Last Saturday, I sat the Royal Australian College of General Practitioners (RACGP) written examination for the fellowship. Now, I have only the clinical examination in May 2007 and assuming that I pass both and gain my fellowship, I will technically be a GP.
Although I am glad that one hurdle is past, I can only say that the written examination was long and painful, and in my humble opinion, unduly so. It was in two parts; a three hour short answer paper in the morning, followed by a four hour multiple choice paper in the afternoon. One has to question whether a seven hour examination actually provides any more information than something that is shorter.
Then, there were the entirely stupid questions like the multiple choice question asking for the antibiotic of choice for Legionella pneumonia. Frankly, if one of my patients had Legionella, the local public health unit and infectious diseases department would be jumping on the patient, I would discuss with my local microbiologist first before commencing treatment, not to mention that they would probably be admitted into hospital. Insofar as the management of Legionella pneumonia in general practice, the choice of antibiotic is frankly one of the least important aspects.
Anyway, four weeks to go until the clinical examination and then FREEDOM!
Although I am glad that one hurdle is past, I can only say that the written examination was long and painful, and in my humble opinion, unduly so. It was in two parts; a three hour short answer paper in the morning, followed by a four hour multiple choice paper in the afternoon. One has to question whether a seven hour examination actually provides any more information than something that is shorter.
Then, there were the entirely stupid questions like the multiple choice question asking for the antibiotic of choice for Legionella pneumonia. Frankly, if one of my patients had Legionella, the local public health unit and infectious diseases department would be jumping on the patient, I would discuss with my local microbiologist first before commencing treatment, not to mention that they would probably be admitted into hospital. Insofar as the management of Legionella pneumonia in general practice, the choice of antibiotic is frankly one of the least important aspects.
Anyway, four weeks to go until the clinical examination and then FREEDOM!
9 comments:
I do not understand Michael. You have told me you are already a Doctor. Why after already being a Doctor must you need to celebrate some additional hurdle? You are going to qualify to be a GP? American speak that stands for General Practioner which is something like the lowest level of medical practice which one is allowed to qualify for (go beyond this and you are a specialist and your time is worth more money per hour).
I guess I am just confused by the Australian medical care system. How can one be a "medical doctor" while not qualifying to be called a "general practioner" without taking an additional test?
Left only to my imagination, I guess the "stamp of approval" from the Royal Australian College of General Practioners just means your time is now worth more money from a socialist medical care system or something?
As I often am, once again I am confused. What the heck. Confusion is only a state of mind!
I didn't think that the US and Australian systems were that different in this regard, but then, I've never been the the US.
General Practice in Australia is a specialty, like many other specialties. It requires a minimum of 4-5 additional postgraduate years of training (of which 3-4 is in the RACGP program) before you can work independently (and call yourself) as a GP. This is regardless of whether you "bulk bill", i.e., bill the government directly or privately bill your patients.
You cannot simply graduate from your medical degree and set up shop (unlike the good/bad old days).
Thus I am currently a GP registrar (i.e., "US senior/house resident" equivalent) as opposed to a "General Practitioner".
I'll try to clarify a few things on how the medical hierachy works...
When you graduate from a medical degree, in Australia, you become an "intern" for a year. As an intern, you are a "doctor" in name, but it is for the most part provisional. You work in public hospitals and you must rotate through terms with minimum standards of supervision and training.
Unlike the US system, there is no "streaming" (entering directly into a specialty training program). In Australia, all junior doctors must work a minimum of 1 (and most people do 2) years of generalist (i.e., through all specialties) terms. Note: this is why many Australian doctors have a dim view (unfairly) of the American system as there is the impression that American doctors often have very poor knowledge outside of their own specialty.
After successfully completing your first year as an intern, you qualify for "general registration" with the Medical Board and can technically work independently. However, to have access to Medicare (i.e., the socialised universal health care system), you must either work for a public hospital (i.e., as a hospital doctor) or be working in the capacity of a training specialist (i.e., "registrar" though this definition is a bit loose) with an accredited training program (e.g., with the Royal Australian College of Surgeons if you want to be surgeon or the RACGP if you want to be a GP). Realistically, you cannot work without access to Medicare unless you work in some obscure field like for an insurance company (as you cannot prescribe medications, ask for investigations, refer to specialists without the patient paying the full fee).
For full unrestricted access to Medicare, you must be a recognised specialist in your particular field (i.e., a fellow of the relevant college). To be a recognised specialist in your field, you must adequately complete the training program of your college. In my case, this is the College of General Practitioners.
Cheers.
Thanks for the reply.
In verbal discussions with others on this subject, I found out that "general practioner" within the United States might also be a specialty beyond being the education and certification required to be certified as a medical doctor as well. I always thought every medical doctor, by becoming a medical doctor, qualified to be a GP.
Once again, I have exposed my own ignorance.
Anway, congrats on your achieving yet another milestone in your occupation.
Congratulations Michael. Now if you can just avoid all the insurance premiums rises due to all the medical negligence cases you'll be on the winning streak!
Luckily I retired from medicine before the RACGP was too powerful. It seemed too much like a trade union - with closed shop and the need really to be a swimming pool socialist.
Most odd though is why the GPs with RACGP seem to be more preoccupied with click clack medicine that fancy knowlege.
I went doctor shoping with Ekbom's syndrome and got nowhere.
My wife has uncontrolled athma etc.
And so do I. So what is the point of all that exotic book learning?
Okay... a lot of random craziness in that last comment! That, or a spam-bot but worthwhile saving for posterity.
Regards.
Maybe random craziness - but based on personal experience.
When they started the RACGP exams you could buy (at a good price) test questions on this and that. When I found they were asking about newborn orthopedics - a subject very few GPs would touch on - I could see their purpose.
Medical information is bottomless and so they could always make people fail or pass to suite their purpose.
If you don't believe in 'click clack ' medicine you haven't practiced in Australia.
I have no idea what "click clack" medicine is and I have ONLY practiced in Australia.
Given that the aim of the RACGP examinations is competence rather than excellence, they are relatively easy examinations to pass (when compared, e.g., to the physician or critical care exams).
Furthermore, the distribution of topics covered in the RACGP examinations are based from the BEACH project so are representative of the types of cases an Australian GP is expected to see.
With regards to neonatal orthopaedics, it is a rare condition so there will be few (if any) questions on it in the exam. However, that being said, orthopaedic conditions in neonates are common enough that a competent GP should have a good working knowledge of it. In addition, given that it appears that you have never sat the exam, I believe that your "personal experience" to be somewhat limited in this regards.
In terms of the college, their role is pretty much accreditation and standards given that it does not directly run GP training any more. Also, it is hardly "closed shop" when there is now a second pathway to become a GP through the Australian College of Rural and Remote Medicine (ACRRM).
It is clear that you have some sort of grudge against medicine but I just don't get your "angle". As before, your first comment here is a collection of "random craziness".
'click clack' is the noise a turnstile makes as the patients are process - "sign here" and exit.
Bulk billing is at the core of it as are the large practices.
As a patient I have experienced this. As have a lot of my aquaintences.
My 'grudge' is based on some 40 years as a GP and some 5 years as a patient.
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