Dr Linda Mann was presented a Recognition of Service award by GPSA for her outstanding commitment as a GP supervisor for 33 years. Linda has local and overseas medical experience, especially in genetics and women’s health including pregnancy care. She is an examiner for the RACGP and is an experienced medical educator. Linda works in the Your Doctors practice and at RPAH.
Linda also makes regular trips to the remote town of Borroloola in Northern Territory 1000km SE of Darwin where she provides supporting medical care.
Registrars need to learn how to be GPs, not hospitalists. The cultural training in hospital, which has political implications of avoidance of bed block, and KPIs for ” efficiency”, has some relevance in General Practice, where time keeping is also important. But we do not need to rush to solve a problem, usually. We have the benefit of repeated visits, and time to observe the effect of treatment over time. Registrars also need to learn that they carry gravitas as a doctor: billing for their time is appropriate and has value. They often worry that their slowness in practice is not something worth charging for. They need to understand that seeing the doctor ( which they are) is of value, and has value, and can solve the problem.
Registrars come from all sorts of places and training experience. Up to date references and changes of practice are easy for me to accommodate when I can see these in practice, eg change from warfarin to NOACs when they were introduced back in the day (I was hesitant at the time, having had no direct education: the registrars were very experienced and it was great to learn from them)
GP supervisors grow GPs. We have the challenge of ensuring that the new GP has all the characteristics that we value, and that they have the required standard of knowledge and skill required by the vocational training organisation, the regulators and the patients. We have challenges with ensuring patient comfort when the registrars fall short of the patient’s expectation, eg when the registrar is anxious, or needs support, or simply is not up to the problem, or makes a mistake. We have significant challenges in balancing the books if the registrar is slow to see patients, unpopular or unwilling to bill.
GPSA provides really useful organised training modules. GPSA is a voice in the medical political marketplace that represents me as a supervisor, and ensures my issues are front and centre. After all, if we do not train doctors to be GPs, the whole community suffers and preventive and chronic care become fragmented and patchy. Training GPs needs supervisors, and the existence of supervisors is not guaranteed without this organisation calling out loud and long for the resources we need to keep supervising.
Being a GP supervisor brings the extra dimension to GP work that allows GPs to continue to grow as they work through the decades. I am obliged to stay fresh, to not settle into comfortable and old medical ways. I am stimulated to change how I talk to colleagues and patients, as the registrars I supervise are now older in their life experience, and feel more and more collegiate. This is how you can work to bring more doctors into General Practice, and the way you can be part of the road they follow to practice good medicine
Date reviewed: 26 March 2024
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Graham was recently recognised by GPSA for over 25 years of service as a GP Supervisor. He has worked at Leongatha Healthcare since 1994 after working in Nepal for 12 years. He is married to Sue and they have 5 children and 4 grandchildren. Graham has special interests in Skin Clinical work and Travel medicine.
Pictured: Dr Graham Toohill with registrar Dr Melissa Lee
What rewards do you feel you have gained from GP Supervision ?
I really enjoy it and and get a lot of satisfaction seeing registrars getting more confident in their skills and experience. It is incredibly rewarding if they come back to Gippsland and practice here, with several previous registrars still practicing in the clinic today.
What type of things do you feel you have learnt from GP registrars?
GP registrars all come at different stages of experience. One guy had worked in plastic surgery previously. It was terrific to see him take off a skin lesion on somebodies’ ankle which looked very difficult to close. He did a horizontal mattress suture and I have learnt from that and used this technique ever since and taught it to other Registrars. We also have lunchtime teaching sessions, where registrars prepare a relevant topic to present which they have researched. I really enjoy these sessions where I always learn something.
What are the challenges of GP supervision?
It’s a challenge to stand back and watch a registrar do things in the practical procedure department, because you never know what they are going to do, and you know you could do it quicker and easier yourself. But you have to give registrars the opportunity to try things and learn in this way. I tell registrars that my door is always open to them and they do come in and interrupt me quite regularly. Patients are very supportive of this and do not mind. One of my current GPs said when he was a registrar, their GP supervisor told them never to interrupt him. I aim be the opposite, with an open-door policy and even though this can be challenging at times, it’s still worth it.
What are the differences working as a GP supervisor in a regional location?
There are much broader education opportunities in regional practices with a local hospital for admitting patients to and continuing to monitor them, rather than sending off to a hospital somewhere else. Registrars get to experience the full range of services in the clinic, including obstetrics, early childhood care and following through the life course up to geriatric and palliative care. All these areas are available to registrars who come here. There is also a terrific ambulance service if patients need to be sent elsewhere. Registrars can learn in all areas of medicine including assisting with caesarean sections, anaesthetics and skin cancer surgery. There are very broad opportunities to learn holistic medical care at all stages of life.
