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Rural general practice training in the Victorian Metropolitan Alliance

  1. Overview of rural general practice in the Victorian Metropolitan Alliance (VMA)
  2. The key features of rural general practice
    1. Comparison with metropolitan general practice
    2. Rural general practice – the ‘soft sell’
    3. RACGP definition of rural general practice
    4. ACRRM definition of Rural and Remote Medicine
    5. Australian Standard Geographical Classification – Remoteness Area (ASGC-RA)
  3. The key features of training in rural general practice in VMA
    1. GP Registrars
    2. Training posts
    3. VMA personnel for rural training
    4. Teaching and learning for rural general practice in VMA
  4. Overview of the rural context in Australian General Practice Training (AGPT)
    1. Where AGPT ‘fits’ in rural training
    2. Choice of pathway
    3. Choice of curriculum
    4. The 3-year program
    5. The 4-year program
    6. The ‘non rural’ rural pathway GPR and the ‘rural’ general pathway GPR
    7. Other options for GP training
  5. Terminologies – RACGP and ACRRM
    1. RACGP domains
    2. ACRRM domains
  6. Comparison of FRACGP (+/-FARGP) and FACRRM
  7. Comparison of location requirements for the rural and general pathways
  8. Training to FRACGP (+/- FARGP) and to FACRRM
    1. Common features
    2. Differences
  9. Requirements for the award of:
    1. FARGP
    2. FARGP – outline
    3. FARGP - details
    4. FACRRM
  10. Costs to GPR
  11. Training support for rural GPRs
    1. Training support for rural GPRs – outline
    2. Incentives for rural GPRs
  12. Structure of training meeting
  13. Rural training resources
    1. FARGP and FACRRM information, documents and forms

1. Overview of rural general practice training in VMA

Rural general practice training in the Victorian Metropolitan Alliance (VMA)?

The terms ‘rural’ and ‘metropolitan’ present a contradiction.However, these terms are compatible within the VMA training framework.VMA provides training posts and teaching which span the geography and the scope of rural general practice.

VMA provides training for rural pathway GP Registrars to the Royal Australian College of General Practitioners (RACGP) curriculum.VMA also provides training to the RACGP National Rural Faculty (NRF) Fellowship in Advanced Rural General Practice curriculum.Rural pathway GP Registrars exit the VMA training program with the Fellowship of the Royal Australian College of General Practitioners (FRACGP) and, optionally, with the Fellowship in Advanced Rural General Practice (FARGP).

General pathway GP Registrars may also enrol in FARGP.

VMA is developing a plan to introduce a program for training GP Registrars to the Australian College of Rural and Remote Medicine (ACRRM) curriculum.These GP Registrars will exit the VMA training program with the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM).The program for training to the ACRRM curriculum and the program for training to the RACGP and FARGP curricula will provide an ‘integrated rural training framework’ (IRTF) for VMA.

Practising rural medicine requires knowledge, skills and attitudes that address location, role in the community, communication, healthcare systems, clinical responsibility and scope of practice (including procedural practice, hospital care and extended skills).

There are differences between RACGP and ACRRM in terminology, curricula, training, assessment and accreditation.However, the differences are in approach and emphasis rather than in concepts.Training to FRACGP and FARGP and training to FACRRM are compatible within an IRTF.In future, GP Registrars may choose to complete ‘all three’ fellowships during their Australian General Practice Training (AGPT) program in VMA.


2. The key features of rural general practice

2.1. Comparison with metropolitan general practice

Compared to metropolitan general practice, rural general practice involves:

2.2. Rural general practice – the ‘soft sell’

What is rural?

One-third of the Australian population live outside urban areas.Compared to urban populations, rural populations have:

The Australian Standard Geographical Classification (ASGC) categorises rural locations in to ‘remoteness areas’ (RAs) according to distance from the nearest urban centre.This classification does not consider size of community, healthcare services or healthcare providers.

Rurality is diverse.Australia’s rural areas include, obviously, the coast, the mountains, the desert, the ‘bush’ and the ‘outback’.Rural populations are culturally diverse including Aboriginal people.Rural industries include farming, fishing, mining, manufacturing, tourism and service industries.

What is rural medicine?

Rural medicine is a diverse specialty.The required knowledge, skills and scope of practice are determined by location, community size and demographic factors.Wherever rural medicine is practised there are challenges and rewards - and a non-urban lifestyle.

