can private or public patients have their choice of doctor? How do the other doctors at the practice usually manage their hospital work?

Billing and administration Is the hospital work paid as salaried sessions or fee for service? 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: Sign a medical indemnity agreement with the hospital. Keep good records of patients seen. Keep good records in the patient notes. Most importantly, enjoy your VMO work. It is one of the most interesting aspects of rural practice!

Contributed by Dr Siew-Lee Thoo

DO IT NOW If you are unsure about any of the items on this checklist, talk to your Supervisor.

105

Erik the e-Rep Your online sales rep from Aspen Pharma Unlimited access to all of Aspen’s medical and non-medical services

★ Brand Name Reminders ★ Sample Requests ★ A-Z Book Series ★ Product Information ★ Product Presentations ★ Consumer Medicine Information ★ Patient notes, news items, Aspen Atlas, and much more …

www.aspenpharma.com.au Physician login information available from Aspen Pharmacare

NB: Use of the Aspen website is confidential and we will not contact you unless you wish us to do so.

FD91018

Aspen Pharmacare Australia Pty Ltd, 34–36 Chandos Street, St Leonards NSW 2065 ABN 51 096 236 985 | Tel. +61 2 8436 8300 | aspen@aspenpharmacare.com.au

| www.aspenpharma.com.au

Preparing for Practice

Mentally

a n x ie ty xi

anore

prepared

depression

schizophrenia

hallucinations

All GPs are involved in mental health and psychiatric care. As a GP Registrar, this can be both fascinating and overwhelming. These tips will help you be mentally prepared.

The statistics speak for themselves. One in five Australians suffers from a mental illness. More than 75% of those who seek help for a mental illness see their GP first. The following tips will help you improve your skills in this important area of General Practice. Meet your local Mental Health Team. Phone and introduce yourself to the team leader and ask how the service works in your area. Try to meet them in person. Ask about your local acute/ crisis management service and how to contact and refer to them. Be aware of Mental Health MBS item numbers. (For example, item 2710 for a Mental Health Care Plan.) Check the new edition of The Rainbow Book for an extensive list and explanation of the item numbers available for you to use. Contact your local Division of General Practice. Advise them of your interest in learning more about mental health. Ask them for a list of local psychiatrists and to inform you of any mental health educational events. 108

psychosis

3 Step Mental Health Training. This is available through your local Division. GP-Psych Support. Phone 1800 200 588, fax 1800 012 422, www.psychsupport.com.au GP Psych Support is a free service available 24/7 that provides GPs in Australia with advice from a psychiatrist. The service links GPs with psychiatrists by phone, fax or email and all questions receive a response within 24 hours. It is intended for non-emergency cases. The service is federally funded through the Better Outcomes in Mental Health Care Initiative. Consider a Psychiatry Extended Skills Post. There are many experienced GPs who would say that no GP Registrar should complete their training without an Extended Skills Post in Psychiatry. During your GP training, it is wise to gain as many skills as you can in assessing, diagnosing and managing mental illness. An Extended Skills Post in Psychiatry is an ideal way to get additional training. This post would be arranged through your RTP’s Medical Educator. It can also be completed as an Advanced Rural Skills Post (ARSP).

Do a Psychiatry course. The NSW Institute of Psychiatry offers an excellent Graduate Certificate in Mental Health. The course is available to GP Registrars and GPs Australia-wide and is conducted by distance learning through core material, weekly teleconferences, online learning, CD-ROMs and weekend workshops. Scholarships are available. There are also other courses. Check their website www.nswiop.nsw.edu.au

USEFUL WEBSITES For other useful websites, see the Mental Health section of our web resource list on page 98.

USEFUL REFERENCE BOOKS Therapeutic Guidelines – Psychotropic Phone (03) 9329 1566, fax (03) 9326 5632, freecall 1800 061 260, email sales@tg.com.au or visit www.tg.com.au

Foundations of Clinical Psychiatry Bloch and Singh, Second Edition, Melbourne University Press, PO Box 278, Carlton South, Vic 3053, www.mup.com.au

General Practice Psychiatry Edited by Blashki, Judd and Piterman (2006), North Ryde, NSW, McGraw-Hill Australia

A Manual of Mental Health Care in General Practice John Davies (2003), Mental Health and Special Programs Branch, Commonwealth Department of Health and Ageing, GPO Box 9848, Canberra ACT www.health.gov.au in the Publications section

Contributed by Dr Sara Fergusson, Dr Naomi Harris, Dr Don Cameron and Dr Kate Kelso

109

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.

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.

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 Benefit Schedule (MBS), a list of medical services and the rebates allocated for each service.

Do a course. There are a couple of courses available to familiarise yourself with Medicare before you venture into GPland. You can do the Medicare Australia familiarisation course, which takes a few hours (ask your practice manager for details) or ACRRM members can do the online Medicare and You module free of charge at www.rrmeo.com

Know what services do attract benefits. These include ECGs, spirometry, office 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.

Read The Rainbow Book general notes. Find the Medicare Benefits Schedule Book (commonly known as The Rainbow Book) in your surgery and read the general explanatory notes or check out the online version at www.health.gov.au. The list of services and rebates is updated annually.

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.

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. 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. 110

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

Have a list of frequently used item numbers. Create a shortlist of frequently used item numbers. Most practices will have one. Get familiar with bulk-billing forms. Familiarise yourself with Direct Bill forms (DB2). You may have to complete them, especially when on call. You must fill out the correct details first, 

DO IT NOW 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 www.health.gov.au/MBSONLINE

More Medicare tips at the GPRA website

By selecting the less commonly used item numbers it is often possible to be better remunerated for your time. GPRA has prepared a comprehensive guide to the MBS with this in mind at www.gpra.org.au

Even more Medicare tips at the RACGP website For a handy summary of commonly used item numbers visit www.racgp. org.au then type into the Search bar “MBS Fee Summary”.

Don’t forget

Your Supervisor and practice manager have had vast experience with Medicare billing, so use their knowledge.

111

Preparing for Practice

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. 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 schedule book. This covers areas such as chronic disease management, mental health care and health assessments, with item numbers for: »» Regular reviews for diabetes and asthma. »» Service incentive payments. »» Care plans and team care arrangement items (700/721/723), which aim to improve coordination of care and allow patients greater access to allied health services. »» Mental health care items (2710/2712/2713), which provide access to subsidised psychological intervention, and allow you to bill for providing mental health care. »» Assorted health checks 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 112

Preparing for Practice

adequately recompensed for your work. Use The Rainbow Book, 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 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.

