Life is pretty tough at the moment being a GP, let alone being a supervisor. On top of looking after your own patients and staff, you are caring for the welfare and training of the next generation of family doctors. It is exhausting having to continually pivot during this pandemic and I am hearing many stories of supervisor exhaustion and burn out.
I too know how that feels. As a sole owner of a 10 GP practice, a vaccinating practice in a regional community which struggles with workforce, I am tired. I kept putting off my holidays because of Covid but I decided to ‘just do it’. Sometimes you have to put your own oxygen mask on first. The best lesson we can model for our learners is self care.
So, what does a GP supervisor do?
A lot more than you think. GPSA is currently negotiating with the colleges and Department of Health on your behalf on payments to supervisors and training practices and what this will look like post transition of training. Key to this discussion is defining who we are and what we do.
We do more than provide in practice teaching
We mentor and provide pastoral care
We ensure that our patients are safe
We ensure that our registrars are safe
We are developing and growing our primary care workforce
We role model supervision and professionalism
The supervisor and registrar relationship is the centre of the training models for both colleges
What are we worth?
To put it simply – if we were properly paid the government couldn’t afford us. If we were paid for training registrars like we are for medical students the costs would be a massive $500M.
Last month we attended a workshop in Canberra with the key stakeholders and the department on National Consistent Payments for Supervisors, Training Practices and Registrars. We have entered the negotiations attempting to grow the pie for supervisors in a tight budget.
The fact that supervisors aren’t paid to supervise is the glaring gap.
One opportunity to expand the pie is an MBS item number for supervision. For example a GPT1 starts on Level 1 supervision where a supervisor is in every consultation which reduces over time. A simple MBS item number triggered by the registrar when they ask their supervisor for assistance is on the table for discussion.
Supervisors will continue to be paid for teaching and practices will still compensated for taking on a registrar with particular emphasis on the early stages of training. At the moment there is significant variation amongst RTO’s and we are working towards supervisors being paid the same across Australia. We also support continued funding for discretionary spending to support practices and supervisors in recognition of issues around complexity and rurality in training.
Yours in training,
Dr Nicole Higgins Chair GPSA
Date reviewed: 15 April 2025
Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.
Reconciliation means ‘coming together’. This is a time for us to reflect on the relationship between the broader Australian community and Aboriginal and Torres Strait Islander peoples. National Reconciliation Week is an opportunity to learn about our shared histories, cultures, and achievements.
Let’s use this next week to teach our registrars and medical students about Aboriginal and Islander health in your region. I will be using the excellent GPSA resources to assist me in my teaching https://gpsa.org.au/indigenous-health/
Dr. Nicole Higgins, GPSA Chair
Supervisor Remuneration and Reform
Supervisors are NOT paid to provide clinical supervision.
Supervisors are paid to provide in practice teaching in GPT1/2 only.
Practices are compensated for when their registrars are away from the practice for educational release.
Clinical supervision is largely voluntary. Supervision of doctors and GP’s in training ensures patient safety and a quality learning experience
There is a lack of consistency of supervisor and training practice support across the GP training pipeline. GPSA has done a deep dive into how this is done across Australia and the programs and is currently informing the department and colleges. Over the next couple of months there will be a series of roundtables with the department, colleges and GPSA/GPRA to review the reform process and better understand what we have and where we would like to go. We will continue to inform and seek feedback from our membership so that we can develop a system that is streamlined, consistent and fair.
GPSA is currently developing a quality improvement framework to support practices in providing a quality training experience. The guiding principle is that it is simple, it builds on what practices already do and can be part of a simplified accreditation process.
GPSA is also working with RACGP as they develop a supervisor curriculum.
Transition to Profession Led Community based GP Training
The transition of GP training was announced in October 2017 by the Health Minister Greg Hunt with both RACGP and ACRRM to fully take over in January 2022. Everything changed in October last year when it was announced that the transition was halted and the department wanted to refocus on ‘workforce solutions’ and ‘efficiencies’. We were told that there would be ‘winners and losers’.
In the recent GPSA survey most supervisors said that they were satisfied or more than satisfied with their RTO’s. Supervisors and training practices were disappointed to discover that the department had deemed that RTO’s “were not the way forward” as they often have a personal relationship with their local medical educators and administrators. The RACGP’s new model will provide a continuity of these relationships through their local teams and case management of registrars.The model ensures the continuity of SLO’s and RLO’s which is vital to support supervisors and registrars.
We are working in a challenging environment where there have been years of neglect and underfunding in primary care, workforce need not only in rural but in regional, outer metro and urban and a cohort of registrars whom are older (average 34 yrs), settled and with high debt from HECS, training and mortgages.
