Is General Practice the career choice for you? A newly trained GP outlines the pros and cons to help you decide.

As you progress through your Intern and early RMO years, a time comes when decisions have to be made about your future training and specialisation. You get exposed to most medical specialties as a junior doctor in the hospital system, but General Practice has traditionally been a bit of a mystery.

Well, General Practice is a mystery no more! Now you can try out General Practice during your hospital training via the Prevocational General Practice Placement Program, commonly known as the PGPPP. I would recommend trying one of these terms. You may find that General Practice is for you. If not, at least you will get some idea of what the GP work environment is like, which will be useful regardless of your future specialisation.

So how do you know if General Practice is the right career for you? I think there are both personal attitudes as well as certain work conditions you should identify with and be willing to accept in order to enjoy training and a future in General Practice. Here are a few questions I have asked myself and at least some of the answers.

What do I like about General Practice?

I love the wide variety of work, covering aspects of every specialty. I like to know a little bit about everything compared to a lot about one or two things. Over time, one can build a relationship with the patient, their family and community. Patients come back and see me and bring their families. I really get to know what makes them tick and what impacts upon their health beyond the physical.

Early intervention and screening, and a trusting relationship, can impact upon a patient’s entire life. Being an advocate for patients is something I enjoy, especially for those with chronic conditions who have to navigate the health system. Rural medicine has additional rewarding challenges, including procedural and accident and emergency skills. These are all things I like about General Practice.

The work environment, flexibility in hours and part-time options are attractive. The training environment offers so many options both during and after training, and there is financial support for training via government incentive payments.

Travel, both within Australia and overseas, is possible with forward planning. You can follow a love of research, complete your training part-time or pursue almost any special interest. Sports Medicine, Palliative Care, Drug and Alcohol, Psychiatry, Paediatrics, Family Planning, Obstetrics, Anaesthetics, Emergency, Antarctic Medicine and more can all be catered for.

It is possible to take leave to pursue other interests such as overseas work and travel, and family time, without a significant impact upon future training.

There are opportunities to run your own business in the future and to learn this during training while you are employed under protected conditions. And every day is different!

What qualifications will I end up with?

There are two Colleges of General Practice – the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM).

Registrars may complete Fellowship of RACGP (FRACGP) and/or Fellowship of ACRRM (FACRRM) to gain vocational registration to work unsupervised in Australian General Practice.

The FACRRM course has an emphasis on the skills required for rural and remote practice so training takes place mostly in rural and remote
locations but once the qualification is complete, Fellows may practise anywhere in Australia.

The FRACGP curriculum covers broad General Practice with plenty of scope for special interests, including some rural medicine skills. For those doing FRACGP with an interest in obtaining additional skills to practise in rural areas, there is the option of the Fellowship in Advanced Rural General Practice run by the National Rural Faculty of the RACGP, which may be studied concurrently and awarded after completion of the FRACGP. Some Registrars choose to complete all three Fellowships, and much of the training can be undertaken concurrently. Some Registrars choose to complete just the FRACGP or ACRRM, which is all that is required for vocational registration.

GP Registrars can also elect to undertake all manner of diplomas or courses in areas of special interest to them such as Obstetrics or Child and Adolescent Health.

The overall vocational training program is called the Australian General Practice Training (AGPT) program, which is administered by a company called General Practice Education and Training Ltd (GPET). It delivers training through 20 Regional Training Providers (RTPs).

What are the employment conditions?

General Practice training differs in that it usually occurs in a private practice environment. Remuneration for Registrars during training is protected by the National Minimum Terms and Conditions (NMTC) document. This document is brokered by Registrar representatives from General Practice Registrars Australia (GPRA) and Supervisor representatives from the National GP Supervisors Association (NGPSA). The document stipulates the minimum salary or percentage of billings that must be paid to the Registrar for hours worked (whichever is highest). Most Registrars are able to earn more based on a percentage of billings generated once they settle into General Practice.

There have been a number of changes to Medicare which now make General Practice a more financially viable option.

Unlike in many other training programs, the Registrar is paid to learn, with a certain number of education sessions and one-on-one teaching by the GP Supervisor at the practice included in the paid sessions. Registrars are also released from working at the practice to attend education sessions organised by their RTPs in their first 12 months of GP Terms (RACGP) or Primary Rural and Remote Training (ACRRM).

How long does it take?

The Australian General Practice Training program usually takes three years for the FRACGP curriculum or four years for the FACRRM curriculum. A fourth year of Advanced Rural Skills Posts (ARSPs) may be added to the FRACGP program to attain the optional FARGP.

The first of these years is undertaken in the hospital and must be after the internship. However, there are ways to reduce this time. If you already have additional years of hospital experience it is possible to have these counted retrospectively by applying for Recognition of Prior Learning (RPL), enabling you to shorten your training time by a maximum of 12 months or enabling you to undertake Elective Terms rather than Hospital Terms to complete your training time.

The length of training can also be extended in a number of ways. This includes part-time training, Advanced Academic Posts, mandatory Elective Terms or leave. You can tailor it to suit you!

Points to consider

The downsides – yes there are a few negatives – but with preparation they can be managed.

• The General Practice environment – adjusting to private practice, the Medicare Benefits Schedule and fee-for-service models.
• Dealing with uncertainty – sometimes you just don’t know what is going on!
• Getting used to recalls and safety netting for the patient become important strategies.
• The effect of government legislation to address critical workforce shortages. GP Registrars must meet compulsory geographical requirements for training (rural and outer metro requirements). This  most likely involves relocation once and sometimes twice during training. This can get more difficult if you have a partner, family, mortgages or other responsibilities but with forward planning stress on the family can be reduced.
• Multiple stakeholders in General Practice training, often with competing political interests. Because of the critical workforce shortage, the GP Registrar workforce and training program will remain a significant political issue. Many stakeholders have unique views on how to resolve these problems. Unfortunately, this can reduce the flexibility and attractiveness of GP training. Fortunately, General Practice Registrars Australia (GPRA) advocates on your behalf for quality training and good conditions for Registrars and is a strong voice.

Being aware of the political environment, compulsory requirements and more difficult aspects of General Practice is the best way to prepare and cope with these aspects. GPRA is a great resource for potential applicants on training issues, terms and conditions and General Practice politics that impact upon GP Registrars. Membership is free! You can visit the website at www.gpra.org.au

Having recently completed my training, I can say I had a great experience, was generally well supported and very happy with my career choice. General Practice could be just what you are looking for!

Contributed by Dr Siew-Lee Thoo and updated by Dr Jen Lonergan, Dr Naomi Harris and Dr Jason Ong