Do you have any anecdotes of a good supervision experience that you would like to share?
I had a registrar here on an ACRRM program who needed to tick off on completing a skin excision with flap repair. About this time I found a growth on my leg and a biopsy revealed it turned out to be a skin cancer. I suggested that this was the perfect opportunity for my female registrar to complete her training in this area. She did the excision and flap on my leg and did a great job. I was very impressed by this registrar and her approach.
How has GPSA Supported you?
GPSA was most helpful to me during supervisors networking weekends. We had some terrific weekends with lectures and workshops and networking. GPSA’s support and input in these weekends was excellent and the main way I have felt directly supported by GPSA.
What would you say to others considering becoming a GP supervisor? Definitely go for it! It’s a wonderful role getting to know someone and gaining trust in them and vice versa. Helping with difficult cases and teaching your knowledge is extremely rewarding and I would recommend being a GP supervisor to anyone who wants to give it a go and have a part in training the next generation of GPs.
Date reviewed: 26 March 2024
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Alvin was recently recognised by GPSA for over 17 years of service as a GP Supervisor. Dr Chua graduated from The University of Adelaide in 1997 and has a wealth of experience in hospitals across South Australia including Modbury Hospital and Lyell McEwin Hospital; and various general practices in rural and metropolitan suburbs of Adelaide. Dr Chua became the founder of the Health at Group in 2001, with fellow Director and Practice Principal Dr Anna Schettini, and currently works at Health at Campbelltown in South Australia, In 2004 Dr Chua graduated Musculo-Skeletal Medicine at Flinders University, and continues to have an interest in Musculo-Skeletal Medicine. Dr Chua is a GP Supervisor through the GPEx Training Program.
What rewards do you feel you have gained from GP Supervision ?
Being able to shape the future of general practice and replace the workforce. Teaching and encouraging people who might look after us in the future is satisfying. I am always learning something everyday and I believe that the day you stop learning is when you become arrogant and dangerous, and you should stop practicing. As a GP you are always learning every day more than other professions, and registrars teaching us as well is a part of this.
What type of things do you feel you have learnt from GP registrars?
The current cohort of registrars put more emphasis on work life balance than my generation. In my time people put in 40-50 clinical hours plus overtime. This generation have a much better work life balance which people of my generation need to work on. Hopefully this prevents more burnout in the future, which I see in my generation with GPs sometimes becoming burnt out, bitter and cynical. The new generation has a much better perspective on work-life balance.
What are the challenges of GP supervision?
The biggest challenge is trying to compete with a dwindling workforce, competing with hospitals which offer much more generous remuneration. This makes it hard to compete for trainees. The GP workforce is dwindling and remuneration is tied into Medicare rebates. Hospitals have been able to increase 3-4% per annum when Medicare rebates were frozen from 2012-19, making us behind the eight ball and trying to catch up. The lack of exposure to general practice in medical training, with only 2-3 weeks during medical school leaves a lot to be desired. Previously, we had the Prevocational General Practice Placements Program (PGPPP) which ran from 2004 to 2014. Under the PGPPP, during their internship, registrars were allocated to a general practice for twelve weeks at a time. A lot of the registrar cohort in this time ended up as GPs and later trained other GPs as well. I was sorry to see that program go, and the whole GP workforce were sorry to see it go. The government does not seem interested in reinstating this program. Generally, there’s an expectation from Government that GPs continue to do things with altruistic values with lower expectation of monetary rewards. This is one of the biggest struggles we face as a profession.
How has GPSA Supported you?
GPSA has supported GP Supervisors like myself with negotiation of the National Terms and Conditions for the Employment of GP Registrars (NTCER) with GPRA. This sometime involves pushback when registrars have their own agendas and we as GP supervisors have our own limitations of what we are able to pay for registrars. GPSA tries to adopt an approach of all of us working together in general practice, not a ‘them’ vs ‘us’ mentality. In the past registrars adopted a ‘them’ vs ‘us’ approach which was not very conducive to working together.
What would you say to others considering becoming a GP supervisor?
Get your feet wet and get into it. You’ll find its quite rewarding and the rewards far outweigh the challenges. Registrars are future colleagues of ours and also our future workforce.
