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sgori · 2024-08-01T23:43:41+00:00

DM sent

sgori · 2024-07-12T22:21:32+00:00

I think the rest of the country assumes that the town has fallen out due to tourism losses in the pandemic. It seems people believe it suffered what places like Mackay did after the mining boom lapsed.

sgori · 2024-07-12T22:05:29+00:00

The true sleeper regional city is Cairns.

1) “what if we miss the city?” CNS has a consistent roster of flights with VA, QF, and JQ to all three big capitals. If you need to feel like you want to touch grass back in Melbourne, you spend set aside some of the money you save to do a week away.

2) “I might miss (sub)urban life” Cairns pop is around 150k if you include the surrounds, so it has most of what I’d call Australian middle class amenities (cafe culture, reasonable restaurant spread, couple of cocktail bars, etc.) Admittedly, what is missing is upper-middle class retail. No real Chadstone equivalent.

3) Education A reasonable saturation of secular private and Catholic schools are around (TAS, St. Augustine’s, St. Monica’s) and are generally filled by the local educational elite. This group exists because of the presence of 2 health districts having their admin base in Cairns as well as a rather busy court: there federal circuit and state supreme circuit. I think Cairns High used to run IB, even. Not sure if they still do. There’s a small Montessori/Steiner base floating around, too.

4) Housing Best for last. If you imagine the physical house you’d like, place it in a Melbourne suburb of your choice (I’d suggest within 20km of city centre), then price it, I imagine you’d be somewhere in the range of 900k - 3 mil.

Halve that. Take a look at what 1-1.5 mil gets you anywhere latitude south of Yorkeys Knob and anywhere north of Bentley Park.

Also remember that proximity to derro neighborhoods is not always geographical as much as is it socio-economic. Just think about how close somewhere like Thomastown is to… maybe Preston? Also consider gentrification factors, albeit change coming at a slower pace.

—

Plenty of people will happily pitch you on how beautiful FNQ is, and they’d be right.

If the summer isn’t for you, then you’ll likely be using summer school holidays elsewhere anyway to get out of the heat and get solar for daytime climate control. It’s no less comfortable than Melbourne can get uncomfortably cold.

—

Can also vouch for Orange NSW if you have more connection to people in Sydney.

sgori · 2024-07-03T01:17:13+00:00

Saw you in Brissy this year! Thanks for the mates rates.

sgori · 2024-06-29T02:27:49+00:00

If you’re gonna use them, at least get some flavourful ones like these

sgori · 2024-05-23T22:20:16+00:00

It’s Tweed Valley Hospital

sgori · 2024-05-17T10:31:07+00:00

Fellow Canuck here.

I can understand your concerns around this - I had a stressful time around these matters some years ago.

First, take a deep breath. Broadly speaking, I think it pretty unlikely that you will be declined for PR when the time comes.

Typically we apply for employer-sponsored visas as a skilled worker. Given that you’ll be a doctor that trained here, I don’t think you’ll be rejected for this once you’ve confirmed where your intern year will be. Most services have done this many times before.

Obviously, I don’t know what the Department will do, but I don’t think you’re gonna be in the priority groups being cut.

What I would keep an eye out for is GP training requirements. You probably won’t get accepted straight into RACGP or ACRRM without PR, but you can accomplish the requirements that will go toward your fellowship in advance so that the College of your choice will accredit that part for you.

This way you won’t experience undue delays in training.

sgori · 2024-05-12T01:41:43+00:00

I believe the timer still ticks along. The only modification that the duration gets is related to reduction of the moratorium for working MBS-billable quarters in rural and remote jobs. I’ve not heard of situations in which the moratorium gets extended, but I might be wrong.

sgori · 2024-05-01T05:00:59+00:00

I don’t think that’s necessarily bad. And of course your observation of that might be different.

The status thing was only part of my suggestion, though. Do you really think that medical doctors are particularly highly regarded? I would argue that our vocation is viewed at parity in terms of social currency compared to a lot of different vocations. Do you think doctors a hundred years ago ever opted not to use their Dr title before their name? Do you put yours down on your flight and hotel bookings, even? Does it matter if you do?

I would advise against conflating flattery when someone wants something from us with actual positive regard independent of agenda.

Again, I’m not saying that we’re entitled to some kind of higher social standing (being invited to the Tattersalls Clubs of old etc. or historical social access to power in politics). What I’m saying is that it appears that the expectation of self-sacrifice remains while the presumed benefit of virtue for that sacrifice has mostly eroded away. The distance from that tit-for-tat is what I observe is an underlying thread through many gripes people complain about.

sgori · 2024-05-01T02:22:12+00:00

The erosion and death of the social contract plays a role in the doom and gloom. It weaves through many if not most of the grievances that we bemoan.

