Category Archives: GPRA

Breathing New Life 2013 (Part 2)

Continued from Part 1

The Leaders’ Forum discussing GP Workforce 2025 was one of the highlights of the conference. Chaired wonderfully by Dr Emily Farrell, it comprised a veritable who’s-who of GP leadership. Prof Murry from ACRRM (covered in the early stages by Dr Davies), Dr Hambleton from the AMA, GPRA Chair Dr Vergara, GPSN Chair Mr Townsend, Dr Baker from NGPSA, Dr Marles from RACGP, Dr Kammerman from RDAA, Sharon Flynn chair of the RTP CEOs and Prof Kidd (no introduction required!).

Leaders Forum FTW

Leaders Forum FTW

Rural workforce issues were a hot topic for the forum generating plenty of debate and also activity on the Twitter feed and some novel ideas for improving recruitment were offered:

Filling in for Prof Murray, ACCRM trainee Marion Davies provided some great advice for aspiring rural doctors during their training:

Up and coming GP leaders like Dave Townsend summarised that training needs to have improved information about where it is possible, communication between providers and collaboration towards a common goal. Dave also demonstrated his Gen Y talent by not only taking part as a forum leader, but also concurrently tweeting the points made by the person sitting in the next chair:

Not so technically savvy, but more than capable of contributing important points was Dr Hambleton. Even though a GP himself and quite likely able to multitask, his AMA media person was helping to keep the Twitter-stream flowing:

Not only was the topic of learning raised, but also that of teaching and growing our pool of supervisors. Trish from NGPSA admitted that supervisors were getting older and also dealing with a more challening mix of trainees:



One suggestion that Dr Ashe Nicholas provided was to increase the membership and role of the General Practice Registrar Medical Educator Network (GPRMEN). This group of registrars would serve to promote the idea of teaching to form and hopefully increase the future number of medical educators and supervisors. Given that the number of AGPT applications are increasing, a much larger cohort will be needed and won’t simply fall from the sky:

For some, the seed of teaching had been planted long before even commencing GP training as described by Dr. Mel Clothier, a gorgeous GP registrar from Clare. Dr Clothier had positive experiences in teaching medical students in her higher levels of med school and tweeted from SA:

Even the wonderful students tweeted suggestions as to how best promote general practice during medical school. It really summed up the beauty of such a conference. Where else could the future of the field so easily fire off ideas to be considered by the top leaders who have the ability to effect change:

The students were a crucial part of the day, not only tweeting, but also providing help for the older generation not across social media or infographics. The infographic (below) constructed by Rebecca Wood, council member of GPSN, summarised the main points made by each forum leader on the topic of workforce issues:

On-the-fly infographic courtesy of @rfrwood

On-the-fly infographic courtesy of @rfrwood

Unfortunately not all the questions were covered, but one that will continue to generate discussion  included the future of primary health care research:

Briefly summarising the latest in GPRA news and updates, Mr Amit Vohra was also proud to launch the new look GPRA website. He told everyone of the brilliant work of GPSN and its incredible cost-effectiveness as a GP promotion tool. Amit also pointed to the Going Places network as the fastest growing of them covering 65% of Australian teaching hospitals while filling the “black hole” that some GP registrars find themselves in while working there. Some of his final remarks centred around the jump of 25% to 35% of all AGPT applicants having been involved in one of the programs. What an amazing pipeline that I’m sure will only increase in calibre and flow (no urology jokes).

The 6th GPRA Breathing New Life conference also offered an insight into GP life as part of the Australian Defence Force (ADF). To begin, Dr Kerry Summerscales described her journey swapping rifle for tuning fork. Although her time in the Australia Army was spent wielding syringes rather than guns, working in the medical corps as a pathology technician. Her stories of deployment and training then flowed into her time at Flinders Uni working with the fledgling GPSN. It prompted some to wonder in jest about the model of employment offered by the armed forces:

The rank and file then heard from Brigadier Rudzki AM, who described the different work that was available to GPs in the military. He told of his operational postings overseas and showed many pictures of the exciting jobs that he held. Having said “I’m not here to sign anyone up” the Brigadier told some amazing storied that had some wondering whether working rurally was challenging enough:

Throughout the day, the food was exemplary as always at Parliament House. They were certainly not scraps from the Cabient table that day:

Given the deliciousness of the food described, hands being used to eat therefore restricted tweeting during the meal breaks and as such was observed from afar:

The Great Debate provided a light-hearted look at some of the serious topics facing general practice. The first motion was “Mandatory return of service for all doctors is the only way to guarantee a rural workforce.”

