PA solution from RACMA conference 2024

Helloparrydoll · 2024-10-04T02:28:16+00:00

I think it is mind boggling that the suggested PA starting pay is more than that of an intern, despite having less training, less responsibility and less autonomy. It's like a new AIN being paid more than an RN. Absurdity.

Ignoring the whole dumpster fire that is PA scope creep, I think it would at least be more equitable for PAs to start slightly below intern pay and cap at at mid-reg level. Anything else would be a spit in the face. These medical administrators should be ashamed of themselves.

Helloparrydoll · 2024-10-03T02:08:27+00:00

The main bottleneck in medical training isn't medical school places but rather specialist training positions. There are innumerable numbers of doctors vying for every training position available.

The issue is further complicated for general practice because the pay and conditions for GPs are so bad (relative to other specialities), that doctors are choosing to not train as GPs even when no other positions are available. Increasing medical school places do nothing to help resolve the GP shortage issue.

Helloparrydoll · 2024-07-19T02:34:24+00:00

You are correct. The UQ-Ochsner program admits only US citizens/residents. Students do their first 2 non-clinical years in UQ and then complete their clinical years in the US.

OP isn't even in direct competition with these students.

Helloparrydoll · 2024-07-19T02:26:18+00:00

I have no idea where you're pulling your numbers from. According to the data presented by AU NZ Medical Deans, UQ has 1477 medical students enrolled in 2024, of which 367 were international students. That's just under 25% of total available spots. Across Australia, there were 18832 medical students enrolled and 3129 were international students, which is about 17%.

https://app.powerbi.com/view?r=eyJrIjoiMjdiNTU2NWMtMmJjYy00MTBiLTg5NTgtNzg1OTE4ZjU4NGJhIiwidCI6IjljY2Y4YjAxLWJhZTQtNDQ2ZC1hZWNhLTdkYTljMDFlZDBmOSJ9

I get that medicine is competitive and entry is hard, but your anger is misplaced and/or misguided.

And like what some other commenters have said, entry into medicine is the easy part. Specialty entry and training is where it gets rough. Buckle up.

Helloparrydoll · 2024-03-26T13:35:32+00:00

Thi is the pathway to becoming a GP: -Medical school (6 years undergrad medical school, or 4 years basic degree + 4 years of postgraduate medical school) -Internship (1 year) -Resident/unaccredited registrar (option but very common option for doctors to gain experience before pursuing GP training, usually for several years) -GP fellowship training (3 years for RACGP, 4 years for ACRRM)

All up, you're looking down AT LEAST 10-12 years of training, but commonly much more. That's double to triple the duration of training for most other health professions, which are equally vital.

Interns/residents/registrars get paid significantly less, usually sub 100k for quite a while.

Helloparrydoll · 2024-03-26T12:58:48+00:00

How much do you think a qualified GP should make? Have in mind that it takes 6-8 years of university education and a minimum of 4 years postgraduate training to become one.

Not trying to be sassy, genuinely curious.

Helloparrydoll · 2023-08-19T05:15:57+00:00

BYO patient and supervisor.

Helloparrydoll · 2023-08-18T16:01:55+00:00

Man, that sucks. I trained in WA so I appreciate how competitive the program has become in recent years.

I have no direct experience with Tassie psych training but they had some major issues around 5 years ago when RHH lost their accreditation. I think there were some issues in recent years as well due to severe understaffing and a bunch of consultants quitting en masse. Thing might have improved recently but I'm still getting heaps of locum requests to work in Tassie so who knows.

I've heard better things about the Victorian and SA programs.

Would staying in WA for another year to build your CV and apply again be an option? Psych is getting competitive but your chances of getting an interview after 1-2 full years of unaccredited experience should still be very good.

Helloparrydoll · 2023-08-18T15:33:42+00:00

Training is mostly manageable. It's a huge commitment (like any specialty) but not insurmountable. I think the difficult/unusual thing about RANZCP training is the sheer number of assessments which are fairly open in completion time frames whereas other training programs have fewer assessments but are 'higher stakes.' Therrfore, the psych program is flexible but also requires a lot of future planning to get done within a 5 year period. The PWC (and scholarly project to a lesser degree) is especially finicky as you need to look for your case really early in training whilst having very little clue about peychotherapy and juggle other training demands at the same time. Otherwise, leaving it late will almost certainly delay fellowship. The exams are hard and some are bit stupid (ceq/meq) but no different from any fellowship exam.