Some important items covered by Medicare ITEM

LEVEL

DESCRIPTION

2501

LEVEL B

Cervical Smear 20 Years Plus 1st Test or Over 4 Years from Last Test

2504

LEVEL C

Cervical Smear 20 Years Plus 1st Test or Over 4 Years from Last Test

2507

LEVEL D

Cervical Smear 20 Years Plus 1st Test or Over 4 Years from Last Test

2517

LEVEL B

Completion of the Diabetes Cycle of Care

2521

LEVEL C

Completion of the Diabetes Cycle of Care

2525

LEVEL D

Completion of the Diabetes Cycle of Care

2546

LEVEL B

Completion of the Asthma Cycle of Care

2552

LEVEL C

Completion of the Asthma Cycle of Care

2558

LEVEL D

Completion of the Asthma Cycle of Care

2710

GP Mental Health Care Plan

2712

GP Mental Health Care Plan Review

2713

GP Mental Health Care Plan Consultations (Greater than 25 Minutes)

700

Health Assessments – 75 Years and Over (Consulting Room)

712

Comprehensive Medical Assessment (CMA)

714

Health Assessments – Refugees and Other Humanitarian Entrants (Consulting Room)

Medicare changes on the way

717

45 to 49 Year Old Health Check

In December 2009 changes were announced to simplify Medicare and encourage quality medicine. The quantity of item numbers will be more than halved. The changes should come into effect later in 2010.

718

Intellectual Disability Health Assessment (Consulting Room)

721

Care Plan – GP Management

723

Care Plan – Team Management

725

Care Plan – GP Management Review (between 3 and 6 Months)

727

Care Plan – Team Management Review (between 3 and 6 Months)

900

Domiciliary Medication Review

In time, many of us will be closely involved in the administration of General Practices. Our training is now, and the Medicare scheme is an integral part of General Practice.

Contributed by Dr Luke McLindon, Dr Naomi Harris and Dr Kate Kelso

113

Preparing for Practice

Prescribing and The

PBS

DO IT NOW For more information on prescribing and the PBS, go to: • The Yellow Book (especially “Section 1 – Explanatory Notes”) – available online www.pbs.gov.au • 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 • PrimEd online education modules on PBS and prescribing www.primed.com.au • Medicare Australia PBS education – online tutorial or face-to-face sessions www.medicareaustralia.gov.au

Tips to make writing any prescription all in a day’s work. Prescribing medications makes up a significant part of a general practitioner’s workload. Yet GP Registrars often have limited exposure to prescribing outside the hospital system or may have worked in health systems very different to Australia’s. 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.

114

Writing PBS scripts Attend the PBS prescriber seminar offered when you obtain your prescriber number and get a copy of the PBS prescription writing tutorial on DVD. Read the explanatory notes at the front of the Schedule of Pharmaceutical Benefits (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. 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.

standard. Just be sure you are still using them appropriately and safely.

Authority scripts

Special circumstances apply to the prescription of S8 drugs of addiction. You need to comply with the PBS requirements (outlined in The Yellow Book/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.

Become familiar with the indications for authority medications you commonly prescribe. Have any information required ready when calling the authority prescription number 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

Prescribing S8 drugs of addiction

Talk with your Supervisor/ practice manager about prescribing these medications, and any practice policies they may have.

Private scripts Pharmaceutical items are included on the PBS (subsidised by the government) on the basis of efficacy and costeffectiveness. 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  115

Preparing for Practice

outside the criteria for a statin. You should still recommend appropriate treatment for your patient, but you may need to explain to them that they cannot access subsidised medication for this condition, and will need to pay more for a private script if they go ahead with treatment. Many private health funds will give some reimbursement for these medications.

Prescribing for travellers 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 116

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.

Contributed by Dr Skye Boughen

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

FREE for all GPRA members enrolled in the AGPT program

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

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

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

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

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

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

The Paediatric Health Update Sydney, 11 September 2010

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

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

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

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

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

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

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

Preparing for Practice

Countdown to Healthcare Identifier numbers As part of a national approach to e-health, new numbers will identify everybody involved in a health care transaction from mid-2010. Communication of health information is a vital part of effective health care. The accurate identification of individuals and providers is critical in all health communication. That’s one of the reasons why the National E-Health Transition Authority (NEHTA) was established – to develop a national approach to better collect and securely exchange health information electronically.

Healthcare Identifier numbers and NEHTA In March 2009 the Australian Health Ministers, through the Australian Health Ministers’ Advisory Council (AHMAC), announced that all Australians will be allocated an Individual Healthcare Identifier (IHI) number for health care purposes. A national Healthcare Identifiers Service (HI Service) is being established to assign and maintain Healthcare Identifiers. NEHTA contracted Medicare Australia to be the initial operator of the HI service. An IHI is a unique 16-digit number that will be allocated to each Australian resident and others seeking health care in Australia. The 118

IHIs will enable important health information about patients to be more readily and securely identified as relating to that individual. Health care providers and organisations will also be identified with a unique number – a Healthcare Provider Identifier (HPI). This will be an Individual (HPI-I) for health care professionals and other health personnel involved in patient care, and an Organisation (HPI-O) that will identify the location, such as the hospital or health clinic where care is provided.

When it will happen Legislation is being developed to establish the HI service and will set out governance arrangements, privacy and permitted uses of Healthcare Identifiers. It is planned to have the IHIs available from mid-2010, noting that the numbers cannot be allocated and used until necessary legislation is in place. HPI-Is and HPI-Os will also be allocated from mid-2010 through a staged approach, noting again that the numbers cannot be allocated and used until necessary legislation is in place.

Australian Health Ministers concluded a monthlong period of public consultation around national health privacy legislation proposals on 14 August 2009. The Government recently commenced a second phase of public consultation around the introduction of Healthcare Identifiers.

