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Attention doctorportal newsletter subscribers,

After December 2018, we will be moving elements from the doctorportal newsletter to MJA InSight newsletter and rebranding it to Insight+. If you’d like to continue to receive a newsletter covering the latest on research and perspectives in the medical industry, please subscribe to the Insight+ newsletter here.

As of January 2019, we will no longer be sending out the doctorportal email newsletter. The final issue of this newsletter will be distributed on 13 December 2018. Articles from this issue will be available to view online until 31 December 2018.

How common is doctor hopping?


Over a quarter of Australians see multiple GPs for their healthcare, according to new research published this month.

The study of 2400 adults, led by Sydney-based GP Dr Michael Wright, found that while 90% of people had a usual GP and 80% had a usual practice, around 25% also saw at least one other GP in the previous year.

Unlike in many other countries with subsidised public health systems, Australians are able to see multiple GPs at their own discretion. Although this may promote choice and competition, it also may also fragment the care patients receive, says Dr Wright.

“In Australia, a patient’s usual GP does not receive information about any ‘non-usual’ practice attendance, if the information is not volunteered by the patient,” he notes. “If important information is not shared between practices, patients could potentially experience worse health outcomes.”

The study found that younger people were most likely to hop between doctors, as were those living in big cities.

A significant finding was that those who had seen more than one GP in the previous year were 56% more likely to have also attended an emergency department. This suggests that those who see multiple GPs have different patterns of health service use and were possibly more likely to have poorer outcomes.

Dr Wright says fragmentation of care engendered by multiple doctor use could be improved if practices shared data with the patient’s usual GP, rather than leaving it up to the patient to volunteer the information.

“The rollout of My Health Record will improve the sharing of patient information,” he adds. “But My Health Record does not have access to the records at a general practice. So patients should still tell their usual GP if they have been to another practice so their GP is aware and their practice record can be updated.”

RACGP President Dr Bastian Seidel says the new research is concerning, as international evidence has found patients significantly benefit from having a usual GP.

“Patients who maintain strong relationships with a usual GP or practice team experience better health outcomes,” Dr Seidel says.

“These patients are significantly less likely to need expensive emergency department or hospital care. Every minute a GP spends with a patient allows them to obtain more information about their life, concerns, fears and expectations.”

You can read the full study here.

The fine art of communication in general practice


Read about our new workshop exploring complex communication in primary care – breaking bad news, end of life conversation and more…

Communication skills are uniquely relevant in the general practice setting, because no other medical practitioner offers the continuity of care that GPs afford their patients. This workshop, conducted by the multiple award-winning Pam McLean Centre, will address some of the most challenging communications in the context of the long-term doctor-patient relationship – breaking bad news, open disclosure following an adverse event, and initiating discussions about treatment options at the end of life. The common theme is talking about things our patients really don’t want to talk about.

Models abound – SPIKES, ABCDE, BREAKS, ISBAR etc. And models have their place. But putting the models into practice can sometimes be surprisingly hard. This workshop allows us to put theory into practice through trial-and-error, working with a highly trained professional actor to negotiate step-by-step through the maze of emotionally-charged communication. Just like learning to intubate on mannequins, working with actors allows us to try various approaches to communication safe in the knowledge that no-one gets hurt. The workshop is based on rigorous research, including one of Prof Dunn’s PhD student’s projects, which measured heart rate and skin conductance in doctors whilst they told a woman that her husband had just died. The results will surprise you.

In this workshop, you will meet two patients (played by two of our most experienced actors) who present all these challenges in a panorama of multiple presentations. There are options to practise the delivery of bad news in different emotional contexts, and to explore appropriate responses to an angry relative when there has been a serious adverse event. Finally we will investigate ways of initiating and supporting discussions around disease progression. You will have the opportunity to stop the consultation at any time and seek feedback from the patient and from other workshop participants. And Prof Dunn will provide insights from the relevant literature to help us along the path.

Sign up to our Complex Communication in Health Care learning module here.

Everything you ever wanted to know about thrombosis in primary care…


Learn more about the best practice use of new oral anticoagulants (NOACs) in preventing stroke and thromboembolic events in patients with non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE).

Doctorportal Learning presents a new CPD accredited ALM aimed at helping GPs better understand their role in managing NVAF and VTE in practice.

This is an opportunity to learn best practice from an expert faculty directly involved in developing the module, including Dr Andrew Sindone, Dr David Lim, and Professor Christopher Ward. The multi-modal learning approach, incorporates slide content, expert video vignettes, interactive case studies, and quizzes.

Why is this education important?

  • Learn how to identify signs and symptoms of AF and VTE so that you can better distinguish other differential diagnoses
  • Improve patient safety by being able to identify risk factors that put patients with AF and VTE at risk of stroke and bleeding
  • Develop appropriate systems to ensure effective management of AF and VTE patients on anticoagulants by gaining a greater understanding of the role of NOACs in the management of AF and VTE.

Click here for an overview of our module covering thrombosis in primary care. Not registered with doctorportal Learning? Click here to get started.

Has general practice lost its appeal?

Medical graduates are increasingly shunning general practice for specialist disciplines, according to a new report from the Melbourne Institute.

Looking at data from Medicare along with a ten-year study of 10,000 doctors, the report found the number of young doctors taking up general practice has declined in real terms over the past few years.

At the same time, for every junior doctor going into general practice, close to ten are opting for a specialist discipline.

“Money does matter,” says Professor Anthony Scott, who heads up the Health Economics Research Program at the Melbourne Institute lead author of the report.

“Specialists are paid two to three times what most GPs are, and that’s the route junior doctors want to take. Often it is those who can’t become specialists that move into general practice.”

The report also finds GPs are increasingly dissatisfied with their work and job-life balance in their profession.

Job satisfaction fell by 1.5% between 2013 and 2015, reversing a previous upward trend. Coincidentally or not, 2013 is the year the federal government instigated the Medicare rebate freeze.

That freeze also led to a decline in real terms of Medicare revenue per full-time equivalent GP.

However, total GP hourly earnings have increased at double the rate of real wage growth in the economy. The report authors say it’s not clear why, considering the decline in Medicare revenue, but it may be down to practice efficiencies or income from other sources.

And despite the Medicare rebate freeze, the proportion of services that are bulk-billed has continued to climb, with 86% of services in the last quarter of 2016.

The shape of general practice is changing, too, with a decline in the number of GPs owning their own practice. Correspondingly, practice sizes are increasing, with a wider range of services provided by a range of health professionals.

Almost half of GPs worked in a practice with six or more GPs in 2008, climbing to 61% by 2015.

Another striking change in general practice, and indeed in medicine generally, is the rise of the female doctor. In ten years, from 2005 to 2015, the proportion of doctors who were women went up from 33% to 40%. Over 60% of GPs under 35 are now women, which is 11% higher than for specialists.

And yet female GPs earn around 25% less than their male colleagues, even after accounting for the fact that they tend to work fewer hours. Being a mother further penalises women, who earn $30,000 a year less if they have children. By contrast, men with children earn $45,000 more than their childless male peers.

You can read the full report here.

Professor Scott’s views on junior doctors’ motivations for opting for general practice are not necessarily those of doctorportal.