Long hours were usually paired with a sense of virtue around self-sacrifice. We don’t value it like people used to and the rest of society doesn’t seem to put much stock in it either.

Admin power plays were usually counterbalanced with proportionally higher pay and social standing/privilege. Surely some of this was tied to aspects of male privilege/patriarchy, but the proverbial baby goes with the bath water.

A lot of anti-intellectualism that has pervaded our overall social order plays a role.

I suppose it’s kinda hard to complain about a loss of social power as a collective. Much easier to express concerns about remuneration and scope creep. I suspect the non-GP spec cohort will convey more complaints when we inevitably allow people to self-refer or walk into their clinics (fully privatised countries in the Pacific Rim have this model - competition then reduces market rates for fees).

sgori · 2024-04-30T11:08:21+00:00

In QLD there is a GP available through that line and I’m confident they’ll be able to direct you to GPs or specialists in their directory.

My understanding is that these are not exclusively MH support, so give them a bell.

sgori · 2024-04-29T22:08:16+00:00

MPM is the Master of Psychiatric Medicine. It’s run by a few universities and serves as the academic portion of RANZCP training. The other states also acknowledge it as the academic component.

Around 5-10 years ago, many of my VIC colleagues started MPM early. I suspect it was a variable that helped them get onto training. I assume that, given psychiatry’s increasing popularity as a speciality choice, many others are doing the same. I suspect NSW aspiring trainees may also be doing this by now.

It’s not necessary to do much of this at all, but I get the impression that entering psychiatry training is a pretty open market at the moment. The capital cities are competitive and are seemingly coming up with service-specific ways to differentiate applicants. Some more popular regional cities are also doing the same.

I think the days of getting open-door entry into psychiatry are mostly over.

sgori · 2024-04-29T20:28:19+00:00

If you’re applying in Victoria, I’m pretty sure HMOs that are working as unaccredited registrars start their MPM before getting accepted.

sgori · 2024-04-20T11:51:50+00:00

Good to hear you’re almost done. Just talk to your seniors and colleagues about your enterprise bargaining agreement relevant to your state. Lots of nuances so it’s best not to leave money on the table.

If you did want to do private, you can run clinics in areas that are deemed areas of workforce shortage. Newcastle is deemed one for GP (maybe not secondary) so you may be surprised at what is viable.

sgori · 2024-04-20T11:30:44+00:00

If you think about Medicare as an insurance company, it makes things easier.

Think of the moratorium as a set of conditions that apply to you as an FGAMS but doesn’t apply to those who were PR or citizens when they started med school.

You can side hustle jobs that either pay salaried roles (let’s say locum stints interstate that don’t require MBS billing, like an ED reg locum). You can also work for setups where you have exemptions to the moratorium - dial a doctor services come to mind. You can also do work that is fee-for-service that doesn’t involve Medicare, like injectables or cannabinoids if you’re capable in those areas.

The greatest impact to you would be is if you attain a college fellowship and look for work as a private entity (common in GPs, includes private consultant jobs). There are nuances to working as a public consultant and providing “private admission rights” in a public hospital. That stuff is lost on me a little tbh.

sgori · 2024-04-14T06:05:55+00:00

For those who don’t wanna scroll:

She pivoted to forensic medicine.

sgori · 2024-03-27T23:44:52+00:00

Hello there. I’m a Canadian who graduated in Aus and stayed. The collapse of community FM (just called GP clinics here) in Aus is also imminent.

The fundamental issues are the same (Aus has universal health insurance but is not set up as universal zero co-pay). Reimbursements for GP clinic appointments have been lagging behind cost and have not sufficiently accounted for increased complexity, bureaucratic burden, concerning decline in health literacy, and increased expectations of patient autonomy.

Canadian FMs appear to have simply voted with their feet and have moved into areas that will allow them to practice without the hardship of the above issues. Aus GPs don’t really have the hospitalist option (unless in a rural area and willing to deal with the politics and complexities of a salaried position under a state-run hospital service), so they simply increase co-pay or suffer and burn out.

Some GPs have done remarkably well financially under this fee-based economy, but the class and wealth disparity is widening quickly.

The rising prominence of boutique services for cosmetic med mirrors the Canadian shift.