Key areas

DO IT NOW For more information on national Healthcare Identifier numbers, e-health reforms and NEHTA’s work, visit www.nehta.gov.au

There are four key areas where immediate benefits will be derived. Discharge summaries. When a patient leaves hospital, and information about ongoing care is communicated to their health care provider/s, the provider will be able to more accurately match the information to the correct patient. Pathology tests. When a patient’s test results are sent to their health care provider/s, the provider will be able to more accurately match the test results to the correct patient record. Prescriptions. Pharmacists can be more confident when receiving electronically lodged scripts that the script is matched to the correct patient, resulting in safer dispensing of medications.

Referrals. When patient records and case histories are communicated between the referring health care provider and a specialist, the specialist can more efficiently check they have the correct information for the correct patient.

Sharing patient information If a health care provider such as a GP needs to provide information to another health care provider in the course of providing treatment, the IHI will clearly identify that the information is about the right person.

Contributed by NEHTA

119

Preparing for Practice

Testingtimes Reviewing test results and notifying patients are important medico-legal issues in any General Practice. A case history The locum GP referred the 45-year-old patient to a radiology practice for investigation of an area of breast thickening. The radiologist performed a mammogram, ultrasound and fine needle aspiration biopsy (FNAB) of the area of thickening. The mammogram and ultrasound did not reveal any significant abnormality and a report was sent to the referring GP, noting the fact that an FNAB had been performed. The FNAB was subsequently reported as showing malignant cells. There was a data entry error at the pathology practice and the FNAB test result was sent to the radiologist but not to the referring GP. The radiologist received the result of the biopsy several days later. He took no further action, assuming the GP would have received a copy of the test 120

result and the patient would return to the referring GP for follow up. Four months later, the patient attended her usual GP for an unrelated problem. The GP noted the locum GP’s previous entry in the medical records regarding the breast problem. The radiology results were included in the medical records but the GP could not find the result of the FNAB. He asked the patient about the biopsy test result. The patient replied that she thought “no news was good news”. The GP rang the radiologist to obtain a copy of the FNAB test result. The radiologist subsequently faxed the pathology report to the GP who organised prompt referral of the patient to a surgeon for further management. Fortunately, in this case, the delay in diagnosis of breast cancer did not affect the patient’s treatment or prognosis.

Medico-legal issues An allegation of “delay in diagnosis” is common in claims and complaints involving medical practitioners. In these cases, there is often an underlying weakness in the system of follow up of patients and test results. While reliance on the patient to follow up their test results is an important part of any follow up system, problems can arise if this is the only system in place. In a recent claim involving an allegation of delay in diagnosis of breast cancer, the judge criticised a surgeon for not following up and obtaining the results of a FNAB that he had performed. The judge concluded the patient’s “failures to ring him... or to attend for the follow up appointment does not excuse the breach of duty of care imposed upon him in that respect. Irrespective of any initiative taken by the 

Preparing for Practice

patient, he owed a duty to find out what the outcome of the pathological examination of the fine needle aspiration was... it is unreasonable for a professional medical specialist to base his whole follow up system, which can mean the difference between death or cure, on the patient taking the next step”.1 Many medical practitioners believe that it should be the patient’s responsibility to follow up their test results and practitioners should not be expected to be responsible for notifying patients.There is no doubt that patients need to be advised and educated about their role in obtaining their test results. The Australian Council for Safety and Quality in Health Care has produced a useful pamphlet to educate patients about becoming more active in their health care. 2 In part, the pamphlet advises patients to “Get the results of any test or procedure. Call your doctor to find out your results. Ask what they mean for your care.” 122

Nevertheless, medical practitioners should be aware that if they order a test, they have a professional and legal responsibility to review the results of that test. As outlined in the RACGP Standards for General Practices: “Reliance on patient memory or motivation alone does not reduce the need for an effective follow up system in the practice. Patients may not follow the recommendations for tests provided by the practice because of their particular circumstances, fear, ignorance, personality, expectations, beliefs, cultural background or a range of other factors. The practice needs to have systems to identify and respond to situations where a particular patient is unlikely to, or may not either understand or comply with, their responsibilities to go through with a test or to follow up the results with the practice. General practitioners in the practice need to reflect on which patients, tests and results justify a suspicion or concern.

The practice needs to have a system that will allow the GPs to take action to address their concerns.”3 This article has been provided by MDA National. This information is intended as a guide only and should not be taken as legal or clinical advice. We recommend you always contact your indemnity provider when advice in relation to your liability for matters covered under your insurance policy is required. MDA National is a registered business name of the Medical Defence Association of Western Australia (Incorporated) ARBN 055 801 771 incorporated in Western Australia. The liability of members is limited. 1 Kite v Malycha (1998) 71 SASR 321 2 Australian Council for Safety and Quality in Health Care. “10 Tips for Safer Health Care.” Accessed at www.safetyandquality.org 3 The Royal Australian College of General Practitioners. “Standards for General Practices.” 3rd edition. Accessed at www.racgp.org.au

7 Term allocation

AND CHOICE

Practice placements, job inter views and even the odd problem need not be ner ve-wracking when you know what to expect and what approach to take.

Term Allocation and Choice

The

Trust MIMS

place

Right Product, Right Place, Right Time

race

Right Product

Right Place

Our range of MIMS products gives you the choice of how to access medicines information that best suits your work practice

PC, PDA or print format ensures MIMS is always within easy reach

Planning ahead with your RLO will give you the best shot at getting the General Practice placements you want. The RTPs are responsible for allocating Registrars to General Practices for each relevant sixmonth General Practice Term and ensuring all placements are appropriate and accredited. The system of allocation is determined by the RTP and varies between RTPs. Allocation systems may involve interviews with prospective practices chosen by the Registrar (for interview tips see page 126). Alternatively, the RTP may determine the placement with little or no Registrar input. The way terms are allocated is influenced by various factors including the range of practices available; Registrar numbers; the educational and personal needs of the Registrar; the location (rural versus urban); and the opportunities provided by the practice and needs of the practice. There may also be unexpected events such as a Registrar or practice withdrawing at the last minute. 124

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 Medical Educator. It may also be an administrative staff member, the Director of 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 choose placements for themselves, especially at Subsequent Term level or later stages of training. The RTP then assists by

DO IT NOW Organise yourself early and talk to your RLO. This will give you the best chance of getting the placements you would prefer.

