[AMA] I'm a General Practitioner - Ask Me Anything

As per the title - I'll try and give my personal and professional experience, without providing any specific medical advice (which is fraught with risk over the internet, without being familiar with your medical history).

I have been working as a specialist General Practitioner for the last 5 years, and am currently working in a COVID screening clinic in Melbourne seeing all the lovely coughs and colds.

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        • -1 vote

          Not sure whose world you are referring, but the MBS is also way below the average wage index. It doesn’t affect GPs so much as it effects patients

  • +2 votes

    Are GP's required to only answer one question per patient? In the recent years, I have had a fair few GPs refuse looking at health holistically. Say, I walk in with symptoms of hair loss and extreme tiredness, I am told "Only one thing can be looked at". Medicare is billed for a 12 - 15 minute consultation. Why am I not given the whole 15 minutes ? I can understand being given 10 minutes as 5 is for documentation/admin - but looking at only one thing at a time. I find that ridiculous.

    • +5 votes

      The answer to your question I believe is partially covered in my response above. I will add that there's no requirement to limit the number of issues per consultation but unfortunately, this is the way that many doctors/practices operate (whether by choice or financial necessity). I agree that it's simply not possible (nor safe) to sort out issues one at a time as often they're related (e.g. fibromyalgia could cause tiredness, muscle aches/pains, dizziness, depressed mood), and there has to be incentives for doctors to be able to spend the extra time with their patients that they need As it stands currently, the system rewards a high throughput of patients

    •  

      You are completely incorrect about the timing. There is no Medicare requirement round timing for a 23. So the GP may be deciding that your rebate is of value for 6 minutes only.

      •  

        GPs don't decide rebates for patients, the federal government does.

        •  

          But GPs get to decide how long to see the patient for and what a given rebate would be worth in their time, and then to charge accordingly. Either to private bill or have no gap (for a non time limited descriptor) and limit the appointment to 6 min. Or whatever.

          • +1 vote

            @cynicor: GP’s should join a union to fight for fair payment for healthcare. Lobby government to consider a better funding model, perhaps a time based model? (Have no idea if that is better or not). Surely there’s something that can be done to establish a more holistic approach rather than simply treating one issue or just dealing with the symptoms.

            And yes, I am willing to pay more taxes for that instead of giving $400million to the great barrier reef foundation or buying land for $30 million instead of $3 million.

            •  

              @Vote for Pedro: This happened around 2 elections back, but the vast majority of the public don't understand that we are fighting for their rebate and not our incomes. It's a distinction the media don't push and politicians are happy to obscure.
              Oddly, it doesn't even need more money in the health system, just some tweaks and fixes and it would be probably cost neutral or maybe slightly more.
              Reductions and cleaning the old MBS that pays a heap for procedures (i.e. cataract ops), reducing over testing and removing low value consults.
              I don't have colleagues who do the "one condition" thing, but another clinic in my town advertise that and say it is to minimise the out of pocket.
              I'm happy to charge and tell patients they should lobby (or stop electing) our Lib/Nats MPs if they have an issue with it.

  •  

    My elderly parents have been going to a GP for years. He suddenly shutdown a few months ago without indication why. We later found he'd been suspended, and we found him on a Lost, Stolen or Forged Prescriptions list.

    1. Presumably the latter is why he was suspended, but what does that mean? Has he been selling prescriptions or something?
    2. Is there any way my parents can get their medical records from him? I don't think they are on My Health Record.
    3. Do you recommend using My Health Record? They do have their own notes about visits, but I don't know if they have copies of blood test results, specialist letters, etc.
    • +4 votes

      A few months ago, I was shocked to find myself on that list you mention, as there was no notification from any regulatory body and I came across it by chance one day. Not sure how it happened, but I have worked with patients with drug dependence issues previously and it's entirely possible some of them forged prescriptions in my name, so it's not necessarily any indication of guilt to have found your parents' GP on that list.

