Dear fellow teachers of perspective,
2018 is a re-negotiation year for the NTCER and as many of you have noted, the NTCER negotiations highlight just how tough general practice is for everyone.
When it comes to decision making around earning potential and which medical specialty one will choose one thing is clear: no-one chooses general practice for earning potential. This is true for supervisors, practice principals and registrars alike.
The most recent words, the media releases and the strategy around registrar claims have disappointed some in the sector.
Some might wonder why GPSA are not responding to every media release published by the registrar organisation. In short, continuing down this divisive path is to the detriment of the GP community.
The simple fact is: it is financially tough to be a GP registrar, GP supervisor, and GP practice principal. This appears to be corroborated by the volume of journalists writing on the topic of GP remuneration.
The NTCER allows business decisions to be made where it is viable to do so, while protecting the earnings of registrars with a base salary and affording registrars the opportunity to earn far greater income than the base as they become more competent.
The first meeting of the negotiations took place with GPRA on 7 July 2018 with the AMA providing impartial chairing of the meeting.
The claims addressed by the registrars at the negotiation meeting held recently identified a number of items largely outside the control of the NTCER and those negotiating it.
More than ever, through this negotiation GPSA’s aim is to provide certainty and stability for all stakeholders as we move into the period of transition of training to the colleges.
This will be achieved with the cooperation, good will and common intent of all the parties to provide certainty to registrars, practices, RTOs and other key stakeholders in the general practice arena.
Good progress was made at the recent meeting – we will keep you updated.
The aim is still to have an NTCER by September/October 2018 in order for practices and RTOs to have certainty with placements for the first term of 2019.
This fortnight I encourage all of you to have a conversation with your registrars about the business costs of general practice. Nurturing your registrar’s perspectives on employment conditions with a view from the employers end will likely support a more balanced view of the context in which they are training.
Yours in GP Training,
Dr Steve Holmes
RMA18 full program announced
Rural Medicine Australia 2018 (RMA18) is the peak national event for rural and remote doctors of Australia, presented by the Australian College of Rural and Remote Medicine (ACRRM) and the Rural Doctors Association of Australia (RDAA).
RMA18 will be held at the Darwin Convention Centre from Thursday 25 – Saturday 27 October 2018 and we’re thrilled to reveal the RMA18 program, which is available online.
With a packed program full of innovative and informative presentations, interactive workshops and social events, along with a heap of exhibitors, you’re not going to want to miss out. This first release is just the beginning – we’ve got even more to add in the coming weeks!
Register now for RMA18
This year we have dedicated streams for our registrars and students that specifically relate to where they’re at in their training and studies. We’re bringing back the ever popular Suturing Workshop for students, and a session on planning and completing your Advanced Specialist Training (AST) for registrars.
We also have dedicated themes for this year’s conference, two of which are Research in Policy and Practice, and Women in Health.
Notable highlights in the program stemming from these themes include ‘Codeine Rescheduling – evaluation of impacts and future implications for rural and remote practitioners and communities’ and, ‘Gender Bias in Rural Healthcare, Planning for Women’.
From sharing the same surname to place of medical practice, Victorian GP supervisors Dr Janet McDonald (pictured left) and Dr Andrew McDonald (pictured middle) also have another link: their GP registrars.
They have each recently received the GPSA Recognition of Service Award for more than 10 years’ service as a GP supervisor.
The pair – who are not married, nor related – started their GP supervision journey together 14 years ago, sharing their first registrar Dr Nicole (Nikki) Hamilton (pictured right).
Janet said while they were experienced at accommodating medical students, GP supervision “came quite by accident” when Nikki approached them for placement during her final term as a GPT4.
As North Mitcham Clinic grew to a larger premises at Donvale, there was room to accommodate a regular stream of registrars, with Andrew and Janet since sharing supervision of up to 20 young doctors.
“Both Andrew and I have enjoyed the challenge of teaching and giving back to the system that trained us,” Janet said.
“It keeps us young – and helps keep us up-to-date … you have to be one step ahead of your registrars.”
On the flipside, Andrew said supervisors also learned a lot from registrars as they explored medical questions and clinical reasoning scenarios together.
He said registrars shared ideas and experience from other mentors and practices, which helped supervisors and colleagues “become more invested in the medical community” outside of their own practice.
