GPRA - General Practice Registrars Australia

>> Part time training

Part- time training is often considered as the only option for those of us that are having babies or raising small children. However, part–time training is an attractive option for many registrars, allowing them to take up other opportunities such as becoming an RLO or an academic registrar. Read more

>> Thinking of Academic Posts?

Ever thought about getting more involved in teaching others and seeing the next generation of doctors learn from your experience? Maybe you have had thoughts about being involved in a research project that alters the way we practice, and seeing your name in a respected medical journal.
The Australian General Practice Training program provides opportunities to achieve these goals, and more, Read more

>> Become an Registrar Liaison Officer (RLO) – you never know where it might lead you

The RLO or Registrar Liaison Officer plays an important role in each RTP. They are employed by the Regional Training Provider as the Registrar representative whilst themselves participating in training. Before I was approached to become the RLO for SIGPT I never would have thought it would be something I would be interested in. Now I’ve finished training I can honestly say it was one of the most valuable experiences I have had. Read more

>> Registrars as Educators

If you have the opportunity to be involved in teaching as a GP Registrar I would strongly recommend it. To teach something is the true test of whether one understands it. Throughout your training you will find you are involved in informal teaching of your fellow registrars. Read more

>> GP Registrar Finishing School

Wollongong put on a spectacular show hosting the first national Lundbeck Institute GP Registrar Finishing School meeting.
It was spectacular because the show of lightening and thunder during the Saturday night dinner at Dunes was enough to rival a George Lucas film. It was spectacular also because of the work of the speakers, the facilitators, The Lundbeck Institute and the GPRA, who made the event possible.
Read more

>> Working as a Visiting Medical Officer (VMO)

Many Registrars in rural practice will be working as a hospital Visiting Medical Officer (VMO) with admitting rights.
To the local hospital. This can be a challenge to arrange for the first time. We asked rural NSW GP Registrar and GPRA Chair Geoff Sparkes to give us the low down on his VMO work. Read More

Part- Time Training
By Dr Sarah Bailey

Part- time training is often considered as the only option for those of us that are having babies or raising small children. However, part–time training is an attractive option for many registrars, allowing them 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 that many people choose it as their career path and the training program has the same flexibility that many of us look forward too.
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 3 and 8 sessions a week. A session being between 3 to 4 hours long.
• Minimum hours are 10.5 hours a week over 2 days.
• You should receive the same amount of practice based teaching during a term as a registrar completing it full time. For example, a basic part-time registrar should have 1 1/2 hours a week over 12 months and a full time registrar 3 hours a week for 6 months.
• You must attend educational activities that are the equivalent to full time registrars.
• The majority of training cannot occur on weekends.

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 a six months full time you will 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.

Many of us are keen to complete the training program in the shortest possible time. Part-time training not only allows us to have greater time with our families and other activities outside of medicine, it also provides us with a greater exposure to educational opportunities over a longer period.
Working for two or three days a week could be just the change you need.

Thinking of Academic Posts?
By Dr Paul Grinzi

Ever thought about getting more involved in teaching others and seeing the next generation of doctors learn from your experience? Maybe you have had thoughts about being involved in a research project that alters the way we practice, and seeing your name in a respected medical journal.
The Australian General Practice Training program provides opportunities to achieve these goals, and more, in the form of Academic Posts. These non-clinical posts foster interested registrars in developing their teaching, research and organisational skills within the setting of an academic department or clinical school, in both urban and rural settings. In fact, many GP registrars who have completed an academic term in the past are now world renown researchers and educators. Other academic registrars have become great community GPs with a better understanding of education and research within their own communities.

Completing an academic post can be done at any stage within the training program, after completing your Basic Term. They can be done throughout Australia, in every State and Territory and can be completed as an Extended Skills post or as an extra component of the GP training program.
These academic positions provide plenty of support and training in both teaching and research skills, allowing the registrar to learn further skills in these areas. Some applicants have known exactly what they have wished to research, whilst others have developed a research project from their own interests, or joined a pre-existing project. The options are only limited by your imagination. The opportunity to teach (medical students, fellow registrars and even experienced GPs!) is an aspect of the academic posts that many registrars have stated has been a highlight, and has often assisted in their own communication with their own patients.

The position can be funded in one of two ways. The most common method is to apply directly to AGPT (see below) for a funded position. This funding is for 6 months full-time equivalent. As most registrars complete this post part-time, the funding can therefore be stretched further (eg for 12 months, half-time). There is also the option of sourcing funding from other organizations (eg State Health Departments), but AGPT doesn’t coordinate this and it is up to the registrar (+/- supervisor) to secure this funding.

