General Practice training during a global pandemic – challenges and concerns for the future | AMA (WA)


General Practice training during a global pandemic – challenges and concerns for the future

Monday July 6, 2020

Dr Shane Head, GP Registrar

GP training is structured very differently from the often rigid arrangements seen in the hospital system, with the vast majority occurring in privately-run practices.

The onus is on a trainee to choose their practice and then negotiate a rate of pay and working hours. While the National Terms and Conditions for the Employment of Registrars (NTCER) sets out expected minimum rates of pay and expected hours of work, many practices view the hours of work as a guide and the rates of pay as set in stone.

The base rates of hourly pay for GP registrars are shockingly low, especially at the entry level. I was on a rate, which was less than when I received during my internship seven years prior.

While there is an option to receive a percentage of billings, most practices will only offer this once every 13 weeks for trainees. Such a structure enables the practice to maximise its cash flow but disadvantages trainees as they miss out on their earned income. This coupled with the low base rates of pay often drives trainees to either seek out locums or work in afterhours services to supplement their income in order to cover the costs associated with training such as exams. Working such long hours is also clearly detrimental while trying to study for a fellowship, often without access to paid study leave.

The COVID-19 pandemic has exacerbated many of the issues facing General Practice. The addition of telehealth services was seen by many as a way of tackling some of these, allowing us to bill for things we previously did for free.

Unfortunately, the carte blanche nature of telehealth as it exists is open to abuse. We have seen pop-up clinics prompting rapid bulk billed “assessments” with no consideration for continuity of care or often, even good medicine.

This is a clear case of profit before patient and is plainly unacceptable to most. There has also been a profound reduction in patient presentations during COVID-19 as they fear leaving their homes. This has been disproportionately felt by our GP trainees, with some now seeing less than half the usual number of patients. A key element of training is seeing a wide variety of patients with a broad range of pathology – our trainees are not getting that currently.

Unlike hospital-based medicine, medical care in General Practice is provided by individuals rather than teams, and most practices are small business just trying to get by. Yet again, we have seen the heavy hand of government try to change the way we practise medicine. The draconian approach to bulk billing during COVID-19 not only fails to recognise the worth of General Practice but fails to understand the cost of doing business.

There are stories of practices with no or limited personal protective equipment (PPE), where mandated teaching time fails to take place, and where supervision is not up to the expected standard as mentors are required to see extra patients to make ends meet.

We need government to recognise our worth and the value we provide to patients. Moreover, we need government to remunerate all GPs, not just trainees, appropriately without shifting costs to patients.

The COVID-19 crisis has also resulted in many trainees missing out on sitting fellowship exams, and therefore having to extend training time. Consequently, they are foregoing the extra income a Fellow enjoys but also risk having to re-sit exams if underprepared when assessments do recommence.

While it is not all doom and gloom, if things don’t change, I do worry about our GP trainees and their future. We need to have an NTCER and employment model, which recognises our skills and values our input – we know our patients do.

We need support and access to PPE and good quality clinical education. We need to feel safe in our jobs so we can keep our patients away from our hospitals and at home.

We need to not worry about having to see six patients an hour so we can pay the mortgage and for our exams.

Finally, General Practice needs to be a competitive specialty and not seen as a last resort because our job is hard and exhausting, and having good quality co-workers who are well trained makes a difference.

We thank the Australian Medical Association (WA) and its strong leadership for lobbying for us, but the battle isn’t over yet and we need to continue fighting to make sure we don’t lose what we have won.

Dr Shane Head is a recently fellowed GP working in Perth’s foothills.