“Registrars come with ideas for setting up new programs, or new ways of doing things,” Andrew said.
“It makes you less isolated in the practice – and helps you stay contemporary.”
Along with altruistic motivation to impart knowledge with young doctors, Andrew said the flow-on benefit of being a supervising clinic was healthy for business succession.
The clinic has a broad range of doctors, bolstered by a number of Andrew and Janet’s registrars returning after fellowship, including Nikki who still practises at North Mitcham Clinic.
“It’s enjoyable watching young doctors come through, and it has also invigorated our clinic with young doctors wanting to come back and work for us,” Janet said.
Andrew and Janet agreed their co-supervision of young doctors had benefited each other, the registrars and patients.
“The value of two of us doing supervision is we both come from different angles, so the registrar gets a broad view of general practice: they see there is more than one way of doing things,” Janet said.
The pair enjoy the variety teaching adds to their working day.
“You get to stop from consulting and talk about clinical issues and medicine, and you both learn,” Andrew said of the supervisor-registrar relationship.
While Andrew and Janet divide their teaching load, they said their registrars also had more access and choice of supervisor for specific queries and during busy periods.
For practices new to GP supervision, Janet advised the first challenge was training administration staff how to educate patients during patient bookings about the role of registrars.
She said other challenges included setting up systems for practical tasks before, during and after the registrar’s term in your practice.
“For example, all the paperwork,” Janet said “and tying up loose ends when a registrar leaves, such as their recalls are covered, and that results that come in after the registrar has left are checked and seen.
“We have Best Practice Software and have regular automation set up for all results to come to me once we have signed off a registrar. So, we make sure things are handed on.”
Andrew’s teaching tips included:
“Be interested in your registrar’s journey so far,” Andrew said.
“A lot of registrars have had quite a stressful time in their careers. It’s rewarding giving registrars an environment where they can enjoy asking questions.”
Janet said she and Andrew “had learnt along the way how to impart knowledge” and acknowledged GPSA as a great support in their teaching journey.
Rural Medicine Australia (RMA) is the peak national event for rural and remote doctors of Australia. This year, RMA will be held at the Darwin Convention Centre from Thursday 25 – Saturday 27 October 2018.
RMA attracts a diverse and collaborative community of junior doctors, students, educators, academics, and medical practitioners who are passionate about generalist medicine in rural and remote communities and ACRRM encourages all registrars to attend.
The RMA18 program aims to cater to the wide-ranging interests and needs of delegates, including professional development workshops, informative keynote speakers, policy discussion, political forums, research presentations, and social and professional networking opportunity.
This year’s themes include:
RMA18 Early Bird ends 31 July
Early bird tickets are on sale until 31 July. Don’t miss this opportunity to save up to $200 on your conference registration. You’ll also be able to secure your spot at social events like the Presidents Breakfast and the Conference Dinner and Excellence Awards – places to these events are strictly limited!
RMA18 is a proudly inclusive conference, and the program will feature a strong line-up of female and male keynote and other speakers from a variety of different fields. This year’s acclaimed speakers include:
This Presidents’ Breakfast is one of RMA’s most highly sought after events where conference delegates get to hear from an influential group of health leaders on a range of health topics.
The cost of this event is included in the Conference ticket; however attendees are encouraged to act quickly as seats are limited and fill up fast.
This year’s Breakfast will cover wide-ranging topics, including:
The RMA Presidents’ Breakfast has been made possible for a third year through continuing generous support from MDA National.
Sponsor a Student
The Sponsor a Student program was designed to bring more students to the conference – as the future of rural generalism, we want to see a large contingent of student guests! The program helps cover the costs for them to attend the conference.
The sponsorship covers full conference student registration, valued at $295. Students who are successful in receiving a sponsorship will still need to cover their own:
If you’re interested in making a donation please follow the link below. Your donation assists an ACRRM or RDAA medical student member to attend the conference, providing them with valuable networking and learning opportunities. Students will be selected for sponsorship based on their responses to an application form.