Interested? Speak to your RTP and also your local university department or rural clinical school. The staff of these departments are keen to encourage registrars develop some experience in the world of academic general practice and can provide plenty of enthusiastic advice. The AGPT application form is quite detailed, so it helps to fill it out with your potential supervisor. It covers your plan for the academic post as well as an opportunity to ‘sell yourself’ as a great candidate. The application process is competitive, but most applicants have succeeded in obtaining a position in the past – provided they have fully completed their application forms.

To find more information, check out the AGPT website about academic posts, http://www.agpt.com.au/praxis.php/category/view/24. This site contains information about the posts, as well as the selection criteria and the application form. In addition, you can contact the Registrar Research and Development Officer (RRADO) with your enquiries rrado@AGPT.com.au, or phone 1300 658 515

Become an RLO…
...you never know where it might lead you!
By Dr Jen Longeran

The RLO or Registrar Liaison Officer plays an important role in each RTP. They are employed by the RTP as the Registrar representative whilst themselves participating in training. Most RLOs work around 10 hours per week although this does vary between RTPs. In some RTPs the RLO input is so valued by staff that they employ several RLOs or have increased the hours of the RLO working.
More recently Registrars have even been employed in Registrar Medical Educator positions. (Registrars are alsoon most RTP Boards: no wonder we rated the GP training program highly for the past 2 years, we run the show!!)

Before I was approached to become the RLO for SIGPT I never would have thought it would be something I would be interested in. I loved clinical practice and did not see the need for any extra activities. (Note: you can have your RLO accredited as a special skills post). Now I’ve finished training I can honestly say it was one of the most valuable experiences I have had.

What you do as an RLO varies in different RTPs. Your main role is in advocacy and support for Registrars, you can also be involved in communication (email list servers, newsletters, giving talks, answering queries fromRegistrars), pastoral care, providing feedback to the RTP, advising Registrars about terms and conditions, education and teaching, promoting GP training and getting involved in the policy and operations within the RTP.

Each RLO automatically becomes part of the GPRA Advisory council. This is a national group of Registrars who communicate via a list server about the issues affecting Registrars around the country. This network provides a host of other great opportunities which include: input into national policies relating to GP registrars, negotiating Terms and Conditions with the GP Supervisors Association, becoming a board member and running a small company, organizing events, writing articles or publishing newsletters
or guides, writing policies, increased access to positions on national committees and most importantly getting to know a dynamic group of people from all over Australia.
(We meet face to face at least twice a year).

Being an RLO helps you develop skills in a range of ways that can enhance your clinical skills and your personal and professional development.
So…..What are you waiting for? Talk to your current RLO, your RTP or get in touch with GPRA (we have a constant stream of national opportunities that would entitle you to join the GPRA Advisory Council). We look forward to meeting you!

Registrars as Educators
By Kate Beardmore

If you have the opportunity to be involved in teaching as a GP Registrar I would strongly recommend it. To teach something is the true test of whether one understands it.

Throughout your training you will find you are involved in informal teaching of your fellow registrars. We often debrief with each other, discuss patients and share our ideas and knowledge. This activity is invaluable to your learning throughout your training as it is self directed and responsive to your learning needs at the time. We should never underestimate the value of teaching each other. You don’t need to be an expert to teach!

Some RTPs have an employed position for a Registrar Medical Educator (ME). It creates an opportunity for registrars to have direct input into the education programme for GP registrars. I am currently in this role at SIAGPT and I have gained experience teaching other registrars and helping determine what we as registrars need to learn.

Registrars can also be directly involved in education and teaching as the RLO. The teaching of fellow Registrars, RMOs or medical students may be a component (or an option) during your Hospital time, General Practice term or Academic post.

If you have the opportunity to teach during your training – take it! Whether you are teaching medical students, fellow registrars or even your supervisor it is an invaluable way of learning how much you know and how much you
have to share!

GP Registrar Finishing School
By Dr Gerard MacMahon

Wollongong put on a spectacular show hosting the first national Lundbeck Institute GP Registrar Finishing School meeting.
It was spectacular because the show of lightening and thunder during the Saturday night dinner at Dunes was enough to rival a George Lucas film. It was spectacular also because of the work of the speakers, the facilitators, The Lundbeck Institute and the GPRA, who made the event possible.

The weekend officially started on Saturday morning with an inspiring talk from Damian Bray who gave food for thought on ways to make general practice the best career anyone could ever choose.
He posed many questions such as:
• What other profession has a constant stream of praises and thanks coming from grateful patients?
• What other profession offers such a variety of medicine?
• What other profession allows for such intimate involvement in people as they pass through life?

