Overview
Welcome back everyone!
This weeks article is PART 2 on how to specialise as a doctor in Australia in just two years!
If you missed PART 1, you can check it out here.
Part 2, will cover the following:
The Interview Process
How to Choose the Right GP Clinic for YOU
1. There is no one-size-fits-all clinic
2. Supervision
3. Location
4. Other Doctors
5. Billing
6. The NTCER
7. How does a Registrar Really Get Paid?
Recognition of Prior Learning (RPL) Application
The Ins and Outs of GP Training
The RTO Interview Process
Last week’s article finished up by discussing the CAAKT score and how to interpret it. Assuming your CAAKT score ranked you high enough (see Part 1 about CAAKT and bands if this is making no sense to you), you will be offered an interview with your Regional Training Organisation (RTO).
Each RTO represents a different region of Australia and they operate as their own solo bodies. As such they all have slightly different interview processes. The two most common formats are panel based and the multiple mini interview (MMI) format. Depending on the Covid situation, they can be online (like mine) or face to face.
The basis for each interview is the same – they are designed to test your suitability for the program according to the five domains of general practice as outlined here.
The interview requires a basic clinical knowledge, which most junior doctors will have acquired during their time in the hospital system. The questions are designed to test your judgement and ability to operate safely as a general practice registrar. They are not expecting you to have the knowledge of a fellowed GP. Instead they want to know that you can operate safely as a doctor and recognise when you need to get help.
The Interviews can go up to one hour in duration (give or take technological glitches). There is usually a short turn around time of a few weeks before the College will inform you of your results. A successful interview means you will officially have gained entry in the General Practice Training Program!
How to Choose the Right GP Clinic for YOU
Once you’ve finished celebrating your entry onto the GP Training Program, the next major hurdle is to select the GP Clinic you will be working in for the next 6-12 months. This can be quite a daunting process, especially as there doesn’t seem to be much guidance online (or from the training colleges). Furthermore, GP Registrars can often feel very isolated during this process as they feel like they are out in the #bigbadworld hunting for a job. As medical professionals, this is something we are not used to doing, especially in a junior years when we’ve been following the medical school and internship conveyor belt.
Just like the interviews, each RTO has their own way of matching their registrars up with a GP Clinic. Some RTO’s prefer to give registrars a selection of a few options whilst others let registrars apply to as many clinics as their heart desires. Check with your RTO on how GP Registrars usually find their clinic in your region.
Regardless of the format of job hunting your RTO prefers, there a few key things to look for in a prospective GP clinic for a new registrar.
1. There is NO one-size-fits-all clinic
GP Clinics come in all different shapes and sizes. Some clinics have one or two doctors, other clinics employ twenty doctors. There are bulk billing versus mixed billing clinics. Some clinics are owned and operated by corporate firms or are part of larger health networks. Others are owned and operated by GPs. Some clinics focus on special interests such as skin cancer medicine and others focus on marginalised communities such as refugees.
Just like GP Clinics, GP Registrars come with their own skill sets, personality and background. Some GP registrars may love a certain practice, whilst others will absolutely hate the very same practice. The motto of the story is to find a clinic that you gel with and one that best supports your learning needs as a registrar. Trust your gut!
2. Supervision
As a 1st term GP Registrar (GPT1) there is NOTHING more daunting than beginning your career in general practice. The first 6 months will be the hardest six months of your entire career. Read that again.
That is why (in my opinion), it is SO important for you to have a supportive and understanding team of doctors, nurses and administrative staff around you during these initial few months.
I would argue that the most important factor when choosing your clinic is to gauge the level of supervision and support you are likely to receive. You are working in a totally different environment, in a new system, with a different cohort of patients than you are used to. You will also be making LOTS of decisions on your own (which is very different from the hospital system). The actual medicine is also very different. All of these factors make those first 6 months of a GP Registrar’s life very stressful.
As a result of this rapid change in environment, it’s important to choose a supervisor who has the time and energy to teach you. You should be able to feel comfortable asking your supervisor questions (because you will have lots!) and getting their feedback on your progress. You shouldn’t feel like you are bothering them or wasting their time or not feel like part of the team. They are being paid to teach you. Remember, the purpose of your GP training years is to LEARN! Chase the money later.
3. Location Location Location
Practices can be located anywhere from a busy shopping centre to stand alone practices on the street. They can be rural, regional or metropolitan. Ideally you will want a practice that meets your learning needs whilst also being a commutable distance from your home.