The RACGP and ACRRM have defined rural general practice and rural and remote medicine respectively (see below).

The terms ‘rural general practice’, ‘rural and remote medicine’ and ‘rural medicine’ tend to be used synonymously and interchangeably – although they do reflect subtly different concepts as defined by RACGP and ACRRM.VMA uses the terms synonymously.

Rural medicine provides and requires a broad scope of practice.It presents a clinical environment in which GPs can practice a wide range of skills with a high level of clinical responsibility.It enables some clinical autonomy and clinical independence.

GP consultations are more complex across many domains (acute care, continuing care, chronic disease and prevention).There are opportunities or requirements for procedural practice (surgery, obstetrics and anaesthetics), emergency management and hospital-based care.

Rural medicine presents a wider spectrum of disease and later presentations of disease compared to urban-based general practice.Continuity of care can be facilitated as rural GPs can, for example, provide care for a patient through emergency presentation, hospital management and care in the community.Continuity of care is multidimensional – across families, across generations and over time.Compared to urban GPs who may be working in larger and less connected communities, rural GPs are able to get to know their patients very well – rural GPs can develop knowledge and understanding of patients, families, relationships and communities which can enhance the doctor-patient relationship, improve care and improve job satisfaction.

Rural GPs typically provide care for patients in the local hospital, managing emergencies, acute medical problems, surgery (emergency and elective) and obstetrics.Rural GPs have extended roles as generalists providing care that might otherwise be provided by specialists in urban areas (for example – palliative medicine, oncology (chemotherapy) and public health).

Advantages of rural general practice

As described above, rural general practice provides a broad scope of practice that is challenging, complex and rewarding, with opportunities for procedural work and hospital work and opportunities to use a wide range of clinical skills.Most regard these as very positive aspects of rural general practice.

Rural GPs are likely to be valued and respected as doctors and as members of their communities.In general, rural communities tend to be welcoming and friendly.Compared to urban areas there are less likely to be noise, crowds, traffic and pollution (and possibly less crime too).

There are lifestyle advantages to living in rural areas – these depend on the individual’s preferences and on the location (eg coastal, mountains, ‘bush’).

Rural GPs are likely to have higher incomes than urban GPs – this reflects a broader scope of practice, procedural work, hospital work, longer working hours (including ‘after-hours’) and rural incentive payments.

The skills acquired and required in rural general practice are also appropriate for working in Aboriginal health and for practising medicine in rural areas overseas and in the developing world.


Disadvantages of rural general practice

Work that is challenging and complex, high levels of clinical responsibility and clinical autonomy, procedural work, hospital work and long working hours may be regarded by some as negative aspects of general practice.

The disadvantages of rural general practice include perceived isolation (personal, professional and geographical), family concerns (partner’s wishes, values and opportunities (employment, social)), children’s education), and workload (long hours, after-hours, on-call, complex problems, emergencies).

Rural GPs may find it difficult to take time-off and to take holidays – they may perceive that they cannot ‘let down’ their communities by being unavailable or by taking leave.

Rural GPs and their families may perceive a lack of privacy and excessive community demands.Rural GPs and their families are likely to be well recognised and well-known in their communities – and although the positive aspects of this are friendliness and respect – the negative aspects are intrusion, gossip and unrealistic expectations.

Managing some of the disadvantages of rural general practice

Rural GPs can develop networks for professional and personal support via peers, colleagues and divisions of general practice.The Rural Medical Family Network (RMFN) provides strong support for rural GPs’ families.

Rural GPs are strongly encouraged to practise self-care and this includes planning time-off, study leave and holidays.There are supports via rural workforce agencies, divisions and other agencies for providing skilled locums for rural GPs.Rural GPs can develop strategies to ‘protect’ their time and their privacy.

Education in schools in rural areas can be as good as and better than education in schools in urban areas.

There are many models for working in rural medicine – eg part-time work, special interests, teaching, no hospital work, no procedural work – rural GPs do not have to subscribe to the so-called ‘superdoc’ phenomenon of ‘24/7 full featured rural medicine’ - including family medicine, hospital work, procedural work and on-call.

Summary

Rural medicine provides fantastic opportunities in professional experience and lifestyle.It is challenging and rewarding.However, rural medicine is not for everyone - for any number of personal, family and professional reasons.GPs who do not wish to pursue a career in rural medicine may wish to consider a rural attachment or rural locum work to experience some of the many wonderful opportunities of rural medicine – without committing to a long-term position as a rural GP.