We were reminded that this same gift of coming face to face with the whole community can also take its toll. It requires mental, emotional and physical energy and that has to come from within.

First and foremost we were taught to “know oneself”. Take time to choose a practice that best suits the style of practice that you wish to be involved in. This includes determining your work hours and a schedule that best suits your lifestyle. “Value yourself”. Dispose of the heroic GP model that was the norm in the past. As a doctor in the community we are valued highly, it makes sense to treat mind and body with respect. “Cultivate your life outside of medicine”. All theses principles lead to better practice and
avoids burnouts.

Workshops were held to cover in greater depth ways to avoid burnout. This can be done by recognising the symptoms of burnout early. Another workshop was held on the difficulties associated with doctors as patients and doctors working for doctors. Discussion focused on acknowledging the peculiarity of the situation and the need to work harder to achieve better health outcomes. Historically medical professionals have a poor track record for following their own advice. The importance of having ones own doctor was emphasised. This was done by virtue of a role play that displayed clear acting potential.

Further discussion was lent to the difficulties associated with offering treatment to refugees and the principles of practicing ethically.

The weekend concluded with powerfully directed address from Professor Deborah Saltman highlighting the need for greater leadership in the medical profession. The key point was that doctors in roles of leadership tend to be more focussed on management. They are more concerned with the way things are done and lack the vision to see what actually needs to be done in the first place. Without leadership, the health care system becomes a disjointed array of micromanagers each with their own sense of direction. A clear example that highlights the lack of leadership by the medical profession is the inefficient cost-shifting that occurs between the state and federal government for healthcare funding. It would take vision to convert funding all to one source. But that was not the content of Professor Saltman’s talk but rather my own political rallying.

Overall, it was a thoroughly enjoyable conference that promoted new partnerships and provided inspiration for registrars in transit to life after postgraduate training.

Working as a Visiting Medical Officer (VMO)
Rural Practice Q&A with Dr Geoff Sparkes

Many Registrars in rural practice will be working as a hospital Visiting Medical Officer (VMO) with admitting rights.
To the local hospital. This can be a challenge to arrange for the first time. We asked rural NSW GP Registrar and GPRA Chair Geoff Sparkes to give us the low down on his VMO work. We have added some extra comments below as arrangements seem to differ considerably across the country. Even with the comments not all situations may be covered. Please refer to the Summary of things to consider and ask about if you have hospital VMO rights also in this year’s guide:

Q: What do I need to do if I am asked to work as a Hospital VMO?
A: It is not compulsory, but is an integral part of most rural practices that the doctors have admitting rights to the local hospital. The exact structure of which doctor admits on which day, who is ‘on call’ and whether private and public patients can be admitted under their choice of doctor varies between hospitals.

GP Registrars can apply for visiting medical officer rights at hospitals with vacancies for GP VMOs at all stages of their training, except the compulsory hospital experience year (i.e, you cannot be a GP VMO to do the first hospital year of the AGPT, you must be employed as a GP registrar or RMO). GP Registrars may apply for rights outside that of the standard GP VMO contract, such as intra-partum care, anaesthetics, surgery or operative Gynaecology, but these are assessed against prior experience and
qualifications.

GP registrars may be appointed as locum VMO’s, where they are technically deputising for another VMO. This method is employed often to speed up the process of appointment as most rural GP registrar placements are only six months.

The process usually involves an application to a particular position with a CV, interview(s) and referee reports. The process may or may not be competitive (i.e there may be other applicants), as per any other job selection process. Once selected, you are required to pass a security check for sexual offences, sign a THICK contract and indicate your roster availability. The process can be done within a matter of days if there is the need/will to do so, but it took me 8 months to get my permanent VMO position while I was working as a locum VMO as the hospital was in no rush.

Currently in NSW there is a NSW Health directive that allows GP Registrars to be appointed to a vacant GP VMO position without the need for advertising of the position.
This was in response to problems where a GP registrarfound it difficult to get VMO credentialing for the majority of the term as the area health service insisted the position had to be advertised for three months before being filled, which was half of the GPR’s term that they were not working at the hospital.

Comments from interstate:
The above information is quite specific to Geoff’s situation in NSW. The way Registrars are employed as VMOs varies between States and at different hospitals and towns: RLOs working in smaller rural areas in different states have reported that they are expected to participate in the emergency department and have admitting rights, the process being simple and not at all competitive.

You will also need to sign a medical indemnity agreement with the hospital on behalf of the State Health Department. You still need to maintain a level of indemnity through one of the MDOs, even if all your work is as an employee of the hospital.

