Gippsland born and bred, it made sense for me to navigate my medical career in my local region. I think there are lots of opportunities in Gippsland for me as a GP and rural generalist.
I undertook my medical training at Monash University, spending a lot of my clinical years staying close to home. I was a Gippsland intern; I’m now working at Warragul Hospital (West Gippsland Healthcare Group) in emergency and I’ve already completed rotations in paediatrics and anaesthetics.
I have enjoyed a lot of things about going rural – the broad scope of practice when you go rural is great, working with consultants has been interesting and challenging, and the work environments are good places to practice and learn.
There are a lot of opportunities in Gippsland for both hospital and general practice based work.
I encourage doctors to consider training in a rural setting as there are quite a lot of opportunities in a rural setting.
For me benefits are
· Opportunities to get hands-on skills and do procedural work
· Excellent supervision
· Great learning
· Ability to start practicing independently
Personally, I like to follow the procedural model hence my choosing ACRRM as my fellowship pathway. I am now in the first year of my AGPT program with Eastern Victoria GP Training.
I chose ACRRM because they are entirely dedicated to rural and remote medicine. I wanted to ensure that I had a solid foundation in acute, hospital-based medicine which ACRRM requires its registrars to undertake. This will enable me to work anywhere in Australia and that’s a massive bonus for me.
I am getting great support from EVGPT and have a great network of mentors. EVGPT has ran workshops and information sessions to help me and my fellow ACRRM registrars navigate the college requirements and encourage us to maximise our learning opportunities in hospital and clinic.
I am looking forward to gaining the skills and knowledge to better serve my community.
I think Gippsland is excellent, you can work in a large town or more rurally like Heyfield. Really it’s just up to you to pick a place where you want to go.
I chose ACRRM because of its rural focus. I like working in a tight-knit community, where you get to look after generations of one family. I’m also working with a small number of staff at the hospital; it feels like I really get to know the people around me. I’ve always wanted to live and work rurally and through medical school, I got to experience placements in remote Australia which I thoroughly enjoyed. These placements cemented my passion for rural practice. ACRRM provides the training to prepare GPs to work rurally and remotely; their program encourages GP registrars to attain extra skills and be able to provide services beyond the consulting room.
I chose to do anaesthetics as a special post because I want to eventually work in remote Australia, and having these skills would give me more confidence in this practice. The post was full-time anaesthetics for 12 months in a supervised position. It involved theatre and preadmission which prepares registrars well for GPA life. We had regular sim sessions which were great practice for the exam and for ingraining how to approach emergency situations. Learning to do epidurals was one of the most rewarding skills I’ve gained. To walk into a room where someone is in such distress (‘just do it already!’), and leave them in such comfort as I leave is such a great feeling…and to be honest, it doesn’t hurt the ego.
Overall, on-the-job learning was invaluable, the practical side of general practice that you gain from your supervisors is not something that can be learned in books. EV provides great support throughout training and the workshops provide great opportunity to swap stories with other registrars.
I am a GPT4 registrar who is currently located in Moe, Gippsland. Born in Ireland, I completed my medical degree and intern and residency training in Belfast before emigrating to Australia in August 2015. I have been based regionally for most of time here working across various hospitals in NSW and Victoria, mostly in ED but I have also completed rotations in other specialities such as O&G, rehab and ICU in preparation for GP training. I am grateful for the breadth of clinical experience I gained before entering General Practice as it truly made me appreciate the importance of a family doctor in a patient’s life and the role they play in improving their lives.
I chose rural GP for a couple of reasons. I wanted to become a vocationally registered GP and as an IMG that is the pathway open to me in Australia. Even allowing for that I still would have made the decision to work rurally. I like the fact that I care for patients with more challenging needs, particularly when it comes to mental health, sexual health, women’s reproductive choices and palliative care because there are gaps in the services offered locally. Identifying the needs of the community has been absolutely pivotal in directing my training and has afforded me the opportunity to upskill and provide services to the community that all patients should be entitled to regardless of their postcode.
In Eastern Victoria we are fortunate that we have regional hospitals with specialists reasonably close by to support us in the community. The challenge for GPs regardless of where you work is to manage our patient’s appropriately in the community and really reserve the resources at those centres for the patients who really need them or we risk the entire system being overrun. As an ex-NHS employee in the UK this really concerns me.
The burden of disease in regional and rural areas is significant and we know that these areas see more preventable hospital admissions than metropolitan areas but given the challenges in recruiting and retraining a rural workforce this does not surprise me. You can be just accept this fact or as I propose view it as a unique challenge to engage in collaborative care with your patient to try and prevent those admissions to hospital and keep them healthy and happy at home.