2.3. RACGP definition of ‘rural general practice’:

“Rural general practice provides its own diversity of contexts and characteristics. In rural and remote Australia, geographical and demographic features lead to great diversity in both the ranges of presentations a general practitioner may encounter and the facilities that may be available to them to administer primary care. Research has shown that rural general practitioners are more likely to be able to provide in-hospital care as well as private consulting room care, to provide after hours services, to engage in public health roles expected of them by discrete communities in which there are few doctors to choose from, to engage in clinical procedures, to engage in emergency care, to encounter a higher burden of complex or chronic health presentations, and to encounter larger proportions of Aboriginal or Torres Strait Islander patients in their overall patient load.

The extent to which the GP will engage in any of these activities and roles, however, will depend entirely on the rural or remote context in which they choose to practice, or the range of general practice skills in which they wish to involve themselves. Some rural doctors in smaller rural towns, for instance, are based primarily at the local hospital, but the practice they conduct is still predominantly primary medical care, even though some secondary and, in cases, tertiary care is also possible due to the hospital facilities. Whilst their practice thus conforms to the core curriculum set for its Fellowship by the Royal Australian College of General Practitioners, it will also involve specific skills sets appropriate to the rural and/or remote health context in which they find themselves. These skills sets may be practiced at an extended or advanced level, depending on patient requirements. These characteristics and practices are supported by the RACGP Standards of Practice and a curriculum developed and maintained by the College and reflected in the Fellowship in Advanced Rural General Practice.”

(This definition supplements the RACGP’s definition of ‘general practice’ - a copy of this definition is available in ‘resources’)


2.4. ACRRM definition of Rural and Remote Medicine:

“Rural and Remote Medicine is typically delivered through private community based practice facilities and hospitals, however, it can also occur on roadsides, in remote clinics, jails, Aboriginal medical services or via telephone or e-health systems. It is one of the hallmarks of a rural and remote practitioner that they have highly developed clinical judgment and extended skill sets which allow them to safely care for patients in a variety of ways that would not be typical of general practitioners in more urban settings.This includes providing certain specialised areas of care such as surgery or obstetrics, and admitting and caring for adults and children in hospital (secondary) care settings.

The clinical scope, practices and values that characterise Rural and Remote Medicine within the medical specialty of general practice are outlined in the curricula and professional standards that are set and maintained by ACRRM.

General practitioners who achieve these standards are recognised through the award of Fellowship of ACRRM.Fellows of ACRRM receive full vocational recognition and are able to practise in any location throughout Australia.”

2.5. Australian Standard Geographical Classification (ASGC)

The ASGC is a geographical classification system which defines Remoteness Areas (RAs).There are 5 RAs based on distance from the nearest urban centre.This system does not consider the population size and health services in a rural or remote community.

Many Rural Health Workforce Strategy incentives are based on RA categories.

RA categories are broadly defined as follows:

Category

Definition

RA1

major cities

RA2

inner regional

RA3

outer regional

RA4

remote

RA5

very remote

The ASGC-RA system was introduced in 2009.It replaced the ‘rural, remote and metropolitan area’ (RRMA) classification system which defined seven categories ranging from RRMA 1 (capital cities) to RRMA 7 (small remote centres).Many rural areas (RRMA 3-5) have been re-classified as inner regional areas (RA2) – consequently GPs in working in these areas have had a reduction in their incentive payments.

3. The key features of training in rural general practice in VMA

3.1. GP Registrars

GP Registrars can train in rural general practice posts irrespective of pathway or curriculum.

Rural pathway GP Registrars must complete all of their general practice term training (or primary rural and remote training) in posts that are in ‘Remoteness Areas 2 to 5 (inner regional, outer regional, remote or very remote)’ (RA2-5) – that is not in RA1 (major cities).

Although strongly encouraged to do so, rural pathway GP Registrars do not need to complete a fourth year in the AGPT program in advanced training and they do not need to train to FARGP and/or FACRRM.Rural pathway registrars can exit the AGPT program after three years with FRACGP and vocational registration (although any moratorium restrictions will apply).

General pathway registrars can choose to complete a fourth year in the AGPT program in advanced training posts and train to FARGP (provided that they have completed at least 12 months general practice training in a rural area) and/or to FACRRM (provided that they meet ACRRM’s requirements for training and assessment).

GP Registrars are encouraged to contact the rural coordinator to discuss their options and applications for posts in rural general practice and advanced training.