      Do you know why he was suspended? If you search the AHPRA register of practitioners you may find out the reason for suspension, alongside any tribunal findings, to shed light on the situation.

      In relation to My Health Record, I know I'm not alone in this and alot of other doctors share similar concerns, however I'm not entirely convinced that the system is secure so I wouldn't feel comfortable having my sensitive personal information in a central repository, for the time being. There have been enough well publicised instances of data breaches for me to opt out of it. Also in theory it's a good idea, but I find the whole system clunky to use, being difficult to log in to, with old out-of-date information and some important documents which are supposed to be uploaded never appear. However this is just my personal experience and opinion and you'll have to decide whether the benefits of MHR make it worthwhile for your family's circumstances.

      The best way for your parents to access their medical records would be to contact their old practice and request a transfer of records/results/letters to the new practice. Note there may be an administrative cost associated with this.

      •  

        Thank you for that.

        I looked him up on the page you linked, and there are no reasons for his suspension. There is noone at the old practice or answering their phone so no apparent way to contact them to access/transfer their records. So it looks like they'll need to rely on whatever notes they took, and any copies of reports.

  •  

    Do any of your patients that you treat make you nervous ? My GP told me yesterday I make her nervous due to my genetic make up and 20 year medical background .

    Have you ever treated a patient with LFS ? Most GP and specialists have never heard of it . As a patient I often have to explain this rare thing to various dr’s , specialists and nurses and medical students . I’m a very rare case in the medical world .

    • +2 votes

      Some patients are 'ticking time bombs', so to speak - they have all the cardiovascular risk factors - obesity, hypertension, diabetes, older age, male sex, previous strokes/heart attacks and smoking - and are prime candidates for another cardiovascular event. You try to chip away at the individual risk factors one and a time, but sometimes it does feel like bailing out a sinking ship with a bucket.

      I'm not familiar with that acronym 'LFS' - you might have to explain it to me.

      • +4 votes

        Going by the user name I'd guess Li-Fraumeni Syndrome.

      •  

        Most GP’s , doctors , specialists have never heard of LFS ( Li Fraumeni Syndrome) TP53 gene mutation as it’s extremely rare .
        Unless they specialise in oncology and / or genetics

        For the past 20 years I have been explaining this rare syndrome to various medical professionals/ specialists and medical students

        That’s why my GP said I make her nervous
        I just jokingly replied
        Try living with it for the past 20 years and knowing you are going to be a ticking time bomb For the rest of your life .

        .

  •  

    Doctor my wife has many medical appointments noting has blood tests with different doctors how ever it seems to be the same tests .all the time. Does that sound ok or not.

    •  

      Why is she straining the medical system. She could be "attention seeking".

    • +5 votes

      Not sure why she is seeing different doctors and also why she's getting referrals for the same tests - as that seems to be unnecessary duplication of investigations. Is there any particular reason for seeing different doctors? Is your wife aware of the tests she is being sent for and the rationale behind them? Something doesn't quite add up and it would be worthwhile exploring further…

    • +4 votes

      Surely, we can worry when we have the covit 19 virus ?

    • +2 votes

      It's way too early to be able to answer your question with any kind of certainty, as we don't even know about (or at least I'm not aware of) any vaccines against SARS-COV2, let alone their relative efficacy/safety. There's been alot of hype about the supposed Pfizer-developed vaccine this week which the Aus Govt has secured stock of (supposedly 90% effective) but that's a commercial announcement and we don't have the published studies to be able to investigate these claims against other published studies.

      Even if the Pfizer vaccine were to have the backing of published research, I strongly suspect there will be other factors such as political favours/pharma lobbying which will determine which vaccine(s) become available to the Australian public so it wouldn't be a simple matter of choosing your vaccine of choice.

  •  

    Hi Doc, my spouse would like to ask your opinion about why a GP denied him a 'baseline' ECG at 40 so he can detect changes later in life before he possibly get a heart attack due to history of heart disease in his family.

