Dr Haque hopes to rebrand general practice by incorporating family medicine and is campaigning for two years of metro training for IMGs, before their rural moratorium.
Victorian practice director Dr Monirul Haque promises a general practice rebrand if he is elected as RACGP president.
Having worked across Asia, Europe and Africa before moving to Australia, he understands the holes in the registration pipeline, and hopefully how to fix them.
As the current director of Sanctuary Lake Medical Practice and a seasoned GP supervisor with a masters in family medicine, he has extensive experience across clinical practice and medical education.
TMR: What is your vision for the RACGP?
Dr Haque: My vision is to see greater general practice in Australia, more power for general practitioners and, most importantly, to improve respect, recognition and remuneration.
You say in your candidate statement that general practice needs rebranding. What’s the current reputation of general practice and how do you hope to change it?
General practice in Australia is great, but the connotation of the term “specialist in general practice” does not give a contented feeling to young Australian medical graduates … and some GPs.
Stakeholders, like the government, the patients and even the other non-GP specialists don’t see the value [in general practice].
The government thinks that general practice is a very, very easy job.
Ninety percent of medical health problems can be treated by general practitioners, but “specialist in general practice” does not provide the proper connotation.
Adding the name “family medicine” into the RACGP would help in many ways.
It would not only open the pathway to grow [scope] further, [it would] … improve recognition and [appeal] to junior doctors as well.
That rebranding will give more satisfaction to the job of general practitioner.
If you had to pick a number one priority as president, what would that be?
To increase our scope of practice.
We don’t need to refer everything to other specialists. General practitioners are the only group of doctors who can do the job better than anybody else.
The RACGP is largely made up of internationally trained doctors like yourself. Having experienced the journey of becoming registered as an Australian doctor from overseas, what needs to change?
The process we have, it’s quite long.
One of the barriers is that [IMGs] can’t do training in the metropolitan cities, [they] have to go into rural areas.
But in the rural areas, there’s not enough supervisors or enough support.
I have proposed to start training with two years in the metropolitan cities, where there are more supervisors, before [IMGs] go into the rural areas.
What sets you apart from the other candidates running for the presidency?
My vision to make the government and the community [see] that we are the right doctors to look after [patients].
Family medicine will give [more] context [on the fact that we] look after an individual in the community and in the family.
Some may think general practice and family medicines are interchangeable, but in the context of Australian general practice, where there are lot of things done by other specialists, it’s not interchangeable.
Combining the specialty in family medicine with the specialty in general practice will increase the scope of practice and will reduce the excessive referral to other specialists.
It will be more economical for people, and people will not need to wait too long to see the other doctors.
But we need a structured training program for this, and I have the knowledge and skill to do that with other academics.
I have done a masters in family medicine at the University of Cape Town.
The family medicine component will include community intervention, community education and more evidence-based treatment.
Family medicine is beyond what general practice is doing nowadays.
We need to go forward to extend our skills further and I have all the skills to do it, with other colleagues.
Can you expand on what additional scope family medicine would bring to general practice?
For example, let’s say someone has acne which is not getting better.
Dermatologists and the government do not let [GPs] prescribe Roccutane.
GPs are in the right position to prescribe it, as we can follow up.
It’s a power game.
If we can train as family physicians, this will give the context to the community, and to the other specialists and to the government, [that we are] specialists in family medicine.
Why do [patients] need to go to a dermatologist and pay $350-$450 when a GP can do it better, effectively and safely.
We need to show that general practice is not just writing a prescription or writing a referral letter.
It’s a field where we can treat individuals in the context of community, in the context of family.
Let’s come together – the academic general practitioners and the grassroots general practitioners – and upgrade ourselves and do the job, so the [patients] can [see] we are the right people to treat complex, challenging community problems.
What would the new specialist training involve?
When you do the [RAGCP] fellowship, first you become a fellow of the Royal Austrlaian College of General Practice and Family Medicine.
Then after three years of post-fellowship, you can do additional extended skills with a structured program, say a certified family physician with an extended skill in dermatology.
Are there other countries that structure the training like this?
Yes, if you go to Singapore or Malaysia they started recently.
America has done it for a long time. Canada started just few years back.
England is a general practice system because they don’t have other private specialists.
If [patients] didn’t need to go to private specialists, we wouldn’t need family medicine.
Non-GP specialists, like respiratory physicians, rheumatologists, dermatologists, addiction medicine [specialists], are doing the bulk of our job, and they are charging patients lots of money.
We keep referring to them because we don’t have the power to prescribe and treat patients.
But we can get training like America, Singapore, Malaysia, Fiji and Canada.
We should also open more departments of family medicine at universities.
There are professors in general practice departments, but they are not connected with the grassroot general practitioners because [we aren’t considered] specialists in medicine.
I’m talking about bringing status in a way that people feel we are also specialists in family medicine, that means we are part of the medicine as well.
So before moving to Australia, you worked in Asia, Europe, and Africa. How does Australian general practice stack up on the global stage?
We are very fortunate that we have Medicare.
The definition of good primary care is accessibility, affordability, sustainability, accountability and responsibility.
In Australia, care is accessible. People can come to a doctor very easily.
It’s not affordable now, because the cost has gone up.
Is it sustainable? It will be difficult for the government to sustain it, if there is no change.
There is no doubt we are, probably, the best in the world at providing preventative health care.
We are the best in the world at providing acute health care.
The problem is, when it comes to complex and chronic problems we are falling behind.
Let’s say I have a patient who has resistant depression.
How do we deal with that? We need more skill, more experience. We can’t wait to refer to a psychiatrist to see privately for $500 in six months’ time to treat the resistant depression.
We need an approach to deal with these kind of chronic and complex problems. We can’t rely on the public psychiatric system, we are dependent on the private one.
There, we are stuck.
[Patients] have started asking why [they are] paying a Medicare levy, when their health problem doesn’t get better?
There is no good mechanism where people can get support for complex health problems.
In the metropolitan city, where many immigrant people are moving, they expect to be treated by the public health system for chronic medical problems, but they are not getting [this care].
Medicare is not good enough to look after [them].
The problem is the status of general practice and the extent of general practice activities.
If we can increase the scope of general practice, by rebranding it with family medicine, that would give the scope to do it better.
Lot of work has to be done, but I’m happy to start it.
And all my colleagues in the GP college and at the university and even the health ministry, have to work together to make it happen.
Are you a candidate for consistency or for change?
I’m committed to change.
We are doing better, but we need to do greater.
A more detailed breakdown of Dr Haque’s priorities can be found here.
TMR will be back with another RACGP presidential candidate interview next week.
Have a question for the candidates? Email laurawoodrow@medicalrepublic.com.au.
This interview was edited for length and clarity.