3.2. Training posts

VMA has eight RACGP accredited rural training posts for GP terms at general practices in the following locations:

These posts are all in ‘Remoteness Area category 2’ (RA2).

Currently, VMA does not have any posts that are ACRRM accredited for primary rural and remote training.

However, a current ACRRM consultation document proposes that RA1 posts may be accredited for six months of primary rural and remote training and non-procedural RA2 posts (such as VMA’s RA2 posts) may be accredited for up to 18 months of primary rural and remote training.If ACRRM endorses this proposal then VMA may be able to provide up to 18 months of the required 24 months of primary rural and remote training for the ACRRM curriculum.GP Registrars who are interested in training to the ACRRM curriculum should contact VMA’s rural coordinator to discuss this.

GP Registrars who wish to do some or all of their training in non-VMA rural general practices should contact the relevant Regional Training Provider (RTP) or Regional Training Network (RTN) to request information about available posts and to submit applications.

A GP Registrar who has accepted a position in a non-VMA rural general practice is required to ‘transfer’ to the relevant RTP or RTN – either temporarily (for the duration of the position) or permanently.

An ‘Application for Registrar Transfer’ form must be completed.The transfer needs to be approved by the CEO of VMA, by the CEO of the other RTP or RTN, and by GPET.Transfers are governed by the AGPT ‘Transfer Policy’.

A transferred GP Registrar follows the relevant RTP or RTN’s training program (including external clinical teaching visits (ECTVs) and workshops).A transferred GP Registrar is not required to participate in any VMA training activities (eg teaching visits, workshops and Weekend Educational Series sessions (WESs)) for the duration of the transfer.

VMA has access to Victorian Department of Health funded posts for advanced rural skills training (ARST) and advanced specialised training (AST) in obstetrics, anaesthetics and emergency medicine.Posts available in Melbourne and Geelong are listed below.(There are many other posts available in regional areas of Victoria – VMA has a database of these posts and VMA can access these posts for GP registrars).

GP Registrars should apply directly to the relevant hospital or health service.GP Registrars should advise VMA of their applications and of the post once this has been accepted.

GP Registrars may apply for other posts that are eligible for ARST or AST.GP Registrars should advise VMA of their applications and of the post once this has been accepted.

VMA manages applications and training for ARST and AST posts in the VMA region for GPRs who are enrolled in AGPT with RTPs other than VMA.

VMA does not manage applications and training for ARST and AST posts in the VMA region for doctors who are not enrolled in AGPT.In other States, Health Departments have contracted with RTPs to manage these posts for non-AGPT doctors.This is not the case in Victoria.Doctors who are not enrolled in AGPT should apply directly to the relevant health service.


Through networks and collaborations with rurally based Regional Training Providers and Rural Training Networks, VMA provides access to a range of general practice posts and hospital based posts in rural areas.

VMA has a database of all ACRRM accredited Advanced Specialised Training posts and Primary Rural and Remote Training posts.VMA can facilitate a GP registrar’s application for one of these posts.

Currently, VMA will not be able to provide training to ACRRM in one of these posts – however, VMA will provide training to FRACGP and FARGP in these posts (except for posts that are not co-accredited by RACGP) or VMA can help to organise a transfer to another Regional Training Provider.


To provide more training opportunities for rural general practice, VMA is developing alliances with the following:

3.3. VMA personnel for rural training

Andrew Baird (rural coordinator) is the medical educator with responsibility for rural training in VMA.

VMA is developing a ‘rural portfolio’ for a GP Registrar Liaison Officer (RLO).

VMA will train a VMA administrator for the role of ‘Administrator (rural training)’ as the VMA’s ‘point of contact’ for rural GP Registrars and for enquiries about rural issues.

3.4. Teaching and learning for rural general practice in VMA

Compared to the Curriculum for Australian General Practice, most of the additional components for training and assessment for FARGP and FACRRM are practice-based and related to clinical experience.GP Registrars, GP Supervisors and Medical Educators need to be familiar with the relevant curricula to ensure that learning objectives are met through experience and through teaching in their rural training posts.

Peer Learning Workshops (PLWs), Weekend Educational Series sessions (WESs) and Catch-up Program modules (CUPs) incorporate a rural perspective on topics where relevant.