Right Time

ensuring practices have the appropriate accreditation. GPRA has been supportive of this method as it encourages Registrars to research the type of practice they are interested in and gain exposure to interviews and negotiating terms and conditions. It also creates opportunities for future employment.

Contributed by Dr Jen Lonergan and Dr Skye Boughen

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

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

Term Allocation and Choice

Facing the

interview You’ll be more confident at practice interviews armed with the right questions. As a Registrar, you may find yourself doing interviews for practice placements for your General Practice Terms. Once training is over, you may 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 ENT diagnostic kit) 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?

126

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 oncall 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 terms of salary or percentage of earnings for your usual hours? 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 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?

DO IT NOW Keep this checklist handy to prepare for your next practice interview.

Teaching and education. How does the practice usually structure your teaching (three hours a week for GPT1 and GPT2 and 1.5 hours a week for GPT3)? 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 National Minimum Terms and Conditions 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.

Contributed by Dr Jen Lonergan and Dr Skye Boughen

127

Term Allocation and Choice

Transferring across RTPs

Want to do a stint on the other side of the country? It’s possible, but it can get complicated. Whether you want to do some of your training in a field only available in a certain locality or you want a permanent location change, transferring between RTPs can sometimes be arranged. Talk to your RLO about what’s possible because it varies a lot between RTPs and individual circumstances. The following gives you a brief overview.

Compulsory Rural Terms Compulsory Rural Terms for General Pathway Registrars are arranged through your original RTP. Rules and processes vary between RTPs. If you wish to communicate your needs and preferences to the rural RTP, talk to your RLO or other RTP staff about how best to do this – and start the process well in advance if you can. Unfortunately, the recipient RTPs vary greatly in how they respond to requests from outplaced Registrars. GPRA has been advocating hard for improvements nationally to this system. 128

Other opportunities Opportunities do exist for Registrars to undertake GP Terms, Extended Skills and ARSPs offered by other RTPs; for example, in Aboriginal Health, Alpine Medicine, Anaesthetics, Obstetrics and Gynaecology and the Irish exchange program. You will need to plan ahead and discuss it with your RTP and probably the recipient RTP if you are keen to take up one of these opportunities. Remember, the RLOs are also an excellent resource in planning a

DO IT NOW If you are considering an RTP transfer either permanently or for a particular training experience, talk to your RLO or RTP early to give them plenty of notice about your plans.

temporary transfer. These types of terms would be subject to availability and agreement by both the host and recipient RTP. If you would like to transfer to a different RTP permanently, you will need to have the transfer approved by three parties: your host RTP, the recipient RTP and AGPT.

In GPRA’s experience, the chances of approval by all parties is much higher if: You are going urban to rural. The host RTP is not short of Registrars (the money for providing your training goes with you). The recipient RTP is short of Registrars. You want to go somewhere where it is hard to attract Registrars. You can prove that the experience you are after is not available in your host RTP. You plan ahead and don’t give up easily.

rave

registrar

Term Allocation and Choice

If things go

pear-shaped

DO IT NOW 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.

If a problem or dispute arises with your training, ask for help sooner rather than later. Sometimes Registrars find themselves in situations where they are unhappy about some aspect of their training. This can range from practice placement, relocation and educational issues to interpersonal problems.

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.

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.

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.

Talk to your RLO Who that someone is 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. As an example, you might try to resolve the problem with the practice or RTP directly. Depending on the nature of the problem, you may talk to your Supervisor, Medical Educators or Director of Training. 130

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, 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 Registrars). GPRA will then act to lobby the relevant stakeholders to review and change their policies.

Dr Julie O’Connell My RTP is Greater Green Triangle (GGT). My current post is at Karuna-Maya Medicine Tree in Jan Juc near Torquay.

A typical workday for me 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

involves the whole range of General Practice care and, until recently, studying for my Fellowship exam.

What I love about General Practice is the ability to make a difference to people’s lives on a day-to-day basis, even in as simple an act as good preventative care. Plus I love the independence.

What I don’t love so much is not getting to manage serious illnesses in their acute phases. My practice does not have admitting rights to our local Emergency Department. My GP role model is my own GP because he always knew how to make me feel better. After hours I love to dance. My favourite movie is The Celestine Prophecy.

A quirky fact about me is that I enjoy performing angel card readings and reiki.

131

Term Allocation and Choice

1o hot questions on the 1O year moratorium

Are you a doctor from overseas? Then there will be restrictions on where you can practise. Doctors from overseas are being welcomed to help fill Australia’s GP gap. But to ensure Australia’s migrant doctors practise in the geographic regions of greatest need, the Commonwealth Government has a policy of only issuing these doctors with a Medicare provider number if they work in certain areas. This means that GP Registrars who have migrated to Australia usually do their vocational training in the Rural Pathway. Generally, the geographic limitation on provider numbers lasts for 10 years, which is why the scheme is known as the 10 Year Moratorium. It applies to international medical graduates (IMGs) and Australian medical graduates who were Australian temporary residents when 132

they commenced their primary medical degree. IMGs are also known as OTDs (overseas trained doctors).

These frequently asked questions may be helpful.

What is the 10 Year Moratorium?

Under section 19AB of the Health Insurance Act, medical practitioners subject to the moratorium are not able to attract Medicare benefits unless they practise in areas designated by the government for a period of 10 years from the time they become registered as a medical practitioner in Australia. It is expected that by the end of the 10 Year Moratorium, the doctor will have obtained permanent residency or Australian citizenship.

ho is under the W 10 Year Moratorium?

Overseas trained doctors who did not obtain their primary qualification in Australia (excluding New Zealand-trained doctors*). Overseas doctors trained in Australia (that is, any doctor who began studying in Australia under a temporary visa and subsequently obtained their primary qualification from an Australian university). It does not apply to doctors who: Registered with a State or Territory Medical Board before 1 January 1997. Made an application to the Australian Medical Council (AMC) which was received and was eligible before 1 January 1997.

Can I apply for an exemption?

Yes. An exemption to these requirements can be granted and conditions can be imposed on any exemption provided. GPRA recommends that any current or future Registrar applying for exemptions discuss this with their RTP. Exemptions may have implications for placements and rural incentive payments.

If I am under the 10 Year Moratorium, can I undertake GP training with the Australian General Practice Training (AGPT) program? Yes. First, you must have medical registration. In other words, you must have passed the AMC clinical exam and have undertaken the mandatory 12 months supervised training with

an accredited teaching hospital or have your degree recognised for the purposes of registration.

