As you progress through your intern and early RMO years, a time comes when decisions have to be made about future training and specialisation. You get exposed to most medical specialties as a junior doctor in the hospital system, but General Practice is a bit of a mystery. As a JMO, there are now more opportunities to try out General Practice via the PGPPP program. I’d recommend trying one of these terms. You may find that General Practice is for you. If not, at least you will get some idea of what the GP work environment is like, which will be useful regardless of your future specialisation.

So how do you know if General Practice is the right career for you? I think there are both personal attitudes as well as certain work conditions you should identify with and be willing to accept in order to enjoy training and a future in General Practice. Below are a few questions I have asked myself and answered “Yes” to.

What do I like about General Practice?

• The wide variety of work, covering aspects of every specialty. I like to know a little bit about everything compared to a lot about one or two things.
• Over time, one can build a relationship with the patient, their family and community. Patients come back and see me and bring their families. I really get to know what makes them tick and what impacts upon their health beyond the physical.
• Early intervention and screening and a trusting relationship can impact upon a patient’s entire life.
• Being an advocate for patients, especially for those with chronic conditions who have to navigate the health system
• Rural medicine, which has additional rewarding challenges including procedural and accident and emergency skills.
• The work environment and flexibility in hours worked (part-time options).
• The training environment: There are so many options during training and after. There is financial support for training.
• Travel both within Australia and overseas is possible (with forward planning).
• Research, special interests, e.g. sports medicine, palliative care, drug and alcohol, psychiatry, paediatrics, family planning, obstetrics, anaesthetics, emergency, Antarctic medicine, part-time can all be catered for in training.
• It is possible to take leave to pursue other interests such as overseas work and travel, and family time, without a significant impact upon future training opportunities.
• There are opportunities to run your own business in the future and the opportunity to learn this during training while you are employed under protected conditions.
• Every day is different!!

What qualifications will I end up with?
In General Practice, the Fellowship Exam (FRACGP) assesses competency to work unsupervised in the Australian context of General Practice. Unlike our other specialty training colleagues, GP Registrars do not have to give up their life for years at a time to study for exams. Registrars sit the exam after 12 months of General Practice terms and prior to completing their training time. For those interested in obtaining additional skills to practise in rural areas, there is the option of the Graduate Diploma in Rural General Practice run by the RACGP and/or the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) run by ACRRM. Eitheror both rural qualifications can be obtained through the General Practice training program. GP Registrars can also elect to undertake all manner of diplomas or courses in areas of special interest to them.

Employment conditions
General Practice training differs in that it occurs in a private practice environment. Remuneration for Registrars during GP training is protected by the National Minimum Terms and Conditions document. This document is brokered by both Registrar representatives (from GPRA) and Supervisor Representatives (from NGPSA). The document stipulates the minimum salary or percentage of billings that must be paid to the Registrar for hours worked (whichever is highest). Most registrars are able to earn more based on a percentage of billings generated once they settle into General Practice. There have been a number of changes to Medicare recently which now make General Practice a more financially viable option.

Unlike in many other training programs, the Registrar is paid to learn, with a certain number of education sessions and one-on-one teaching by the GP Supervisor at the practice included in your paid sessions. Registrars are also released from working at the practice to attend education sessions organised by their RTPs in their first 12 months of General Practice terms. Many regions are in the process of developing and instituting programs for subsequent time.

How long does it take?
Core General Practice training takes three years. The first of these years is undertaken in the hospital and must be after the internship. If you already have additional years of hospital experience it is possible to have these counted retrospectively by applying for ‘Recognition of Prior Learning’, enabling you to shorten your training time by a maximum of 12 months or enabling you to undertake elective terms rather than hospital terms to complete your training time.

The length of GP training can also be extended in a number of ways. This includes: part-time training, Advanced Academic posts, Advanced Rural Skills Posts (4th year of training), mandatory elective terms or leave.
You can tailor it to suit you! (See later for the types of terms available in the Australian General Practice Training program).

Points to consider:
The downsides – yes there are a few negatives, but with preparation they can be managed:

• The General Practice environment – adjusting to private practice, the Medicare Benefits Schedule and fee-for-service models.
• Dealing with uncertainty – sometimes, you just don’t know what is going on! Getting used to recalls and safety netting for the patient become important strategies.
• The effect of government legislation to address critical workforce shortages. GP Registrars must meet compulsory geographical requirements for training (rural and outer metro requirements). This most likely involves relocation once and sometimes twice during training. This can get more difficult if you have a partner, family, mortgages or other responsibilities but with forward planning stress on the family can be reduced.
• Multiple stakeholders in General Practice training and often with competing political interests. Because of the critical workforce shortage, the GP Registrar workforce and training program will remain a significant political issue. Many stakeholders have unique views on how to resolve these problems. Unfortunately, this can reduce the flexibility and attractiveness of GP training. Fortunately, GPRA has been around over 30 years advocating for quality training and good conditions for Registrars and remains a strong voice!

Being aware of the political environment, compulsory requirements and more difficult aspects of General Practice is the best way to prepare and cope with these aspects. GPRA is a great resource for potential applicants on training issues, terms and conditions and General Practice politics which impact upon GP Registrars: www. gpra.com.au. Membership is free!

Having recently completed my training, I can say I had a great experience, was generally well supported and very happy with my career choice. General Practice could be just what you are looking for!

This document has been prepared by:
Recent graduates of Australian General Practice Training program