The Victorian director of the ARA board on what trainees want, how to grow rural rheumatologists and why a gap year works.
Dr Maninder Mundae is the Victorian director of the ARA board.
She spoke with Rheumatology Republic about challenges the sector is facing, ways to turbo boost trainee supervision and how get a regional rheumatology clinic up and running.
Dr Mundae works across Western Health hospitals and her private practice in West Brunswick, Melbourne. Every couple of months she travels to Stawell for rural service and during covid helped set up Ballarat public hospital rheumatology clinic.
Despite the considerable workload Dr Mundae still exercises daily, enjoys socialising and prioritises a six-week family holiday each year.
Such a well-managed, work-life balance may well have started very early in her career when she hefted a backpack and bought a ticket to England.
What’s been your career path so far?
I first did my undergraduate studies at Monash and Flinders Universities – Bachelor of Pharmacy and BMBS. Then I trained at the Western Hospital, the Alfred Hospital, and the Royal Melbourne Hospital, finishing in 2008.
But I wasn’t quite ready to be a consultant rheumatologist yet. I wanted to do a little bit of travel so I went over to Cambridge in the UK and did a fellowship at Addenbrooke’s Hospital in Cambridge for about a year.
It was a really good consolidation year for me. I didn’t have to be on call and could be an extra numerary. I was lucky, I had a few friends in different specialties that were doing the same thing in the UK. Cambridge is near Stansted Airport so we would fly to places like the Greek Islands on weekends. It was a lot of fun.
What did you do when you flew back to Australia?
I joined a colleague’s private practice around 2009 and started working at a couple of public hospitals as well. Over time I streamlined it down to just one hospital – Western Health.
In 2015 I opened my own practice, Northern Rheumatology and Specialists Group, and now have almost five rheumatologists working here with me. My husband has a business background and helped me with the business side of opening a practice. I also do a little bit of medicolegal work on medical panels.
What do like about the medicolegal work?
It’s a lot more musculoskeletal type work and it just breaks the week up from pure clinical rheumatology. I really enjoy working with colleagues from other specialisations as well. I’ve learned about how they approach conditions and have picked up a few tips on examining joints. It’s helped to have people that I can just call up and say, “Can I pick your brain?”
You are also an advocate of trainee wellbeing. Any ideas on how to make supervising more effective?
I know that when you’re really busy as a consultant, you can sometimes forget about what the trainees need. The trainees I have worked with over the years all want us to be teaching them but they also want a critical workload that they’re learning from as well.
In clinics, make sure you see all the patients with the trainees. Teach them how you examine. Take the time to teach them how to do joint injections properly. Make just a few extra minutes in the day to ask, “Okay, how did you examine the joints? Show me how you did the hand exam.” And then demonstrate ways it could be improved or let them know if they’re doing a great job.
Before covid we would do grand rounds once a month. The two registrars would present a case to the whole unit. Then we’d all go together and see that patient and discuss that patient. But that changed with covid.
What can be done to boost rheumatologists in regional areas?
It’s a huge problem. First of all there’s huge workforce issues in actually having enough rheumatologists, let alone having enough of them working in the regions. We need to create training positions in regional and rural hospitals.
For example, I know Ballarat public hospital is trying to create a rheumatology trainee position, but they can’t get the funding. Geelong applied for funding but were told they’re in a waiting list of 200 applications.
We also need to increase government awareness about what rheumatologists do and why we need trainee position funding. Or, at least have a system whereby larger hospitals rotate rheumatology trainees out to regional and rural areas.
How did the Ballarat public hospital clinic get up and running?
It was a collaborative effort between Western Health and Ballarat Health Services (now Grampians Health Services) to create a new position and start a public clinic up there a year and a half ago.
We send one rheumatologist up from Western Health and there’s a local rheumatologist working there as well. Initially we got government funding for half of the role and then Grampians Health came to the party and provided funding for the other half. We managed to get a non-accredited registrar initially but Grampians Health were so keen to get it going that they funded the consultant position as well.
Demand has exploded already. I’m hoping they’ll have more rheumatologists join and then create a core trainee position and eventually function as a full functioning unit in a public hospital.
That sounds very busy! What do you do in your downtime?
I have a trainer two or three times a week and I run with some friends three times a week. We’ll do a run and then have a coffee and chat.
I find that I problem solve a bit too when I’m running. If something’s on my mind, I’ll run and I’ll be working through it as I’m running. I don’t listen to music, I listen to my breathing. I find it meditative actually, like it’s a real relaxation time for me.
I also love family time. I have a seven-year-old boy and we like to go out for hikes or walks or skiing. What we’d do at the end of every year, before covid, was take six weeks off and do a trip in Europe with just the three of us.
This year we’re going to Italy. I’m not sure where exactly, my husband’s organised the itinerary. I’m happy to just go along with it!