One WES session may be developed exclusively for rural GP Registrars using an online learning environment as this is convenient and efficient and it models an appropriate mode of learning for GPs practising in rural or remote areas.The content of a rural WES session may include emergency management, hospital-based management, retrievals, clinical networking, tele-health (and other communication relevant to rural practice), role in the community and issues in self-care, family, and work-life balance.


VMA will fund rural GP Registrars to attend one or more procedural medicine programs/emergency skills courses delivered by external education providers.For example:

4. Overview of the rural context in Australian General Practice Training (AGPT)

4.1. Where AGPT ‘fits’ in rural training

Irrespective of pathway, curriculum and program duration, successful completion of AGPT certifies competence for unsupervised unrestricted general practice throughout Australia.This includes practice in metropolitan, regional, rural and remote areas.

Many general practitioners who practise in non-metropolitan areas will complete further training to develop skills that are relevant to the scope of rural medicine.To complete training posts for the full range of skills for rural medicine would take at least eight years – for example 12 months of emergency medicine, 12 months of obstetrics, 12 months of anaesthetics, 24 months of general surgery, 12 months of adult medicine, 12 months of paediatric medicine and 12 months in ‘special interest’ areas (eg Aboriginal health, mental health, remote medicine or palliative medicine).

However, most general practitioners will complete further training in perhaps two or three of these areas during their careers.General practitioners will also acquire skills in many of these areas in the course of their experience in rural medicine – without completing formal training posts in those areas.

The AGPT program enables GP Registrars to complete 12 months of training as the ‘fourth year’ of AGPT in posts that are relevant to rural medicine.This training is described by ACRRM as ‘advanced specialised training’ and by RACGP as ‘advanced rural skills training’.

After completing AGPT and obtaining fellowship, general practitioners may choose to complete further training in posts that are relevant to rural medicine.These posts are arranged directly by general practitioners who apply for relevant posts in hospitals or health services.

There are programs to support general practitioners who wish to train in procedural medicine – principally, the (competitive) General Practitioner Procedural Training Support Program (GPPTSP) which provides a subsidy of $40,000 for general practitioners who wish to train in anaesthetics (in an AST or ARST post) or in obstetrics (to DRANZCOG ‘advanced’ level).GP Registrars may be eligible to apply for a subsidy in the GPPTSP.

The Rural Procedural Grants Program (RPGP) provides funding for educational activities and clinical attachments for rural proceduralists to maintain or upgrade their skills (in anaesthetics, obstetrics, surgery or emergency medicine).The RPGP does not provide funding for initial training in procedural medicine.

4.2. Choice of ‘pathway’

Medical practitioners can choose to apply for vocational training in general practice via the general pathway or the rural pathway provided that they satisfy both of the following conditions:

  1. basic (primary) medical training completed at an Australian medical school
  2. Australian citizen or Australian permanent resident when started basic (primary) medical training

Other medical practitioners (overseas trained or trained in Australia as an international student) are restricted to vocational training in general practice via the rural pathway and the 10-year moratorium applies.The ‘clock’ for the 10 year moratorium starts when the medical practitioner first obtained, or first obtains, registration with the Medical Board of Australia (or with a State or Territory Medical Board prior to 1 July 2010). There are exceptions to the moratorium eg, medical practitioners who obtained full registration with an Australian Medical Board before 1997 are not subject to the moratorium.

The duration of the moratorium may be reduced (by ‘scaling’) for GP Registrars and GPs who practice in rural areas – further information is provided on the DoctorConnect website (www.doctorconnect.gov.au)

4.3. Choice of curriculum

GP Registrars can choose to train to either the ACRRM curriculum or to the RACGP curriculum or to both curricula (irrespective of pathway).GP Registrars must train in posts that are accredited by the relevant colleges.Currently, VMA does not provide training to the ACRRM curriculum.

Both FRACGP and FACRRM certify competence for unsupervised general practice throughout Australia – including metropolitan and rural settings.

4.4. The 3-year training program

GP Registrars can exit from either pathway with FRACGP and vocational registration after three years of training (or less with ‘recognition of prior learning’ (RPL)).

It is possible for rural pathway GP Registrars to exit from AGPT after three years with FRACGP and vocational registration.However, any moratorium restrictions still apply, and all general practice training must be completed in RA2-RA5.

4.5. The 4-year training program

GP Registrars who have trained to the RACGP curriculum can do a further 12 months of training in advanced rural skills posts, complete four years of training (or less with RPL) and complete the FARGP.

