ONE of the signs that one is ageing in medicine is that one goes from receiving career advice to dispensing career advice. In my case, this manifests as medical students and junior doctors seeking my opinions on GP training and which college to choose. This has become more topical of late, as it is now much harder to concurrently train towards both the Fellowship of the Royal Australian College of GPs (RACGP) and Fellowship of the Australian College of Rural and Remote Medicine (ACRRM).
Many of my non-GP colleagues frequently express confusion regarding the state of play in “GP land”, not understanding why GPs have two colleges.
I will attempt to answer the common questions: who, what, when, where, why, how and which.
Both colleges are made up of GPs, both urban and rural. GPs can be members of both colleges.
ACRRM Fellows need to have trained and practised in rural areas at some stage but need not remain in a rural area to remain part of the ACRRM.
The ACRRM and the RACGP are both approved by the Australian Medical Council. They are both permitted to train and examine GP registrars seeking to attain fellowships. This leads to vocational registration recognised by the Department of Health.
Like other colleges, they oversee and run continuing education, set standards, undertake research and offer member benefits.
The RACGP is an older, larger and more financially secure organisation than the ACRRM.
The RACGP is about 60 years old and ACRRM is about 20 years old.
Both are national organisations with members in all states and territories. The RACGP headquarters are in Melbourne; those of the ACRRM are in Brisbane.
Both colleges seek to maintain high standards of practice within general practice, believing that this will help patients, doctors and Australian society as a whole.
The ACRRM was formed in order to promote rural and remote medicine in its own right, recognising the special hospital and procedural skill set rural doctors and rural communities rely upon.
This is where things get interesting. The colleges go about doing their business in different ways.
They each have different governance structures, which can be viewed on their respective websites. The ACRRM board consists of five working clinicians, led by Thursday Island senior medical officer Ruth Stewart as president, and the council is made up of eight ordinary members and three ex officio members. Conversely, the RACGP is run by the its Council, comprising the president, Dr Bastian Seidel, the censor-in-chief, the chair of each state/territory faculty, the chair of RACGP Rural, the chair of RACGP Aboriginal and Torres Strait Islander Health, a GP registrar representative and co-opted council members who are not necessarily doctors. For example, at the moment former Victorian police commissioner Christine Nixon, and Oxygen board member Martin Walsh sit on the Council. The RACGP did attempt to change its governance earlier this year; however, the proposed changes – demoting the Council to providing guidance on clinical affairs, and leaving broader strategic decisions to a seven-member corporate board, including up to three non-GP members – failed to gain the support of its membership voting in an Extraordinary General Meeting.
Training pathways to fellowship vary between the colleges. The common ground is that registrars can train via one of the nine regional training organisations or the Remote Vocational Training Scheme; both of these paths follow set training protocols.
Both colleges also allow independent training; however, recognition of prior experience and learning is something that each organisation handles differently and can often be a source of grief for applicants. The RACGP has a practice experience pathway while ACRRM has an independent pathway. I encourage early enrolment into a college for anyone wanting to become a GP, in order to avoid potential rejection of prior experience.
Assessment and qualification for Fellowship also differ. The RACGP offers a 3-year program, followed by a three-pronged exam of two written papers and one objective structured clinical examination. The ACRRM has a 4-year program, including 1 year of advanced skills (eg, obstetrics, emergency, anaesthetics, paediatrics), and a more complex assessment that includes an in-practice assessment, logbook and assessment of advanced skills.
The longer, harder path to Fellowship makes the FACRRM harder to achieve than the FRACGP. It also means that more registrars, even rural registrars, opt for FRACGP – 1 year shorter and fewer, simpler exams. I have heard more than one Fellow of the RACGP boast that it is possible to attain a FRACGP without holding a scalpel or doing a Pap smear; I find that sad.
The RACGP now offers the Fellowship in Advanced Rural General Practice. This requires 12 months of recent rural practice, some extended study and some extended skills. Unlike the FACRRM, it does not require a prolonged immersion in rural practice.
Continuing professional education can be recorded and administered by either college. I suspect other competitors will appear very soon, as hospitals, universities, insurers and others look for new revenue streams and influence. The RACGP has been in hot water recently over its new Quality Improvement and Continuing Professional Development formula for the next triennium, which includes a $2 fee every time a GP completes a CPD activity, resulting in some high-profile GPs venting their frustration and threatening to move to the ACRRM Professional Development Program.
The ACCRM and the RACGP also have different approaches to politics and policy. Lately there has been a real shift in how colleges play ball, as they adopt a more political role. For example, the RACGP has recently challenged the government over the rebate freeze, while funding the large “not just a GP” advertising campaign. The RACGP says that the wish of membership drives this change. Not all members – I am one – agree, preferring colleges to stick to education and standards. In contrast, ACRRM keeps a lower profile.
I have always felt that the boxing gloves should be left on the hands of the AMA and the Rural Doctors Association of Australia.
The crux. Did you expect me to give you an answer?
I’ve done my Fellowships … now it’s time for you choose!
Dr Aniello Iannuzzi, FACRRM, FRACGP, FARGP, FAICD, is a GP practising in Coonabarabran, NSW and a clinical associate professor in the Sydney Medical School. He has been a previous board member of ACRRM and is currently on the ACRRM Quality and Safety in Practice Council. He is a paid-up Fellow of both ACRRM and the RACGP.
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