Location can also have a large impact on the patient demographic that you see. A rural practice will have a very different cohort to an urban practice in the middle of a shopping centre.
Consider the closest tertiary referral centre. Is it 10 mins away or 3 hours? How will that change your clinical practice and skillset? What are the other services nearby?
4. The Other Doctors
Some practices are sole traders, others have over 20 doctors. The benefits of having a practice with multiple doctors is that you often get the opportunity to learn from each of their special interests. For example, if you have some doctors interested in skin cancer medicine, they might be able to show you how to perform skin excisions. It’s also important not to go to a practice SO big that you get lost in the hub-bub.
5. Billing!
This is quite a large topic in of itself, and probably deserves it’s own article!
In a nutshell, “billing” is how GP’s earn their money. To “bill” a patient is to charge them a fee for a service (healthcare) you have provided. Hence it General Practice runs on a “fee-for-service” model.
To simplify it, there are two main types of billing in General Practice. Bulk billing practices charge Medicare for every consultation with NO out of pocket cost to the patient. Mixed billing practices charge a higher amount for each consultation with only a portion of that amount rebateable to Medicare. This means the patient has to cover the out of pocket cost.
6. The NTCER aka Registrar’s Contract
As a GP Registrar, it is essential that you are familiar with this document. The NTCER essentially outlines the minimal standards of pay and conditions a GP Registrar is entitled to. It outlines everything from annual leave to sick leave to pay rates for GP Registrars. As a GP Registrar, it is important to remember that you are no longer working within the safe confines of the public hospital system where your salary and benefits are taken care of for you. In General Practice, the contract you negotiate and sign is the one you will be bound by, so it’s important you getting yourself a fair, safe and appropriate deal. For more information on the NTCER, I would recommend the GPRA website.
7. How Does a Registrar REALLY Get Paid?
The minimum pay for all GP Registrars (regardless of how many patients they see per fortnight) is outlined in a document called the NTCER. As discussed above, the NTCER is essentially the baseline contract for all GP Registrars. Some practices will allow you to negotiate above this base rate, although it can be hard when you are in your first two terms of GP training. As a registrar, you have two ways in which you can get paid:
- Your salary as outlined in your contract/NTCER
This is fairly self explanatory, it is the fortnightly wage as outlined in the NTCER. Nothing more, nothing less.
- Billings
Your ‘billings’ is the sum total of consultations you have seen in a given time period.
For example, if you see 100 patients for a standard consultation in 2 weeks, your total billings would be:
100 x 38.75 (the Medicare rebate for a standard consultation) = $3875
As per your contract, you will be given a certain percentage of your billings (usually 45-50%). Assume your billings were 50%, then you would get 50% of $3875 (or $1937.50) pre-tax. As you can imagine, the higher your billings are, the more money you take home. Your billings will be tallied at the end of a period known as the “billing cycle”. This can be anywhere from 1 week to 13 weeks.
Your take home pay is determined by which of the two options (salary vs billings) gives you a higher income. Overall, it is advantageous to have your Billings be higher than your Salary, but this may not be the case in your first few months of General Practice. This becomes more achievable as you progress through your training.
The Recognition of Prior Learning (RPL) Application
The Recognition of Prior Learning (RPL) Application is completed by GP Registrars who a retrospectively applying for their hospital terms to be accounted towards their Fellowship.
The most common scenario in which you would have to complete an RPL application form is if you applying for GP Training in your PGY2 year as a resident medical officer, with the intention of beginning in a GP clinic in PGY3. In this case, RACGP requires that you prove that you met certain requirements of training during your PGY2 year. This is a fairly straightforward document that requires you to list the dates of each placement and reflect on the learning outcomes relevant to General Practice. RACGP will also require record of all of your end of term assessments or supervisor reports so its important to keep them handy!
The Ins and Outs of GP Training
Phew! That was a lot of work. Getting into GP training and finding your first practice can be a stressful and arduous process. Now the real fun begins.
In Australia, GP Registrars undertaking their fellowship through the RACGP under the General Pathway, can expect 2 years of training. The rural pathway has a third year added on. During this time, you will essentially be working as a GP with extra time allocated to in-practice teaching, hub teaching and mandatory workshops. Fellowship exams are held in the second half of your training.
Final Thoughts
I think that’s plenty of food for thought on the GP Training Pathway. I’ll be writing plenty more articles on each of these topics in the future so stay tuned.
In the meantime, if you have any questions, feel free to contact me at askdoctornisha@gmail.com
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