Registrars and pathology – a complex issue

The recent research article in the MJA on pathology test ordering by early career general practitioners was paralleled with a mild media frenzy “raising eyebrows” about why registrars ordered more pathology than other GPs and suggesting registrars may need “stricter” supervision. Scroll down to read more.

   

Experts remain optimistic about general practice 

Three keynote speakers at the GPRA National Strategy Summit on 1 April made very strong, positive statements about the value of general practice during video interviews. Professor Michael Kidd, Professor Di O'Halloran and Professor Simon Willcock each, from their own perspective, supported the role of general practice and the value of working in general practice. Scroll down to read more.

   

Rostering woes - enquiry of the month 

When I commenced with my training practice we came to a verbal agreement that I would work one Saturday morning per month. Circumstances have changed at the practice and the practice manager has indicated that I will need to work three Saturdays per month from now on. What can I do? Scroll down to read more.

   

Royal Flying Doctor Service health findings

On Wednesday 2 August, the Royal Flying Doctor Service (RFDS) released its newest research paper entitled "Health care access,
mental health and preventative health
.” The RFDS worked with key organisations in preparing this paper. Scroll down to read more.

   

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Registrars and pathology – a complex issue 

The MJA article reported that during the “first 18-24 months of clinical practice, the number of pathology tests [registrars] requested increased by 11% per 6-month full-time equivalent term”. The article conceded, “the reasons for this substantial increase in test ordering are not entirely clear … ", but also noted “with increasing time in clinical practice, general practice registrars seek less advice from supervisors …”

One of the issues frequently raised by registrars is the escalating demands on their time and decreasing levels of support and advice they receive as they progress through training. Registrars are increasingly left to cope by themselves and this can contribute to “play safe decision-making”, particularly in the current medico-legal environment, resulting in increases in pathology ordering. As raised by the GP Supervisors Association (GPSA), the funding model for registrar training and supervision simply doesn’t cover adequate support and advice. We support calls from GPSA for the role of GP supervisors to be valued, so as to ensure registrars can access quality supervision throughout training.

A key issue the article fails to address is the relevance of the pathology ordering to the needs of the patients. We need to ask whether registrars are given a disproportionately high percentage of new patients to a practice, for whom there is no pathology record. This is not an unreasonable suggestion. Longstanding patients may, for the most part, prefer to see their regular GP who would have their previous pathology results readily to hand. The higher level of pathology ordering by registrars may, in fact, be evidence not of over-servicing but of due diligence and appropriate care. Use of figures about ordering pathology have very limited value if no context is available but they do make for good story lines for the media.

The MJA article concludes with a telling observation: “designing a general practice registrar education model that embraces the complexity of cost-conscious care is difficult. … the ideal place to start decisively tackling this educational and clinical priority is in the real world of general practice training.”

The fundamental issue is much broader than pathology ordering; we need to reassess training approaches to ensure that what is provided is fit-for-purpose for the contemporary and future healthcare needs of the Australian community, particularly in areas such as management of chronic disease and mental health. We also need to boost support for GPs to provide holistic care for patients and curtail the costs associated with an oversupply of “specialists”. Most importantly, GP training must give better support to young GPs and directly tackle mental health issues and suicide. The whole system of training and supervising of new general practitioners must have a strong focus on what will deliver best patient outcomes and lower health system costs. If this is not the case, then it may be time for an overhaul?

Andrew Gosbell
CEO General Practice Registrars Australia



Experts remain optimistic about general practice 

As GPRA continues with consultations across the sector, and escalates representation of registrars and medical students, the insights and learnings from the summit will be put to good use, as will the support of academic champions of general practice.

Please click on the image below to watch presentations from Professor Michael Kidd, Professor Di O'Halloran and Professor Simon Willcock.

Professor Michael Kidd

Professor Di O'Halloran

Professor Simon Willcock



Rostering woes - enquiry of the month  

According to the NTCER, if a registrar is employed on a full-time basis, the ordinary hours of the registrar shall be 38 hours per week averaged over 4 weeks. These hours are to be worked over at least four days per week, averaged over 4 weeks. Furthermore, the span of ordinary hours includes 8am to 1pm on Saturdays.

GPRA's advice is to ensure that your ordinary hours are agreed on prior to commencing a term and that your ordinary hours be itemised and detailed in your employment agreement. An employment agreement is legally binding. If rostering detail is specified, then this becomes a contractual obligation for the practice. It cannot be altered without your written consent.

In this case, as rostering was by verbal agreement, any negotiation in relation to the roster change would be based on the clear intent of the NTCER, in that the registrar “obtains training across the spectrum of general practice and shares the patient workload with other doctors in the practice”. As such, your roster should be similar to other GPs in your practice. If no other GP at your practice is working three Saturdays per month then this would be a key point for negotiation. In addition, if the rostering is adversely impacting on the patient mix you are seeing, this should be raised with your RTO.

Key point for registrars: Ensure that all items negotiated and agreed on in relation to your remuneration, working conditions and other terms and conditions (including rostering details) are documented in your employment agreement prior to commencing your training term.

For more negotiating tips please see the GPRA Negotiating Employment Guide.



Royal Flying Doctor Service health findings  

This report describes the results of an online survey of 454 remote and rural Australians that sought their responses regarding: the most important health issues impacting their communities; areas of health that money should be spent on to improve health outcomes for people living in their community; their access to doctors for both non-urgent and urgent health care; their use of RFDS health services; and their own health and demographics.

You can read the full report on the Royal Flying Doctor Services website.

   
 
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