GP Registrars who are training to the ACRRM curriculum must complete four years of training (or less with RPL) and complete FACRRM in order to exit the AGPT with vocational registration.

The 4 year training program is for GP Registrars who are training to FRACGP+FARGP, or FACRRM, or FRACGP+FARGP and FACRRM – irrespective of their training pathway (ie general or rural).


4.6. The ‘non rural’ rural pathway GP Registrar and the ‘rural’ general pathway GP Registrar

It is acknowledged that a GP Registrar may choose to train in the rural pathway or be required to train in the rural pathway - without intending to practise in rural medicine beyond completion of the AGPT program or beyond any moratorium requirements.Such GP Registrars may elect to exit AGPT with FRACGP after 3 years of training.Although such GP Registrars are following the ‘rural pathway’ for AGPT, their attitudes and intentions may not have a rural focus.They will be encouraged and supported to pursue a career in rural medicine.

Conversely, a GP Registrar may choose to train in the general pathway with the intention of maintaining an option to practice in rural medicine after completing the AGPT program.In VMA, such GP Registrars will be encouraged to consider training to FARGP (and/or to FACRRM when training for this can be provided in VMA).

4.7. Other options for GP training

AGPT is not the only option for GP training.Medical practitioners can also train in general practice via the Remote Vocational Training Scheme (RVTS), via the specialist training pathway and by independent practice-based assessment.

5. Terminologies – ‘near equivalents’ for ACRRM and RACGP

ACRRM

RACGP

Rural and Remote Medicine

Rural general practice

Rural Medical Generalist (RMG)

Rural general practitioner (Rural GP)

Core Clinical Training (CCT)

Hospital Term training (HTT)

Primary Rural & Remote Training (PRRT)

General Practice Term (GPT) training

Advanced Specialised Training (AST)

Advanced Rural Skills Training (ARST)

Primary Curriculum (CCT+PRRT)

Curriculum for Australian General Practice

Advanced Curricula (AST)

i)Advanced Rural Skills Training Curricula

ii) FARGP Curriculum

MiniCEX (Mini Clinical Evaluation Exercises)

ECTV

StAMPS (Structured assessment using multiple patient scenarios)

OSCE

7 domains*

5 domains

5.1. RACGP domains:

  1. Communication skills and the patient-doctor relationship
  2. Applied professional knowledge and skills
  3. Population health and the context of general practice
  4. Professional and ethical role
  5. Organisational and legal dimensions

5.2. ACRRM domains:

  1. Core clinical knowledge and skills
  2. Extended clinical practice
  3. Emergency care in generalist practice
  4. Population health
  5. Aboriginal and Torres Strait Islander (ATSI) health in generalist practice
  6. Professional, legal and ethical practice
  7. Rural and remote context

* Compared to the RACGP domains, ACRRM adds ‘extended clinical practice’, ‘emergency care in generalist practice’, ‘ATSI in general practice’ and ‘Rural and remote context’.ACRRM does not include ‘communication’ as a separate domain

6. Comparison of FRACGP(+/-FARGP) and FACRRM

Training for FRACGP (+/- FARGP) requires a minimum of 12 months of hospital term training (HTT).This can be started at any time after completing the intern year.There are no geographical requirements for HTT.HTT must be completed before starting general practice terms.The intern year plus HTT must cover a minimum of seven rotations in disciplines related to general practice of which general surgery, general medicine, emergency medicine and paediatrics are mandatory. These rotations must have been in Australian Postgraduate Medical Council accredited posts.

Training for FACRRM requires a minimum of 12 months of core clinical training (CCT).This can be started at any time after completing the intern year.There are no geographical requirements for CCT (although the hospital must be accredited by ACRRM.ACRRM accepts Postgraduate Medical Council (PMC) accreditation as a proxy for ACRRM accreditation).CCT must be completed before starting primary rural and remote training.The intern year plus CCT must cover rotations in general medicine, general surgery, emergency, paediatrics, obstetrics and anaesthetics.These rotations must have been in Australian Postgraduate Medical Council accredited posts.Note that obstetrics and anaesthetics are not required for training for FRACGP.

A rotation is usually 13 weeks – but as little as 10 weeks is acceptable. ‘Rotation’ and ‘term’ are synonymous.

Once HTT or CCT has been completed, a GPR progresses in AGPT as follows:

RACGP:


ACRRM:

7. Comparison of location requirements for the general pathway and the rural pathway

General pathway GPRs must complete either 12 months of general practice training in a rural area (RA2-RA5) or an outer metropolitan area or 6 months of general practice training in a rural area (RA2-RA5) and 6 months of general practice training in an outer metropolitan area.

