Supervisor Liaison Officer update
Registrar remuneration and contract negotiation
The subject of GP and registrar remuneration has been a hot topic in medical news of late. I have reflected on some of the sensitivities in contract negotiations between practices and registrars since that time is almost upon us, once again.
When I was a registrar, my medical educator advised our training cohort that she and the practice owner where she worked had crunched the numbers for employing their registrar. They worked out that they roughly broke even. Rubbish, I thought, that could not be true! Or it must be a very inefficiently run business – they must be doing something wrong! It would have been helpful to detail some business costs, as I could not comprehend that a practice could be so expensive to run.
Fast forward 16 years and I had the opportunity earlier this year to give a talk to our local registrars about the costs of running our practice. They expressed surprise at the many types of expenses and the total costs. Many of the costs of running a practice are unseen. Registrars and contractor GPs can easily see the big-ticket items, like administrative staff wages and rent. If they do some mental maths, they may incorrectly feel they are being short-changed in contract negotiations.
Our practice running costs in the 2018/19 financial year – $2.45 million:
- Employee expenses $1.25M (e.g. salaries, superannuation).
- Premises expenses $513K (e.g. rent, repairs, maintenance, waste removal, cleaning, electricity, water and gas).
- Repayment of fit-out loan $153K.
- Operating expenses $520K (e.g. accounting, accreditation, advertising, software subscriptions, equipment maintenance and rental, postage/freight/couriers, minor equipment, insurances, IT support, online booking service fee, security, staff education, stationary, phone, internet, website, vaccines, medical consumables, bookkeeping, catering).
Information on profit margins in general practice is not readily available. Some medical accountants estimate a usual range of 2-7% of gross revenue. GPRA advises registrars it is likely around 5%.
GP profit margins are slim compared to many other business types. There is the very real potential for the business to make a loss. I know several practices owners who take home a lower percentage than their GP contractors and registrars, while running a fully booked privately billing clinic.
Registrars are given tips on how to negotiate contracts by GPRA:
- 9 key points when negotiating your employment as a GP registrar
- NTCER Negotiating Your Employment Agreement for 2020 webinar.
As a supervisor, I found these resources helpful to review. They highlight the expectations of registrars, their common concerns, and questions they have been advised would be helpful to ask.
GPSA has teaching resources on business costs: Teaching the Business of General Practice – Easy Reference Charts.
At the end of the day, supervisors want to have positive working relationships with registrars.
A better understanding of practice running costs may just help with that.
Dr Melian Deery | Supervisor Liaison Officer
Last week there was a transition update meeting with the Regional Training Organisation Network (RTON), the Department of Health and the Royal Australian College of General Practitioners (RACGP). The RTOs (including GP Synergy) have regularly met with the Department and the Colleges to discuss the transition since the Minister made his announcement in 2017.
The key messages from the Department were:
- The Minister is committed to seeing transition occur at the end of 2021.
- The Government has confirmed its commitment to ensuring all Australian General Practice Training (AGPT) funds remain in GP training.
- The Government is looking at ways to make general practice more attractive.
- There will be a new approach to supporting workforce in areas of need, involving regional entities.
We have been informed that the role of RTOs will be different, with details to be determined. We have also been advised that the colleges will have full responsibility for all aspects of education from selection to fellowship. Late yesterday afternoon, the RACGP circulated an email to its members regarding this.
We are highly conscious of the potential impact of changes on registrars, supervisors and communities. As a network, and individually as GP Synergy, we will continue to work closely with the Government, the RACGP and the Australian College of Rural and Remote Medicine (ACRRM) to ensure the smooth transition of training at the end of 2021.
We are committed to engaging regularly with you throughout this process and when more details are known.
GP Synergy Annual Reports
We're proud to present the GP Synergy Annual Report 2019-2020, and for the first time an annual Research Report 2019-2020.