I commenced in the AGPT program, training towards the RACGP fellowship, with Eastern Victoria GP Training (EV) in 2018 and spent my hospital year at Latrobe Regional Hospital. I completed the GPT1 – GPT3 terms in Gippsland and have been very well supported by the various practices.
I am enjoying my general practice training at EV, especially in the rural setting, and the EV team at Churchill have been super supportive and caring. My positive experience with the EV team motivated me to apply for the RLO position in 2019 so that I could be more involved with EV’s training program and support my fellow peers within the program.
In 2020 I have taken up the Registrar Medical Educator role which is done part-time alongside a part-time general practice term. This has helped fulfil my passion for medical education; work which is considered an Extended Skills Training post and counts towards my GP training time. I think that mentorship and effective medical education will go a long way in building a sustainable workforce. Whenever you take a student or a younger doctor under your wing and show them how to do something and then watch them flourish, you personally get a real degree of satisfaction from that.
Looking forward to 2021 I am hoping to complete Advanced Rural Skills Training in Palliative Care under the new Rural Generalist program. This is a decision driven by own passion but also after identifying a need in Gippsland to support the services already in place. In the long term, I would like to become a GP supervisor locally because I am firm believer that if you want to help shape the future workforce you need to be involved at a grassroots level.
On a personal note, I plan on being in Gippsland for some time, having just brought a property with my partner, which has been very exciting. As a life long metropolitan person I never envisaged living on a hobby farm, filling my weekends with composting, cows and never-ending maintenance. So in summary, I absolutely recommend rural general practice. Come work in a place where you will be welcomed and a place where you might learn something new about yourself too.
General practice was not my first choice in speciality. Ever since medical school, I have always wanted to do Paediatrics and I was certain that I wanted a career in a hospital. Getting into the Paediatric program was everything I dreamt of. It was fun and rewarding but also, intense and challenging. Eventually, the shift work, rigidity of leave, staff shortages, hospital politics and the demands of the job alongside training began to take a toll. I realised that this was not what I wanted. I wanted to develop long term therapeutic relationships with my patients, beyond their childhood. I wanted to treat more than just paediatric patients, I wanted to treat the whole family. Choosing General Practice made these things possible.
But why did I choose the rural pathway? I have always worked in the metropolitan areas but when I worked a couple of years as a locum, I had the opportunity of working in rural areas like Traralgon and Albury/Wodonga. This is when I started to really appreciate the style of working as a team with the local country GPs and, the perks of living in the countryside. So, I applied for Eastern Victoria General Practice Training (EVGPT) and I was fortunate enough to receive a place in the rural program.
I began my GP training at Bairnsdale Medical Group where we also did on-calls at the local hospital. After a year, I moved to Trafalgar Medical where I am currently working as a GPT4 registrar. Although we are not on-call for the local hospital, we are on-call for our clinic and our local nursing home. Both experiences have helped broaden my skillset immensely. I have worked with some fantastic GPs, nurses and receptionists who have all supported me to balance work, studying and life.
During medical school, I remember hearing time and time again the shortage of doctors and health professionals in the countryside. So far, I would have to the say the biggest challenges are still the limited resources and access to specialists. However, what I did see during my training is how the GPs stepped up as “fill–in specialists” in the interim until the patient got to see the specialist. Even though this felt daunting as a GP registrar, I experienced great support from the rural health professionals I worked with.
The best part of working in a small community is feeling appreciated by the community. During Covid-19 restrictions I have seen my current clinic go above and beyond to be there for their community. The patients have shown their appreciation with simple gestures such as bringing in baked goods and homegrown vegetables for the clinic.
Another bonus is the chance to learn new things every day on the job. One of the consequences of not having good access to healthcare is that patients in rural settings tend to be sicker by time they present to their GP. Patients who would be managed by a subspecialist in the metropolitan settings are mainly managed by their GP in the country because they may be hours away or there are limited appointments available. As a rural trainee, I have had the chance to assess and manage more diverse and complex cases.
I am grateful that I have taken the scenic route to get here. I enjoy the unknown that each day brings and getting to know my patient and their family. You must remember that no training programs are easy, but it helps finding a speciality that puts an emphasis on work-life balance. Oh, and it helps working and living in a beautiful place, like Gippsland!