GP Training… it’s all about quality and managing risk
I marvel at the Australian GP Training System. I marvel because as GP Supervisors we are driven by more than money and fear. Despite the risk to our patients, our careers, our businesses and ourselves, we take on the commitment to supervise registrars. These junior doctors arrive in our practices, treating our patients with variable degrees of competency. As this management can occur behind closed doors adverse events may occur despite the most rigorous supervision and is a cause for great anxiety in most training practices.
It would be easy to batten down the hatches and just treat patients. It would be simpler to only employ experienced fellowed GPs to work in our practices. The risk can be huge, expensive and yet, despite all of that, GP Supervisors continue to accept GP registrars into our practices because of the promise they represent. The opportunity to influence, develop, mentor and mould them – to become our replacements, our doctors, our practice owners, our supervisors; the future.
The conversation in the medical press and social media reflects the pressures being experienced across the sector. It is a difficult time to be a GP and even more difficult to be a practice owner and supervisor. With declining incomes it’s not surprising that some focus their attentions on money.
As we enter the NTCER negotiations in 2018, GPSAs mandate from the membership is clear: We’re under pressure. Our income has been in decline. We have so many things to be concerned about… like patient safety, maintaining best practice, CPD, attendance to medicolegal matters, RTO compliance paperwork and registrar wellbeing.
GPSA are here for every last Supervisor, through every experience and always looking for new ways to assist in making your work lives better, easier and more rewarding. With over 5000 supervisors caring for our communities and our registrars nationally, its clearly not a role that all of the 34,000 plus GPs care to perform. It is therefore incumbent upon the AGPT community to look after our relatively small, but diligent volunteer supervisor workforce in the same way we look after our registrars.
Recognising the risk management strategies that practices and supervisors need to put in place and always to remain vigilant as well as caring and supportive. Despite characterisations to the contrary, payment of percentages on 13-week cycles is not compulsory, nor exploitative. You are at liberty to manage your exposure to risk as a practice. It’s a business decision and an item for negotiation. Due to the challenging circumstances we assist members to navigate with their registrars, GPSA certainly recommends practices pay base salary payments every fortnight with the bonus percentage top ups every 13 weeks. A bonus that is unique to training doctors in GP land.
GPSA have no interest in seeing practices do wrong by their registrars – registrars after-all become tomorrow’s supervisors. We welcome a dialogue about quality and risk management as we progress towards the transition of training to the colleges and the next NTCER. But we need to also understand that training must be sustainable and if the costs outweigh the benefits then supervisors and training practices will walk away. We can only hope that our registrars are equipped to lead the discussion around quality and risk management. Are they in our practices to primarily earn or learn?
Chair – GPSA
Former GPSA Chair Dr Bruce Willett has nominated for the presidency of the Royal Australian College of General Practitioners, pledging to continue making the organisation more member focused.
The current RACGP Queensland chair and long-time GP supervisor said his focus as president would be listening and responding to member feedback on key issues facing general practice and the wider profession.
Bruce, 56, said the RACGP had an important role to play in advocating for general practice during the changing landscape of primary care.
“There are a lot of forces seeking to fragment patient care and the RACGP has a key role in cementing the care position of general practice in providing primary care services,” he said.
As president, Bruce plans to lead the organisation in a proactive and collaborative approach to achieve: strong advocacy for the role of general practice and the importance of having a regular GP; proper remuneration and support for GPs; working together with other GP groups to advocate for general practice; and examining innovative, new models of care.
“We (RACGP) will work with other organisations, such as GPSA and GPRA and other major stakeholder organisations,” Bruce said.
With a long history in GP training, Bruce has also pledged “to protect and enhance the quality of training as the RACGP steps back into training”.
“I remain committed to a training system that gives registrars the best possible experience and protects the apprenticeship model,” he said.
The Queensland University graduate has more than 30 years’ experience as a GP and 26 years as a GP supervisor, having trained about 80 registrars.
As a passionate educator and general practice advocate, Bruce said his RACGP nomination was “an extension of training GPs to supporting and improving the system that they will go to work in”.
His journey as a GP supervisor started under the guidance of the RACGP, then with the Central and Southern Queensland Training Consortium – now General Practice Training Queensland (GPTQ). He has been a GPTQ medical educator, and its supervisor liaison officer for the past 15 years.
Bruce is practice principal at Victoria Point Surgery, a group practice in the Redlands on the southern outskirts of Brisbane.
