Adventure, Skills and Impact: General Practice in tropical Australia

Tarun Sen Gupta

JCU College of Medicine & Dentistry& Generalist Medical Training

1

www.gmt.edu.au

Brief overview

Tropical Australia

(it’s not all) about me

• Adventure – have fun, play hard

• Skills – do it well, work hard

• Impact – make a difference, it’s not hard

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Darwin

Cairns

Brisbane

Sydney

Melbourne

Adelaide

Perth

Rockhampton

Population 949,819~1/3 of total OR/R&R pop

138,201 Indigenous pop(14%, 30% national total)

Tropical Australia

Northern Territory

Kimberley & Pilbara

Cairns

Mackay

Tropical QLDTownsville

Population 19 million

Southern Australia

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www.gmt.edu.au

The northern Australian context

• Themes: • Major population centres + rural & remote communities• Tropical health & exotic medicine• Large stable Indigenous populations

• Isolated non-Indigenous populations• Employment base in service, pastoral, mining and tourism

industries• Proximity to northern neighbours

Rural, Remote, Indigenous and Tropical Health (RRITH)

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My experience in North Qld

… applies to tropical Australia

“North Western” Qld

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Q1. Who is the most famous resident of NQ?

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All about me -

My career in general practice• Preparation, orientation to the community• Roles of a rural doctor• Post-rural career

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Richmond is: (multiple T/F) – Q2

• In the south east corner of Qld

• On an island off the Great Barrier Reef

• Home of Kronosauraus Korner

• On the shores of Lake Fred Tritton

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Richmond NW Qld

MSRPP, other titles (DAME, GMO)

Hospital, house, surgery

BUT no award, no

professional support, no

aeromedical

co-ordination,

~ no organizations

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Australian Medical Council (AMC) Graduate Outcomes

The medical graduate as a:

• Clinical Practitioner

• Scientist and Scholar

• Health Advocate

• Professional and Leader

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Clinical Practitioner

• Expected roles: GP / family doctor, Public Health and Emergency Medicine (‘the bookends’), obstetrics

• ‘Unexpected’ roles – dispensing doctor, GMO, DAME, Council MO, DVA

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Clinical Practitioner - issues

•Medicolegal – police work, PMs

•Ethics – confidentiality, conflict of interest / boundaries

•Training

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Q3 How many sheep did this man shear in his life:

a) 0

b) 1000

c) 1000 000

d) 1000 000 000

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Adventurevivid mix of people and landscapes

beaches and mountains

hinterlands with spectacular rainforests and rich farmland

wide savannah country, wilderness, the red soil of the Australian outback

World Heritage listed national parks

Great Barrier Reef

Aboriginal and Torres Strait Islander cultures

rodeos, sunsets, performing arts, festivals, crafts, colourful weekly markets … an abundance of leisure activities

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Why work and play in North Qld?

Tropical treats Exotic locations

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Why work and play in North Qld?

Abundant wildlife No pollution

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Why work and play in North Qld?

Big fish in a small pond Famous places

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Q4 Where is this pub?

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It may not come as a surprise but more people live inside the circle than outside of it

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www.gmt.edu.auhttp://www.health.qld.gov.au/ruralgeneralist/content/greatadventure.asp

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Q 5. Location?

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Famous people #1?

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SkillsThe skills needed to meet the needs of the region are many and varied

3 Regional Training Organizations (RTOs) in the tropicsdeliver training in urban, regional and remote locations

decentralised structures, investing in locally focused delivery that is

proactively community-oriented, community engaged, and regionally devolved.

Emphasis on locally-relevant issues including rural and remote health and Aboriginal &Torres Strait Islander health.

Queensland’s Rural Generalist Pathway has pioneered an integrated service and training program providing a career pathway supplying the needs of the bush

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GMT Region

• Teaching nodes:• Thursday Island

• Atherton Tablelands

• Cairns

• Mt. Isa

• Townsville

• Mackay

• Longreach

• Rockhampton

• Wide Bay

• Sunshine Coast

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www.gmt.edu.au

Australian Medical Council (AMC) Graduate Outcomes

The medical graduate as a:

• Clinical Practitioner

• Scientist and Scholar

• Health Advocate

Q6 – what’s next• Professional and Leader

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2012 Ernst and Young report

Four transformational pillars:

1.Recognition of profession2.Value of practice3.Pathway4.Service and workforce redesign

QRGP conception, implementation and progress.

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QRGP Intern commencement by year

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18

31

3740

36

4038

44

54

77

0

10

20

30

40

50

60

70

80

90

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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Choosing a Pathway

Program Length • The AGPT program is 3-4

years of full-time training depending on fellowship

Program Commencement• AGPT Program commences in

January/February each year

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PGYear

Rural GeneralistPathway

Queensland Hospital &Health ServiceAppointment

Salary Status

Qld RuralGeneralistPathway

Scholarship

AustralianGeneralPracticeTraining

RVTS

Australian Collegeof Rural &

RemoteMedicine

(ACRRM)

Royal AustralianCollege of General

Practitioners(RACGP)

1Prevocational

Training

Intern Level 1 ROS* Apply - - -

2Junior House Officer

(JHO)Level 2 ROS* Yr 1 -

Core ClinicalTraining

Hospital Training

3/3+Advanced

Specialised/Skills Training

Registrar / PrincipalHouse Officer (PHO)

Level 4

Deferralunless training

in location

approved for ROS

Yr 2 ApplyAdvanced

SpecialisedTraining

Advanced SkillsTraining

4/4+

VocationalTraining

Senior Medical Officer (SMO) (Provisional

Fellow)

Medical Officer with Private Practice (MOPP)

