1 November 2019

Confessions of a tree-hugger

Practice Management

So you’re looking for a general practice in which to work? Maybe your first general practice after finally finishing your training and receiving your fellowship?

Aside from location (obviously) what do you look for when trying to find the perfect place to practise?

Recently I was looking at the program of an upcoming Australian rural GP conference and noticed one of the topics was related to recruiting and retaining GP staff. I know this is a huge issue in the bush where they have a number of unique issues, especially in more remote areas. But it did get me thinking about what it is that makes a GP enjoy their practice and want to stay there.

Sure you could say it’s the medicine, the money or the patients, and all of these would certainly be a factor. But let’s face it, these are often the same across lots of practices.

Having worked at many practices over many years, I would have to say one of the most important aspects of a practice, at least for the GP who is working there, is the staff. In particular, the reception staff.

These are the people who can be the difference between you feeling competent and supported, or being overwhelmed and feeling incapable. These are the people who can give you a sense that you’re part of a team or can make you feel like you’re a factory worker, churning through patients as though they were on a conveyer belt..

General practice can be a perversely lonely specialty. We may see 30 different people in a day and have very meaningful conversations with them, but it is very one-sided. Strangely enough, they are not all that interested in you or your life, in general. The GP is  there to listen, assess, advise and treat – not make new friends (even though these relationships can often become friendships of sorts).

Having staff who you can share a laugh with, who can forewarn about difficult patients, diffuse angry patients, and be understanding and supportive both of you and the patients can bring real joy to your working day in a way that is often unrecognised and underestimated.

No one ever says check out the staff when looking for a new place in which to work, and the reality is they should. Even though the “staff behind the front desk” can change, the attitude that is displayed is very often a clear example of the culture of that particular workplace and that will usually persist despite individuals coming and going.

GPs who own their own practices are no doubt acutely aware about the importance of hiring the right reception staff, they are their practices’ face to the world. But for all of the rest of us who work in corporates or in group practices as contractors, we generally have no say on who is hired in these key roles. And I’ve seen some real rottweilers as receptionists – the sort you feel you have to apologise for, as you bring the patient into your room. They can be fierce – often as nice as pie to you, the doctor, but they scare the patients. I have known patients who won’t go to a particular surgery because of the front desk staff. And to be honest, there’s a specialist I won’t refer to for the same reason.

It’s very hard to say what it is that makes a really good receptionist, at least in terms of being a really good receptionist to work with. It’s more than just being very nice and friendly.

Some really lovely receptionists can never say “no” to patients, which leaves the GPs with half a dozen “squeeze ins”, an extra house call rather than lunch, and usually a whole stack of scripts and form requests to be completed, after you finish seeing patients and before you stagger home for the night. Lovely receptionist – half-dead doctor.

You really need the staff you’re working with be switched on. To have an awareness of what is happening both in your waiting room and in your surgery. It can make all the difference in the world if the receptionist warns a newly arrived patient that you, the doctor, is running late and they’d like to go and get a coffee. Of course, the GP could ask the receptionist to do this, but it really makes a huge difference if you don’t have to.

It’s only an example, but it is that sort of awareness that fosters the sense of collaboration in general practice that is so important. If you are planning on staying at a practice for a while, remember it is the reception staff who you will be sharing a lot of your working day with. They have the capacity to really add joy to your clinical practice, but they also have the capacity to make it a real nightmare.

The expression “can’t see the wood for the trees” is basically a warning about not looking beyond what is right in front of your nose. But if you want to gauge whether you might like to work in a particular practice,  don’t forget to check out the trees as well (no offence to my lovely “trees” where I work).