He is the immediate past chair of GPSA (2014-2016), serving on the board for four years from 2012.
Bruce described his experience with GPSA as an “exciting time” where he enjoyed the support of “a great board and chief executives (Margo Field and Glen Wallace)” during a period of “remarkable growth and development”.
“We achieved a lot in establishing respect for supervisors and GPSA,” he said.
Since working as RACGP Queensland chair from October 2017, Bruce has worked with industry leaders in a bid to alleviate burdens on local services.
He aims to continue working with industry leaders to ensure GPs remain the cornerstone of primary care under a patient-centric led model of care.
Other roles taken on by Bruce include: director of his local GP division; GP representative in the Queensland health diabetes network; GP supervisor liaison network chair; and RACGP examiner for nearly 20 years.
He is an experienced commentator in the media on GP issues and has represented the interests of general practice with ministers and senior public servants.
Bruce and his doctor wife Gertrude have three adult children, including one who has followed in their footsteps and is working as a junior doctor.
The RACGP council election takes place in June.
POLICY NEWS JUNE 2018
MABEL (Medicine in Australia – balancing employment and life)
There has been a fair bit of attention in the medical media to recently released MABEL data and in particular, its revealing stats on GP earnings compared to other specialties.
None of this will be news to GPs who have endured the medicare freeze.
GPs are reportedly the lowest earning specialty at a median of $103 per hour
Many are earning $74 per hour. And that’s before tax. This compares with $170 per hour for orthopaedic surgeons in the lower quartile.
And of course, like households, the cost of almost everything in running a practice has gone up – electricity and other utilities in particular but also rent, transport etc.
What hasn’t moved much across the general economy for a number of years now is wages growth. Pick pretty much any sector and the story is the same. Some industries have disappeared altogether e.g. car manufacturing.
The story is worse for women (no surprises there) with female GPs earning up to around $12 less than their male counterparts.
The gender pay gap is across virtually every industry globally and often begins upon graduation for those in the professions.
General practice is no different.
BEACH data may shed some light on whether the differences are due to the apparently different nature of consults done by male versus female GPs.
Check out or interrogate the MABEL data for yourself here:
Well the budget came and went without much fanfare. Most of it’s all been said and done.
The main general practice win was the 55c increase on the standard consultation rebate that kicks in from 1 July.
Other than that, the big winners are rural health and aged care.
An additional 100 rural generalist training posts will be made available from 2021 under the AGPT program.
And 300 new places for rural junior doctors on the rural generalist pathway. Good news for rural areas.
A new Junior Doctor Training Program sees junior doctors working outside of capital cities with population greater than 50,000 (MMM areas 2-7) able to get a Medicare provider number that attracts 80% of the MBS scheduled fee.
Non-VR on a pathway to Fellowship will get 100% of the rebate.
Good news for supervisors? These junior doctors will still need to be under the supervision of a VR GP.
That’s more than the $83.3m attached to the Stronger Rural Health Strategy, so it’s a big win for rural areas.
Non-vocationally registered doctors and IMGs were a big target in this budget. Many of the non-VRs working in Australia do not have Fellowship of either ACRRM or RACGP and there is a big push, supported by dollars, to make this happen over the next 5 years. Winner? The colleges – they get the money.
200 places have been axed from the IMG GP visa intake, reducing it to 2,100 places. Probably just the beginning…
There will be a new rural medical school based in Wagga Wagga. This will form part of the Murray-Darling medical schools network which includes University of New South Wales (Wagga Wagga), University of Sydney (Dubbo), Charles Sturt University/Western Sydney University (Orange), Monash University (Bendigo, Mildura); and University of Melbourne/La Trobe University (Shepparton, Bendigo, Wodonga).
Not sure what that means educationally, but in dollar terms it’s a cool $95.4m.
MBS Review Taskforce
A swag of recommendations were accepted by the Australian Government in late April.
These are for MBS items in the following areas:
Get all the details here:
A GP now heads the AMA
Dr Tony Bartone, a GP from Melbourne is the new President of the AMA and is calling for action on general practice funding.
Should be an interesting year……
RESEARCH ROUNDUP JUNE 2018
In this month’s Research Roundup, we look at some of the latest papers on professionalism including a handy app for students, quality indicators of postgraduate medical e-learning and….early predictors of exam performance for GP training! Read on!