The affirmative took a military approach led by Captain Summerscales, Brigadier Maxell and Corporal Considine who contended that we are at war against maldistribution and that we must form a Coalition of the (Medicare) Billing.

The negative team wanted to be more peaceful about the situation and offer more incentives or “carrots”to attract more doctors to the country:

By a vote of louder claps to lesser claps, the affirmative team took the honours:

The next motion was that “Generalists will rule the world in 2025” with some great debate highlighted in the resultant twitter stream:

Dr David Chessor once again demonstrated his flair for simultaneous debate and tweeting much to the chagrin of the opposition team:

and on occasion, from the audience:

At the conclusion of the day, everyone present offered a large round of applause and the ‘Twepreciation’ came flooding in:

Although all the days online action may have seen some reaching for the Voltaren gel:

For the students it was an inspiring day to hear about the benefits of a career that they may consider. For GP registrars it was sobering to understand the challenges facing them into the future. For current GPs it must have been heartening to see a motivated group of young students/doctors ready to answer the call for Australia’s health workforce into 2025. For the associated GPRA staff and organisers it was once again another truly magic day and I for one thank them one thousand times over. Until next year, ruralflyingdoc at Parliament House, signing off.


DISCLAIMER: If any of Part 1 or 2 of this BNL summary ends up in Mr Amit Vohra’s GPRA report, then I am not pressing charges. He will however be buying me drinks for the entirety of GPET 2013….

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Filed under BNL, General Practice, GPRA, Health Policy, Rural GP

Breathing New Life 2013 (Part 1)

It is quite fitting that I sit down to write this summary of the Breathing New Life (BNL) conference held in Canberra recently. At the conference last year, I was so inspired by the stories of other GPs and the use of blogs and twitter, I decided to start my own blog. It is the one you are reading now. Since then I have kept updating my flying training progress, commented on social media policy in healthcare and attempted a humorous post (or two). Unfortunately, I never got around to summarising my experience at BNL 2012 and you can still see the lonely post here. But luckily, I was inspired once again…and hopefully a little more motivated and better at writing!

The BNL conference is the annual showpiece event for General Practice Registrars Australia (GPRA). They are the peak representation body for GP registrars in this country. In the past, GPRA has successfully advocated for National Minimum Terms and Conditions, timely GPRIPs funding, teaching guidelines and many other registrar issues. As a Registrar Liaison Officer with my GP training provider, I am lucky enough to sit on the advisory council of GPRA. We meet bianually before BNL and GPET conference in September to discuss such issues and workshop solutions.

But BNL itself is a day long conference held in the Great Hall of Parliament House that aims to bring GP training, recruitment and support into the spotlight. 2013 was no exception. From the outset, use of Twitter was encourage to pose questions, comment on speeches and connect using the hashtag #bnl2013. As the day progressed, we even started to see comment and opinion from our collegues in New Zealand. It is with this real-time connection, that the role of Twitter in health care is immediately obvious:

Highlighting the importance of the venue for the day were keynote speeches by the Health Minister, The Hon Tanya Plibersek MP and The Hon Peter Dutton MP which were both warmly received. Even though the Minister needed to hurry off to an ALP caucus meeting and the Shadow Minister was a touch late in arriving before a feisty Question Time in the house of Reps and didn’t get to answer one last question from Dr. Jonathon Ramachenderan:

Health Minister talking up GP

Health Minister talking up GP

The Minister reiterated the importance of general practice stating that “GPs are at the heart of our universal medical system.” She also affirmed the position and continuation of the e-Health record and Medicare Locals. I was heartening for all present to note that the Governments thinking in relation to the future challenges of health care revolve around improving GP access. The Shadow Minister retorted in his address that he thought that the Government could do a lot better in primary health care and echoed the Minister saying that “GP care would be central” to any future health system. My question from the floor The Shadow Minister was “given there is a lot of uncertainty about the future of government initiatives such as the e-Health record and Medicare Locals in this election year, what advice can you give to the future of GP assembled in front of you.” The response didn’t cover e-Health, but he hinted strongly that Medicare Locals were not the most efficient or efficacious way forward. Once again, Twitter provided the means to pose a few rhetorical follow-ups:

The Hon Jim McGinty discussed the work of Health Workforce Australia 2025 and the issues surrounding retention and planning with our current state of workforce maldistribution. The recent controversial paper entitled “Too Many GPs” was also given attention. And promptly panned:

With The Hon McGinty describing the report as “full of inaccuracies ,” he was quick to remind all present that given the current state of GP distribution, more are needed at the coal face. However, a number of references to nurses evidently ruffled a few Twitter feathers:

Following this brief look at the future, we were allowed a moment to reflect on the amazing work done by the General Practice Student Network (GPSN) which celebrates its fifth anniversary in 2013. We heard of humble beginnings and a huge base of support that now includes over 9,500 student members. This we were told, had been largely driven by the tireless work of council chairs, their councils and the representatives on the medical school grounds holding numerous events.

It was heartening to see that indeed future GPs are out there and will be ready to meet our nations challenges in health demonstrated by Jim McGinty. The Twittersphere also erupted in e-birthday wishes for GPSN:

Indigenous health was a highly anticipated topic of the day and was supported by the GPRA Closing the Gap campaign launch. We heard from The Hon Warren Snowdon who stated that “GPs have an important central role in improving Indigenous health.” MP and Dr Andrew Laming MP noted in his speech that the “100,000 Indigenous people living in remote communities will be the real test of the Close the Gap efforts.” It was refreshing to hear bipartisan support and understanding for once.

Also On each table were a number of wristbands that will serve to draw attention to and remind wearers to effect their own small change in this area. To discuss some of the change possible, the Indigenous health panel debated, discussed and took questions from the floor and twitter:

Make a difference

Make a difference

The response to this were themes relating to difference in cultural and educational experiences felt by Indigenous students and registrars. Also that the Indigenous population are a heterogeneous mob all over the country and as such may require personalised consideration. Some suggestions from Indigenous doctors in the audience included needing to recognise cultural differences and reducing threats like ‘you might be kicked out.’ Dr Aleeta Fejo was a standout member on the panel who commented that at the GP registrar level “they are already brilliant people, as they have overcome so much just to get there.” She is a testament to this herself having recently passed her RACGP written exams and winning the inaugural indigenous General Practice Registrars Network award:

Aleeta also shared some gems about encouraging young Aboriginal children to join the GP workforce. She showed that it was as easy as asking “Are you going to be a doctor like me? ‘Coz I need your help!” Planting the seed early with children and especially their parents was the message. Getting across to the family that this prospect is actually possible. The facilitator Dr Mark Wenitong tempered that he would always check a kids ears for pus before putting the stethoscope in their ears!

There were some great opinions on how to encourage non-Indigenous registrars to consider working in an Aboriginal Medical Service. Dr David Chessor pointed out that he has got much more out of AMS work than he put in. David Townsend, current chair of GPSN commented on the need to spread this sort of message:

He went on to say that AMS cases are much more interesting and complicated. Perhaps then this side of registrar training needs to be better advertised? With Rural Health Workforce Agency doing so much good with their #gorural campaign, maybe it’s time for #goAMS? Drs Tim Senior and Michael Bonning are already doing some amazing and innovated work with the #supertwision project and should be followed with interest:

RACGP president Dr Liz Marles weighed into the benefits of AMS work given her long experience in the area with comments like “learning from patients every single day”,”…rewarding place to be” and “patients are non-demanding, generous and trusting” leading to many registrars thinking that these traits in patients have been lacking in their own non-AMS practices.

To come in part 2: The Great Debate, general practice and the defence force, GP Leader’s forum, the GPRA update from CEO Mr Amit Vohra and plenty more tweets!