    • +1 vote

      Why does he think a baseline ECG would be of any use?
      Consider CAC instead: https://www.health.harvard.edu/heart-health/should-you-consi...

    •  

      Generally we wouldn't do a 'baseline' ECG at the age of 40 unless there's a strong family history of ischaemic heart disease (i.e. it wouldn't be done just because your spouse's cousin twice removed once had an episode of angina thirty years ago) or personal risk factors (such as a strong history of smoking or hypertension). However if they did, then by all means most authorities would recommend getting one done as it is a quick and simple procedure.

      If there are particular concerns about their cardiovascular risk then there is a cardiovascular risk stratification tool (based on the Framingham Risk Equation) available which most GPs would be familiar with, however this is only validated from the age of 45 years and older (or 35 years and above if from an ATSI background).

      • +5 votes

        As an ED doc, I would frigging love everyone to have a 'baseline ECG' on record. It makes it so much easier knowing if something is new or old.
        The number of 40yr old without 'normal' ECGs is staggering.
        And an ECG realistically takes some stickers, some paper and 20 seconds.

        Have a picture on your phone (in the cloud) and your ED doc will love you. (as well as a record of all your past medical hx, your medications and WHY you take them)

        Can definitely understand that the utility of a random ECG in someone with no symptoms is currently useless. But the future!!

        •  

          words from someone after my own heart :)

        •  

          Would a 6 lead ECG suffice or is 12 needed for better diagnostics?

    •  

      Maybe if he was willing to pay completely privately, but Medicare couldn’t be billed for it. And ordering tests with no indication is a bad idea as it leads you down nonsense paths of over investigation.
      It’s also a terrible screening test, as above.

  • +10 votes

    OP, are pharmacists uniquely gifted at birth to understand doctors’ handwriting, or before graduating with a pharmacy degree all pharmacists first have to pass the units ‘Deciphering doctors’ handwriting, 101, 102 and 103’?

    • +3 votes

      I can't tell you how many times has been wasted ringing the referring Specialist trying to understand the writing .
      I know its rocket science to type somehow the test or drugs required .

    • +8 votes

      Big up to my pharmacist colleagues who have to deal with this on a daily basis. I think it's a huge waste of everybody's time (not to mention safety risk) trying to decipher poorly written handwriting and there's simply no excuse for it. My writing has definitely deteriorated since graduating from high school, but I always make sure to write scripts and medication charts legibly (which is in fact a legal requirement).

      Fortunately something like at least 90% of prescriptions these days are computer-generated, which makes things alot easier all around.

  • +1 vote

    What are your thoughts on annual checkups?

    •  

      Quite interested in this one too - I haven't been to a gp in five years or so. Don't have any complaints really. If I show up and ask for a general check up, will I get laughed out of the office? Are there any blood tests that could / should be done as an annual/5 year check up?

    • +1 vote

      https://www.racgp.org.au/download/Documents/Guidelines/Redbo...

      Preventative health guidelines. Depends on your age and sex and risk factors as to when screening should start.

    • +4 votes

      I think it's great to have regular check ups as it shows you're proactive and keeping on top of your health issues. Kind of like how you have to maintain your car (even if it's running well) at the mechanic to ensure it stays that way. Even so, the number of people out there who don't know they need to do regular oil changes is scary.

      To be honest it's so encouraging to see someone who is that motivated in their health, and I'm not sure about other docs but it motivates me in a sense to make sure that they maintain their physical health, and I'll go the extra mile. I wish more people did come in for check ups, because honestly most people come in when they have issues that need to be sorted, by which time it's too late.

      There's no "one size fits all" check up, as this depends on someone's age, sex and comorbid medical conditions. For example in a teenager we might be more focussed on things like their psychosocial well-being, whereas in the middle ages (40+) cardiovascular health starts to become more relevant.

      The resource Natasqi mentioned is probably the main guide to the various preventative health activities that we undertake in General Practice and I recommend reading through it and bringing it in to discuss with your GP, if that's something you're keen to address.