I wasn’t planning on being a rural GP. Heading into medical school I had some ideas about what specialties interested me, and that wasn’t on the list. In my third year, I made a last-minute impulse decision to go rural for that year, thinking the extra hands-on experience might be useful in setting me up for a highly specialised, metropolitan career. I ended up in Foster, South Gippsland and that year really changed my career path, to the extent that I am now a PGY3 (post-graduate year three, AKA I’ve been a doctor for three years) training with ACRRM (the Australian College of Rural and Remote Medicine) the EVGPT (Eastern Victoria GP Training) and heading back to Foster next year as I continue my training program to become a Fellowed rural GP.
There were multiple factors during that year in Foster that brought rural general practice into the frame for me, first as a possibility and then as my chosen specialty. There was the variety and interest of the medicine practised in the clinic and across the road at the hospital, the appreciation of the patients, the warm camaraderie of the clinic staff, the connectedness of the community and the excitement and passion of the local footy every Saturday. The beautiful setting in the rolling green hills just a short drive north of Wilson’s Prom didn’t hurt either.
As much as it was a gradual shift over that year, there are some moments that stand out for me. early on I remember a lovely lady of advancing years getting surprisingly feisty as she recounted a conversation she’d had with a doctor in her recent metropolitan hospital stay before her transfer back to town in the local hospital. She’d asked for her transfer and the doctor had dismissed the idea, saying it was too small and only had, what, thirty beds? “Sixteen, and don’t you go slagging off our country hospital, they’re a place where people actually care about you and patients get better!”. The pride and attachment of the local community to their health services was something I hadn’t experienced in my earlier metropolitan placements.
Another moment came while I was tagging along with Dr Owen Casson, and we were reviewing a patient in the small local hospital. She was an elderly lady with an acute illness on the background of an end-stage chronic disease. I listened and watched to a really gentle, reassuring and empowering discussion about shifting the focus of her care from curative measures to supportive management of her and her symptoms in palliative care. We left the room, took a moment then it was straight off to the birth suite to deliver a beautiful healthy baby. I thought to myself, only a rural GP could have those two patients back to back, there was something special here.
To briefly summarise my career since then, I completed both my intern and an HMO year at Bendigo Health, with rotations out to Swan Hill and Echuca giving some valuable smaller hospital perspective to the excellent training I was getting at the major regional hospital. This year I have been completing an advanced skills training post at Latrobe Regional Hospital in Traralgon so I will be able to practise as a GP-anaesthetist at the completion of my training, allowing me a really stimulating mix of clinical and procedural work. I am very excited to be returning to Foster next year to continue my training, back to the place that inspired my enthusiasm for rural general practice.
That’s my journey (so far), yours will be different. Work out what’s important and rewarding to you and pay attention to how different roles might give you those factors. But I would encourage you to give yourself plenty of exposure to different areas in Medicine and across Australia. You might like what you find.
Sonia chose general practice to make a real difference in her patients’ lives. She is passionate about preventative health and supporting patients throughout their life journey.
“The thought of being able to follow and support my patients’ journeys throughout their life excited me. I wanted to be able to provide continuous care for them after their hospital stay, as well as in day-to-day life. I wanted to be ‘their doctor’.”
“I love the variety and breadth in General Practice. Each day you never know what presentations come through the door – from neonatal care and geriatric health, to cervical screening tests and mental health counselling.”
Sonia says there is a lot to learn but she has enjoyed it all.
“I have enjoyed the rapid learning curve and daily challenges of General Practice. My current supervisors have been fantastic by exposing me to interesting presentations and sharing their experiences as General Practitioners.”
“My favourite moments have definitely been building rapport and a professional relationship with my patients. It has been so rewarding to listen and show care to my patients when they need it most.”
“I am passionate about preventative medicine. Each day I have the opportunity to improve my patients’ lives by educating them on how to live a healthier life. It is so rewarding when patients come back to tell me that they have managed to quit unhealthy habits with my support and motivation.”
Need I say more? It’s a lovely succinct program and you can go from registrar to consultant in 2 years (or a few more if you train part time like me)
Unlike the hospital system where you hours are dictated to, in general practice, I’ve found my working days / hours have been much more flexible. I work around kinder commitments and I always add a few breaks into my day to make sure I leave on time. It’s just a totally different atmosphere to the night shift, over worked hospital doctor lifestyle I was used to.
Areas To Specialise In
In GP, you can continue to find areas that you are interested in or are passionate about. I love women’s health and children’s health so during my training I have done by the certificate of women’s health as well as the Sydney child health diploma. This means I can provide shared care, even as a registrar, and I end up attracting more of these patient’s because of the training and my passion in these areas.
Variety of Work
No two patients are alike. From one consultation to the next you might have someone with reflux, someone with suicidal thoughts, chest pain, needing to break a new diagnosis of cancer and then vaccinate a baby. You might see someone in their first years of life followed by patients in their last. It’s just so varied that I actually love the ‘just here for a medical certificate’ consultations which people would tell me was all I would do in GP. It’s not.