Commonwealth Government). Visit www.doctorconnect.gov.au for more information.

Which training pathway in the AGPT program can I do? Currently, AGPT will only allow those subject to the moratorium to enrol in the Rural Pathway. AGPT will not accept an application for the General Pathway unless you provide documentation proving you have been granted an exemption.

Where can I work when I have completed my training? On completion of training, you must serve the remainder of your moratorium time working in an Unmet Area of Need (defined by each State or Territory) and/or Districts of Workforce Shortage (defined by

Can I work in a region other than RRMAs 3-7 (RA2-5**) during my training? Public hospital-based placements do count towards your moratorium time, so it is possible to do an Extended Skills placement outside RRMAs 3-7 (RA2-5**) areas. Contact your RTP for further advice about this. It would need to be recognised by your RTP, the AGPT and the Department of Health and Ageing.

When does the 10 year period start?

The period starts from the date you register as a medical practitioner in Australia, provided you become a permanent  133

Term Allocation and Choice

8 Exam resident or citizen before the end of your moratorium. (This is a new ruling and is dependent on the completion of proposed new Government legislation.)

What about New Zealand graduates?

From April next year, New Zealand permanent resident and citizen doctors who have obtained their primary medical education at an accredited medical school in Australia or New Zealand will not be classified as an “overseas trained doctor” or “former overseas medical student”. Therefore the 10 Year Moratorium will not apply. (This is a new ruling and is dependent on the completion of proposed new Government legislation.)

134

How can I find out more?

See the Do It Now panel.

Contributed by Dr Jennifer Mooi * This is a new ruling and is dependent on the completion of proposed new Government legislation. Visit www.agpt.com.au for updated information. Note, with the successful completion of new legislation there may be additional changes that will benefit people under the 10 Year Moratorium. ** From July 2010 the existing Rural, Remote and Metropolitan Areas (RRMA) system will be replaced by the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system.

PREPARATION

DO IT NOW Talk to your RTP, visit www.agpt.com.au for more information or phone the AGPT selection team about your individual situation on (02) 6263 6776.

Pass your exams with confidence. These tips, tricks and resources from past Registrars are designed to help.

Exam Preparation

Top tips for exams

Successful candidates for the FRACGP exams and FACRRM assessments advise careful planning, teaming up with study buddies and making time to laugh. The 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 136

assessments. Check page 169 for exam dates and the RACGP website for dates when enrolments open and close. Call the RACGP or visit www.racgp.org.au for an enrolment pack; it 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 169 for a timetable.) Candidates must complete an enrolment form for each assessment type and return it by the required cut-off date. ACRRM assessment 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 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 the last 12 months 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 on-call for a while, then do it early. Try not to be covering for a principal on leave over the exam period. However, remember that seeing patients can be one of the best ways to practise for your exams. 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. Do you do best gathering to read things 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.

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. You will find a summary of exam and assessment dates on page 169.

Be creative. Email resources to each other, consider an online discussion, teleconference to go through questions or hold a Skype video conference. Or video yourself doing a timed 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 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.  137

Exam Preparation

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 and Medicine Today have MCQs and brainteaser questions with pictures. gplearning has lots of MCQs, KFPs and a timed practice exam. Websites are useful (see page 78 of this guide as a starting point) for up-to-date guidelines. Your practice or RTP may have the last two years of check/AFP, or you can order them from the RACGP Library (free postage). For the clinical, the marking structure and case proformas can be downloaded from the RACGP website so you can make up your own cases. The Online Exam Resources (OER) from GPRA can also provide you with cases to practise. 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 exams, sample questions, feedback you receive from formative components of the assessment, advice and resources from your Supervisor and RTP. In addition, the Online 138

Exam Resources (OER) from GPRA are a useful resource. 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. 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. 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. 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 

Exam Preparation

get online exam resources (oer) 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

9 Money MATTERS

Read information, questions and answers carefully. You can get more 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. 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! 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 clinical, 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. 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

140

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

As a GP Registrar, you are well paid without the extreme hours of some other specialties. Check the updated salar y rates and incentives as well as the workplace contract issues you should be aware of.

Money Matters

2010

National Minimum Terms and Conditions

Salary guide – new 2010 pay rates These are the new minimum salary rates negotiated on your behalf by GPRA. This annual pay increase is the only change to the 2010 National Minimum Terms and Conditions. This is because a major two-yearly review was carried out in 2009 and will again be due in 2011. Rates for 2010 have been increased by a CPI indexation factor of 2.1%. Make sure your practice is aware of these new rates which apply from the 2010 training year. Annual salary

Weekly salary

Superannuation

GPT1 or equivalent

$65, 612.80

$1,261.78

Plus 9% superannuation

GPT2 or equivalent

$82,715.00

$1,590.67

Plus 9% superannuation

Or 45% of in-hours gross billings, plus 9% superannuation, calculated over a three month cycle – whichever is greater. Note, these are minimum rates – you are free to negotiate higher rates.

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 2010 NMT&C. 142

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.

You can view the 2010 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.

Negotiating your employment contract – GPT1 and GPT2 or equivalent 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. 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 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.

Pay cycles for calculations of 45% of gross billings 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. 

143

Money Matters

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

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.

Practice billing policy

Safe working hours

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 $32 for a bulk-billed patient compared with $50-$70 for a private-billed patient. 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). 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 144

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. 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.

Service Incentive Payments

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.

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

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.

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

After hours and on-call

In-practice teaching

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. 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?

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

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.

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. 

145

Money Matters

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 then click on 2010 National Minimum Terms and Conditions – “Read More”.

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.

How is my annual leave calculated?

Know your value

See our document “Examples for Annual Leave Calculations” on our website.

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.

Hot topics

What are PIPs and SIPs and should I be paid for them? 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. For further information, see our document “SIPs and PIPs Explained – Information for Registrars” on 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” on our website. See also the article on page 148.

146

Money Matters

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

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 three-kilometre limit on geographic restraint of trade. It is important to discuss restrictive covenant with your practice, but any mutual agreement should not impair your ability to complete your training.