      • +2 votes

        Thank you Inasero for the AMA and the very helpful information and thank you to all the other Doctors/GPs who have been providing their insights as well.

        I want to be more proactive about my health (and know there are lots of room for improvement) - there are lots of general information out there how to 'be healthy' eg Eat a healthy diet and exercise.

        My questions:

        1. What activities/things do you do to keep/have a good bill of health?

        2. In your opinion what are the top few things that come to mind that you would encourage your patients/friends to do/dont do from a health perspective (apart from dont smoke, dont drink/do drugs)? Eg Is sleeping early very important? (Relevant as I posting this at 1am!) Stress less?

        3. There was discussion above about having regular (annual) check ups being a good and proactive thing to do. If a GP only orders say cholesterol test, but not a blood glucose test for diabetes (in family history) can we go back and ask for one or will that be frowned upon as it may cause an audit? How often should do a blood test to check for diabetes if in family history?

        4. You mentioned in your answer above that the blood tests that should an annual check up blood test should cover will depend on the age, sex and other factors. Would there be any tests you consider should be included regardless? as a baseline? Eg checking levels of salt and potassium, other minerals? in blood, liver and kidney function tests?

        5. Do you take vitamins, or supplements or any health products?

        I will read the 'Red Book' that Natasqi kindly shared and you confirmed it was a good resource to read and discuss with a GP.

        Thank you very much.

        • +4 votes

          You're most welcome! I'm glad people find it informative and if it helps people to engage with their health then it's a worthwhile exercise for me. There's quite a bit to the question so I'll unpack it in point form below:

          What activities/things do you do to keep/have a good bill of health?
          Don't look to me as a saint in these regards, but in GP we have an acronym "SNAP" to refer to preventative health activities - these stand for smoking (avoid/quit it), nutrition (at least 5 serves of veg and at least two serves of fruit daily), alcohol (avoid as much as possible, or limit to 2 standard drinks per day if you must) and physical activity (at least 60 minutes of moderate-intensity physical acitivity on at least 5 days per week). However I would hasten to add that these are very general guidelines and you should always consult your own GP for tailored advice to your situation

          In your opinion what are the top few things that come to mind that you would encourage your patients/friends to do/dont do from a health perspective (apart from dont smoke, dont drink/do drugs)? Eg Is sleeping early very important? (Relevant as I posting this at 1am!) Stress less?
          Generally, "bang for buck" the above interventions are the ones which provide the most return for the effort and which should be address first. However other things which can I recommend or personally practice are regular social interaction, engaging in hobbies you're passionate about outside of work, keeping adequately hydrated, maintaining a regular sleep routine and daily reflection (some people like journalling, others pray, do whatever works for you)

          There was discussion above about having regular (annual) check ups being a good and proactive thing to do. If a GP only orders say cholesterol test, but not a blood glucose test for diabetes (in family history) can we go back and ask for one or will that be frowned upon as it may cause an audit? How often should do a blood test to check for diabetes if in family history?
          There's no hard and fast rules about when we can check for diabetes, or how often these should be done, but the guidelines (which you should see referenced in the Red Book) recommend the AUSDRISK screening tool from the age of 40 onwards and blood tests every couple of the years (fasting blood sugars or HbA1c) from the age of 45 years onwards. However this is for someone of average risk, and there are other factors such as a positive family history, or the presence of comorbid medical conditions, which may influence the age at which we start screening and how often the tests are performed. As always, consult with your GP for advice tailored to your personal circumstances

          You mentioned in your answer above that the blood tests that should an annual check up blood test should cover will depend on the age, sex and other factors. Would there be any tests you consider should be included regardless? as a baseline? Eg checking levels of salt and potassium, other minerals? in blood, liver and kidney function tests?
          There are no baseline panel of tests which are applicable to each and every individual, these need to be discussed with your doctor

