This article was originally published in VicDoc Winter 2021 edition. Introduction by Dr Ines Rio (Chair of our Board) and report by Victorian PGY3 Doctor AMA member.
Introduction – by Ines Rio
After hearing of recurrent concerns in conditions and pay for GP registrars, in 2018 the AMA Victoria Section of GP passed a motion calling for GP registrar equity in conditions and remuneration compared with non GP registrars.
On behalf of the section, I then shepherded this to the AMA Federal GP Council, who along with the Federal Council of Doctors-in-Training, supported the principle.
This was then supported by over 95 per cent of delegates when passed as a motion at the 2019 AMA Conference. AMA Federal has since been actively advocating for GP registrar equity in pay and conditions.
However, this cannot come out of the pocket of general practice. It must be funded by government. It is a fundamental element of ensuring a viable general practice and the reorientation of resources required for general practice.
There is an overwhelming evidence base that this rebalancing would result in more equitable, more comprehensive, more affordable and better healthcare outcomes.
There have been recent reports that over 30 per cent of GP registrars now do second jobs in order make up for the lost income in moving from hospital to general practice settings.
The following article was written by a friend’s daughter. She wants to enter GP training, but for the moment the barriers are just too much.
Why I am deferring GP training – by Victorian PGY3 Doctor AMA member
I applied for and studied medicine with the intention of working in general practice, so it is hard to believe that I am now delaying applying for my preferred training pathway because I genuinely believe I am better off in the public hospital system than in GP training.
Despite the many workplace issues faced by public hospital doctors-in-training (DiTs), the EBA (Victorian Public Health Sector — Doctors in Training Enterprise Agreement 2018-2021) is largely protective of its subjects.
It defines certain minimum entitlements for DiTs, and serves to safeguard junior doctors’ rights within the hierarchical structure of the public hospital. Conversely, GPs-in-training (GPiTs) are not afforded similar protection by the equivalent (but in no way comparable) document, the NTCER (National Terms and Conditions for the Employment of Registrars).
The NTCER is a non-enforceable guideline outlining the minimum employment terms and conditions for GP registrars. It reads as a defensive document designed to empower GPs as employers and small businesses, and risks leaving GPiTs vulnerable to unfair working arrangements and exploitation.
There is a culture among junior doctors to “grin and bear it”, rather than speak up about the issues that affect us.
This is why junior doctors find ourselves in unsafe clinical situations for which we are ill-equipped; why we work excessive amounts of overtime; and why we go through the onerous task of reapplying for 12 month employment contracts every year.
But staying silent does not facilitate change, and change is what is needed for GPiTs and the NTCER.
I am a PGY3 resident currently working in a tertiary public hospital in metropolitan Melbourne. Having had my first child at the end of medical school, I applied for and was allowed to complete my internship part-time over two years as part of a job-sharing arrangement.
I have since worked full-time in an effort to gain experience in a range of areas that I see as important and relevant to a future career in general practice, and I am due to take several months’ maternity leave for the birth of my second child in the coming months.
I have to stop myself from writing, “I am lucky to have been afforded flexibility” in favour of writing, “I am covered by an award that has entitled me to fair and flexible working arrangements”! However, the situation in general practices is far more dire.
Once I leave the public hospital system and enter GP training, I lose very significant rights and remuneration.
I commit to several years of even worse job insecurity (due to sixmonth employment contracts for GP registrars), a substantial salary reduction (and an end to penalty rates and salary packaging privileges), hazy/non-existent parental leave entitlements and a reduction in leave flexibility.
My experience is not unique. My concerns are shared by other prevocational doctors looking to enter GP training, current GP registrars and recently fellowed GPs.
I am hopeful the AMA’s advocacy for GP registrars in remuneration and rights compared with hospital registrars via a single employer model might mitigate some of these issues which undoubtedly contribute to the declining interest in GP training.
Further, I hope the GP training policy and workplace landscape develops to provide the incentives needed for general practice to be the specialty of choice for more trainees, and for a greater recognition of the vital role GPiTs play in our healthcare system.
I and others wait with anticipation for this, so that we can enter and complete training in our preferred speciality of general practice.