2018 GPSA National GP Supervisor Survey
Yes, it’s early this year! In response to demands from stakeholders to have the results available at GPTEC in September, we’re running the annual GPSA National Supervisor Survey right now instead of in August!
So hop to it here and tell us what you really think! And go in the draw for a chance to win one of three $500 Qantas travel vouchers.
Go on! You know you want to!
Professionalism is the holy grail and catch-all, it seems, but how do you Promote it? Model it? Or (heaven help us) remediate the lack of it?
These three papers address those aspects.
Self-reflected wellbeing using a smartphone app
This NZ study by Elizabeth Berryman et al describes a feasibility study into developing a phone app that medical students (and presumably postgraduate students also) could use to manage the depression, anxiety, burnout and suicidal ideation that many students experience that has been the subject of attention in the literature and in other media channels.
This was a mixed methods study involving a survey and focus groups to use self-reflected scores as a measure of wellbeing and how they changed before and after using the app.
Increased wellbeing was associated with:
Decreased wellbeing was associated with:
My own comment about this second list is that it is important to note that a number of these are issues where the student has identified they felt that way – possible explanations or causes for those feelings is not addressed.
Themes to emerge included: finding time for reflection, the utility of a tool that could help create habits of self-reflection and that daily reflection increased self-awareness of wellbeing.
Real food for thought and could it be used by practitioners as well?
Form your own view by reading about it here:
Illuminating exemplary professionalism
This study by Butani et al looks at appreciative inquiry as a strategy to stimulate learner reflection on exemplary professional behaviours.
Appreciative inquiry “explores and identifies successes and best practices within a culture so as to build on them (asset-based strategy for change) as opposed to focusing on the problems (deficit-based strategy).” So AI is a means for facilitating dialogue between learners and mentors.
Using a framework developed by others (Arnold and Stern) this paper uses the concept of professionalism as a virtue to which all physicians strive. The observable behaviours associated with it include clinical competence, ethical and legal understanding of the practice and the profession, and effective communication.
The four pillars that link all this are the aspirational values of humanism, altruism, accountability and excellence.
The themes that emerged from this study are:
Adopting a principle-based attitude such as thinking about patients not as their illnesses but as individuals was the most frequently identified intrinsic facilitator to professionalism.Emotional intelligence was also pretty important.
The authors also highlight the need for greater explicit discussion of self-humanism within the curriculum as a way to promote exemplary professionalism and foster resilience.
This paper is well worth the read:
Framework for remediating unprofessional behavior and developing professionalism competencies and a professional identity
This paper by Barnhoorn et al highlights the concept of professional identity formation (PIF) – remember the term, you’ll be hearing a lot more about it in the future.
The adaptation of the multi-level framework by Korthagen that the authors espouse has the following levels and focus in medicine:
Environment – where am I?
Behavior – what am I doing?
Competencies – what can I do?
Beliefs and values – what do I believe in?
Identity – who am I?
Mission – why do I do what I do?
Depending on whether the perspective is behavior, attitude or process based, different strategies will apply.
Applying this to remediation means viewing professionalism through different viewpoints which will each have different goals.
For example, from the behavior based perspective, the goal of medicine is to deliver competent doctors to society who behave professionally. Behaviour is easy to measure and so can be potentially be remediated more demonstrably.
The goal of medical education from an attitude based perspective is to foster the virtues and values needed for good practice. But not so easy to measure or remediate (using reflection and feedback).
From the process-based perspective, the goal is the formation of the professional identity which is only achieved over time and in stages.
The use of the multi-level professional framework describes a nonhierarchical interplay between different levels relevant to professionalism.
This paper provides an illustration of how the multi-level framework can be applied.
Read all about it here: https://doi.org/10.1080/014259X.2018.1464133
Quality indicators of postgraduate medical e-learning
Perhaps surprisingly, this study by de Leeuw et al finds that there has never been a set of e-learning quality indicators!
So they set about developing such a list using 13 international education experts and 10 experienced users of e-learning in a Delphi study that can only have been a nightmare to administer!!! (but I digress).
They came up with a list of 37 indicators that grouped under the subjects of motivate, learn and apply.