          Do you take vitamins, or supplements or any health products?
          Personally? I aim to drink one serve of red wine and eat kimchi and natto daily for the probiotic effects. When I was lifting weights earlier this year (before lockdown) I used to drink whey protein (though not currently). I generally don't believe in or encourage multivitamins, as they're mostly excreted by the kidneys, should be replete in a well-balanced diet and I don't want to encourage the mindset of relying on these products. However there might be certain situations or circumstances where this is relevant, e.g. iron supplements in iron deficiency anaemia or pregnancy multivitamins containing folate perinatally, so I know you've heard me say it but I'll say it again - consult with your GP for advice tailored to your personal circumstances :)

  •  

    How much training in nutrition were you afforded whilst earning your qualifications?

    • +3 votes

      Not nearly enough! If I recall we had a few lectures, and discussed a few of the diets which were (and still are) popular at the time e.g. 5:2, DASH, Atkin's, CSIRO, Mediterranean but the approach was very much still in line with the 'Healthy Eating' Pyramid which advocated mainly refined carbohydrates. We definitely could benefit from more training in this area.

      I think there's been a huge shift in thinking over the past 1-2 decades away from starchy carbs, in line with our understanding on their effects on weight gain and insulin resistance (Low Carb High Fat, and Paleo diets).

  •  

    Did you complete your tertiary studies in Australia or from overseas? Reason for that question is I want to know if you have a choice when you go for placement/residency training during your student years?

    My child is interested in pursuing medicine but would prefer to stay in a metropolitan area all her life.

    • +4 votes

      Most Australian born and trained docs will have to do some time out of metro. Foreign trained will usually be required to work in an area of need. Training in Brisbane, we were all required to do a rural term as a student, and another as an intern. Then when you do specialty training, many will require you to rotate outside of metro centers for part of your training, unless it's a specialty that really only applies in big tertiary centers. I will almost certainly have to do 6-12 months somewhere like Townsville in the next few years.

    •  

      In our first year of uni we had a week of rural clinical experience, and in the second year we had two weeks. Not sure what it's like at the other universities but I would imagine they have their own mandated rural curriculum. I also chose to spend the whole year in a rural clinical school in my third year just for the clinical experience, however this was optional and it is possible to spend the whole of your clinical training years in metropolitan areas (or at least it was in my time).

      There's no residency program here in Australia like what they have over in the States - the closest thing is postgraduate specialty training and that doesn't come until after graduating from uni and working a few years in the hospital system.

      If she's interested enough in medicine then I'd say go for it - the rural experience was really insightful in it's own right and she'll benefit from it and may even change her mind, and if she doesn't want to go rural then she can choose to stay and practice in metropolitan areas (assuming her medical schooling wasn't a rural bonded position).

    • +1 vote

      25% of CSP medical school positions (government funded) are required to spend at least one year rurally during medical school.

    •  

      Recently graduated here, about 1/5th of students are allocated to rural placements for a year or two. Although we put preferences about where we wanted to be, you can still be unlucky with where you end up. Specifically for my uni (UoM), some enrolments were 'rural' enrolments which would require them to be placed in more remote communities (e.g. Echuca) for a year. There are also bonded enrolments which require students to work rurally for a year after graduation.

      Otherwise, the average metropolitan student will do roughly 4-6 weeks in a rural setting throughout their course.

      •  

        How do these students support themselves with these rural placements? Are they given any lodging or moving allowances? Or does it get funded with whatever training salary he/she gets?

        •  

          Depends on the med school. Our rural year is completely funded for housing and they have a car or 2 in the pool (for 10 students). They get all utilities paid for and a bunch of other stuff. Used to also get cash and a phone allowance too!

  •  

    Do you see drug reps?
    What's your relationship with them like, esp in relation to the care and privacy of your patients?

    • +4 votes

      I used to, mainly for their sweet lunches (they like to bring in sushi, foccacias and chinese takeaway for some reason - maybe it was the restaurants in my area), however I've made a choice not to do so anymore due to the potential to bias my prescribing choices, but I'll still eat their lunches after they've left the practice ;P

      Not all drug reps are bad and they're just trying to do a job and bring awareness around their portfolio, but some can be quite pushy and I prefer to obtain my own unbiased sources of information (of which there is plenty e.g. NPS).