Exit clauses Rarely, a GP Registrar may not be able to fulfil the full 6-12 months of their training term. 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

Restrictive covenant/restraint of trade 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. However, GP

147

Money Matters

Employee or 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. Each of these structures provides slightly different benefits, mainly in the areas of tax and asset protection should one be sued. Most tax advantages associated with these structures relate to the business. A GP who does not own a practice will find far fewer tax advantages in these structures. GPT1 and GPT2 Registrars are classified as employees, even if paid by percentage. Only GP Registrars in Subsequent Terms may sometimes be offered the choice of being contractors. Later, as a fully qualified GP, the option may come up again.

148

What is an employee? An employee is the basis upon which all of us would have been employed in the hospital system. As employees, we have a number of entitlements including: Paid annual and public holiday leave. Sick leave. Employer superannuation contributions of 9% of salary.

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

contractor? 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 “GPRA does not recommend superannuation. The Superannuation GP Registrars work as Guarantee independent contractors. Contribution (SGC) There is some concern that rate is 9%. Please check with your due to the supervised nature accountant.

As far as the Tax Office is concerned, the onus is on the person paying you money to prove whether you are a contractor or an employee. If a practice incorrectly pays you as a contractor then it is the practice that is responsible.

A contractor receives money only when they work. There is therefore no sick leave, annual leave or public holiday of GP Registrar work, we pay. Because of this arrangement, cannot really be considered an As a contractor, there are specific anti-tax contractors independent contractor.” avoidance provisions are likely to that state income have income protection insurance. They also carry their earned from personal effort must be taxed as income of that individual. There is a misconception own professional indemnity and public that it is somehow possible to reduce tax by  liability insurance.

149

Money Matters

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 and become the employee of this company. The company you own then provides GP services to the practice where you work. As a company employee, you can then obtain a company car and there may be some asset protection advantages to this structure. The tax advantages of a company car must be weighed against the additional costs of running a company.

Can I be a contractor as a GP Registrar? 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.

DO IT NOW For further information on what it means to be an employee versus a contractor, please visit www.gpra.org.au

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. GPRA would like to thank Mr Mick Saunders and Mr Warwick Hough from the Federal AMA for assisting us to understand this complex topic and for their ongoing involvement in the GPRA/NGPSA National Minimum Terms and Conditions negotiations.

Contributed by Dr George Manoliadis and Dr Jen Lonergan

We apply the same amount of care to your business that you apply to your patients. Your business needs specialist care, not unlike the patients you treat. That’s why we set up our new 24/7 Healthline. It’s managed by a team of dedicated Healthcare Business Bankers with an in-depth knowledge of the healthcare industry – so it’s perfect for tailoring financial solutions to suit your business’ unique needs. It’s our way of showing we treat your business with care. For more information on financial services for your healthcare business, contact Healthline today. Call 1800 657 151 24 hours a day, 7 days a week.

We would advise that any GP Registrar wishing to work as a contractor in private General Practice seek independent legal and accounting advice.

150

Commonwealth Bank of Australia ABN 48 123 123 124. CBABM0761

Money Matters

incentive

Money Matters

payments

In addition to your salary, you can claim an array of other financial incentive payments as a GP Registrar. Make yourself aware of what’s on offer – then stake your claim.

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

152

General Practice Rural Incentives Program (GPRIP) The new General Practice Rural Incentives Program (GPRIP) will commence from 1 July 2010. It will replace the Registrars Rural Incentive Payments Scheme (RRIPS), which applies to GP Registrars in the AGPT program, and the Rural Retention Program, which applies to general practitioners. The new incentives program will provide a consistent set of incentive payments that applies on an equal basis for GPs and Registrars in rural locations. For further information, see the table on page 26.

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

HECS Reimbursement Scheme The HECS Reimbursement Scheme applies to graduates who have graduated in 2000 or later only. Participants in the scheme will have one fifth of their HECS fees reimbursed for each full-time year of medical training undertaken or service provided in areas with RRMA classifications 3-7 (RA2-5). This means that over five years of

working or training in a RRMA 3-7 area, you could have all of your HECS fees for the study of medicine reimbursed.

More Doctors for Outer Metropolitan Areas Program This is a Commonwealth Department of Health and Ageing (DoHA) program. GP Registrars who have completed their training and are prepared to work in an outer metropolitan area for two years are eligible for payments up to $30,000. For those prepared to set up their own practice and stay for three years, there is a total of $40,000 available. Speak to your RTP for more information or visit www.gpra.org.au For a more detailed explanation of this program, see page 154.

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

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

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

153

rave

registrar

Money Matters

$30,000

Outer Metropolitan Grants

Dr David Wong My RTP is Tropical Medical Training (TMT).

Want to financially kick-start your General Practice career? THEN JOIN OR START YOUR OWN OUTER METROPOLITAN PRACTICE AFTER TRAINING. What is the Outer Metropolitan Relocation Incentive Grant (RIG)? The More Doctors for Outer Metropolitan Areas Relocation Incentive Grant (RIG) is a financial incentive of up to $30,000 (or up to $40,000 for new GPs setting up their own outer metro practice). The grants are offered to eligible doctors who agree to work in an outer metropolitan practice for a period of two years.

Where are the eligible outer metropolitan areas? Eligible areas for the grants include all the outer metropolitan zones of Australia’s capital cities and all of Darwin. Maps of each city are available online at www.health.gov.au/outermetro

154

Will I be eligible for the grants?

What if I want to set up my own practice?

Generally, doctors who complete the RACGP Fellowship requirement via the General Pathway of the AGPT program are eligible to receive a grant of up to $30,000.

GP Registrars who wish to set up their own outer metropolitan practice could qualify for a Relocation Incentive Grant of $40,000 if they work full-time at their new approved location for at least three years. Registrars who want to take part in setting up a group practice can still apply individually, though they need to state that it is a group practice being established. Amounts are adjusted based on full-time or part-time status.

Does it matter where my final training placement is? No. You can still be eligible for the grant once you have completed your training on the General Pathway and attained Fellowship regardless of whether your last placement is in a rural or metropolitan area. You need only decide on an outer metropolitan practice to work in to apply for the grant. If your last placement happens to be in an outer metropolitan practice you can also elect to stay on for a further two years and be eligible for the grant.