Level 13

ROSto be

completed in approved

location

Yr 3 Yr 1Primary Rural &

RemoteTraining

GP Terms

5/5+ Yr 4 Yr 2Primary Rural &

RemoteTraining

GP Terms

6/6+

ContinuingProfessional

Development

SMOMedical Superintendent

With Private Practice (MSRPP)

MORPPVisiting Medical Office

(Advanced Practice)

Level 18 –25

- - -

FACRRMInc. Advanced

SpecialisedSkills Certification

FRACGP/FARGPInc. Advanced Skills

Certification+

Certified Women’sHealth

7/7+ - - -

8/8+ - - -

Rural Generalist Pathway – Training Progression Table

* ROS ( Return of Service) – PGY1 & 2 eligible for ROS or Service Period retrospectively upon completion of Rural Generalist Medicine Prevocational CertificationRVTS – Remote Vocational Training Scheme

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Following Prevoc Training

Subject to an open merit application process, Trainees generally complete Advanced Skills Training (AST) in PGY3 in a dedicated PHO or Registrar position at a regional Queensland Health facility. Rural Generalist Medicine Advanced Skills include:

Anaesthetics * Indigenous Health

Obstetrics & Gynaecology* Paediatrics

Surgery Mental Health

Emergency Medicine * Adult Internal Medicine

* most popular

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Locations in Qld which have hospitals and may attract RGs

Prevoc and AS 45

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Four pillars of the Qld RGP

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Famous people #2?

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Impactthe greatest attraction is the impact of living and working in a community where your skills are valued

every day you make a difference–not just to your patients, but to your friends and neighbours, your community.

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The crisis of our time relates not to technical competence, but to a loss of the social and historical perspective, to the disastrous divorce of competence

from conscience

(Boyer, 1990)

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We need to be constantly reminded of a fundamental truth: community service should not be regarded an inconvenient period in a medical career. A medical career should be cultivated as a continuous act of community service.

It is the rural experience which gives doctors the humanity our patients yearn for in us.

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Top and tail for the first time… living the dream

Q8 Where?

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Famous people #3?

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This map shows (in white) where 98 % of Australia 's entire population lives.

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Q9 how many ASGC RA categories are there?

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In closing

• Values matter

• Count what counts

• You will have great training – use it wisely

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Questions?

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Enjoy your career in general practice, just don’t get bogged

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www.gmt.edu.auAugust 2012 QHRSS

www.gmt.edu.auAugust 2012 QHRSS

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The line on this map shows all of the world's Internet connections in 1969.

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This map shows the countries (in blue) where people drive on the left side of the road

Generalist Medical Training

Information Session

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About GMTGeneralist Medical Training (GMT):

o is a unit within James Cook University’s College of Medicine and Dentistry

o is contracted by the Australian Government Department of Health to deliver the Australian General Practice Training (AGPT) program for the North Western Queensland region

o has over 70 Administration and Medical Education staff, located in 8 offices throughout the region

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Training with GMT

• The AGPT program provides training towards Fellowship of the Royal Australian College of General Practitioners (RACGP) and the Fellowship of the Australian College of Rural and Remote Medicine (ACRRM)

• GMT offers GP Registrars a choice of diverse and exciting Training Posts with extended scope of practice

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10:00 am AEST 11 April 2016 Applications Open

10:00 am AEST 9 May Applications Close

13 June – 4 July National Assessment Centres – SJT online

24 June – 17 July2 July – 3 July See AGPT website for dates

National Assessment Centres – MMIsTownville National Assessment CentreBrisbane National Assessment Centre

1 August Applicants are notified of scores and given opportunity to change preferences (Preference Distribution Matrix posted)

10:00 am AEST 8 August Applicant Preference changes due to the Department

10 August Applicants notified of RTO Shortlisting

12 August – 2 September RTO Placement Assessments

10:00pm AEST 12 September Outcomes Due

2017 AGPT Applications

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GP Training Landscape

When can doctors apply?• Doctors can apply as early as

intern year, to begin training in the following year.

Eligibility• Please see AGPT Program

Eligibility Guide in the AGPT Handbook (back page fold out)

Training Qualifications1. FACRRM2. FRACGP (FARGP)

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Training Requirements

Part Time Training • Doctors are accepted on a full-time basis. Registrars can apply to

GMT to undertake part-time training

Leave from Training• Leave from the program requires prior approval and is subject to

AGPT policies. Policies can be viewed on the AGPT and GMT website.

Recognition of Prior Learning• RPL applications are made through GMT and then assessed and

approved by a college censor (ACRRM/RACGP). RPL Applications should be made during the first year of primary care placements.

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GMT Region

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Choosing a Training Site

• Preference 5 of the 10 regions

• Detail learning requirements

• GMT matching process → Interview at 2 practices

• Note: Smaller sites will be able to offer all training (3+ years) so that Registrars do not have to move during training

• These details will be available on GMT website

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Useful Websites

• www.gmt.edu.au

• www.agpt.com.au

• www.acrrm.org.au

• www.racgp.org.au

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The vertically integrated rural pipeline

•High school (? Upper primary) ~ 1st degree

•University

•Junior Hospital doctor

•Vocational training

•P/Grad - CPD

Connections

Location of

campus

Selection

process

Program

Support

P/grad

training

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QRGP cumulative Intern commencement

10

28

59

96

136

172

212

250

295

348

425

0

50

100

150

200

250

300

350

400

450

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Trai

ne

e #

An email from the USA....

Tarun:

I wish to advise you that A-- punched me in the nose today around 11am. The event was witnessed by my partner Dr C--. I will let you sort it out with her upon her return.

L--

JCU graduates & the Mackay region, 2006 to 2013 (n = 131)

Practised in Mackay Mackay origin

[52 total] [54 total]

Mackay Clinical School

8

23 13

10

43

23 11

90