For rural pathway GPRs, all general practice training (GPT1-4 (RACGP) or PRRT (ACRRM)) must be completed in posts located in RA2-RA5.

For PRRT, GPRs may work in ACRRM accredited general practices, hospitals, Aboriginal Community Controlled Health Services, or RFDS posts – that is, not just ‘general practice’.For PRRT, ACRRM accredits posts, not facilities (eg a ‘post’ could include working at a private general practice and at an associated hospital)

8. Training to FRACGP + FARGP and training to FACRRM:

8.1. Common features

8.2. Differences


9. Requirements for the award of:

9.1. FARGP

9.1.1 FARGP – outline

There is no summative assessment and there is no examination for FARGP.

9.1.2 FARGP - details

FARGP was revised in 2012.

GPRs who undertake FARGP nominate a medical educator (or FARGP mentor) as their supervisor.

The ‘learning and educational assessment portfolio’ (LEAP) has been replaced by a ‘learning plan’ which is based on similar principles to the VMA learning plan.The learning plan is completed online (via gplearning).GPRs review the plan with their medical educator (or FARGP mentor) four times during the course of their FARGP.

The core module, ‘Working in rural general practice’, has been replaced by a single six-month community based ‘Working in rural general practice’ project on a topic selected by the GPR.A GPR should complete the project during his or her GP placements – and the project should be relevant to the local community. Resources for this project are provided via gplearning. GPRs who have completed postgraduate studies in public health, Aboriginal health, health promotion or other relevant courses may apply for an exemption from the requirement to complete this project.

The core module, ‘Emergency medicine’ has been replaced by ‘Emergency medicine activities’.A GPR is required to attend two advanced emergency medicine courses (eg EMST, ALS, ALSO, APLS, CEPM (Advanced)) – note that VMA will provide funding for a FARGP GPR to attend two of these courses. A GPR is also required to complete a ‘skills audit’ and an ‘analysis of four emergency medicine case studies’.A GPR who has completed the Certificate of the Australian College of Emergency Medicine is exempt from the requirement to complete ‘Emergency medicine activities’.


Advanced Rural Skills Training (ARST)

A core requirement of the FARGP is the completion of 12 months of advanced rural skills training in an accredited training post. A GPR who completes a relevant ARST before enrolling in the FARGP will have their training recognised and will not have to complete further training.

ARST posts (procedural)

ARST posts (non-procedural)

ARST posts (other – on approval of Rural Censor, National Rural Faculty, RACGP.Criteria for approval include caseload, supervision, curriculum and/or learning plan)

The STRGP curriculum was revised in 2012.A GPR is required to complete a set of activities and a 12-month community based project.Alternatively, a GPR can complete the set activities, a 6-month community based project, and six months of other ARST.A GPR who completes STRGP is exempt from the requirement to complete the ‘Working in rural general practice’ project.

There is no longer a requirement to complete 160 hours of self-directed educational activities.

9.2. FACRRM

10. Costs to GPR

RACGP

Membership:

FRACGP exam fee:

FARGP fee:

ACRRM

Membership:

PRRT (MSF, miniCEX, StAMPS, MCQ)

AST (project, miniCEX or StAMPS)

DRANZCOG (advanced – training and certification):

Joint Consultative Committee on Anaesthetics (JCCA):

Costs to GPR

ITEM

RACGP ($)

ACRRM ($)

Membership (Registrar) per annum

330

275

Membership (Fellow) per annum

1050

995

PRRT exam

-

4852

AST (per AST, excluding obstetrics and anaesthetics)

-

1100 - 1800

FRACGP

6460

-

FARGP (RTP pays $250)

0

-

+/- JCCA (anaesthetics)

0

0

+/- DRANZCOG (advanced)

495

495

11. Training support for rural GPRs

11.1 Training support for rural GPRs - outline

GP Registrars who are training in a rural post (irrespective of pathway and curriculum) will meet with the rural coordinator every three months.The initial visit in each GP term and ARST post will be ‘face-to-face on-site’ at the GP Registrar’s practice or hospital.Other visits (including hospital terms) may be by phone or videoconference.All visits will be structured and documented

11.2 Incentives for rural GPRs

The Rural Health Workforce Strategy (RHWS) provides incentives for GPRs and for GPs who work in rural areas.Detailed information is available at the following websites:

The following RHWS incentives are available to GPRs who train in rural areas:

General Practice Rural Incentive Program (GPRIP) – Registrar component

Payments are scaled by location (RA category), by training time in the relevant location and by workload (the maximum payments are based on billing Medicare > $20,000 per quarter – although there is a ‘flexible payments system’ for GPs who do not bill via Medicare (eg RFDS, Aboriginal Medical Services, State-employed Medical Officers)).Payments are made 12-monthly – although GPRs working in RA3-5 will receive a first payment after 6-months.