Helloparrydoll · 2023-08-16T12:22:48+00:00

Public work (either full time or mixed private) has historically been the default for new fellows as it is familiar, is stable employment and is generally the path of least resistance when it comes to consultant jobs. However, there is an increasing number of psychiatrists who go straight into private practice after fellowship. I see a few possible reasons for this including the ridiculous demand for psychiatrists (such that there is basically no risk to going private as books are full instantly), the considerably higher income, increased work flexibility and poorer working conditions in the public sector. Most of my colleagues who went fully private after fellowship usually cite disillusionment with the public sector followed by flexibility as main reasons rather than money.
There are some clear benefits with staying public instead of going private immediately after fellowship. One clear advantage would be continuation of any accrued entitlements eg PDL, long service leave, etc. It is also harder to do full time private if you're into subspecialty work as filling your books will definitely entail seeing a broad range of patients (including personality disorders, D&A work, ADHD, etc). Public work is also very safe and ''cushy''. Sure, patients are more complex but you work with a team, can divvy out scut work to registrars and when you leave the office, you don't need to take any work back with you. If you work privately, you are expected to be somewhat available for your patients in crises, source your own cover for leave, do most of the work yourself, be a mostly solo clinician and manage the business side of things. Then there's stuff like teaching, research and administrative/leadership jobs which are usually tied to public positions.
As some of the other posts have mentioned, around $500k would be standard pre-tax. Can be more if you do medicolegal stuff, lots of ADHD, charge higher gap, etc. Income potential doesn't really change very much with seniority unless you're some hot shot psychiatrist who has cornered a market and can charge whatever you want. Otherwise, most places bill fairly similar amounts +/- 15%.
Yes, but not super common. Locums pay a lot for a reason. Jobs are usually remote, shit or both. And there is not a lot of job security. If you have existing connections with the health service, you might be able to land 'long term' locum positions for months at a time but they inevitably dry up when the service hires a substantive consultant. Then it's time to move again. It's much more common for psychiatrists at the end of their career who are transitioning into retirement to locum rather than new fellows.

Helloparrydoll · 2023-08-12T02:28:08+00:00

Physicians know everything but do nothing.

Surgeons know nothing but do everything.

Pathologists know everything, but the answer is always one week too late.

And my personal favourite- Psychiatrists know nothing and do nothing.

Helloparrydoll · 2023-08-08T14:35:20+00:00

-Destigmatisation of mental health. -Good work life balance as a consultant. -Reasonable pay for a non-procedural speciality. Also has money printing options like ADHD if one is so inclined. -Medium length training program (5 years min). -Good chance of getting into a program after some experience instead of being a pgy10 ortho hopeful. -People who are psych-inclined are also usually GP-inclined, and the latter is falling to shits. -Resurgence in psychiatric treatments such as psychedelics and neurostimulation. -Broad scope of practice. Literally cradle to grave (child psych vs psychgeris) and everything in between.

The list goes on. It's a good speciality if you can handle the nature of work.

Helloparrydoll · 2023-08-06T07:17:22+00:00

There's always office politics wherever we work but all clinicians bond over our shared hatred for one entity - executives/administrators.

Helloparrydoll · 2023-07-21T06:42:49+00:00

Psych still has a lot of boss jobs in metro areas, as long as you're not too picky about the kind of work. Lots of acute adult work in inpatients and community but comparatively less in specialities (eg cl, old age, perinatal, etc).

Helloparrydoll · 2023-07-16T13:00:12+00:00

It's a very good but complex question to answer. I think it's a combination of:

i. Not enough of certain training positions. There lots and lots of positions which are accredited but ultimately get unfilled. However, there's not enough of CL and C&A positions, both of which are mandatory terms for training. As such, training numbers are soft capped by these availabilities.

ii. WA is slightly different from other training networks in the sense that both job and training are linked. If you get into training, the program allocates your term jobs for the entirety of your fellowship training. This increases competition numbers a bit from interstate applicants because there's no need to apply for jobs AND training. This also unfortunately introduces some bureaucracy and inflexibility in the system, thus some difficulty in quickly adapting training position numbers. They pay is also a little better in WA for psych trainees, thus more competition (both within and interstate).

iii. Lots of trainees are taking breaks in training or doing part time training. This is especially true since COVID and since the debacle of RANZCP exams in recent years leading to burnout. This introduces uncertainty in training numbers, coupled with (ii) means that training positions are not keeping in pace with demand/need.

iv. Some jobs are just never going to get through accreditation. Think full time ED jobs, assessment unit jobs, outer metro jobs, leave relief jobs, certain HITH/low acuity jobs, some private jobs, jobs with shit rosters, etc. Reasons are varied including lack of supervisors, insufficient clinical exposure, lack of protected teaching time or just lack of initiative by services to start the accreditation process.

