If you’re contemplating GP training or are a new registrar, you might be wondering what to expect. Here, three GPTQ registrars talk about why they chose general practice, as well as provide insights into their training experience on the AGPT rural or general pathway. Both Jessica and Bronwyn began their GP training in PGY2 and Colin started his training in PGY9.
Meet our Registrar interviewees
Bronwyn Hope, Colin Davis and Jessica Hockey are all GPTQ registrars in different stages of their GP training career:
I’m an RACGP Registrar in my first year of training (GPT2). I attended medical school at UQ and completed my Intern and JHO years at Redcliffe Hospital.
I work at an Aboriginal Medical Service (AMS) in Morayfield, close to where I live. I chose to work at an AMS as the lecturers I found most inspiring during medical school were those who worked in Indigenous health.
At my AMS, they have an integrated model of care that targets social determinants to try to overcome barriers faced by Aboriginal and Torres Strait Islander people. It’s an approach that resonates with me, and I feel fortunate to be able to contribute.
I’m an RACGP Registrar currently in my final training rotation. I completed my undergraduate Bachelor’s Degree in Advanced Science at The University of Sydney, and then moved up to Queensland for medical school, studying in both Brisbane and Rockhampton.
I currently live and practise in Brisbane, consulting at Kenmore Family Medical Practice.
I’m a PGY5 ACRRM Registrar in my first rural GP training year. I’ve completed my advanced skills training in anaesthetics.
I live and practise in Warwick, a rural town of around 15,000 people. It’s a lovely community and everyone has been incredibly warm and welcoming to my partner and myself.
I currently work alternate weeks between my local rural hospital and the local GP clinic. It presents a fantastic mix of acute and general practice work, and it’s so rewarding to follow my patients’ healthcare journey through each of the different working environments. I definitely never get bored!
Why did you choose general practice?
I’ve always been passionate about health promotion and preventative care, so from that perspective, general practice was a logical specialty choice. I’m also naturally curious about the whole of what may be happening for a person, their stories and their context. The GP setting really enables me to practise medicine holistically, as well as build enduring relationships with patients and their families.
I chose to study medicine because I wanted a career that was constantly stimulating, and involved problem solving mixed with the chance to help people. I found general practice fit this perfectly.
I chose general practice as I found hospital specialties have a somewhat narrow scope of care, and this can limit your ability to actually get to know your patients. To me, understanding a patient’s background – where they’ve come from, and what makes them who they are – means you can tailor treatment plans around this, rather than just treat the disease.
There’s also so much flexibility in general practice. You can choose your hours, work at multiple locations and subspecialise. In my case, I also enjoy procedural work, so several of the GPs in my practice refer their skin cancer excisions, lacerations, iron infusions, joint injections and musculoskeletal patients to me. I also give educational presentations to junior doctors as a GPTQ Registrar Medical Educator, surgically assist privately and occasionally supervise medical students at our practice.
As a medical student and resident, I fell in love with parts of every clinical rotation I did. Some specialties were easy to rule out due to years of unaccredited training or fairly limited consultant job prospects, while others had some indoctrinated cultural components that I didn’t like.
I knew I’d found my specialty after doing a clinical rotation at Dalby Hospital. I was blown away by my time there, and the diversity and challenge of providing care in a rural environment. I was so humbled by the compassion and humility the staff incorporated into their patient care, and it was then that I knew rural general practice was my specialty.
What do you love about being a registrar?
Hands down, the most rewarding experience has been the opportunity to get to know my patients and their families. Some of my patients face some pretty significant obstacles, and their courage and resilience is inspiring. I also feel genuinely excited when they achieve goals we’ve set together, like quitting smoking or reaching their HbA1c or weight loss targets. It’s rarely an easy journey for patients so it’s nice (and important) to stop, reflect and celebrate those moments along the way.
