I am a NSW rural gp trainee, with advanced skills in emergency and obstetrics.
Although I grew up in Sydney, I fell in love with rural generalism as a medical student after I spent a year with some fantastic rural mentors who did general practice, emergency, obstetrics and anaesthetics in a small town where their skills keep the hospital thriving, and their community is ever grateful for their hard work.
I chose rural general practice because of the continuity of treating a patient from start to finish throughout every stage of their life. I meet women planning to fall pregnant, look after them through their pregnancy, deliver their baby and earn a newborn patient while continuing to care for mum too.
It’s a wonderful journey and a privilege to be part of. Patients are often grateful for the care I provide and this gives me the career satisfaction to continue in my training.
I also chose rural general practice because I wanted to help where I am needed most, where they can’t find enough doctors to train.
My qualifications are highly sought after because there aren’t many young doctors like me around. Part of the reason for this is the way we have designed primary care training in Australia.
Junior doctors in Australia begin their careers in the state-funded hospital system. They enjoy the privileges of a salary with accrued sick leave, annual leave, parental leave, salary packaging, public resources and collegiality.
This crucial time in their lives is often when they are thinking about the specialty they wish to pursue, whether they will buy a house or start a family.
Imagine offering these young junior doctors a career pathway where they suddenly lose their accrued leave entitlements and actually face a drop in income by leaving the hospital system. If they or their partner get pregnant, they may not get any pay when they aren’t working.
While their colleagues continue in the familiar environment of the hospital, they face a little-taught system of Medicare billing. If you bill incorrectly, you may be audited and face penalties. If you bill poorly, your income suffers. This career path is general practice, and it is no wonder our young doctors are turning away from it.
Take a medical intern:— Dr Marian Dover (@DoverMarian) July 18, 2021
???? Give them zero exposure to GP terms
????Offer a drop in income to enter GP
????Remove all their leave entitlements leaving the hospital
And this, ladies & gentlemen, is what we’ve done to Primary Care.#auspol #justaGP pic.twitter.com/PATD4bwwWk
What I am asking for is a Single Employer Model, where I can work between community general practice and rural hospital inpatient services with a salary.
For this to work, it needs to be a salary that reflects my level of experience and my additional skills. For example, I should be earning more than the unaccredited PGY5 in the hospital who hasn’t done an advanced diploma in Obstetrics and Gynaecology, but I should be earning less than my PGY 15 GP colleague and mentor.
Ideally this salary model should start from the time I sign up for GP training and continue into my career as a fully qualified fellowed specialist rural general practitioner.
I am sure there are many senior and experienced GPs who wish to be small business owners later in their career, after they have completed their family and mastered the art of Medicare billing, outgrowing the value of a salary. They should have the option of becoming small business owners as an alternative model.
But this model does not appeal to young doctors, especially those with children.
Why can’t GPs be paid a negotiated salary by their practice, who recoups their Medicare billings, with the usual components of annual and sick and maternity leave, until they choose to take the risk of becoming a partner in or starting their own practice?
We owe our nation the value of having a sustainable general practice workforce in the future, and can only achieve that by listening to the needs of trainees.
I dream of a future training model where I don’t need to worry about how many patients I am seeing, and whether I am billing smart to maintain my income. A model where I can continue to focus on being a great doctor, across community and hospital settings. A model where I can fall pregnant and still have some income to support my family, or know that if I catch covid or become unwell, I will still have money to continue paying my mortgage.