We are all working towards a smooth transition of training to the colleges. The discussions and negotiations are robust but respectful.
Yours in training,
Dr Nicole Higgins Chair GPSA
Date reviewed: 15 April 2025
Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.
GPSA welcomes the return of training to the colleges. Supervisors are the experts in knowing how to mentor and nurture our learners into the profession. GP’s are the experts in knowing what is best for their profession and their patients. What we need now is detail, certainty and a time frame from the colleges and the department, to inspire confidence in the future of the profession.
The Australian GP Training Program made an important first step towards articulating itself to stakeholders last week, but the lack of detail has many stakeholders feeling nervous.
Why? Because the Devil is always in the detail.
Last month GPSA published the findings of its member survey in which 83% of respondents identified that they did not feel adequately consulted which is extraordinary given the dramatic changes afoot in the AGPT program.
Supervisors ensure our patients and registrars are safe. Governments, ministers, departmental staff, Regional Training Organisations and registrars all come and go, but Supervisors are always there. We are the constant in GP training.
Supervisors and training practices are the foundation of general practice training. Supervisors, training practices and supervision related issues feature explicitly in the RACGP model and there is an absolute commitment to the apprenticeship model. We acknowledge the RACGP for recognising the importance of the relationship between supervisor and registrar.
GPSA met with RACGP following the release of its much anticipated training model. What is reassuring is that the College are indeed listening. Supervisors and training practices now want to see the detail and to understand what a regionalised delivery model will mean to them. There is a great deal of uncertainty within the sector as many training practices remember how difficult the transition was in 2015.
GPSA’s feedback and discussions have really focussed on what we can see so far, which is not a lot.
Progressive assessment
The act of supervision is unfunded. We have fed back that progressive assessment throughout a registrars journey is likely to work well, but the college will need to think about who is expected to complete the assessment and what level of time impost it will require. If this is another thing supervisors are expected to do unfunded, then they need to be aware supervisor time and resource is finite not infinite.
Who will hold and distribute the supervisor funds?
The question over who will hold the funds for supervisors and how the said funds will be distributed remains up in the air. It is a BIG deal. This very question is something GPSA has been grappling with for months in its review of payments across programs.
The challenge is really that the GP training system from a supervision perspective is woefully underfunded, and as we see across programs, no one agency has come up with a reasonable rationale for how and why supervisors are funded (or not). Our industry bodies do not appreciate, nor understand the complexities of supervision across the whole of what we do.
AGPT – funds supervisor education activities but not supervision – All AGPT registrars require level one supervision at the start of their first term which means we need to see all of their patients to ensure that the patients and registrar are safe. Supervisors are only funded to deliver 1.5 – 3hrs of in practice teaching only for GPT1/2 but not for the rest of the week that they are supervising a learner.
MDRAP funds supervision but a workforce agency administrator determines who “needs” what, in a less than transparent or nationally consistent way. Most of the doctors engaged in this program require level 1 supervision.
RJTIF, once the travel, accommodation and junior doctor salary is removed, is a subsidy in its funding of supervision – these doctors require level 1 supervision.
PEP and IP DO NOT fund supervision at all. That’s not to say that these doctors don’t need supervising – it is just that a bureaucrat thought that they weren’t worthy of the same experience as Australian trained GP’s in training. We have the most vulnerable of doctors working without supervision.
Medical student placements – these students require level 1 supervision.
Why is this significant?
When supervisors are doing a good job – nobody sees what we do. We are the safety net of the training system. We keep our patients safe. We protect our registrars.
We (not supervisors, but ‘the system’) seem to forget the time it takes to effectively supervise a level one learner.
It is costly to the person providing that service. One that requires a supervisor to:
check every single patient before they leave the practice,
enquire or read about the history,
assess the diagnosis and treatment plan presented
use the event as a learning opportunity to explain what and why an alternate course may be more appropriate,
ask any qualifying questions that may have been missed by the learner
check that results have been interpreted correctly and acted on appropriately
Supervisors are an invisible service to Government and to patients, and seemingly even our industry colleagues, at times when they design programs without funded supervision. Supervisors underpin the safety of the primary care system.
Supervision is seamless and safe for the patient and the learner. So seamless the patient often isn’t aware they are being treated by a learner. The learner will never forget those moments a supervisor saved them and their patient from a really unfortunate outcome.