I also recently learnt the meaning of the word ‘salutogenesis’, which is to focus on factors that support human health and wellbeing, rather than those that cause disease. I think it perfectly sums up what I love about working at an AMS, but it can equally be applied to general practice. There really is an explicit focus on recognising people’s strengths, which is very empowering for patients and communities. I love the positivity of this concept, and I hope to embody it as I practise medicine.
The first is the great work-life balance. In the hospital, you fit your life around your work. As a GP, you have the opportunity to fit your work around your life. Being able to enjoy trips away, relax in my down time and self-regulate how much I work is so important in ensuring I’m the best I can be for my patients.
I love the variety that each day offers. You never know what will come through the front door. That used to scare me (a lot!), but with time and experience, you realise that’s what makes it a great career. For example, last week on a single day I did a squamous cell carcinoma excision with a flap repair; an iron infusion; put a cast on a broken arm; helped a patient with their depression; diagnosed another with temporal arteritis and yet another with shingles; and to brighten the mood, had the opportunity to encourage and support someone who’s lost 30kg, and excitedly tell a young couple about their unexpected (but very welcome) pregnancy!
Of course, one of the best parts about general practice is getting to know your patients, and having the privilege of treating multiple generations of the same family – from talking to a couple preconception to their baby checks, to educating dad about his heart, to treating mum’s arthritis, to excising grandpa’s skin cancers, to caring for grandma after a stroke. I can’t stress how much more satisfying it is seeing patients for more than a single episode of care, and to look after people where you know more about them than just their condition.
To me, general practice is the ultimate in undifferentiated medicine. There is a delightful intellectual juiciness working with a patient to figure out a tricky presenting complaint.
I also love the diversity of rural general practice – I can work in the emergency department one day, perhaps seeing multi-trauma patients or someone with sepsis, and then in general practice the next, managing a complex chronic patient or providing antenatal care.
The continuity of care with my patients is also wonderful. It’s the first environment I’ve worked in which really facilitates long-term patient relationships. It’s great to feel like I am practising true person-centred medicine.
How have you found your training experience to be so far?
I feel incredibly lucky to have spent this year within a very supportive teaching practice, under the guidance of a fabulous clinical supervisor. As a new GP registrar, the learning curve is steep, so it’s made a huge difference to somewhere that’s well set-up to support registrars.
I’ve also loved working within an AMS, and learning more about providing culturally safe healthcare for Aboriginal and Torres Strait Islander communities.
The thing that stood out from day one at the practice was how valued you are as an equal member. The hospital hierarchical system simply does not exist in general practice. Everyone works as a team to help patients.
I’ve also found that during your second year, you tend to practise more independently. While the support is still there if you need it, you learn how to solve difficult problems on your own and become a proficient GP. It doesn’t mean you don’t talk to other GPs about complex or challenging patients, but you might find they sometimes come to you for your advice too.
The teaching and learning so far has been wonderful in rural general practice. My senior colleagues are really invested in registrar learning, and have such an amazing wealth of varied experiences and interests.
What initial challenges have you faced and how have you dealt with them?
Coming from the hospital system, where clinical decisions are often made as part of a medical team, the transition to being a GP registrar involves a lot more independent decision making.
It was definitely a challenge for me early on, especially coming across the multitude of conditions that people present with. Anything and everything can come up during a patient consult, including those conditions that we become used to advising hospital inpatients to ‘follow-up with your GP’ … now that GP is you!
Apart from studying and reading up to continually expand my knowledge, it’s been important to recognise my limitations and seek clarification from my supervisor.
Another challenge is that patients frequently present with a ‘shopping list’ of issues. I struggled to manage my appointment times, whilst adequately addressing patient concerns and expectations. I’ve also found that addressing too many issues in one consult can actually overwhelm the patient and be counter-productive.
I’ve worked on developing skills in setting expectations for what can be covered during an appointment. Alongside patients, I prioritise issues and then come up with a manageable plan of action. Although some things may need to be addressed urgently, it’s important you recognise that general practice is about the long game. You often have the benefit of time to work through issues with patients.
