Why are GP supervisors working for free?

The rural doctor lobby group has landed in Canberra asking for action on this disparity between general practice and other specialities.

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The Rural Doctors Association of Australia has used its annual Canberra visit to draw attention to the fact that GP supervisors, unlike their hospital-based counterparts, receive virtually no remuneration for training registrars.  

Shoring up GP training – particularly in rural areas – has been a focal point of pre-budget submissions from GP advocacy bodies this year.  

ACRRM, the RDAA and General Practice Supervision Australia all used their submissions to call for targeted funding for GP supervisors to, as GPSA put it, “reverse the tide” on the dwindling general practice workforce. 

The current funding model for GP supervisors only remunerates them for certain activities, like group meetings with registrars, professional development and time spent as a lecturer.  

Training practices get a subsidy and a teaching allowance, but these may not always be passed on to the supervisor. 

There’s no money for the actual task of clinical supervision.  

As the RDAA pointed out in its own budget submission – if supervisors in any other specialty were subject to the same terms, they would likely quit.  

GPSA chair Dr Srishti Dutta said the current level of funding for medical students in general practice only allows for the “pot plant experience”, where the student sits silently in the corner of the consult room.  

“As my colleague Dr Bruce Willett has said, general practice is not a good spectator sport,” Dr Dutta told The Medical Republic.  

“There’s evidence to show that medical students are more likely to benefit and return to general practice if the gold standard, which is parallel consulting, is provided.” 

Being able to provide the gold standard is, of course, dependent on the practice being able to physically facilitate the student’s needs and the supervisor being able to take the time to be present; something the current system cannot provide for.  

“The majority of the supervision payments are based on the construct of a minimum amount of time and education required, as opposed to an optimum amount of time and education required,” Dr Dutta said. 

With the Medical Deans of Australia and New Zealand planning to expand opportunities for students and junior doctors to gain meaningful experience in general practice, GPSA said the time to improve supervisor conditions was now.  

“GPSA is advocating for broad ministerial recognition of the crucial role the community (private) general practice plays in converting this expanded cohort of medical students and junior doctors to vocational GP training pathways,” its budget submission read.  

“Without this recognition, and without suitable financial reward to balance out the added burden on resources training placements impose on the community practice, the benefits of this strategy will potentially be undermined.  

“Indeed, the damage of such a failure would be felt for generations to come.” 

RDAA president Dr Raymond “RT” Lewandowski III told TMR that GP registrars had been “priority number one” during the group’s annual trip to Canberra to meet with politicians. 

“We don’t have doctors in the bush,” he said.  

“We’re very short, and we have to find a way to produce those doctors. That’s why we’re focusing on training – because without that, we got nothing.”  

It’s also why the matter of GP supervisor pay is so urgent: without supervisors, there can be no registrars. 

“In every other specialty in medicine, you’re paid to supervise your trainees,” Dr Lewandowski said.  

“And [general practice] is the only one that that’s not true for.”  

The RDAA’s vision for a fairer system starts with simplifying the six or so different sources of Commonwealth funding for supervision and creating a single consolidated payment. 

It goes on to recommend a $50 million investment in GP supervision.  

The other big agenda item for the group’s week in Canberra was related to childcare in rural communities.  

“A number of our rural communities have no access to childcare,” Dr Lewandowski said.  

“That limits several of our members from being able to attend their practices or participate in a hospital roster, even when they want to, because they have no way to care for their children.” 

The RDAA’s proposed solution is a grant program to establish small childcare centres on the grounds of rural and remote hospitals to service healthcare workers.