  • +10 votes

    At the start of the year I felt like shit. Super high temperature. Ended up presenting to ER. Turns out, my appendix had ruptured and my insane pain tolerance hadn't alerted me. Spent a long time in a hospital being looked after by amazing Nurses and Doctors, who honestly saved my life. I emerged from hospital into a Covid 19 reality, which was strange.

    Thank you, for looking after everyone. Thanks for the support over a shit year. I don't know you personally, but the sacrifices medical staff have made is mind blowing.

    • +1 vote

      I feel pretty well protected being in General Practice and the COVID screening clinics wearing PPE, so it feels kinda surreal being compared to superheroes (especially at the outset of the pandemic), but it's nice to get the acknowledgement and appreciation of the public.

      Hope you're feeling better know and back to full function!

  •  

    What happens when doctors retire? Do you receive goodwill from the medical practice to buy out your business? I personally feel doctors do not get paid nearly enough for the commitment and dangers, both medically and legally… There needs to be more attraction to the profession and medicare/government does little to support this..

    • +1 vote

      Not sure on this one as I haven't reached this stage of my career yet - I'd also be interested to know. I agree that for the amount of personal and professional risk we're in the remuneration could be higher, but again we didn't join the profession solely for that reason and it's rewarding in itself getting good outcomes for our patients.

      • +1 vote

        I can tell you. It depends on what you own. Do you own IP and goodwill, or assets in a physical practice?
        If you don't own a practice, and you are a contractor, then you probably own nothing and will just retire, handing your patients to someone else. You often try to transition them if you cut down slowly, makes it easier.
        If you have a viable practice that can run without you (i.e. not a solo-GP situation) then you may be able to sell your share, but it may end up being partners buying you out.
        If you have a practice no one wants (soloGP, small clinic) then you may just need to give it away, give the records and patients to a larger clinic. The benefit of this is you get ot avoid the tail off of keeping records and liability for 7 years in terms of medical requests for notes etc.

  •  

    Would you ever break the Hippocratic oath?
    Do you think GP’s could, at some future point, assist in ending life for some with terminal diseases?

    •  

      Wife and I were on a cruise a few years back. Was at the Captain table (fancy food and wine) and one guest was a GP. Someone asked him about what he’d do if he was on a plane and someone needed a doctor urgently (heart attack whatever). His answer was he would say nothing as he was on holidays and wouldn’t go to help.

      •  

        Are they not legally obligated to help?

        • +1 vote

          I'm not sure about this one, tricky question. I think there's a definite ethical imperative to help and in Australia the "Good Samaritan Act" provides legal indemnity against claims arising out of rendering emergency medical assistance (e.g. rib fractures are a not uncommon consequence of chest compressions in CPR, if done correctly). It might sound crazy, but people have in fact been sued for this very reason (I know right!) so I can understand if medical professionals are hesitant to provide emergency medical assistance in some jurisdictions. Not sure what the implications of a medical emergency in international waters would be - perhaps someone with expertise in maritime law might be able to elucidate?

          • +2 votes

            @inasero: In layman's terms, you are legally obliged to help as soon as you disclose you are a doctor/medical professional. You are not legally obliged to help if you do not disclose. So as per the original post, if the doctor doesn't want to help, they merely not say anything. It's that simple.

      •  

        Imagine the GP in this situation

        You have no equipment, no drugs, and you haven't been in an ED in years so you are also not well practiced.