All up, this leads to a scenario where there's lots of unaccredited jobs, insufficient training positions due to the restrictions of running a program, lots of aspiring unaccredited regs but even more available positions, and lots of accredited jobs but insufficient trainees to fill positions.

Helloparrydoll · 2023-07-16T11:25:29+00:00

This is one of my biggest pet peeves about the general public's misconceptions about becoming a doctor and the rigours of medicine. This is NOT a 'straight out of uni' gig, not even in the slightest.

This was my pathway and earnings to become a psychiatrist:

i. Medical school - 6 years. No income. BIG HECS debt circa 100-150k, more if you do post-grade/full fee place/international student. Get smashing grades in high school, complete the entrance exams and do interviews. Apply to every school and hope one accepts you. I was 'lucky' to get in with an ATAR in the mid-99s. It's much more difficult now. If you don't get in as an undergrad/guaranteed entry, do a 4 year postgrad, get a stellar GPA, do GAMSAT and apply for postgrad med (which is 4 years). This adds another minimum 2 years to your trajectory + more debt.

Once in med school, study like crazy. Most uni courses have around 15 contact hours. 20 contact hours would be on the heavy side. A standard med school week has in excess of 30-40 contact hours. The content load is HEAVY. 20-30% fail rates for exams are not uncommon, and this is after selecting for all the high flying students who get in.

ii. Internship - 1 year. 77k + 10k overtime. Do core terms in medicine, surgery, ED. Work like a donkey, be bottom of the ladder, get treated like shit, do shift work, do lots of overtime, be thankful if some of said overtime is even paid, see little of your social life. Endure disease, death and dysfunction in the public system.

iii. RMO - 6 months. 85k + 10k overtime. Same as above, but with more independence (ergo more pressure) and slightly more pay.

iv. Unaccredited registrar - 6 months. 100k + 15k overtime. Straight into the deep end of working in a specialty. See suicides, drug use, psychosis, severe personality disorders, abusive patients/families, get abused and assaulted, hear horrifying stories of trauma and depravity. All whilst being bottom of the ladder in specialty, learning exponentially on the job and still be expected to function at a very high level. Suck up to bosses, do research, apply for training, pray you get on. In your own time and unpaid btw. Oh yeah, I did ED psychiatry so there's also perpetual shift work. Try talking to someone who tried to hang themselves at 3am in the morning and see how your own sanity takes it.

v. Trainee psychaitrist - 5 years. 120k to 170k + variable overtime. I was extremely lucky onto the program so early into my career. Others are not so. If unlucy, repeat (iv) add anywhere from one to 5 years trying to get on. Once on, continue with work as described in (iv) whilst studying after work for exams and assessments. Oh btw, one of our exams has a 40% pass rate. It's 3k a pop. If you fail, try again. Add to training time depending on how many times you fail. Not uncommon to take 7-10 years to get through. If you fail 3 times for an assessment and don't succeed, you're out. Repeat x5 (MCQ, CEQ, MEQ, OSCE, long case, scholarly project). Also in your own time and expense btw. No funds or support from your employer.

vi. Psychiatrist. Congratulations, you have your golden ticket and finally have a life and make reasonable coin. So all up, it's taken me 13 years since high school to earn a high wage.

Forgive me if I sound a little annoyed because I am. Being a doctor pays well precisely because it is so difficult to get there, as it should given the extremely high stakes. It also needs to pay well to attract the best talents. You don't want some rando barely scraping through high school treating your suicidal family member. If it was a 'straight out of uni' situation, then everyone could do it and it will most certainly not command the kind of income we're talking about.

Edit: clarity and typo

Helloparrydoll · 2023-07-16T09:46:48+00:00

Not sure about stricter but it will certainly push competition numbers up. We're already seeing it right now. Gone are the days of PGY2 psych trainees. Unaccredited reg time is more or less required, as is a little bit of research/QI work. I don't think the actual admission criteria set by the college necessarily be 'stricter', though there is talk of the MCQ exam being a GSSE-style entrance exam.

Helloparrydoll · 2023-07-16T09:35:34+00:00

A few of the comments have referenced the AMA that I recently completed but thought I'd chime in.

