Key items to consider when you negotiate
Things to consider before negotiating
Your years as a registrar are, essentially, a learning experience. There are many other aspects that should be kept in mind when negotiating an employment agreement. These may include the availability of training in the areas that interest you, a willingness by the practice to fit in with the days you want to work, and the ethos and values of the practice and its staff. These will differ from registrar to registrar, but finding a practice that suits you is important to your wellbeing.
Below are some of the main points you should discuss with the practice when negotiating your employment agreement. These should be considered each time you negotiate an employment agreement.
The details of the structure of your average working week should include start and finish times, scheduled consulting hours (including home, hospital and nursing home visits), locations, time allocations for administration, in-practice teaching, educational release and any on-call and after-hours duties. This is a very important discussion you need to have with the employer. Ensure the results of this discussion are documented in your employment agreement.
Think about your personal life, family, friends and hobbies. Is there anything that will be happening during the term that you need to advise the practice, such as annual leave, a medical procedure, major events or exams? How many hours are you planning to work each week? This will impact on the category of your training and employment (see Employment terms and conditions).
Number of patients per hour
GPT1 registrars may start with 2–3 patients per hour and increase up to the maximum average of four patients per hour as their skills increase (as outlined in the NTCER document). Sometimes the patient mix can determine the number of patients per hour. For example, if you are the only female doctor in a busy practice, you may get a particular patient mix which impacts on the total number of patients you can see. This is something to keep in mind and to discuss with your practice.
Education and supervision
Familiarise yourself with the Australian College of Rural and Remote Medicine and/or The Royal Australian College of General Practitioners training standards that apply to you. Your areas of interest Your training organisation supports your formal training with an individual learning plan, guidance and monitoring by medical education staff and GP supervisors in a practice environment. Keep in mind your medical areas of interest and those of the practice and your supervisor. It is important to define your areas of interest in your learning plan and determine how the people and skill-sets within the practice can help you meet your personal learning goals. Talk to the practice about your learning plan so that you can identify any potential issues that may arise, and to try and ensure that your learning needs will be met ahead of time.
It is important to discuss the nature of your in-practice teaching with your supervisor prior to starting work at your practice. Where possible, document this discussion to ensure there is a mutual agreement and understanding on how and when your in-practice teaching will occur. In-practice teaching can take many forms, such as tutorials with supervisors or others in the practice, supervised procedures, educational practice meetings or corridor teaching. A useful tip is to schedule dedicated teaching first thing in the morning or immediately after the lunch break to ensure that your time is not compromised by patient consultations running late.
Find out what your mandatory and optional educational release commitments are from your training organisation at the beginning of each term. The amount of educational release time tends to reduce each term as you progress through the training program. Your practice is not obligated to fund extra or optional educational release or workshops run by your training organisation beyond the minimum, compulsory requirements, nor educational release in GPT3 or GPT4.
Your supervisor’s obligations
Your employer must provide supervision that meets Australian General Practice Training guidelines. Mutually agreed supervision must be available at all times including for after-hours and on-call work. The supervisor, or a delegate, should be available to attend in-person to support the registrar in the event of an emergency, except in circumstances approved by the college(s). This may depend on your stage of training, and a risk assessment conducted by your supervisor.
GPRA recommends that you set a date to review your employment agreement, remuneration and pay cycles, perhaps after three months. There may be the opportunity to negotiate a better deal if you have been performing well. It’s also a good chance to revisit any elements of the agreement that may not be working. If nothing else, this formal review is an opportunity to receive and give feedback on your employment and training with the practice. If you like the practice, ask about long-term job prospects. Many practices will be looking for registrars to permanently join their team. So if you fit in well, this may be an opportunity to discuss future opportunities.
Other talking points
The following points are unlikely to be core issues in your employment agreement, but points you may wish to clarify as part of your discussions.
- Orientation: Will the practice conduct an orientation session?
- Consulting room: Will I share a room or have my own room?
- Bulk-billing versus private billing: What is the bulk billing versus private billing mix? Which patients are bulk-billed?
- Appointment booking system: What is the practice appointment booking
- Booked appointments versus walk-ins and emergencies? What about home, hospital or nursing home visits?
- Follow up of test results: What is the normal procedure for following up patients’ test results at the practice?
- What happens with test results that come in after you have left the practice?
- Registrars teaching obligations: Will I be doing in-practice teaching of medical students or others? Is this paid? When will this be required and how often?