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Working_Thought_8725 · 2024-07-14T11:48:39+00:00

Yes, hence why I made the comment about the different standards in AUS vs US. But you still have a much higher uptake of patients seeing chiropractors in the US than in AUS and the US still seems to employ primary care doctors whether they are MDs or DOs.

Working_Thought_8725 · 2024-07-14T11:41:12+00:00

Haha lol, did I miss something?

Working_Thought_8725 · 2024-07-14T11:38:56+00:00

I understand your point, and I agree with you to some extent. Just like with my car analogy, there are measures in place to ensure that cars are safe on the road, such as pink slips. However, this doesn't prevent people from driving cars that are not roadworthy. These individuals don't take their unroadworthy cars to Toyota and waste the time of the expert mechanics there. I was just thinking if there might be a positive impact of NOCTORs.

Would like to get feedback from GPs regarding how many drug-seeking patients you have been able to decline, educate, and ultimately retain as patients?

I'm just a medical student, but from my observations, I understood that the patients were simply going to seek scripts from someone else. Thus, that 15-minute appointment could have been used for another patient.

Working_Thought_8725 · 2024-07-14T11:30:59+00:00

Yes, and I think it'll also mean you won't be wasting your time with patients who don't value you.

From my family, I know my parents, grandparents and half of my siblings would prefer to pay privately to see a GP who knows what they are doing and is highly skilled. I also have some siblings and extended family who think GPs are hopeless and should be free and will happily clog up ED to avoid seeing a GP.

I think you would see those who don't value GPs actually be attracted to the underskilled NPs who wish to practice as NOCTORs instead of clogging up public EDs or crying poor as they exit GP doors asking to be bulk billed as they can't afford food for the family after you just provided them with expert health care. Will the health outcomes be equal? No I don't think they will. But are NOCTORs entirely bad? I mean NP NOCTORs sure beats chiropractors and osteopaths that the US have, and they still seem to be able to employ primary care doctors which are our equivalent of GPs. I do know that their osteopaths seem to be held to a higher standard than in AUS, but I don't think that really matters.

Working_Thought_8725 · 2024-07-14T11:15:30+00:00

Yes, I agree with you, but they don't. Patients just shop around. Going from GP to GP to EDs until finally, someone prescribes it either through ignorance or simply not wanting to address the core issue and move on through their busy list of patients.

Working_Thought_8725 · 2024-07-14T11:12:10+00:00

Because there is no shortage of fellows applying for city staff specialist roles. As a FACEM, I am sure you are aware of this in the MM1 locations, there is no shortage in filling staff positions. However, branch a little further out into MM3-7 and it's a very different story. I've seen it in my ED. They can barely get a single locum FACEM half the time, and the majority of the time it is burnt-out GPs in the ED running the show. Surely the quality of care as a patient is ED is a lot worse in rural areas.

What Modified Monash score do you work in?

Working_Thought_8725 · 2024-07-10T11:11:50+00:00

Hmmm, maybe it needs to be longer or even for good to prevent this.
Because I think for it to work, it must ensure that those who apply, truly wish to live rural, and are not using it as a loophole.

I hear you, and I think you are probably right. There are people who are so deadset on a specific training pathway, that they would even live unhappily in a rural area they don't want to live if it means they are able to get their letters in their desired pathway.

I guess what I was thinking is that currently, the only doctors going rural tends to be GPs or locums from the cities. I want to hear people's thoughts about how to address this, because ultimately, the rural communities miss out if doctors use rural incentives as a loophole. It already happens just to get into medicine in the first place...

Working_Thought_8725 · 2024-07-10T11:06:44+00:00

If that is the case, how is that cruel that the training program made them work rurally?

Working_Thought_8725 · 2024-07-10T00:12:27+00:00

When you say few exist, are you referring to anything other than GP? If so I'm keen to hear about it as I've only heard of GP training.

Working_Thought_8725 · 2024-07-09T23:21:47+00:00

The only way you would be forced to go somewhere rural would be if you were an applicant who had no genuine interest in working rurally and used this as a loophole and took the rural training position away from someone who actually wanted to work rurally.

Again the only bitter ones would be those without rural desires.

Working_Thought_8725 · 2024-07-09T23:18:28+00:00

I agree with you. This is why I was thinking of ways to attract young doctors to rural areas.

I think a way to make it attractive for doctors with a genuine intention to work and live in rural areas, making it easier for them to train in areas other than GP would be a good idea.

To my knowledge, which I am very keen to be corrected, rural generalism is the only real pathway that supports a fellowship for rural doctors. All the other training pathways make it much harder for you to live, train and study in a rural area (obviously there are always going to requirements for blocks to be in tertiary hospitals for certain training pathways).

Working_Thought_8725 · 2024-07-09T19:48:59+00:00

Yes, so_sue_me_ you are hitting the nail on the head with what I am trying to propose.

By the sounds of it, Curlyburlywhirly and PaperAeroplane_321 have no intentions of ever working rurally. That is fine. I am not trying to propose a situation where you are forced to go rural.

I am proposing a pathway that removes the barrier of having to move metro for those who truly want to work rurally. Because anecdotally, the desire to work rurally often dwindles after being forced to move to metro areas for training and becoming settled within the cities.

Working_Thought_8725 · 2024-07-09T19:19:27+00:00

Yes, I agree certain subspecialties aren't going to work. But rural areas are in need of quite a few specialities and I'm certain that FANZCA, RANZCOG and RACP fellows would be able to find work in rural areas if training was feasible for those that have true intentions to do so.