        You aren't able to do much more than first aid, but as a doctor you carry huge legal liability

    • +7 votes

      This is a highly contentious and topical area at the moment, particularly at the extremes of life. Now that "Voluntary Assisted Dying" is legal in many states in Australia, this has opened up the gates for people to access euthanasia services if they should so desire. However, as a Christian I believe that all life is sacred and I personally choose not to be involved in the process. Even from a humanistic standpoint, I have strong moral objections to people making these kinds of irrevocable choices when there are so many options available to alleviate suffering in the face of terminal illness. When you hear of children potentially being afforded euthanasia because of mental illness, something is really fundamentally wrong with the way we view illness and suffering, and represents a dangerous slippery slope.

      However, this is just my personal opinion and doesn't necessarily reflect the views of the whole medical profession.

      • +1 vote

        just a quick comment on this, it is a very sensitive subject and I'm not sure of my own opinion.
        I am aware it is very regulated and not set up in a blink of an eye, I believe many cancer patients for example die of complications before accessing the drug.
        motivations and values are different for everyone, this may be a solution for some and not for others, I believe clinicians can decline participating but it would be unfair to imagine them blocking the whole process.
        As a teenager i had a teacher commit suicide based on a grim diagnosis in which she refused to lose her dignity through her deterioration.
        As long as it concerns themselves should we judge others decisions?

        you mention as a Christian, does that mean you are also against contraception? (are there other practices that are frowned upon religiously or conflictual during patient interaction?)

        -sorry about my english, its a bit rusty

        •  

          I thought no contraception was a Catholic thing, not an overall Christian idea.

          •  

            @PVA: possible although i think it varies from country to country. i cant say i have kept up with the trends

            •  

              @juki: Watch Monty Pythons meaning of Liff.
              The Catholic/Protestant scene 😀

              •  

                @PVA: love that movie although if thats the latest trend :D your sources are pretty old - i went to protestant and catholic schools in different countries it seems the local branches pick and choose what they believe is right or wrong

  •  

    How many years of education does it take to become a GP? Did you ever consider specializing instead?

    How much ongoing research and training is required for you to keep your knowledge current?

    •  
    • +2 votes

      How many years of education does it take to become a GP?
      3 years full-time after medical school, and at least two year mandatory hospital internship and residency

      Did you ever consider specializing instead?
      General Practice is a specialty in its own right - see my previous reply on the first page

      How much ongoing research and training is required for you to keep your knowledge current?
      Each triennium we're required to complete 120 CPD points of education and undergo a mandatory CPR/BLS activity. The RACGP publish a monthly self-education modules (the CHECK program) which count for 6 points each and take up to 3 hours to complete, and I'm sure the ACRRM have something very similar. The points can also be made up from attending conferences/seminars/educational event and the number of CPD points for these activities vary depending on their complexity and duration.

  •  

    Do you Bulk Bill. Why/why not?

    • +2 votes

      I've worked in both types of settings before- pros and cons to both:

      Bulk billing - higher number of patients, generally less complicated issues (or you bring them back for another appointment if there's more than a few issues), can get repetitive/boring, less demanding

      Private billing - easier pace, potentially more complex patients, more time dedicated to addressing issues thoroughly, patients tend to be more demanding e.g. expecting you to return their calls to discuss issues, rather than booking in an appointment

      My personal preference and style of practice would be to work in a privately billing clinic, however these are becoming less common (see my previous comments regarding increasing rates of bulk billing) with private GPs/practices tending to be more established with pre-existing patient bases, or in niche areas of practice.

      • +1 vote

        Thanks.

      •  

        a privately billing clinic, however these are becoming less common

        That's interesting, I guess it's a location thing too. It's very difficult to find a bulk billing (for adults) practice near my home, have to travel a bit, so we end up going to the local private one.

      •  

        Interesting that where you are private billing clinics are less common, and probably explains why you think the vast majority of GPs bulk bill.
        I advertised my skills recently and was offered to look at about a dozen clinics, 6 of which were in a 10 min drive from my house.

  •  

    1) How do you pick which specialist to refer to? For example, let's say you need to send a patient to a cardiologist. Do you send the patient to cardiologist Bob or cardiologist Jane?

    2) Are there any bulk billing specialists other than GPs? Is there a directory where you can search for these specialists?