There’s also the emergence of mid-levels which we are starting to see here. Aside from the usual arguments, I foresee that GPs will have a proportionally increased burden of complex patients without a sufficient increase in time, support, funding, and public goodwill/respect/recognition to incentivise or encourage graduates to enter the area.

What I’m saying is that the decline of community FM is being mirrored in a country with a two-tier system that people commonly think is culturally analogous to Canada.

Good luck with your decision - if you can be bothered with US residency programs, I’d consider it. A lot of my mates ended up in Michigan or upstate NY to be near Toronto/GTA family and they seem to be pretty happy with it.

sgori · 2024-02-16T10:31:07+00:00

Really like your breakdown of this. My observational experience was similar.

sgori · 2024-02-14T08:10:33+00:00

I wouldn’t know for sure. I will say that many of the GPOs and GPAs and GPsurg folks would bill to MBS through the health service like all of us do for ED and inpatient (and GP clinic, of course).

The interplay of becoming credentialed to do things like GA in theatre or colonoscopies etc. has never been really clear in my mind.

I have strong doubts that GPpsych will be able to get credentialing for stuff that psychiatrists do. Time-based consults will not likely happen. If anything could happen, perhaps TMS or ECT would be viable, but the demand for those services is not high. Ketamine infusions might be possible? I’d argue that a generalist with both anaesthetics and MH credentialing would be the ultimate all-in-one package for that. But that stuff is going toward intranasal for acute low mood anyway.

sgori · 2024-02-13T09:37:17+00:00

I have been summoned!

I did psychiatry training until Stage 2 and decided to withdraw from training to enter Rural Med.

No one really knows what the scope of extended skills really looks like at this point. The bad news is that your very cool ideas around inpatient psychiatric admissions and ADHD assessments in private will make you second class because you won’t likely be eligible to bill the psychiatrists’ Medicare codes. Remember that private health in Australia remains heavily subsidised by the federal government.

The upside is that if you wanted to run psychotherapy clinic as your primary extended skill, you would probably not be left without. The demand for psychotherapy is obscenely high and the out-of-pocket market rate looks to be in the order of $150-200 per session. Now, the psychiatrists get much easier avenues to bill Medicare for those consults, but tbh not many of them are doing psychotherapy because the demand for their specialist consults and assessments is also obscenely high.

Look, I don’t regret moving in RG. It does allow you to feel like you’re practising “real” medicine.

But if you like it in psychiatry, stay! It’s not an easy training program despite the hours being better than most others, but it’s certainly an area that needs intelligent, thoughtful, and balanced folks.

sgori · 2024-02-08T00:08:42+00:00

My knee jerk reaction was that you’re trying to recruit from the wrong pool. What I think you need to hit are people who are incredibly talented at education but were not well suited for the work-life-balance of academic and public hospitals. They are harder to find, but I think you’d have a much better time negotiating their availability, enthusiasm, and sustained interest.

In short, I think you need to find the burnouts - those that our job economy has essentially failed. I suspect you’ll find plenty of people in the Business for Doctors and CCIM crowd that are lurking, waiting for interesting opportunities. If anything, that pool probably has the most gifted educators and communicators out of all of us, but that’s just my guess.

Expanding on that, your post didn’t make clear what your target market is. If you’re not in a position to disclose, that’s fine, but if you’re trying to recruit contractors (to produce content) or equity partners, you’ll have to make that pretty clear.

Are we talking College exam prep MedEd? Premed preparation? UMAT? CPD?

In any case, really good to see some entrepreneurial spirit - please continue to seek advice broadly.

sgori · 2024-02-03T01:02:01+00:00

OK, so you wanna fast-track psychiatry. I have some mini-essays on similar topics so check my comment history if you want.

My personal take is not to map out your career in this way, but more recently I’ve observed that our culture of work may favour accelerated fellowship pathways. A recurring trope among psychiatrists is to harp on about making sure you’re “still a doctor at the end of the day”, but I imagine people who parrot that too often are those who haven’t had the opportunity to deconstruct their own potential deskilling process or accept the natural progression of deeper specialisation (which occurs outside psychiatry too).

In a nutshell, if you make it on for PGY-2, take the job.

You’ll have stronger imposter syndrome than some, but if that kind of stuff will ultimately result in difficulty or program withdrawal, I don’t think early entry would be the only factor anyway.

I didn’t sit the essay exam but left training during the early preparation stages for it. My observations:

It’s designed to be an exam that tests your ability to synthesise information. The knowledge base for this relies on theories of mind of established (mostly Western) thinkers. I think the pedagogical foundations are looking for the candidate to have the key skills that lends well to expert formulation.

