GPSA - General Practice Supervision Australia

**Why get involved with GPSA? “Having lots of skin in the game,” says this high-flying GP**

Dr Kate Manderson is a name associated broadly with Australian general practice and GP supervision yes, but also with aerospace medicine, corporate and clinical governance, advocacy and – above all else – family and community.

On the eve of the transition of GP training to the GP specialty Colleges, this experienced GP and practice principal decided it was time to contribute her vast skills and experience to ensuring quality and passion remained at the heart of clinical supervision for future GPs in-training.

So it was that this ADF-trained health professional, businesswoman, Principal Medical Officer of CASA, Senior Aviation Medical Officer of the Royal Australian Navy, Graduate of the AICD, Medical Educator and past President and Chair of the Australasian Society of Aerospace Medicine (ASAM) came to be elected onto the Board of GPSA in October 2022.

Kate recently talked with our Communications Manager, Pauline Ingham, about her burning desire to get a better deal for Australian GP supervisors.

What do you think has brought you here to this role on the GPSA Board?

“After 25 years as a GP I have been inside the GP system for a long time and gained a lot of valuable experience.

“Like a lot of GPs, I have a lot of ‘skin in the game’, having worked as a GP, a Medical Educator and a Supervisor.

“I understand how it works, how it could be improved, and have seen some challenging times.”

Why GPSA?

“At a time when I couldn’t contribute to GP training at the coalface, I still wanted to contribute meaningfully.

“I saw the opportunity to use my experience and skills in clinical leadership and governance through the role on the GPSA Board… as a way to help our system, our supervisors and our trainees on a broader scale.”

She notes that she was encouraged and supported by colleagues who said, “Kate you can do this!” – and she decided the time was right.

“My experience in governance, company directorships and leadership came into play. Having an understanding of the importance of operating a viable and strong business, combined with my supervision experiences, enabled me to put myself forward and make a contribution to GPSA."

How have your various roles prepared you for your work with GPSA?

“My first role as a GP registrar prepared me by going through the system. I was privileged to train in Tasmania and on the whole had fabulous education, mentoring and training, working with pioneers and leaders who are still involved today. I learned from people who showed me how great it could be.

“My placement experience varied after that – some practices gave little support; however, it was still the early days of training, and often I was on my own. Some practices straddled the line between good and bad: offering great mentoring and supervision, but less structured education.

“So I had the opportunity to experience lots of different perspectives as a trainee as to what supervision looked like, could look like, and what it actually should look like.”

How did that view of supervision you had as a trainee change when you started supervising?

“When I moved into the role as a Supervisor and had the opportunity to be on the other side of the table, I instantly realised how hard it can be to be a supervisor!

“I was so determined that there really is no excuse for being a poor supervisor, but the actual experience of doing the job for more than a decade, and having more than 50 trainees over the years, has led me to realise it’s not that simple at all.

“Supervisors deal with registrars of varying needs, and this requires a flexible system that can be very difficult to achieve.”

As a practice owner, what do you see as the challenges facing educating and training the next generation of GPs?

“I see two big challenges or barriers – adequate funding and adequate recognition.

“You want to be altruistic and you want to help somebody – vulnerable people and vulnerable communities – and you want to spend lots of time with patients. And that is beautiful, but you can’t do that if the practice closes because you can’t pay the wages.

“Let’s start with money, and we must talk about that. If your business goes bankrupt you can’t help anyone. It's a fundamental part of what I teach trainees, they have to understand the business of general practice."

So let’s talk about the money!

“It can seem unpleasant to raise, but thinking that money isn’t important is part of the reason we have ended up in this current situation.

“It is important – and there are some key barriers we need to address.

“To start with, the funding model of general practice is fit-for-purpose for 1975, but it is not fit-for-purpose for 2025, 2035, 2045… It hasn’t been fit-for-purpose for a very long time because everything has changed around us, just not this funding model. That is the biggest barrier.

“We are not funded as supervisors, and until that changes we will not have consistency in the quality of training placements… Which means appropriate funding is needed urgently for supervisors and training practices as well as the trainee.

“There is a vast difference between the funding for hospital-based supervisors with payment built into their contracts, and how GP supervisors do it: GP supervisors take a pay cut to teach!”

Any other barriers you’d like knocked down?

“The culture of general practice.

“The idea of #justagp – ‘Are you a specialist or just a GP?’ – is problematic.

“We need something much more powerful in recognition of the specialty of general practice.”

“I believe we must bring back the PGPPP so that everybody gets a turn in general practice – so they understand what it’s about.

“I also strongly believe that we need a name change, because everyone uses ‘GP’ whether they should or shouldn’t.”

“We need to identify our unique skill set, it’s got to be marketed, again back to the finances... We pay equivalently, we recognise the specialty equivalently, and everyone understands what the specialty does."

What challenges are presently of greatest concern in the realm of supervision for our members?

“My sense is that the biggest concern is ‘who’s going to take over when I am done?’

“We have members who are passionate, dedicated and committed in that role. And they are altruistic, self sacrificing, they are doing it without any money, without any recognition, because they want to and they think it’s important.

“Part of it is they are there for the future of the profession, part of it is they are there for the future of their practice. They are thinking, ‘If I am not supervising, we can’t get trainees; if we can’t get trainees, we can’t get succession planning and workforce’ and so on.

“I am living that experience right now. I am not currently supervising registrars in my practice so this equates to empty consulting rooms in my practice.

“People might say if we can’t get registrars then why not get Fellows. That is proving almost impossible in the current climate.”

We need more women in supervision. How would you encourage women to pursue roles as supervisors?

“Firstly, GPSA’s current Women in Supervision research is important because if it doesn’t get measured it doesn’t get fixed.

“Data is key and can be used strategically. Commonwealth Departments respond well to data, and politicians respond to real life stories. So you have to tackle any issues with submissions and data.

“With regards encouraging more women into supervision, I’ve already said that supervision is altruistic – you give of your time and your money. Women already have less money and less time, and we are asking them to have even less money and even less time. We have to fix that!

“Another factor is that historically women carry the greater burden of child care. If we have more, better, financially accessible child care for women in primary care, women would do more in primary care.

“If GPSA found a way to subsidise women volunteering to supervise with a cleaner? We’d be inundated! Essentially, childcare and financial recognition are the two things I think will get more women into supervision.”

“If we can adequately remunerate or financially recognise supervision overall, then this will no longer be yet another cut to women who are already being cut by the financial disparity we continue to endure. This would benefit everyone - not just women of course, but it would proportionately benefit women even more.”

What would you like to say to Australia’s supervisors?

“My message to Australian supervisors is to hang in there!

“You are special, you are doing amazing things. GPSA understands this and we’ve got your back. We’re going to do everything we can to make it better for you, so please hang in there while we do that.

“I’d also like to send a message to our trainees, our early Fellows and our new supervisors, and that is to please show up, please don’t expect everyone else to do it. It is a champion team, so show up, be brave, put yourselves out there.

“I urge you to support the industry leaders who are saying GPs have to charge privately and we have to charge our worth to make it so that we can afford to supervise in practices. Be brave, be there, show up and take it on!

“I am taken back to my time in the Navy when the mantra in an emergency or attack was to never leave the ship – the three step approach was ‘Fight, Move, Float’ and ‘we do not abandon ship!’

“So I say to my colleagues: we value you, we need you, don’t abandon the ship!”