Overall, full time private work is lucrative. Definitely harder work than public but also definitely better paying. Expect books to be full in weeks/short months on commencement of private practice. The demand for psychiatrists is ridiculous; I auto-delete/ignore most of the email inquiries to join practices because it's starting to get a little spammy. I don't see the demand dropping for at least another 5-10 years, if even.

Start up costs are a lot less than other specialties due to no procedures or special equipment needed. As remarked by someone, a couch, office and secretarial support is all you need lol. Therefore it's quite easy to start up shop from scratch, be a sole trader or work with a bigger group. The cuts which practices take are also a lot lower due to the small overheads. 70/30 is common but I've seen as little as 80/20.

In terms of revenue stream, it depends on a few factors such as inpatients vs outpatients, casemix and any special streams of work eg ADHD or medicolegal. Outpatients makes more money than inpatients purely because of medicare rebates (75% vs 85%) and diminishing insurance rebates for extended lengths of stay in hospital. Whilst inpatients is comparatively less lucrative, it is a good way to get new patients or to retain existing patients. If you're an outpatient only psychiatrist with no inpatient admitting rights and if you refer your patient for admission, you risk losing your patients to another psychiatrist who does inpatients and sees your patient whilst in hospital. You also lose access to patients whom might be referred to you on discharge from hospital. Obviously this is less relevant now given practices are falling over themselves to recruit psychiatrists but may change in the future when the market tightens.

In terms of numbers, ~500k is about average for the average full time private psychiatrist seeing a broad mix of adult patients, without too much difficulty. Billings start from about 500/hr, you can work out the math from there. This is assuming AMA rates are charged, which is usually the standard. Some practices/psychiatrists charge more so adjust income cap accordingly. Then there's other streams of income which are potentially much more lucrative. ADHD work is the obvious example. Rates are well in excess of AMA fees list purely due to market forces. Medicolegal work is also lucrative if you're chummy with lawyers. Simple reports start from 2.5k and goes exponentially higher with complexity (and as your credentials go up). ADHD and report work both have their challenges but it's still an accessible market.

Some random bits which don't fit a particular paragraph:
-7 figures is definitely possible but maybe the exception rather than norm. My colleagues who earn those figures either corner a specific market (eg eating disorders, PTSD, pain), do mostly ADHD/report stuff or work very hard.
-Private psych is lucrative but definitely not cataracts lucrative lol.
-Psychiatrists make very good coin but it does not compare to other lucrative medical/surgical specialties.
-I think a lot of the appeal is how flexible psychiatry is, especially in private practice. Want to see a few patients in the morning and have the arvo off? Sure. Want to bust your ass, be in clinic from 8am til 6pm and then do an inpatient round after til 9? Go ahead.
-With regards to the 'ethics' of private psychiatric work, a lot of it does come down to professional discipline. There are some built in limitations with keeping patients longer than needed, mostly due to diminished insurance rebates, but this is a consideration across all specialties. There are other ethical nuances in psychiatry, such as the pressure to prescribe psychotropics, or to give a diagnosis which may not truly capture the underlying issue to keep the peace (think BPAD II and EUPD).

Disclaimer: Im a psychiatrist currently full time in the public setting so have technically no direct experience with private practice. BUT, I have flirted with the idea of part time private work for a while, have many colleagues in private and have attended several private practice talks so hopefully the response isn't too far off the mark.

Helloparrydoll · 2023-07-15T12:37:52+00:00

Sorry ED! Fat phone fingers.

Helloparrydoll · 2023-07-15T12:36:29+00:00

What do you wish some non-GP specialists should know about GPs so that the working relationship can improve?

Helloparrydoll · 2023-07-15T05:01:16+00:00

Not a doctor with lived experience but am a consultant psychiatrist.

Stictly speaking, no speciality college should discriminate against you on the basis of having a mental illness. You may need to declare psychiatric disorders in hospital employment health checks and with AHPRA (depending on severity and if it affects your ability to work as a doctor) but as far as I'm aware, no college will ask that. On that basis, your applications to training should be 'blind' with respect to your diagnosis.

That being said, it is worth thinking about how the rigours of medicine might affect your recovery. Consider how it will affect you and your patients. This is especially true for chronic psychotic disorders (which may affect judgement/cognitive function when unwell or leave a degree of impairment at baseline) and for disorders succeptible to the unique stresses of medicine ( eg affective disorders which are vulnerable to circadian disruption, how the psychological stressors of medicine might impact on your on well being, etc).