Our Annual Report demonstrates how in conjunction with supervisors and training facilities we're training highly skilled GPs contributing to healthier communities.
Through our Research Report you can explore the achievements of our Research and Evaluation Unit, who work directly with GP medical educators, supervisors, registrars and other researchers to gather and analyse data to ensure the highest standard of GP training.
We have been circulating information concerning the impact of COVID-19 on the training program. This includes FAQs and changes to our face-to-face education program.
Key dates for 2021.1 training placements
Wed 14 October 2020 – Practice and supervisor caps advised.
Mon 19 October 2020 – Registrars will be able to apply to practices within their assigned grouping.
2020 Rural video competition
The competition closes 25 October, so there is still time to make a video about the benefits of a career in rural general to help inspire the next generation of rural GPs, as well as vie for one of the great prizes!
Do you know a medical student interested in a scholarship?
The GP Synergy Medical Student Scholarship is a great opportunity for medical students from participating NSW and ACT universities to explore general practice and general practice research.
Applications for the 2021 scholarship program open Tuesday 6 October to Monday 9 November 2020.
Teaching in the practice
As the year progresses supervisors have continued to adapt well to the changing environment that the pandemic has dictated in supporting registrars in their learning.
In my own practice the most recent turn of events with the Queensland/NSW hard border closure has meant that one of our registrars has had to revert to 100% remote telehealth for a period for general practice consultation and supervision. Formal teaching weekly via Zoom, and corridor support via WhatsApp calls during or after her consultations as well as her participation in our case conferences and practice meetings online has become a whole new experience for everyone.
Overall, I can say that it is working reasonably well. Interestingly she said to me the other day in our Zoom teaching session that because of more practice and time with the history taking part of the consultation she feels now very well versed with this and I have certainly noted this when reviewing her progress notes. Of course, refining and honing her examination skills in the GP setting remains the challenge. This must now be either delayed or somehow role played through Zoom teaching. I have spoken to other supervisors about this and I know this has been a common challenge throughout the pandemic.
Next teaching session I am planning to get her to observe some YouTube musculoskeletal examinations (there are a number of examination playlists on the GP Synergy YouTube channel) and then see if we can get her to either talk these examinations through or ideally demonstrate with a role play patient (if she can find someone) whilst I am observing via a Zoom link.
Supervisor professional development
Supervisor workshops in each subregion are proceeding online with the local Medical Educator with Supervisor Portfolio (MESP) team members and experienced supervisors involved. The topics are ‘What’s going on in there? Consultation analysis’, and ’Professionalism, reflective practice and self-care’ and the online workshops include video role plays and smaller Zoom break out rooms to stimulate discussion The supervisor events calendar lists upcoming events in all regions.
With planning underway for next year’s supervisor workshops, you will have received an email from the MESP team for expressions of interest in sharing your teaching expertise with supervisor colleagues. The session will be titled ‘Teaching showcase – hints and tips for supervisors by supervisors’ and we will be looking to interview and record some short videos of supervisors sharing their top teaching tips as a stimulus for discussion.
I am looking forward to seeing all the great tips and hints from supervisors that we can share.
Dr Rob Trigger | Medical Educator with Supervisor Portfolio
Tips for supporting registrars to get the most of CTVs
Clinical teaching visits are continuing remotely with visitors observing via Zoom.
The type of CTV allocated to your regsitrar is based on educational need. The majority involve observation of patient consultations over Zoom. Registrars with established consultation and communication skills may be allocated a random case analysis CTV or case based discussion CTV where no patient consultations are observed.
As supervisors it is worth considering how we might best support our registrars to get the most out of these remote CTVs. CT visitors are encouraged to contact the registrar and/or the practice early to schedule and prepare for the visit.
For patient observation CTVs one important factor is setting up the technology to get the most benefit. In my experience, when the registrar is using a separate device for Zoom (either a phone, iPad or laptop) rather than using the desktop computer the external visitor may see and hear both the registrar and the patient which has worked well for me.