Contributed by Department of Health and Ageing and Dr Tim Francis

My current post is as a Medical Officer in the Australian Army, deployed to Timor-Leste. A typical workday for me starts

DO IT NOW Want to work in an outer metropolitan area? Completing the General Pathway of the AGPT program? You need to achieve FRACGP then apply within three months of gaining Fellowship. To download the application form and find out more about the Outer Metropolitan Relocation Incentive Grants visit www.health.gov.au/outermetro or email outermetro@health.gov.au

with the morning inpatient ward round and handover at the hospital, then onto the commander’s orders group and anything can happen from there.

What I love about General Practice is the variety and diversity of work. What I don’t love so much is having to attend so many meetings.

My GP role models are Brenda Murrison and Katy Templeman, my Rural Clinical School Coordinators in Geraldton (WA) when I was a fifth year medical student. They showed me what being a rural GP and doctor was all about. After hours I love to hit the gym and punch the boxing bag.

A quirky fact about me is that I was involved in treating the President of Timor-Leste, Jose Ramos-Horta, after he was shot in an assassination attempt in 2008. 155

Help others fill your shoes. Become a Mentor.

10 Keeping

YOUR BALANCE General Practice gives you the flexibility to balance your personal life with your working life. Parental leave? Par t-time? Interests outside medicine? Here’s how your General Practice training makes it possible.

Keeping your Balance

parental leave. They might consider employing a second Registrar part-time as well. This takes pressure off you, in case you are unwell, want to extend your leave or reduce your sessions.

Pregnant pause Can you combine pregnancy with vocational training? Your GP training offers generous parental leave and part-time options as Dr Ingrid Buchner, who is a mother of three, an IMG and RLO, explains.

ustralian General Practice Registrars are entering their training later in life. So it’s no surprise that Registrars are unwilling or unable to wait another three years to finish their training before they start or extend their families. Completing your training adds to the usual juggle of combining a young family with work, but knowing some of the rules helps make it easier to finally be successful in your career and enjoy your little ones as well.

158

What you need to know All parental leave is unpaid. You need to apply to your RTP – it is up to their discretion to grant it or not. Applications must be made in writing to the RTP at least three months before the expected date of leave. The primary caregiver is eligible for leave of up to 12 months following the live birth, adoption or assumption of guardianship of the child or children. GPET guidelines encourage part-time as an option. Your training time can actually commence with parental leave.

Tips for a pregnant pause Put your practice in the picture. If you like your practice and want to stay on, let them know sooner rather than later, especially if you plan to work part-time during pregnancy and after

Ask about part-time work. Speak early with your Medical Educator and Training Advisor as there might be some part-time opportunities.

DO IT NOW 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.

In our RTP, we occasionally have part-time positions in Sexual Health and Palliative Care available. Become an RLO. 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 childfriendly and my son loved the attention!) Work from home. You can determine your workload and do most of the work from home. Most RTPs count that time as one or two sessions (according to workload and job description) of Extended Skills and therefore training time, if you have finished your earlier General Practice Terms.

Getting back into the workforce Work part-time. To work part-time, you need to work a minimum of three sessions a week. Accelerate your training. This means that if you see an appropriate number of patients per session it might be counted for more training time. Talk to your Medical Educator before you return to work as it cannot be done retrospectively. Think about E units. If you are in year three of training to FRACGP, you can apply for elective training (E units), which allows you to just work one or two sessions a week in the first 12 months after the birth of a child. This will unfortunately not

count towards your training time, but it might give you and your children the opportunity to gradually ease into childcare arrangements.

More juggling tips Less is more. Plan to return with fewer sessions rather than too many, as most practices can grant your wish to increase your sessions (if you have an angel as a child and the perfect nanny in place), but it might be more difficult for the practice to cope with your absence. Share your plans. Let everyone involved (your practice, your Medical Educator) know early of any change in your plans as a courtesy. Study and network. Join a study group, journal club and attend the day releases or other educational events of your RTP while on parental leave. Take your baby with you – it’s good for both of you! Overall, General Practice will enable you to finish training and care for your family. Most RTPs are used to Registrars taking maternity leave and I found everyone very supportive and understanding.

Contributed by Dr Ingrid Buchner

159

Keeping your Balance

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

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

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

160

Registrar completing it full-time. For example, a part-time GPT1 Registrar (FRACGP) should have 1.5 hours a week over 12 months and a full-time Registrar three hours a week for six months. You must attend educational activities that are required of you by your RTP. Most training usually occurs on weekdays. The RACGP states that General Practice experience gained while working part-time is valuable 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.

Working for two or three days a week could be just the change you need to explore new opportunities or enjoy family life.

Contributed by Dr Sarah Bailey

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

Keeping your Balance

Life as a

Registrar mum

sleepless nights? How does one do a fungal scraping? What if I can’t find the cervix? What are the side effects of Nifedipine? What’s Nifedipine for anyway? I hoped I would remember. Then there were the logistical issues of care for my baby while I was at work. My husband (lovely man) could look after Maxine one day a week. For the rest of the time I must rely on childcare, a prospect that I approached with trepidation. I put Maxine’s name down at umpteen places and fortunately was accepted at one close to work.

Back in the swing GP Registrar Dr Kate Wylie had mixed feelings about going back to work after the birth of her first child but she’s now loving life as a working mum. In March 2008 I gave birth to my beautiful daughter, Maxine, and life will never be the same again. No more late nights, no more sleep-ins, no more leaving the house in five minutes. Now sleep is opportunistic, my life revolves around feeds and laundry and leaving the house is a logistical exercise unequalled in the modern world, requiring perfect timing, a truck full of gear and the tenacity of a Tenterfield terrier. Fortunately, as a GP Registrar, I was able to take six months of maternity leave. My baby and I had time to get to know each other, without the added stress of work. I am well aware that if I were in any other training program I would not get this time. 162

Half-time load Alas, all good things come to an end, and in August it was time to resume my GP training. Again, I am fortunate to be a GP Registrar as I was able to return part-time. I chose to do a half-time load. I approached the return to work with mixed feelings. While I was excited about practising medicine again and using my grey matter on things not baby related, I was saddened that the special time with my newborn had passed.

Nappies and sleepless nights There were other concerns too. Had I forgotten all my medical skills in a fog of nappies and

In early August I arrived for my first day. It didn’t take long to get back in the swing of things. My first patient was 15 minutes late and on her way out the door said “oh just one other thing!” There I was running an hour late after my first patient on my first day. Ah, the joys of General Practice.