Q: How is the pay different?
A: You are paid directly by the area health service, based on one of two options - fee for service or sessional. Fee for service means that you are paid for each patient you see each time you see them, each procedure you do and each investigation you interpret.
The item numbers are similar to the MBS item numbers, but, at least in rural NSW, are indexed at 120% of the MBS rate as per the Rural Doctors Award. Sessional work means you are paid for a block of time that you see or do a variable amount of clinical work in no matter what, at an agreed hourly rate.

In general hospital billings have less overheads (i.e. you do not need to cover the costs of employing nurses/ other staff or using consumables) as they are paid by the hospital and can be more lucrative than community GP sessional work.
Hospitals may prefer to pay their VMO’s a gross amount which requires the VMO to have an Australian Business Number (ABN). Taxation is due on this income, but by being paid via an ABN the taxation is not taken out of each payment i.e. not a ‘pay as you go’, or PAYG, system. The tax component must be paid in total at the end of the financial year by the VMO as per any other source of income.

Some hospitals can offer salary sacrifice arrangements for a total of up to $17,400 of gross income, but this is an added extra and is not in standard VMO contracts.

An ABN is simple to arrange - for an accountant. I would not try to do it myself again, as the hassle factor is large. There are two basic types relating to this area. If total billings paid under the ABN are likely to be less than $50,000, then the ABN is not required to be registered for GST. If the billings paid to the ABN exceed $50,000, then the ABN should be registered for GST to allow for the input tax form GST to be claimed as a business expense (a 10% tax deduction). These matters are best to be fully
discussed with an accredited accountant or financial advisor.

Additional Comments: Information and on-line application for an ABN can be found via the Australian Taxation Office website http://www.ato.gov.au/businesses/content.asp?doc=/content/25316.htm

The situation may differ for other States and individual VMO arrangements practices have with their local hospital. Some practices allow each GP in the practice to use the practice ABN, the practice bills the hospital for patients seen and then pays the GP negotiated percentage. The minimum percentage you should be paid for hospital-based work is 55% of billings as outlined in the National Minimum Terms and Conditions document.

This is negotiable and of course will be affected by your nature of employment with the hospital and your practice, if the practice manager submits your billings, your experience and level of supervision required. Some hospital positions are just salaried, in which case you can usually salary sacrifice and have all the entitlements of an employee.

Q: Do I need to keep records of the patients I see whilst working in the hospital?
A: Yes you do. I keep mine in a diary, using the patient hospital stickers (I bet you all wondered why specialists always were so interested in getting a sticker of anyone you talked to them about or they saw when we where RMOs - now you know). The patients’ details are submitted to the hospital accounts department, usually monthly, for payment. The required information on each patient is their name, medical record number, date of birth, their hospital billing code, the date seen and the item number(s)/description of service. The process of doing the hospital accounts is not difficult and can be done by the GP registrar themselves if desired, or by practice staff.

Private patients are not billed via the hospital, but rather via direct private invoice sent to them. This is because these patients require an individual invoice to be able to claim back from their health funds.

As a result, you are left with public patients billed directly via the hospital and private patients billed directly. The easiest way is to use the resources of the practice to do both, as these different types of billings are easily handled by most practice managers. The amount ‘charged’ by the practice to do your billings for you is variable between practices and negotiable.

Additional comments:
The patient notes must also be sufficiently detailed in case of disagreements about billings. If the hospital does an audit of your billings; the patient, time seen, level of complexity of consult/procedure as you have documented in the notes must be consistent with your billing codes, otherwise they may refuse to pay!
E.g. a common scenario: when you see a patient twice in one day, if you do not document time seen on billings and have 2 entries in the patient notes, the hospital may dispute the claim.

The VMO Checklist
A Summary of things to consider / ask about if you have hospital VMO rights during your General Practice term:
• What are the hospital rostering requirements for the working week? Do I cover the Emergency department?
• Who is on call for the patients on the weekends and after hours?
• Can private or public patients have their choice of doctor?
• How do the other doctors at the practice usually manage their hospital work? How much time is generally involved?
• Do I need my own ABN or do I use the practice ABN?
• Do I need an ABN registered for GST (required for gross billings of > $50 000 per annum)?
• Do I apply to the hospital directly to be a VMO? Is it part of a pre-existing practice arrangement or am I “deputizing/locuming” for my supervisor?
• Is the hospital work paid as salaried sessions or fee for service?
• 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? Myself?)
• What percentage of hospital billings am I entitled to?

Remember to Sign a medical indemnity agreement with the hospital
• Withhold tax
• Keep good records of patients seen
• Keep good records in the patient notes

Enjoy your VMO work; it is one of the more interesting aspects of rural practice!