Date reviewed: 26 March 2024
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Richard recently received a recognition of service award from GPSA recognising his work over 10 years as a GP supervisor. Dr Richard previously worked in supervision of junior doctors, students and registrars at The Medical Clinic in Millicent SA, before moving to Ferrers Medical Clinic (Mt Gambier) from 2011-2016. Following this, he opened his own practice, the Dr Try Medical Clinic in Mt Gambier, SA. where he has worked ever since and supervised registrars.
Pictured: Dr Richard Try and Dr Rowan Kruysse
What rewards do you feel you have gained from GP Supervision ?
The biggest reward is the satisfaction of seeing registrars develop and qualify to become fully fledged GPs and provide independent care. Seeing the joy (and sometimes relief) when they pass their exam results is very rewarding.
It is also a way of giving back to the profession. Each one of us was trained and some of us had better experiences than others while training. Training GPs is my way, I think, of giving back for the supervision I benefitted from.
Do you feel that you learn from GP Registrars also? If so, what type of things have you learnt?
Yes, in many ways, supervision is a 2 way street: Registrars have usually just come from hospital posts and so are very up to date and capable. I feel I need to stay very up to date to keep up with them. Often they will help with this and present at clinic meetings to update us all.
I also have to adjust how I supervise and teach to fit the needs of each registrar. No two are the same, so I have had to learn how to adapt and identify areas of concern that they might not even know themselves and then help them develop these areas.
They also help me examine my own approach to medicine in terms of consultation skills and to the job as a whole. It is very easy to get stuck in a rut but supervising registrars helps keep us fresh and enthusiastic. There is nothing like teaching to give you insight into your own practice.
Working in a regional centre, do you feel there are additional challenges for GP supervision? If so what type of challenges have you experienced?*
Lack of a local support network for GP Supervision is the main one. We don’t have anyone local that we can call upon as there is no local support network for us. At the moment, the ME for our area is based in Adelaide, 450km away. I joined GPSA to try and fill this gap.
Retention of registrars is also an issue. Often registrars have to leave the clinic just when we are getting used to them and this can be frustrating for the clinic and patients. There is a regional recruitment and retention crisis and registrars moving on adds to this. Patients are sometimes reluctant to see a registrar as they feel they won’t stay. The first question a new GP often gets asked by patients is “are you staying?” I think this can put the registrar in an awkward position and we have to counsel them on how to answer it.
When we get the registrar for their second attachment, they rarely stay beyond 1-2 years, if at all. The city seems to call them all and there is no flow of qualified doctors back. Sometimes it can feel we are putting a lot of effort in for no reward but we have to temper this with the reward of seeing newly qualified GPs spread their wings and know that there will be other communities that will benefit from them.
Ultimately, we do this job to train new GPs not to recruit to the clinic however much we would like them to stay.
How has GPSA Supported you as a GP Supervisor?
GPSA has a wealth of guides and teaching plans. We all have our different experiences and sometimes might need resources to help teach an area that we have less experience in than others. I have found the resources very useful in this respect including in supporting registrars who might be struggling.
What would you say to others considering becoming a GP supervisor?
Do it – you won’t regret it. It provides variety to our work and keeps us fresh and enthusiastic. It can be very rewarding seeing a struggling registrar develop into an independent GP.
Date reviewed: 26 March 2024
Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.
Peta recently received a recognition of service award from GPSA recognising her work over 15 years as a GP supervisor. Peta has been working at South Side Medical in McKay, Queensland since its opening in 2007. She has a drive and enthusiasm for all aspects of family medicine. She is committed to educating medical students from James Cook University and will often have them assisting her during consultations. She also mentors GP Registrars in rural and remote locations and is an examiner for JCU, RACGP and ACRRM. Peta is also a GP Supervisor for James Cook University (RACGP, ACRRM and RVTS).
Pictured: Dr Brian McPherin with Dr Peta Cornwall
What rewards do you see from GP Supervision ?
It keeps me learning and keeps me up to date with the latest developments. There is also a sense of pride I feel from seeing registers improve their skills and knowledge. It helps me to keep abreast of the latest research and keep looking things up. Unexpected questions from registrars help me to keep asking why things are done in a certain way. It also makes me realise how my thinking has changed over time. It helps me to look beyond pattern recognition and consider different possibilities in diagnosis also.
What are some of the challenges you find as a GP supervisor?
One of the challenges I find is that all registrars are different and as adult learners, they have different learning styles which I have to adapt to as a supervisor. Different personalities also respond to different ways of teaching. This can be interesting as well as challenging at times.
How have you found your experience in remote GP supervision?