DO IT NOW Talk to your RTP for more information about Registrar leave from AGPT and part-time training.

Expressing milk Life as a working mum is hectic. It still takes a supreme effort of organisation to get us both ready to leave the house. (I start getting ready on Sunday, for Tuesday.) I have never been so busy. I am constantly on the go and don’t sit down until after the baby’s in bed at night, but I am fulfilled and very, very happy. Thanks is owed to GPET for their flexibility regarding maternity leave and hours worked.

That night I picked my baby up from childcare and although she was a bit disgruntled she had survived, was well fed, had a clean nappy and, importantly, that night she slept normally.

One last word, if anyone plans to express breast milk while working, invest in an electric expresser that does both sides at once. You’ll feel rather bovine but it’s quick and effective.

It is now October, and we are cruising. My medical brain has turned back on. I know about Nifedipine and I’m a whiz at milestones and immunisation. I enjoy my workdays and because I am part-time I can also enjoy days with my child.

Must dash, the baby’s awake!

Contributed by Dr Kate Wylie

“My baby and I had time to get to know each other, without the added stress of work. I am well aware that if I were in any other training program I would not get this time.” 163

Keeping your Balance

Being resilient Learning to look after yourself is as important as being able to look after your patients,yet it is a skill that is usually not taught. Burnout is an important issue in the medical community – research has shown that over 50% of Australian GPs have considered leaving General Practice at some time because of stress. Our profession generally entails more than a “9-to-5” job, with long hours, weekend work and on-call the norm. Added to this are increased organisational, financial and legal pressures in the medical professional environment. Doctors tend to be perfectionists, and our selection and training encourages us to be 164

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

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

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

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

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

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

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

165

Keeping your Balance

Real Resilience Resources

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

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

166

Goal setting. Physical fitness ideas. Inspiration. Fun stuff. RCUBED includes an e-newsletter as a reminder to you as a busy Registrar to make your own health a priority. If you are a GPRA member, look for the regular RCUBED e-newsletter in your inbox.

www.rcubed.org.au

11 Info FILE

Info File

GPRA

CALENDAR 2010

Important GPRA Functions Function

Dates

GPET RLO Orientation Workshop, Canberra

15 -16 March 2010 (Mon - Tue)

GPRA Breathing NEWLIFE into General Practice General Practice: The Next Generation, Canberra

17 March 2010 (Wed)

GPRA Advisory Council Meeting, Canberra

18 March 2010 (Thu)

World WONCA 2010, The Millennium Development Goals: The Contribution of Family Medicine, Cancun, Mexico

19-23 May 2010 (Wed - Sun)

GPET Registrar Research Workshop

To be advised (May - July 2010)

GPET Convention, Alice Springs

8 - 9 September 2010 (Wed - Thu)

GPET RLO Workshop, Alice Springs

10 September 2010 (Fri)

RACGP Exam Dates Exam

Assessment Date

Cost

AKT

6 March 2010

$1,480

AKT

21 August 2010

$1,480

KFP

6 March 2010

$1,480

KFP

21 August 2010

$1,480

OSCE

8 May 2010

$2,950

OSCE

24 October 2010

$2,950

Visit www.racgp.org.au for further details regarding the RACGP examination system.

GPRA Advisory Council Meeting and AGM, Alice Springs

11-12 September 2010 (Sat - Sun)

RACGP GP 10, Shape Our Future

6-9 October 2010 (Wed - Sat)

ACRRM Rural Medicine Australia 2010

To be advised

Exam

Enrolments Close

Assessment Date

Cost

GPRA Future Series, Sydney

29 - 30 October 2010 (Fri - Sat)

MSF

Can enrol any time

As arranged by candidate

$400

3 - 6 November 2010 (Thu - Sun)

MCQ

22 January 2010

20 March 2010

$495

MCQ

2 July 2010

28 August 2010

$495

StAMPS

30 April 2010

17-18 July 2010

$935

StAMPS

24 September 2010

4-5 December 2010

$935

miniCEX

11 December 2009

February-July 2010

$1,035

miniCEX

14 May 2010

August-December 2010

$1,035

AGPN Forum, Sydney

ACRRM Assessment Dates

Visit www.acrrm.org.au for further details about the ACRRM assessment system.

168

169

g. au

Check out our online resources for GPs...

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

INFO FILE

HOW MANY WAYS DO YOU LOOK AFTER YOURSELF?

We want your feedback on Explorer 2010

We aim to continually improve the support we offer GP Registrars and we value your opinions and constructive comments. â&#x20AC;˘ Were the articles and information valuable to you? â&#x20AC;˘ Are there any other topics you would like to see? â&#x20AC;˘ Is there anything you would like to see more of? â&#x20AC;˘ Is there anything you would like to see less of? â&#x20AC;˘ Do you have any suggestions for future topics? â&#x20AC;˘ Are you interested in writing an article for future editions? â&#x20AC;˘ Are you interested in assisting on the editorial team?

Looking after you - The Doctorsâ&#x20AC;&#x2122; Health Fund When youâ&#x20AC;&#x2122;re busy living life to the full you donâ&#x20AC;&#x2122;t expect things to go wrong, but if the unexpected strikes, youâ&#x20AC;&#x2122;ll be glad you are prepared with the right health insurance so you can concentrate on enjoying life. Join your not-for-profit private health insurance fund which offers high quality health insurance with the flexibility for you to choose the hospital and extras insurance that works for you. With hospital insurance, from the very economical â&#x20AC;&#x2DC;Smart Starterâ&#x20AC;&#x2122;, to â&#x20AC;&#x2DC;Top Coverâ&#x20AC;&#x2122; with the greatest medical benefits in Australia based on AMA List fees. The choice is yours. For all the information you need and to join visit www.doctorshealthfund.com.au. Contact us at info@doctorshealthfund.com.au or call 1800 226 126.

Please send us your feedback by email PUBLICATIONS GPRA ORG AU OR BY PHONE

172

www.doctorshealthfund.com.au

GENERAL PRACTICE REGISTRARS AUSTRALIA T: 1300 131 198 www.gpra.org.au E: enquiries@gpra.org.au