If you can’t beat ’em, embrace the single employer model

3 minute read

Raising the prestige of general practice in the minds of medical students is one of the biggest challenges for the colleges in addressing workforce.

During his tenure as head of a rural generalist training program, Dr Alam Yoosuff would reliably receive two to three calls each year with the same request from junior doctor supervisors.

“They always go something like this: ‘I’ve got a nice guy, but he’s not quite good for anaesthetics’,” Dr Yoosuff told delegates at TMR’s Burning GP conference last week.

“‘But he might be good for GP anaesthetics, why don’t you talk to him.’

“And then another fella will call me and say ‘I’ve got a guy who wants to do surgery but I don’t think he’s good for surgery – but he could do general practice’.”

It’s an insulting ritual based on the idea that general practice is only ever a second-choice specialty.

It is not unlike Professor Malin Fors’ theory of geographic narcissism, where clinicians in rural and regional areas are perceived as being sub-par.

Dr Yoosuff is perhaps best known as one of the leaders of the first single employer model pilot specifically aimed at GP registrars, which was run in the Murrumbidgee Local Health District.

Registrars on the pathway split their time between hospital and general practice training but receive all wages from NSW Health and accrue employee benefits like paid leave.

Following success in Murrumbidgee, there are now 80 places on a single employer pathway across NSW, and new trials of the same model have been announced in almost every state.

One of the key reasons for that success, according to Dr Yoosuff, is that it brings general practice up to the same level as non-GP specialist training.

“We have added hospitalist work and we have added skilled training positions to hospitals, but more than two thirds of work is done in private general practice,” he said.

“This is a model where state and federal can work together [and it] doesn’t decimate private practice.

“This is a model that attracts and entertains the Australian graduates who aren’t from rural clinical schools.”

Speaking at the same panel, Rural Doctors Association of Australia CEO Peta Rutherford said around 40% of registrars were interested in training under a single employer model.

Part of the reason for its popularity, she said, is its similarities to the hospital system most junior doctors will be familiar with.

“There are a lot of benefits around fatigue management, industrial support and what you get paid in [a state-run] single employer model,” Ms Rutherford said.

“And certainly one thing that our junior doctors, from a rural perspective, have struggled with is understanding what they going to be paid when they go into general practice.

“I think there’s a lot of negativity around that, about not having a clear vision of how much they’ll get paid … so the single employer model answers a lot of those questions for people.”

It’s the RDAA CEO’s position that the market will eventually determine whether single employer models sink or swim.

If practices refuse to participate, they effectively decrease their potential pool of registrars by 40%.

“I think if we have a mindset that the way we’ve been doing it for the last 50 years is the way we’ve got to take it forward, then general practice will just go further downwards,” said Ms Rutherford.

“I think we have to open our minds to doing things differently.”

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