Here’s a couple of examples of the indicators:
Motivate: provide an overview of all content, provide easy accessibility from all locations and devices.
Learn: allow non-linear learning, create interaction with the content.
Apply: make the content translatable to the real world, update and maintain the e-learning.
They think they’ve come up with the goods here! Judge for yourself:
Predictors of exam performance in GP training
This elegant paper by Rebecca Stewart et al looks at whether there were any associations between four predictor variables and the RACGP Fellowship exam components (AKT, KFP, OSCE or all three).
The predictor variables were: performance on selection assessment (includes a SJT and MMIs), MCQ, performance at ECTVs and supervisor assessment (as a dichotomous at or above expected standard vs behind expected standard).
Firstly, the predictors of poor exam performance are different to those predicting the need for in-training remediation.
The pre-commencement MCQ, SJT and MMI are predictive of exam performance.
Selection scores and very early assessments can predict trainees more likely to be unsuccessful in the Fellowship exams.
“In-vivo” assessments of complex clinical performance predict the need for remediation.
So look for a big investment in an AKT-type assessment as part of selection!
Oh, and if you’re older and male your exam results may be not so hot.
Don’t take my word for it! There’s a lot more juicy detail in this one!
Go read the paper here:
GPSA NTCER Update – May 2018
2018 is a re-negotiation year for the NTCER and the process formally commenced in January 2018.
We have listened to our members’ concerns and are approaching the NTCER process with diligence and in good faith in the interests of the GP community – both current supervisors and registrars, who are the supervisors of the future.
The NTCER and process has consistently delivered realistic, sustainable outcomes for GP supervisors, registrars and practices in a time of economic stagnation and decline in real wages for most workers.
And it has delivered terms and conditions that are sustainable and realistic at a time when the medicare rebate is still frozen.
The transition of GP training to ACRRM and the RACGP is a time of great instability and uncertainty in the sector.
The NTCER delivers certainty and stability to registrars and supervisors alike. It delivers terms and conditions that are consistent across practices. And that are negotiated in an effective, transparent and consistent manner.
Negotiating in good faith is an exercise in trust and respect.
GPSA provided the names of its negotiating team to GPRA in November 2017.
We are still awaiting the names of the GPRA team so that negotiations can commence.
GPSA calls upon GPRA to now come to the table negotiate the NTCER in good faith as is expected of us by the AGPT community.
So that together we can deliver realistic and sustainable outcomes to registrars, supervisors and practices and stability to the sector at a time of great uncertainty.
Last month the latest KFP results came out and, as has become common to results week, the GPSA office fielded a number of calls from concerned supervisors. As supervisors, we want our registrars to do well, so when they don’t, not only does it significantly affect them, we feel their pain.
So far 2018 has been a year of action, giving you the tools you need to support in-practice teaching and development of your registrars. We have brought you the supervisory relationship measure – a tool you can use to facilitate discussion and progression of your registrar. We have added the GP Study System cards for use in preparing registrars for examination.
2018 is a re-negotiation year for the NTCER. GPSA are working with GPRA to get this process underway. GPSA provided the names of our Negotiating Team in November 2017. We are, however, still waiting for the names of the GPRA Negotiating Team and their log of claims so we can embark on the next round of negotiations and together we can deliver realistic and sustainable outcomes to registrars, supervisors and practices and stability to the sector at a time of great uncertainty.
We have been providing feedback to the Department of Health Transition team, looking after the AGPT transition to college delivery, in highlighting the challenges faced by supervisors and training practices and the opportunities for efficiency and enhancement throughout the sector.
Support around NTCER, payroll, leave, percentages and employments are just some of what our staff work diligently to get members the very best advice. We continue to provide our membership with free open access to valuable resources with over 50 teaching plans available on our website and a number of online learning modules. Later this month GPSA will launch the Communication Toolbox including five online learning modules and additional teaching and learning resources. The Toolbox has been developed to assist doctors, particularly those that have trained outside of Australia to navigate the organisational structures and systems in which we work as well as the cultural, societal and communication considerations that contribute to patient care.
GPSA is always keen to hear from our members, feedback regarding any of our resources, webinars, online learning modules or other issues to be considered in the NTCER negotiation would be very appreciated.