Longitudinal Role in a Patient’s Health Journey
I love getting to see a patient through their healthcare journey. My favourite example is when I helped a woman prepare for pregnancy, celebrated with her when she became pregnant, helped manage her pregnancy and then got to see her baby when he was born, as well as become his doctor. It’s an amazing feeling.
You have your own consulting room and you start to accumulate your own loyal patients from day one with the added benefit of the support and back up of your supervisors.
Another misconception was that GP would be lonely. It’s not. There’s always someone around for a chat, be it coming in for some help in a consultation or you being called in to see something interesting. In between patients you can always say hi to people and I’m often off having a chat with whoever is free.
Yes. You’re in your own room when you’re doing consultations but it has never felt isolating, in fact, being at a good GP clinic feels like you’re a part of a family which is why I absolutely love going to work.
I remember being overworked and undervalued in hospitals, feeling guilty for taking a sick day. In GP land, if you’re unwell, they send you home (the nurse marches you out, no questions asked). If family commitments come up they’re happy to work around you, and if a family emergency comes up they cancel your patients and get you out of there. It’s a sort of caring that you don’t get elsewhere. As I said before, it’s more like you’re a part of a family rather than just a cog in a big machine.
Ebony wanted to find a career that was both clinically challenging whilst also allowing her to fulful her life priorities and have good work balance. She has found that in general practice.
“I like a challenge and I enjoy working with people and am passionate about health and wellbeing.”
“I think a few things contribute including an ability to find satisfaction in the work that you do and the ability to switch off from work when away from work. Being able to maintain adequate sleep, good nutrition and exercise most days and engagement in activities outside of work is also paramount.”
“I have lots of outside of work interests ranging from running, swimming, triathalons, pilates and playing tennis to baking and really just any excuse to get outside such as hiking or being at the beach. I also love spending time with my family and friends.”
Her advice to doctors considering general practice as a career is to look at the big picture.
“I think it is important for someone considering their options and choices in their medical career to identify what their priorities are. For me I wanted a career that was family friendly and allowed me freedom and flexibility and ability for good work and life balance. This, along with enjoying most aspects of medicine, led me to general practice.”
“I would encourage all junior doctors to get a broad range of experiences in their first 2-3 years in the hospital system to get an idea for which aspects of medicine they enjoy most. I found I enjoyed most terms but particularly obstetrics and palliative care. Without having done a palliative care term I don’t think I would have realised how rewarding this aspect of medicine could be.
Ebony has been able to pursue her special interests in general practice.
“Before starting in general practice, I worked in the hospital for 4 and a half years with almost 2 of those years being in obstetrics and gynaecology. I am very passionate about women’s health and enjoy working with mum’s (or mum’s to be) during and after pregnancy. I have been able to integrate this into my work in GP and plan to do shared care once I have completed my training.”
“General Practice has been an excellent opportunity to be able to balance work and life with much more friendly weekday hours and less weekends than what was needed in the hospital system.”
Thong pursuit of a medical career was influenced by his early years. A family member was unwell and he was exposed to doctors and nurses.
“My father was unwell when I was young and spent a fair amount of time in hospitals. The amazing care doctors and nurses I saw provided for my father inspired me to pursue a career in medicine. The best ones showed strong communication skills, work ethic, academic ability and compassion.”
Thong chose general practice as his medical specialty and commenced with EV in 2018. He believes your career choice is a very personal decision.
“Career choice is a highly personal decision and I have seen my friends and colleagues make their choices in very different ways. It is such a personal choice I sometimes hesitate in giving advice. What I can advise is, take a moment and reflect on your own values and what is important to you in life, not just work. Knowing this will help you decide.”
During his training he worked as an EV Registrar Liaison Officer, working with both registrars and management.
He likes the variety general practice offers combining it with other aspects of his life. He says being organised is important.
“Accepting that all of parts of your life can at times be a bit chaotic and balance is a fluid concept that means different things on different days. More practically, have a daily schedule!”
“Work life balance can sometimes be elusive, especially as a junior doctor in training. I always schedule in time for myself, with my family and with friends. I am quite vigilant about this time and will not let work interfere with this time.”
Having a focus on what his goals are is important to Thong.
“Being a doctor can at times be difficulty, challenging and very stressful. I heard a GP medical educator speak about ‘finding meaning in your work’ which really resonated with me. Having this lens on my work makes getting through the tougher days a lot easier and has given me an overall better satisfaction of my work.”