Doing remote supervision I have drawn a lot on my experience working in rural and remote communities. It is important to know physically where the registrars are located, the type of patients they have, and what access they have to facilities and equipment. For instance, is it 100km to the nearest radiology centre, or is it just down the road ? Understanding geographic restraints such as this as well as getting a sense of the community can be difficult when doing remote supervision if you don’t have experiences working in remote and regional settings. By comparison, I find it much easier supervising registrars in my own clinic, as I know the environment and constraints they have to work within intimately.
Tell us about how GP supervision is different in a regional community? *
Supervising in a regional community offers additional challenges, as the practice is often smaller, with management of time being the biggest factor in being able to deliver GP Supervision. Trying to balance clinical work with supervision of registrars, it can be difficult to ensure that registrars are receiving enough supervision. There are also challenges with access to timely testing and pathology results, and a limited number of colleague GP Supervisors who I am able to discuss issues with.
Given that women are often under-represented in the GP supervisor workforce, do you feel there are any additional barriers that prevent women from becoming involved in GP Supervision? *
Most people who don’t want to become GP supervisors think they don’t have enough knowledge and are worried about the loss of income that comes with GP supervision. Perhaps women working less hours might find it difficult to justify financially the time spent in supervision. As the main earner in my household, I really had to justify to myself the personal rewards I gain from supervision to justify the loss of income from doing it. I have experienced some IMG graduates who had difficulty responding to me as a woman supervisor based on cultural differences, but ultimately they adapted to the situation as they needed my support to develop further.
How has GPSA Supported you?
I have used templates supplied by GPSA and gained access to support and contacts through GPSA. I have appreciated their advocacy for GP Supervisors in negotiating terms and conditions also. I often utilise flash cards from GPSA to start a training session, as they bring out some interesting discussions and problems. I have also used teaching plans for running sessions.
What would you say to others considering becoming a GP supervisor?
You have more to offer than you think. It’s rewarding and educational. Having a go at supervision for a day or two often gets people started. It can be fun and inspiring to have people interested in what you do. GPs sometimes get nervous about the challenges, but they are only challenges for a short time. Different registrars you encounter will inspire you again and encourage you to keep going. So give it a try.
Date reviewed: 26 March 2024
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Mt Beauty GP Supervisor Dr Libby Garoni was recognised with a Recognition of Service award from GP Supervisors Australia (GPSA) in May 2021 for her outstanding contribution to Mt Beauty and the surrounding community nurturing the next generation of GPs. Libby was born and bred in the Kiewa Valley, has previously worked in Paediatrics and also has a Diploma of Obstetrics and Gynaecology. Her recognition award from GPSA recognises 17 years of supervising GPs in the Mount Beauty practice, passing on her wealth of knowledge.
What rewards do you see from GP Supervision ?
It helps to make me a better doctor as I need to describe what I’m doing and why. It also builds team bonds and team relationships. Good medicine is about being part of a team and the friendships I have established have made it very rewarding. I remember once attending an operation for my daughter and one of the doctors remembered me from supervising them many years earlier. Meeting people down the track who you have previously supported like this is a very rewarding experience. I expect to go on supervising as part of my normal work as a General Practitioner well into the future.
What are the challenges of GP supervision?
Time management. Quality training, like quality medicine, takes time and can’t be rushed. Being a supervisor also means you must always stay up to date with current information to provide the best training possible.
How has GPSA Supported you?
I am grateful to GPSA for their support for myself as well as for practice management as a whole. Helping with resources such as contracts and allowances and keeping our Practice Manager happy have been an additional benefit. I regularly access resources and know that there is somebody there to go to if I have questions. I have found the guides and resources invaluable. GPSAs help in training and development of new registrars has always been there.
What would you say to others considering becoming a GP supervisor?
I’d always encourage them to become a GP supervisor as it’s part of being a good GP and a really fulfilling part of what I do. It makes me a better person as well as a better doctor. It really improves relationships within the practice and I can’t imagine not doing it.
Date reviewed: 26 March 2024
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The call to GP supervision found Dr Nicholas Hamilton early in his career.
In 2015, two years post fellowship, the young doctor registered as a supervisor “through circumstance” to help facilitate supervisor capacity at the newly opened East Canberra General Practice.
Dr Nicholas Hamilton
“My supervisor during my final training term was practice principal and was setting up another practice from scratch,” Dr Hamilton said.
“It was a good opportunity for me to work in a new building with all new equipment. I became a supervisor out of necessity so the practice could be a training practice.”