    •  

      Alot of the time it's through experience of the local area and word of mouth from other colleagues and patients. Sometimes when starting out, the non-GP specialists will do the rounds on the local practices in order to get their name and face known and build up a referral base, and also bring along a lunch to butter us GPs up. Others have been around for ages and have a solid reputation and don't need to advertise themselves - for example if were to name a certain brain surgeon practicing in Sydney I'm sure most people will think of one particular individual. Whether that equates to quality I'm not sure as I live in Melbourne, but I like to think people have earned their reputation for a good reason.

      Sometimes patients have recommendations through their friends or though social media and request specific specialists, and I'll refer to them if that's their preference.

      Among non-GP specialties there are even further sub-specialties. For example among cardiologists, there's interventional, electrophysiology, nuclear etc. Most of the time I don't need to worry about these sub-specialties as the specialists will on-refer as required if it's out of their training/comfort zone.

    •  

      In WA there's a book, and an online version of a referral directory. If you aren't in it you basically don't exists. It lists all your sub interests and a bunch of other details. It's the best resource ever.

  •  

    I operate a small retail pharmacy. Within the group of shops in which my store is located there are several vacant shops (closed due to Covid downturn). I would like to attract a GP to the group as this would be beneficial to my script numbers. There was previously a GP in the center (single practitioner who closed the practice when he retired) and my clients complain about wait times and service at other local practices, so I assume the location and demand may support a GP.

    I've mentioned this to the managing agent who provided a "yeah that would be great wouldn't it" type response. I then put a proposal to the landlord stating I would be prepared to cover a portion of a GP's rent and or outgoings if they would specifically target GP's. The agent and landlord said "oh great idea" but basically did nothing to attempt to target GP's.

    After some months I then spoke to a consultant who agreed they would be able to assist me to target GPs but their fee is circa $165 per hour. I asked the landlord if they would consider sharing this cost (given the consultant may find a tenant for the landlord but I will also benefit by virtue of an uplift in script business) - they laughed me out the door and suggested they'd love me to spend my money on a consultant but they wouldn't be contributing to the cost. Out of principal I dont think its right that as a tenant I should be bearing the entirety of the cost to help find the landlord another tenant, so at this point I haven't proceeded.

    So - question is; the landlord seems content to preside over a 1/2 empty shopping center, the agent doesn't want to vary their marketing strategy, 9 months later several of the shops in the center are still vacant - within reason i'm prepared to do whatever it takes to get a GP into the group. Is me paying some/all of a GPs rent + outgoings something a GP would be interested in? If not - what can I do to encourage a GP to commence or expand their existing practice into the shopping center in which I operate?

    • +1 vote

      You want a practice to start up, or a GP? Sole gp practices are rare because they are are hard and time off is pretty much impossible without huge cost.
      Starting a new practice is hugely expansive and with a relative shortage of GPs not many people are will to start new ones in somewhere with high rent. Bottom line, you’d need to subsidise way more than you would get out of it, for the first few years.

  •  

    What is the salary progression for being a doctor?

    like 1st grad out of uni, then 2nd year, 3rd year etc etc then GP, GP 1st year, GP 2nd year

    thanks

    • +1 vote

      Pay rates are available online publicly via most state gov pages. WA salaried medical officer agreement is there; you can look at the rates for intern, resident 1 and 2 etc.
      After that GP really doesn’t have a pay rate. There’s a minimum ( around 85k PA) but you’d have concerns if anyone was earning that. It’s also usually a huge pay cut in your first few months to year.

  • -1 vote

    What's your knowledge about lifestyle medicine - diet/nutrition and exercise in terms on prevention/deferring many diseases?

    Are you conflicted in genuinely applying this (vs throwaway comment), because it would effectively change or do yourself out of your current job (and potentially not providing sufficient return on your investment/time studying/qualifying) of diagnosing and treating?

    PS: what is your daily diet and what exercise/movement do you undertake?