Open market accreditation
It is also apparent that the RACGP intends, seemingly at the behest of the department, to follow an open market practice and supervisor accreditation scheme. Allowing anyone who wants to be accredited to be accredited. While we understand the fair competition argument, we have fed back that having too many training practices where they are not needed just makes GP training unsustainable for everyone. Constantly accrediting practices who may not get a registrar is not a cheap endeavour and in fact, having an uncertain supply of registrars is also problematic for practices who build up their patient lists to accommodate an extra practitioner only to have no registrar in the subsequent term and finding themselves oversubscribed. The constant flux in patients is unsustainable.
Given the cost of accrediting, monitoring and maintaining more and more practices, the risk of this strategy leading to practices having to pay for accreditation is high. The question is how many barriers and costs to practices and supervisors can be put in place before practices can no longer afford to take on learners? And… is it an accreditation system that actually leads to quality outcomes? This all remains to be seen.
The mission now for the RACGP is to build out their model with more detail and to check in with the sector to see that they have it right at local state and national levels. They can only be certain they aren’t simply marketing to themselves if they actively engage with the sector. The signs are promising and we will keep you posted as further detail comes to hand.
So where is ACRRM?
At this stage we have not seen a training model nor the detail that sits behind it from ACRRM. We encourage them to be open about their intentions and to be checking with the sector to ensure they too haven’t convinced themselves their model is a good idea without bringing training practices and supervisors on the journey with them. The 83% of supervisors who stated they had not been adequately consulted was not college specific. Meaning both colleges need to do better in communicating their models.
How will the colleges work together?
GPSA have also asked the colleges to articulate how practices will be accredited. RTOs have commonly streamlined the accreditation process by accrediting practices and supervisors for both colleges at the same time. RTOs have reduced the burden in this way on practices. With the replacement of RTO’s at the coal face, and despite the colleges indicating they have a great relationship, we have not seen whether that extends to being great and mindful of training practices and supervisors, who are often the same regardless of the college a registrar has chosen.
We are 18 months away from a new model of training and the sector are none the wiser in understanding how and why they will be impacted by each college’s version of professional led training on the ground. We encourage both colleges to get their skates on.
COVID Vaccination roll-out
As a supervisor and practice owner who has been engaged in the respiratory clinic initiative and now the COVID vaccination initiative, I appreciate how challenging this time has been for all of our members. GPSA has fed into the Primary Health Care COVID weekly. We will continue to do this and if you have anything you would like us to share with the department, we would be happy to do so on behalf of GP supervisors at the coal face.
National Council of Primary Care Doctors (formally UGPA)
The band is back together with a new name to better represent who we are and what we do! GPSA welcomes the collaboration between GPSA, RACGP, ACRRM, AMA, GPRA, RDAA and AIDA. We are meeting regularly to discuss key areas relating to general practice such as training, accreditation, reducing red tape, wound care and telehealth.
Yours in training,
Dr Nicole Higgins Chair GPSA
Date reviewed: 15 April 2025
Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.
More than half of respondents based in rural areas to the Medicine in Australia: Balancing Employment and Life (MABEL) survey Australia’s general practitioners are supervising GP registrars, GPSA researchers have found.
The finding is part of an Australia-first study that looks at factors related to rural general practitioners supervising registrars and provides a valuable insight into the circumstances in which GPs outside major cities are most likely to take up supervision.
Key findings included:
Fellowed Australian and IMG GPs are more likely to supervise than non-Fellowed IMGs.
Supporting GPs in smaller practices to engage in supervision and fostering the continued involvement of GPs in larger practices has the potential to build rural supervising capacity.
GPs with experience supervising medical students and interns were more likely to supervise registrars.
GPSA chair Dr Gerard Connors said the research would contribute to the knowledge base that has been previously lacking around GP supervision and provide a foundation for strategies to increase the number of rural GPs becoming supervisors.
“Potential strategies to enhance rural general practice supervision capacity include increasing the number of Australian-trained doctors in rural general practice, and increasing support for IMGs to train vocationally and to supervise once Fellowed,” Dr Connors said.
“GPs in larger rural practices have been shown to be more likely to be supervisors – 57.8 per cent according to this study – so that raises the possibility that with more support, doctors in smaller settings could be encouraged to take on a GP registrar.
“This information gives us more to work on than we have ever had to identify ways to increase supervision capacity in rural Australia.”
The project, led by Dr Belinda O’Sullivan, was supported by the Royal Australian College of General Practitioners and funded by the Australian Government under the Australian General Practice Training Program.
Date reviewed: 16 April 2025
Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.
Novel corona virus distracts from bushfire devastation
The novel corona virus now occupying our thoughts internationally has shifted much focus away from those who still need us.