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Country GP is boring

Doctor/pilot x 2

Doctor/pilot x 2

I remember a colleague in medical school commenting on my intended choice of general practice saying “oh, I couldn’t do that…how boring.” Perhaps a small part of me agreed with them. Sure, I had sat as a student in a room with an urban GP and even completed a 6-week GP term in the country with some tedious moments. But now at the end of 12 months and my first registrar placement in rural general practice, I can look back and see how wrong my classmate was. I can’t even remember the number of times that my supervisor, Dr. Scott Lewis (above), and I would see a particularly interesting case and remark (tongue in buccinator) “geee, how boring is country general practice!”

During the year we have retrieved and transferred patients via RFDS for a variety of conditions including:

  • Haematemesis with a Hb of 55
  • Three appendices in the last 2 months
  • Suspected septic knee joint in an 18 month old
  • 2 cases of severe bronchiolitis in the space of 2 weeks (Thanks RSV)
  • Numerous renal colic, some with pyelonephritis
  • Suspected spinal epidural abscess

But it’s not all about the high end critical care stuff, no matter how much the PHARM/ED/ICU/anaesthetic gurus will trumpet. The nuts and bolts of GP are there too:

  • Immunisations and baby check ups
  • Cancer screening
  • Preventative care for heart disease and diabetes
  • Family planning
  • Skin lesion removals
  • Antenatal care
  • One of my favourites, ear syringing
  • Palliative care planning, to name a few

For this reason general practice (and country in particular) has been termed “womb to tomb” or “cradle to grave” care. However, I do prefer the alternative: “crack to croak.”

Perhaps the real scope of rural general practice was demonstrated a few weeks ago. Wudinna recorded the highest temperature in the country that day, reaching 48.2C. To add further difficulty, my supervisor (the only other doctor in town) was away. Luckily I had the help of a great Flinders 4th year student. Here’s a brief summary of what happened:

End of a *hot* day

Start of a *hot* day

Woken up at 3am – Chest pain brought in by ambulance – MSK, likely thoracic spine in origin

Morning Clinic

  • Fasting bloods x2
  • 12 month immunisation
  • Funny rash on shoulders – pityriasis versicolour
  • Follow up after USS for ?DVT

Up to hospital for foreign object in eye – used slit lamp to examine

  • Follow up after ureteric stenting
  • 18 month immunization

Up to hospital again for facial laceration – 7 stitches and epiglue

  • Change in bowel habit with PR bleeding
  • Diverticulitis


*** Cut short by a car rollover with three occupants 30 km out of town. All self extricated. Blood alcohol levels on each and C-spine XR on driver to clear neck and removal collar. ***

An ex-Ford Fairlane

An ex-Ford Fairlane

Afternoon Clinic

  • Hoarse voice in 7 month old

Up to hospital. 3-year-old not tolerating orals, vomiting – admitted for observation

  • Diabetes check-up
  • Blocked ear – eustachian tube dysfunction
  • INR check
  • 6 week post-natal check
  • Chronic leg ulcer

Would be hard pressed to call that day boring! Was it stressful? Yep. But fortunately the vast majority of our days were not this busy, but the variety was always there.

More than one SAAS crew at hospital = bad

More than one SAAS crew at hospital = bad

General practice allows the doctor to be a true jack-of-all-trades and master of some. Some have said that specialities are learning more and more about less and less, until one day they know everything about nothing. The converse might also be said about GP work. But as long as I know what to look for and ask my specialist colleagues for help at the right time, I’m happy. Not only with the management of patients, but also my choice in medical specialty. General practice is never boring, you just need to look for inspiration in right places.


Applying for GP training:


Filed under Emergency Medicine, General Practice, GPRA, Rural GP

Breathing New Life 2012

On the 19th of March 2012, GPs, GP Registrars, interested students and junior doctors descended on the nations capital for a day that saw General Practice placed firmly “in the hot seat.” Speakers included the Federal Health Minister and her Shadow counterpart, Professor Des Gorman from NZ and others. In the audience listening along with the future faces of General Practice were GPRA patron Prof John Murtagh and Prof Michael Kidd. A number of blogs, opinion pieces and photos from this weekends conference are to come on this site. Stay tuned!

Catch up with the Tweets from the day: #bnl2012

Follow the author on Twitter: @ruralflyingdoc

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