As supervisors it is worth remembering that the CT visitor will need to contact you to talk about how your registrar is going. Having a system in place for how this might best work for you and your practice will be helpful.
Dr Rob Trigger | Medical Educator with Supervisor Portfolio
ReCEnT reflections – insights into problems seen by registrars
Part three of our ReCEnT reflections during the COVID-19 pandemic explores the types of problems registrars saw in the 2020.1 compared with what registrars have seen in previous terms.
Understanding these changes in the types of problems seen enables registrars and their supervisors to direct their learning and teaching towards the general practice curriculum they may have missed during the term. Registrars and supervisors are encouraged to review the 2020.1 ReCEnT report together to discuss how these learning gaps may be met in the 2020.2 term.
Meet a GP Synergy alumnus
When Dr Maelle Morgan moved to Moree for her GP training, she only expected to stay for two years. Five years later, she is a fellowed GP and GP supervisor who can’t imagine living anywhere else.
GP registrars’ experience during training with patients with mental health problems
Evidence from the GP Synergy NSW & ACT Research and Evaluation Unit – each month we present findings from our work that may be of interest to registrars and their supervisors.
Mental health problems are common in general practice, community levels of mental health morbidity are high, and college mental health curricula are broad. So registrars’ experience of managing patients’ mental health problems within the supported learning environment of vocational training is of great importance.
Using ReCEnT data from 2010-2017, reflecting practice of Term 1, Term 2 and Term 3 registrars in NSW, ACT, Victoria, South Australia, Tasmania, and Queensland, we aimed to establish the prevalence, characteristics, and associations of GP trainees’ management of mental health problems.
Multivariable logistic regression analyses were conducted with the outcome being whether a problem/diagnosis seen by a registrar was a mental health condition.
During the 15 six-monthly rounds of data collection from 2010.1 to 2017.1, 1659 registrars provided data on a total of 218,325 consultations. Of the 340,453 problems/diagnoses recorded by registrars during this period, 8.3% were mental health conditions. This prevalence of mental health problems in registrars’ practice is similar to that of established GPs in other studies.
Patients with a problem/diagnosis of a mental health condition were more likely to be male, to be of Aboriginal or Torres Strait Islander background, and to be of English-speaking background. Senior registrars, and those who obtained their primary medical qualification in Australia, were more likely to see patients with mental health problems/diagnoses. At the practice level, location in a lower socioeconomic area was associated with increased odds of a problem/diagnosis being a mental health problem/diagnosis.
Consultations for mental health problems were longer than average and involved fewer other problems/diagnoses being addressed in the consultation. When seeing patients for mental health disorders, registrars were less likely to access information, assistance or advice than they did for other problems.
The cultural and socioeconomic associations of registrars’ in-practice experience with mental health that we have established emphasise the complexity of mental health management and will inform education and training approaches.
Stone L, Tapley A, Presser J, Holliday E, Ball J, van Driel M, Davey A, Spike N, FitzGerald K, Mulquiney K, Morgan S, Magin P. Early career GPs, mental health training and clinical complexity: a cross-sectional analysis. 2019. Education for Primary Care. 30(2): 62-69. DOI 10.1080/14739879.2018.1551070
If you would like to discuss this analysis or the paper, contact Parker Magin.
Hot Topics - Live Webinars
Medcast will be running a Hot Topics course via webinar on Saturday 7th November and Saturday 14th November 2020.
The discount code for GP Synergy medical educators and supervisors is HOTGSME.
GP Synergy PD calendar
Make sure you don't miss an event or webinar by accessing the supervisor professional development calendar on our website.
External activity noticeboard
Explore a list of activities and online modules. This includes modules on children's health, dermatology, mental health, prescribing and more!
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Find key GP Synergy contacts including Practice Liaison and Support Officers, Supervisor Liaison Officers and Medical Educators with a Supervisor Portfolio.