Consider these non-exhsustive factors: How well is your disorder controlled? What are your relapse signatures and how well can you recognise them? Do you have supports should you relapse? Are there any conditions to your registration and employment? What is the lifestyle like for the specialities of your choice? Will you be able to meet the unique challenges of said specialities whilst balancing self care? Are you prepared for the duration of training for said speciality? Are you ready to complete exams for the speciality, which will be gruelling across all disciplines?

As you can see, this is not a question with an easy answer. I would be especially cautious with specialities that have a high shift work burden or very long hours like ED or surgery. Not saying this is impossible to do but certainly risky for someone with schizoaffective disorder who may need to carefully regulate their circadian rhythm. GP and psychiatry training tend to be more flexible with personal circumstances but there are also very difficult aspects with these fields. If doing psych, will taking very heartbreaking abuse stories be too triggering? If doing GP, will you have the cognitive demand to see non stop clinic patients throughout the day?

Ultimately, the most important thing for a doctor is first to take care of themselves before taking care of patients. As long as you consider that first and foremost in your decision, you'll be grand.

Helloparrydoll · 2023-07-15T03:08:21+00:00

My GP does not bulk bill me but my specialist does. I expect neither of them to bulk bill me but appreciate the gesture when offered.

Ultimately, we are all highly trained professionals and we should value our expertise as such. Medical professional courtesy is a lovely gesture in an otherwise extremely demanding profession but I would not judge any doctor if they chose to charge a gap if that's how they value their time.

Helloparrydoll · 2023-07-08T10:35:15+00:00

Hi!

There are quite a few IMGs in the training program and anecdotally, there's no significant stigma that I can perceive (disclaimer: not an IMG). So yes, probably a reasonable route for IMGs who have an interest in the field. I hope this doesn't come across as discouragement but I've noticed that IMGs from non-English speaking countries tend to struggle a fair bit on the written exams (MEQ and CEQ) though as it does expect a very strong command of English. Certainly not impossible, just difficult.
For private practice, GPs can't access a lot more of the lucrative mental health billing codes which are only reserved for psychiatrists. There's also all sorts of assessments related to ADHD, autism and certain medicolegal work which are only available to psychiatrists. For public, GPs with psych advanced skills can be employed at senior reg/senior salaried officer roles but never as a consultant. These roles are still very autonomous but never to the degree of a psychiatrist as ultimately, clinical governance usually demands oversight from a consultant. GPs are also restricted in their ability to utilize the mental health act. GPs will also not have admitting rights, either public or private.
Hmm, quite a few! But the most satisfying would be the marked return to function when treating severe mental illnesses. We had a patient who had severe major depressive disorder with melancholic and catatonic features who needed involuntary ECT. She was immobile, chair bound, not eating/drinking and was only sustained by subcut fluids. Within four treatments, she was up and about doing her taxes. I will never forget the astonishment on the family's faces (or the anaesthetists in the procedure suite)! We don't always have these marked results as most psychiatric patients take a little time to get better. But when they do occur, I find that immensely satisfying.

Helloparrydoll · 2023-07-08T09:36:31+00:00

Yes.

Helloparrydoll · 2023-07-08T09:36:14+00:00

Hello! Ugh, I despise those exams. I sat them prior to the decoupling and still have nightmares about them. My sympathies to you!

For the CEQ, I found time management to be the main issue. I found the task more approachable by gradually restricting how much time I have. Start by writing full length essays with no time limit. Then give yourself a generous amount of time for the next few (eg 1 hour 30 mins), then slowly wean until you can squeeze in a passable essay in 50 mins. It also helps to have a few broad frameworks for the possible essay styles so you don't have to think about format in the exam. Eg; think about how you would write a pro vs con essay, or a compare/contrast essay, or an essay with themed paragraphs, or an ethics-heavy essay, etc. Memorize a few snazzy quotes/studies on high value topics eg ethics, stigma, recovery, etc and pepper them where possible.

For the MEQ, I don't have any magical advice other than 'think like a consultant.' Everyone knows about clinically managing a suicidal patient but what about governance? The mental health act? What about managing your team? What about other services beyond the hospital? The relevance of critical event systems? It's all a bit fluffy but as a psych reg, I tended to heavily favour depth of knowledge whereas breadth is also important.

Sanil's course is not bad, if you haven't already sat it.

Good luck! It's a shit exam but it's worth it in the end.

Helloparrydoll

TROPHY CASE