How GP training in a rural setting makes you a better doctor

After more than half a decade of undergraduate medical education and years working in a hospital or health service setting, you’ve reached this point – applying for specialty training. As you weigh up your options, ask yourself, ‘what kind of doctor do I want to be?’.

If you got into medicine because you love a challenge and you want to make a real difference, learn from current registrars and fellows about how undertaking the Australian General Practice Training (AGPT) program in North Western Queensland can shape you into an exceptional specialist.

From the rugged Outback to the Tropical coastline, our diverse training region covers all of Queensland except for the South East, and offers a unique training experience. Registrars in our region all have their own story to tell, but there is a common thread tying them together: the scope of practice you get as a rural GP is unbeatable, and you’re more competent, confident, and fulfilled because of it.

Just ask Dr Steve Salleras, a GP with 21 years’ experience practising in Far North Queensland and Medical Educator with James Cook University (JCU).

“Guaranteed, rural and remote medicine will make you a better doctor,” Dr Salleras says. “You’ll learn resilience and self-efficacy at a level you cannot learn in an urban environment.”

General practice specialty training commences through AGPT from PGY2 and it takes three years to complete full-time. It’s a shorter training pathway that’s available to you earlier than most other specialties, but don’t be fooled into thinking that makes it the ‘easy choice’. General practice is challenging, just as it is rewarding.

“It’s a hard job,” Dr Salleras says. “Even now I don’t have ‘neat and compact’ days where everything is easy. But I didn’t become a doctor looking for easy. The challenging and unexpected aspects of rural medicine are part of why it is so satisfying.

“As far as living a life of purpose, meaning, and connection, rural general practice ticks all those boxes in a big way,” Dr Salleras says.

From what Dr Salleras has seen in his role training JCU GP registrars in Cairns and surrounds, the broad scope of practice and the challenges of limited resources are part of the formula for rapid skills development and knowledge.

“As a rurally based GP registrar, you’re exposed to a range of cases, and you could be involved in the whole system in terms of service delivery. It brings a perspective and habits that can be really helpful in reducing barriers for your patients,” Dr Salleras says.

Broaden your horizons with a broad scope of practice

Are you considering general practice training because of the diversity of presentations and broad scope of practice? Not all GP training experiences are created equal. Rural practice offers more diversity and responsibility than you could probably expect in an urban setting.

One young doctor who can attest to this is Dr Daniel Bakhsh, a JCU GP registrar from Melbourne who has recently taken up a training post in Tully, 140km south of Cairns. Only a few months into his GP-based training, Dr Bakhsh is already feeling like he is right where he needs to be.

"In metropolitan and tertiary centres, GP registrars often feel more like referral centres for hospitals, and that your role is largely administrative in the context of a medical team. You don't really have the opportunity to grow and develop as a clinician,” Dr Bakhsh says.

“Even as a relatively new rural-training registrar, I've already been able to undertake procedures, manage complex patients and make significant medical decisions for my patients, under the supportive guidance of my GP supervisor, who has a vested interest in the health and wellbeing of their community,” Dr Bakhsh says.

For Dr Bakhsh, the experience he is receiving at the town’s only general practice can be summed up simply as ‘this is why I became a doctor’.

“I'm engaging with medicine in a really meaningful way, and finally directly applying the skills and knowledge I've acquired over the past several years of training to better the health of my patients. It's incredibly gratifying,” Dr Daniel Bakhsh says.

Experience the best of both worlds as a rural generalist

Do you like to be in the middle of the action? Rural GP training gives you the opportunity for you to provide continuity of care while keeping your connection with a hospital. The Rural Generalist Pathway combines the provision of community-based GP services as well as hospital-based specialised services such as obstetrics, anaesthetics, and emergency medicine.

As a Rural Generalist, you can call the shots and experience real variety. ACRRM Fellow and rural generalist Dr Emma Gillmore moved to North West Queensland in 2018 to complete GP training with JCU. She says Cloncurry offers a broad scope of practice and diverse patient caseload, which provides the perfect opportunity for junior doctors to fast-track their growth and competency.