Although GPRIP defines a ‘Registrar component’ and a ‘GP component’ – payments for these components are identical.

Training time in eligible locations under GPRIP will be counted towards the year level for payment under the GP component of GPRIP for post-AGPT GPs who continue to work in rural areas (that is, GPs who continue to work in rural areas do not ‘go back’ to ‘year 0’ on completing AGPT with regard to the GP component of GPRIP)

General pathway and rural pathway GPRs are eligible for equal payments under GPRIP.

GPRs should contact the GPRIP hotline ((02) 6263 6707) to confirm their eligibility.GPET will contact GPRs at the end of each eligible training placement to confirm that training records are correct.GPRs should confirm that this information is correct by replying to GPRIPadministrator@gpet.com.au. GPRs should complete a ‘bank details’ form (to enable payments) and send this to Medicare Australia.

The following table provides examples of GPRIP annual payments according to RA category and to time worked in the relevant RA.


Rural area

Annual payment after 1 year

Annual payment after 5 years

RA2

$2,500

$12,500

RA3

$10,000

$18,000

RA5

$21,000

$47,000

The following table (from www.doctorconnect.gov.au) shows the full schedule of GPRIP payments.

RA location

Practice time in rural and remote location

0.5 year

1 year

2 years

3-4 years

5+ years

Other

-

$2,500

$4,500

$7,500

$12,000

RA2 (Inner Regional)

-

$2,500

$4,500

$7,500

$12,000

RA3 (Outer Regional)

$4,000

$6,000

$8,000

$13,000

$18,000

RA4 (Remote)

$5,500

$8,000

$13,000

$18,000

$27,000

RA5 (Very Remote)

$8,000

$13,000

$18,000

$27,000

$47,000

GPRIP was introduced in July 2010.It replaced the complex (and lucrative) Registrar Rural Incentive Payment Scheme (RRIPS).GPRs who started AGPT before 1 July 2010 and who submitted relevant RRIPS paperwork before 31 December 2011 will be eligible for ongoing RRIPS payments until 31 December 2012 (under a ‘grandparenting’ arrangement).GPRs who receive payments under RRIPS will cease to be eligible for these payments once they complete AGPT – or if they ‘opt out’ of RRIPS (as some GPRs may be advantaged by changing from RRIPS to GPRIP).Training time for a GPR who received payments under RRIPS will count towards the year level for payment under the GP component of GPRIP if the GPR continues to work in rural areas after completing AGPT.

Rural pathway GPRs who worked in RRMA 3 to RRMA 7 were eligible for RRIPS. From 2008, and after a qualifying period of six months, general pathway GPRs who worked in RRMA 3 to RRMA 7 were also eligible for RRIPS.

To add to the complexity of RRIPS, payments were based on 5 categories of ‘remoteness’ (A-E) defined by the GPARIA classification (GP Accessibility Remoteness Index of Australia) – the categories roughly mapped to the five categories in RRMA 3 – RRMA 7

HECS reimbursement


GP Procedural Training Support Program (GPPTSP)

Rural Procedural Grants Program (RPGP)

CPD for Rural GP – subsidy program

Accommodation subsidy

Reduction in moratorium restriction

12. Structure of training meeting.

Organisational

Professional training

Personal support.


13.Rural training resources

13.1. AGPT, FARGP and FACRRM information, documents and forms (all are also freely available from the following websites)

Royal Australian College of General Practitioners:www.racgp.org.au

Australian College of Rural and Remote Medicine:www.acrrm.org.au

Australian General Practice Training:www.agpt.com.au

Doctor Connect:www.doctorconnect.gov.au

General

GPRIP

FARGP

For further information, contact the National Rural Faculty, RACGP.

T: 1800 636 764

e: fargp@racgp.org.au

w: www.racgp.org.au/fargp

FACRRM