Starting at a practice is both exciting and absolutely terrifying at first. It’s definitely a very steep learning curve seeing patients on your own from day one, and trying to recall all those conditions you haven’t had to think about since medical school.
Fortunately, if you do get stuck, the support and advice of your supervisors is just a phone call (or door) away. They have so much experience and wise words to help you navigate the general practice world.
I think with diversity comes the inevitable challenge of just not knowing enough. I learn something new multiple times per day, and am constantly researching, and calling on those with more specialised knowledge to provide good care to my patients.
While it’s fantastically engaging, it can also be exhausting. I have absolute respect for my senior GPs, who seem to know not just the intellectual clinical tidbits for a huge range of conditions, but also carry in their minds a gigantic compendium of practical resources and local referral sources for every condition imaginable.
What advice do you have for registrars preparing for their GP terms?
Remember that you’re part of a team. Never forget to be kind – to yourself, your colleagues and your patients.
When it comes to patients, take your time – there is no rush, this is not a formal exam. Not everything needs to be fixed at once, and thankfully many conditions in general practice don’t require immediate intervention.
It’s also okay to not know the answer. While this goes against what you’ve learnt (and possibly your personality!), sometimes sitting on your hands, monitoring and reviewing, is all that’s needed.
Try to align yourself with a practice that has supervisors with special interests in the areas you like. You’re only a registrar once, so use this chance to absorb all the knowledge you can from experienced GPs, educators and specialists.
As much as we don’t like to talk about it, establish the nitty gritty rules for hours, weekends, holiday allocations, salary etc early to prevent conflict later. Don’t sell yourself short – remember that as a newly qualified GP, you’re highly employable. Take the time to find the right place to work, and the right people to work with.
On a personal level, make sure you have your own GP!
The first few weeks in general practice can be an absolute whirlwind! New software, 15 minute appointments, dozens of new patients, and all new referral resources is a lot to get used to.
Remember the great thing about general practice is continuity of care; there’s no rush to get everything done today. Iron out anything urgent, take good notes, and write an issues list for yourself. You can (and should) then take the time to chat with your supervisor, or do some extra research before making definitive plans, let alone actioning them.
It’s also good to keep in mind you’re no longer working towards an end point, but are instead walking with your patients through life’s many health ups, downs and curveballs. Take a kind and curious approach, and when things get challenging, remember you’re on the patient’s team. It keeps things in perspective, ensuring the work remains meaningful and rewarding.
What advice do you have for those who are aren’t sure if general practice is the right specialty for them?
General practice offers so many opportunities, and there is scope to tailor your work to suit your areas of interest. The degree of flexibility is greater than many other specialties, both in work hours and the nature of work.
It’s not uncommon for people to start medical school with a certain specialty in mind, only to find themselves following a very different path a few years down the track. While it’s great to have a goal, I think it’s also important to be open to changing your mind!
Be inquisitive. I found the way junior doctor years are set up skews the perception of general practice. Ask your GP, ask other GPs and ask your hospital consultants about their jobs. What do they enjoy about it, and what does it actually involves outside of what you see day-to-day. Then you can work out if that’s what you want to be doing in your future.
There is also a common myth amongst junior doctors that once you become a non-GP specialist, life gets easier. I challenge that.
Give it a try! Even if you decide it isn’t for you, a term in general practice may just completely change your perception of the specialty.
Almost all non-GP specialties share their patients with GPs, so even if you decide you don’t want to become one, understanding how it works and the various strengths and challenges enhances your patients’ health care experience.
If you do fall madly in love with general practice, a rotation also provides a great opportunity to look ahead, and think about how you can juice the most of your remaining junior medical education to support your future career.
Making that GP decision
If you’re yet to choose your specialty, hopefully Bronwyn, Colin and Jessica’s insights into why they chose general practice helps. Equally if you’re a new registrar, we hope their advice goes some way towards enhancing your training experience.
Rural registrars and those considering the rural pathway, learn more about Jessica’s rural journey.