In December 2019, GP Synergy presented the supervisor of five years, now aged 38, the Murrumbidgee and ACT Supervisor of the Year Award.
Dr Hamilton has supervised 13 registrars, including some who have returned to the practice post fellowship.
In nominating Dr Hamilton for the award, a grateful registrar said: “This time was invaluable to my learning and ensured that I felt well supported and a valued member of the practice.
“Nick included me in practice discussions and decisions, and I grew to feel part of a community that shared my desire to support our patients while also prioritising our own interests and self-care.”
Dr Hamilton in turn values the support of his former supervisor Dr Clara Tuck Meng Soo, a recipient of the Medal of the Order of Australia for service as a medical practitioner to the community of the Australian Capital Territory.
He is grateful Dr Soo offered the opportunity to work and supervise at her new Canberra practice, and become practice principle and a co-owner so early in his GP career.
“I became a supervisor so early because Dr Soo was very experienced and inspiring,” he said.
Dr Hamilton admits being a young supervisor comes with advantages and challenges.
With a fresh recollection of life as a registrar Dr Hamilton – who is also an examiner – says it is an advantage as a young supervisor to “still be in touch with the examination process”.
“I know what it is like to be in the registrars’ shoes,” he said.
Equally, Dr Hamilton said teaching the reality of uncertainty in general practice was more challenging for a young supervisor than their senior peers.
“I feel more confident now as a supervisor in not always knowing the answers, and teaching that uncertainty is not always a bad thing; it is a part of general practice for doctors of all ages and experience.”
Dr Hamilton favours a pastoral care approach to supervision over didactic teaching sessions, largely because registrars (particularly those with speciality training) already have extensive medical knowledge and access to learning resources.
“General practice is a demanding job and you can feel quite alone; so, a lot of my teaching sessions are pastoral care conversations to help registrars strategise and work out their consultation style.
“One of the hardest things to teach a GP registrar is the need to take charge of patient care into the future; trying to help them make the switch from being reactive to proactive and giving the patient the sense that the doctor is there for them in the long term.”
Date reviewed: 19 July 2022
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Dr Sultan’s Quest to ensure each registrar reaches their potential
GP registrars under Dr Mohammed Sultan’s supervision experience a prime example of cradle-to-grave care in a small community.
In one instance, Dr Sultan treated up to four generations of one family – and happily accepted the family’s invitation to attend a milestone celebration for the family’s oldest member.
As the treating GP until the patient moved into a nursing home at 99, Dr Sultan had little hesitation in clearing his calendar to attend his former patient’s 100th birthday.
“We are a family orientated clinic, treating a few generations of some families,” Dr Sultan said from his clinic in Gatton, Queensland.
“This was my first experience of a patient under my care reaching 100 and I was pleased to be there with his family to celebrate his 100th birthday in 2016.”
Family Health Gatton serves a rural population in the Lockyer Valley, about 90km west of Brisbane, and has a wide demographic base in age, gender and medical conditions treated.
Dr Sultan, who trained and graduated in South Africa has practised in Australia for 20 years, and has supervised GPs for about 12 years.
In this time he has supervised between 20 to 25 registrars, and is a recipient of the GPSA Recognition of Service Award (10-plus years).
“It’s absolutely enjoyable to help young doctors grow and mature into great doctors; seeing them along their journey and knowing you have contributed to their learning as a GP,” Dr Sultan said.
“I always say to my young registrars that they probably know a lot of theory of medicine being fresh from uni, but I’m here to share my experiences as a GP, and teach them the practicalities of general practice along with the business and relationships required for them to ultimately be the best doctor he or she can be for every patient under their care.”
Dr Sultan said his journey as a supervisor was prompted by the excellent training he received as a medical student and young doctor in South Africa “from an amazing group of educators and consultants”.
Having trained in an environment where the learner is shown the procedure once, replicates the procedure, and pays the knowledge and skills forward to future doctors underpins Dr Sultan’s motivation to supervise registrars.
“My motivation to supervise is to educate the future community of doctors to be better skilled and knowledgeable of general practice.”
While supervising the future generation of doctors was a rewarding journey, Dr Sultan said it also brought challenges.
He said these challenges included dealing with different levels of knowledge and skill sets among new registrars, helping registrars better understand the transition from a hospital environment to GP setting, and dealing with the different administrative roles.
Dr Sultan’s advice for other supervisors?
“Patience with new registrars; share practice tricks and tips; and make sure that you pass on education of management of GP business and also employee responsibilities, as they differ so much to hospital.”
Date reviewed: 20 July 2022
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