Three years after achieving Fellowship, Dr Lisa Fraser bought her own medical practice in Gordonvale, far north Queensland. Now, as a private practice owner, no two days are the same.
Today, Lisa familiarises herself with the latest on Coronavirus and then briefs her staff on the practice’s new policies on the virus. With a sick staff member, Lisa moves their appointments around, treats her own patients, and then orders more vaccines for the clinic—all before lunch time.
“Practice ownership is well-suited to those who feel confident that they can find their own answers. Other great qualities are being positive, persistent and flexible…and you have to like people because you deal with a lot of people,” says Lisa.
“If you’re having your first baby or buying your first house, you may not have the head space for buying a practice, but where there is stability in your life and you’re ready for a challenge, it is good.”
Lisa’s most important years were the early ones; she quickly discovered her passion for medical education and advocacy.
Currently, Lisa is a supervisor with JCU GP Training, the Treasurer of General Practice Medical Educators Inc (GPME), and the outgoing Chair of the Royal Australian College of General Practitioners (RACGP) Queensland New Fellows Committee.
“General practice is probably one of the most complex and diverse professions. You need to just take your time and be thoughtful about where your career goes, because if you don’t plan it, you might lose the opportunity to keep it fun and interesting.
“Medical education is an extremely complementary skill to a GP’s career at any stage.”
The realities of practice ownership
Autonomy is what attracted Lisa to practice ownership—being the one to decide the practice culture.
“Our practice’s culture is one of tolerance and diversity. I don’t want hierarchies or unapproachable bosses. I want a natural kind of disappearance of the things that I don’t like and a fostering of things that I do.”
“I wanted to create a practice where doctors can be themselves and where we support each other.”
“General practice is a team sport because we need that to manage some of the medicine we do and to tackle the preventative aspects.”
Many new GP trainees may not fully understand the financial reality of running a practice, Lisa explains.
“My biggest realisation was how much it costs to run a practice…at the end of the day I make a loss out of my GPT1 registrars, in terms of paying the nurses and the administration, and buying consumables.”
“But what I love is that it creates a culture of learning, educates patients on the importance of training doctors, and markets my practice to the wider junior training doctor community.”
When it comes to negotiating salary, Lisa advises GP trainees to look beyond the percentage and consider days of work, hours, after-hours, and special skill sets.
“When negotiating, think about what it is you bring to the table.”
Lisa adds, “remember, what you may be asking for could be more than what another doctor is earning in the clinic…I am very supportive of flexible working hours and I’m very happy to have part-time registrars.”
Staffing is the biggest cost to running a practice—also Lisa’s biggest concern.
“I’ve got some doctors who will be planning their retirement over the next few years, and the issue with senior doctors is that because they’ve been in the town for 25 years, they know everyone…and because they know people so well, they don’t need to see a patient for very long to understand and assess problems.”
“They can see a huge number of patients per week. It will take two new Fellows to do the work of one senior doctor…but that’s not any fault of the new Fellow or the GP trainee.”
“No matter what, I want all my staff to do quality preventative medicine and to work at their own safe pace. It’s just a reality of life, so I need to recruit a lot of doctors in order to sustain this practice into the future, especially as this is an expanding area.”
Practice management, Lisa says, is about planning, setting goals, and letting go of micromanaging.
“If you employ good people they will want to be given a bit of room to move in their job. It is quite satisfying to see when staff develop in their independence and leadership.”
A medical educator
Lisa’s journey into medical education was gradual. One opportunity led to another, including a role as the RLO for GPTQ. She quickly found that the skills of a medical educator to be extremely complementary to a GP’s career at any stage.
Medical education is an essential skill to those in medicine, Lisa asserts, and GPs have more skills in the area than what they may think.
“As an intern or as a medical student, you’re constantly sharing, learning and teaching those following behind you. To say that medical education is only a specialty for those who do extensive work and training is not correct—we all have skills in medical education.”
Medical education doesn’t stop with one’s peers—it is critical to a GP’s everyday practice.
“GPs educate patients,” says Lisa, “we try to motivate and help people learn about their health.”
Medical education benefits the educator just as much as it does the student.
“I just realised how much fun medical education was…it buoyed me through the exam process; it helped me study; I actually think I did better [in my exams] because of it.”
With a smorgasbord of options available to junior doctors, Lisa urges people to not forget about the non-clinical options.
“I firmly believe that we all sign up for continuous service to our junior colleagues as part of our oath, and in that way I think that medical education is not actually a choice—it’s a professional obligation.”
“On the other hand, medical education is something that I look forward to…it lifts me up and gives me new interest in my clinical work.”
Lisa wants to see more new Fellows opting to become supervisors and medical educators.
Currently, a qualification isn’t necessary to work as a medical educator, “Which is great,” says Lisa, “because everyone needs to have a try before they commit and we want to keep barriers to entry low.”
GPME can provide informal mentoring to those with a special interest in medical education.
“Medical education is something that I look forward to...it lifts me up and give me new interest in my clinical work.”
‘Every GP supervisor is different’
One of the most enjoyable aspects of medical education, Lisa shares, is being able to train up the next generation of GPs.
“The majority of learning in GP training occurs on the ground as you are practising with your patients…the person that is most useful in directing learning, aside from the GP trainee themselves, is the GP supervisor.”
“If that relationship is good and the environment is good, that gives you the best opportunity to learn.”
To create and maintain a good relationship with your GP supervisor, Lisa advises making time to talk and try to understand each other’s needs.
“I’m a huge extrovert and I like to be very involved,” Lisa explains, “so if I have a registrar that is a real introvert and doesn’t need much social interaction, I can’t go expecting them to do the kinds of things I like to do.”
Lisa advises that the most important conversation a GP trainee will have is the one where they meet up early with their GP supervisor and discuss what they want out of supervision.
“Find your strengths and needs, and then plan how you’re going to get along together.”
Every GP supervisor is different, Lisa explains, and if expectations are not matched, there is the possibility for conflict.
“I know supervisors who don’t like to be called during the consultation…some have not trained their patients to accept being interrupted as a normal part of practice…but I love to be called during the consultation, because the sooner we answer the question and keep things moving, the better for me.”
“Because I am a new Fellow my teaching and supervision style is pretty supportive…my new registrars are to call me any time, and we always spend a few days in orientation.”
“I want my registrars to be happy. I would love for them to stay on.”