“There’s only a couple of us in town, so if you’re on call then whatever comes through the door, you’re the doctor who handles it. The other day, a patient needed a lateral canthotomy, which is a really rare procedure. Another doctor and I performed the procedure, and it’s not something we would get the opportunity to do in a larger tertiary hospital setting,” Dr Gillmore says.

“You see a lot of patients with significant chronic diseases that you wouldn't necessarily see in city areas. You manage everything out here. You manage strokes, heart attacks, car accidents, paediatric issues, gout, arthritis. You’re the rural GP, it’s up to you," Dr Gillmore says.

Working rural can advance your career

With a less competitive training environment compared to larger settings, GP registrars, like Dr Shane Sadleir, have discovered plenty of opportunities for professional development in a rural setting. Just a year into training in Cooktown, he’s taken on a clinical lead role as Senior Medical Officer with the Torres and Cape Renal Unit at the hospital.

“I’m really enjoying the role and the added responsibilities. You get a lot of diversity, and your day is so different and often quite exciting,” Dr Sadleir says.

It’s a similar story for Dr Welwyn Aw-Yong in Barcaldine. The ACRRM Fellow completed his JCU GP training in 2020 alongside his wife Dr Priscilla Aw-Yong. They chose to stay in Barcaldine, and they’ve been embraced by the medical and broader communities. Welwyn is now the Acting Director of Medical Services at Barcaldine Hospital, in addition to his work at the nearby Barcaldine Medical Centre.

“Barcaldine is the type of place where you have to think on your feet. Sometimes there might not be anybody else; you can’t just refer them ‘down the road’,” he says. “You do all these investigations and emergency procedures yourself, particularly as you get into advanced skills training. You have this really broad scope of practice and that is very rewarding.”

Advanced skills training opens doors and contributes to healthier communities

Another element of general practice training that can make you a better all-round doctor is advanced skills training. Advanced skills are focused on enhancing the procedural and clinical services GPs can provide in non-urban settings. For ACRRM registrars and registrars completing a Fellowship in Advanced Rural General Practice (FARGP) through RACGP, advanced skills training is a compulsory requirement.

A wide range of Advanced Specialised Training (AST) for ACRRM registrars, or Advanced Rural Skills Training (ARST) for RACGP registrars, includes:

• Aboriginal and Torres Strait Islander Health
• Academic Practice
• Adult Internal Medicine
• Anaesthetics
• Emergency Medicine
• Mental Health
• Obstetrics and Gynaecology
• Paediatrics
• Palliative Care
• Population Health
• Remote Medicine
• Surgery

Dr Erica West is a JCU GP registrar on the rural generalist pathway who chose to do advanced skills in paediatrics.

“This advanced skill allows me to practise medicine in an acute setting as well as focusing on preventative health and health education to help grow stronger and healthier future generations,” Dr Erica West says.

In a vast region with far-flung remote communities, the hospital and health services in Mount Isa play a crucial role in meeting the health needs of a population of approximately 32,000 people across 300,000 square kilometres.

“I would encourage other GP registrars to go rural and do advanced skills, purely for the fact that you get a lot more experience in an area where you get to develop your interests and become very useful. It’s a lot of fun to get more involved in one area, but it doesn’t take away from any other areas that you get into in rural generalism,” Dr West says.

So, are you up for the challenge?

General practice training in North Queensland is challenging and rewarding, and it can help unlock your full potential as a doctor. Dr Salleras sums it all up in these terms:

“In our world of medicine, it’s crucial we have people working at their maximum capacity. People have an enormous capacity, but they’re often underperforming because of the system they’re in. It causes burnout because it’s frustrating, not to mention an incredible waste of resources.

“Compare that to rural medicine, where you will be stretched and tested in a way that grows your skills and competency. You’re much more likely to be using your full capacity in rural practice,” Dr Salleras says.

The Australian General Practice Training (AGPT) program is opening its second recruitment intake for 2023, providing 1,500 Australian Government-funded places for registrars to attain a GP fellowship.