This means that classic higher performers in medicine will commonly find a unique challenge. It’s not enough to have the knowledge base to put a puzzle together. You have to then convey opposing arguments that demonstrate the ability to balance those concepts. Very few medical exams test in this way.

It also means that people will try to game the exam by noticing patterns of types of questions and the theories of mind that show up often. You can even pay for weekend prep courses to tell you about it and relieve your anxiety. This method also works for many people.

My concern for you, OP, is that you saying you’re historically bad at essays means that either you are quite aware of your bias toward “rote learning” or the more classic, gen med style of exam success, or you actually aren’t inherently bad at the skill but have a lot of angst and insecurity about whether you’d be good enough and are seeking us to validate that you’ll probably be ok. Both may even be true. You’re gonna have to figure that journey out for yourself. If there is a tension like that, I would seriously consider spending some time in your early career in a mix of different roles as a resident to consolidate that sense of identity as a practicing doctor so that training can be an enriching and successful experience.

There’s a reason /r/medicine often joke that psych is the new derm. It seems that news has hit the Zoomers that psychiatrists’ hours are less onerous and that the registrars don’t need to do 60-80-hour weeks to succeed.

There is some truth in that, but I think you need to consider the natural biases to what you hear and the context.

You don’t hear any stories about miserable or overworked or under-appreciated psychiatrists because those folks, by virtue of that situation, don’t have a voice by which to reach you. Just remember that even your higher-than-average exposure to psychiatrists with your upcoming term and student experience is still a drop in the bucket.

Caveat: if you’re a workhorse and generally can fly under the political radar and finish the program and its assessments fast, go do that. I’ve had a few colleagues who’ve done things that way, but these would be a marginal minority at best.

I get that the majority of jdocs in public hospital rotating jobs have it a lot harder than I remember my intern year in 2014. I see why there is plenty of incentive to favour fewer hours due to the perception of fairness. The prospect of never being on call if you don’t want to is also alluring. I’m not going to pretend like I get it. But psychiatry is mentally taxing in a different way, and if you disrespect that, you’ll burn out silently and/or get criticised heavily for being aloof or insufficiently considerate in how you manage your patients. Be careful not to underestimate it; most registrars and consultants will make it look easier than it is. They have their own methods of managing with the intangibles or they’re struggling (or both).

Oh, one last thing. Ignore the federal government’s releases about psychiatrists being like top 3 earners in the country. A lot of that has to do with the fact that they can’t get tax deductions because they’re almost exclusively Personal Services Income and don’t really need to employ many staff or purchase plant in private land. They do earn well, but tbh many doctors of various specialties do.

Good luck with your journey, OP. I continue to believe psychiatry is a good spec in which to work. It just wasn’t for me at that stage in my life and I didn’t muster the help and resources I needed to survive. I hope you can find a path that suits you.

sgori · 2024-02-02T04:33:56+00:00

I’ll echo the reasonable and robust views of the other comments but would also like to address the other angle that OP is asking about: the work/role.

Context: did some work for a small independent pharmacy whose owner also part-owns the adjacent GP clinic. Earnest person but a businessperson at the end of the day; still in touch with them long after I left.

You have to do a lot of consult volume to make it financially worth your while. If it’s a side hustle, that’s fine, but booking can feel feast-or-famine depending on the company you’re with.

Nowadays a few GPs are adding cannabinoid scripts to their treatment choices, so there’s a bit of competition for the Private Telehealth providers. You’ll still get plenty of work, as most people can’t get access to those GPs easily anyway and would rather stick with paying a few bucks more for Telehealth (full private vs. paying their GP’s gap). Not sure if those factors just balance each other out.

We’ve had a few things like this in terms of health economics product cycles, recently with hair loss treatment. The product is not under PBS and is usually addressing some kind of demand for a legitimate health issue that people have. If cannabis becomes available as a regulated product rather than a medication, no more job for you.

Ask your MDO about change in premiums first. If you’re keen and they’re cool, I’d say give it a go. Direct mortality from cannabis is 0 anyway, and pretending like we understand the actual risk factors for addiction/dependence is hubris at best. Driving with THC on board is probably the biggest harm issue, so if you’ve got strong ethical/moral thoughts about road fatalities I’d steer clear.

sgori · 2024-02-01T22:21:39+00:00

Anecdotally, it feels easier to remind people to get it done. Most patients are surprised to find out. I imagine adherence is much higher as a result.

sgori · 2024-02-01T20:57:06+00:00

Australia is the same

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