While we should expect that with a 24/7 news cycle that one singular issue is not likely to remain topical, GPSA has been considering how best to continue to assist our bushfire-affected communities since the media attention and flood of public donations have dwindled.
GPSA contacted the Mallacoota Medical Centre, whose community and surrounds were devastated by the January 2020 bushfires. The key message received loud and clear is that all communities affected by the fires nationally continue to struggle with staffing, supplies and not only the community’s general PTSD associated with the fires but the PTSD clinicians have likely sustained themselves that they have had to work through for their patients’ sakes.
Mallacoota Medical Centre is one of many centres in bushfire-affected areas that will need ongoing support and attention. For these communities, they are no longer novel like the corona virus, but their existing realities are just as dire and will be for a very long time. Please continue to give your time and donations generously.
RTO and College support for remote supervision in affected communities
GPSA wrote to the RACGP (you can read the letter here) and the CEOs of your training providers (read the letter here) in January specifically seeking a college and local training provider solution to enable remote supervision of registrars interested in providing locum support or indeed supervisors with registrars being able to provide remote supervision while they engaged in locum relief to bushfire-affected areas.
While nothing will ever beat the gold standard of onsite GP supervision for GP registrars, GP supervisors are typically pragmatic and very generous.
Previous disasters around Australia have highlighted the challenges that exist when communities affected by disaster have their registrars removed at a time when they are needed most and the challenge of retaining assistance after the immediate attention and concern wears off. So, we have sought a pragmatic solution for those who wish to engage and support affected communities.
Transition of AGPT policy and eligibility to Colleges in early 2020
The Department of Health and the Colleges have advised (you can read the formal notification here) that the AGPT policy and eligibility functions previously administered and managed by the Department of Health will be formally handed over to the colleges in early 2020. They have advised that AGPT policy will remain stable until the end of 2021 to ensure continuity for the sector.
Rural Generalist Coordination Units
The Department of Health has sent out non-competitive grant opportunities to state health departments to apply for funds to establish coordination units in anticipation of the rural generalist pathway commencing in 2021. The grant opportunities closed on 17 January 2020.
GPSA has written to the department about this to express our concern that previous communication from GPSA to the Hon. Minister Greg Hunt and Department of Health personnel (read the letter here) about the risks associated with the single employer model do not appear to have been resolved prior to a single employer being appointed.
Department personnel have responded stating that the coordination units are separate to considerations around the single employer mechanisms or alternate proposals.
Dave McNally, Director GP Training Systems, advised that the risks, challenges and conflicts identified by GPSA have absolutely been received and the department is working conscientiously through the issues associated.
GP Supervisor Review
As advised in the eNews before Christmas, GP Supervisors Australia has commenced a consultancy with the Department to review GP supervision of a range of programs. We have had some great input from the GP supervisor community about the degree to which supervision is in/adequately funded.
This project is a unique opportunity for GP supervisors to feed into identifying just what is required into the future. Please do take the opportunity to contribute by registering your expression of interest to be interviewed here.
New training terms
As I write this all regions have either already commenced a new training term or they are about to. This is a busy time for practices and supervisors. There is induction and orientation of new registrars, contracts and getting your registrar settled into the practice. Getting to know where your registrar sits on the competency register can take time. Some over, while others under, estimate their competence (over/under confident) and some have an appropriate self-awareness. Like a patient consult – time will tell. It is not easy what we do, but it is absolutely vital to our patients and our communities.
College support for GP supervisors
GPSA has written to both the RACGP and ACRRM seeking their assurances that once they take over GP training funding that they will continue to support funded supervision into the future. We will continue to engage with the colleges constructively throughout 2020 to ensure the GP training community remains secure that the GP supervisor community’s remit is to deliver internationally recognised gold standard GP training and we can only do that through support from the colleges when funding for GP training transitions to them in 2022.
GPSA resources there to support you
Importantly, GPSA has a range of resources to support you throughout 2020. We encourage you to have a look at the orientation checklist, teaching plans, guides and other resources that are all free and open access to assist you.
Have you taken a break recently?
Finally, to those of our community who worked through Christmas and New Year and much of January to ensure their communities had access to primary care and their staff and colleagues could take a well-earned break – thank you!
Please be sure to consider taking a break yourself also – sustainable practice includes looking after your team, which includes yourself. See our new teaching plan Doctors’ health and self care for some great advice for GPs and their registrars.
Yours in GP training,
Dr Gerard Connors
Chair GPSA
Date reviewed: 15 April 2025
Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.