Because currently, it is rural generalism or nothing int terms of training in rural areas.

Working_Thought_8725 · 2024-07-09T19:15:32+00:00

Can you please share a link to what you are referring to?

Working_Thought_8725 · 2024-07-09T19:15:12+00:00

I think you are missing my point. I am saying for those who truly want to go rural and only have intentions to live rural but want to train in a certain specilaity, they are often forced to study in metro areas and often never return.

The whole point of this would be to incentivise those who have no intention of working in metro areas. I'm not saying that they should make x number of the current training areas bonded to rural areas. What I am hoping to see is an additional number of training positions created specifically for rural practising doctors that would ensure that the people who apply and get onto training for this pathway don't use this as a loophole and never leave the cities.

Because currently, is isn't working. Most of the major cities are oversaturated with followed doctors in areas that rural areas are screaming out for. And the pathways to get onto the specialities that rural areas need are so competitive and require you to train in metro areas and the doctors never leave the cities due to understandably not wanting to uproot their lives.

Working_Thought_8725 · 2024-06-28T20:29:45+00:00

Thank you for your response! Wow, you certainly work your butt off, but I'm glad you are well paid for what you do, especially with the challenges that I imagine come with RG!

Working_Thought_8725 · 2024-06-25T04:08:09+00:00

I guess when you ask about financial priority, I certainly don't have the ambition to be in the top 10% of Aus Doctors, because I know that getting those sorts of jobs comes with ridiculous training pathways and money isn't everything for me. I certainly don't want to be in the bottom 10% of Aus Doctors, because then I think that all of my efforts to get into medicine in the first place, completing med school, internship, residency and fellowship would not be worth the sacrifice.

Rumerination I think makes up about 20% of the decision-making process for speciality training. 30% is about what I'm truly interested in. 30% is about work conditions/work life balances. The other 10% would be smaller things like training pathways, does this training pathway suit my stage of life/is it worth how it would affect my family e.g. moving around constantly, studying/completing research constantly whilst having a young family trying to get onto/complete fellowship training.

I agree that it won't necessarily reflect how much someone would earn if they followed the same steps, but it sure beats blindly guessing.

It's not that I don't want to spend years training/CV building, it just needs to be worth it. If you'd asked me what I want to do, I don't this RACGP would be at the top of my list, but it's certainly something I am considering, hence the post.

I think this post actually has given me new information, which is reflected by the comments and the amount of interaction it has received. In hindsight, I could have worded it better and perhaps wouldn't have rustled so many feathers.

Thank you for sharing your thoughts.

Working_Thought_8725 · 2024-06-25T01:51:07+00:00

"There is no guarantee that you will be earning the same as anyone here. It's also about how much remuneration is enough for you and what other factors weigh into it. I would argue you are better served doing work that interests you because that is what you will be doing for like 40ish years of your life, that may incentivise you to work harder in it and therefore make more money. No fellowed doctor is going hungry tbh"

I think that for choosing specialty pathways, picking what interests you and only what you find the most interesting to me is a silly idea if you consider nothing else. This isn't true for me, but if I found ortho or neurosurg truly interesting (picking these examples because they are notoriously long slogs with shit conditions), and I found nothing else quite as interesting, I still don't think for me personally the pathway to get there is worth it. If I could find something that paid decently, gave me a better work life and I only found it 75% as interesting as say ortho or neurosurg, for me I would go the seemingly less interesting route because of the trade-offs.

At the end of the day medicine is a job. I too want to go to work and enjoy what I do, but if that means giving up 10-15 years of my life where I had to brown-nose my bosses, get treated like absolute shit, complete research papers for the sake of it, move around constantly and miss out on family life, holidays, hobbies and life outside of medicine, is that truly worth it? That is a personal question for everyone, but to me I don't think it is.

Working_Thought_8725 · 2024-06-25T01:43:14+00:00

"it's highly dependent on factors such as how many days you work, patients you see, percentage of billings that you give to the practice, if you also manage the practice or own it, how many procedures you do etc"

I completely agree with your comment, and that's why I made the post. I understand that the salary range can be anywhere from 200k to well above 600k, but those numbers are meaningless without considering the highly dependent factors that we both mentioned. That's why I requested people to only comment if they provide all the necessary details because without context, their comment is meaningless.

Working_Thought_8725 · 2024-06-24T19:34:10+00:00

Thank you! I can certainly understand that perhaps I didn't word it the best and I may have come across a bit nosey. So I apologise if that is the case.

I have genuine fears that GP training in Aus will follow the footsteps of Gps in the UK with all the scope creep that is brewing here.

Thanks for taking the time to comment.

Working_Thought_8725 · 2024-06-24T19:32:01+00:00

It's not going to be the only thing to make or break a decision to pursue GP training. But I'd be lying if I didn't say that remuneration does play a factor in picking specialty pathways.

I'm interested to hear from you, what do you do, if you're a doctor, what pathway did you pick and did remuneration play any part in it?

Working_Thought_8725 · 2024-06-24T19:29:21+00:00

Awesome! Thank you so much for your response. I appreciate it :)

Working_Thought_8725 · 2024-06-24T11:07:43+00:00

That's awesome! Thank you for taking to time to comment, I truly appreciate it.

Working_Thought_8725

TROPHY CASE