Most rheumatologists will spend at least a portion of their working life in private practice, but the fundamentals are missing from training
The vast majority of rheumatology takes place in private, community settings, and yet rheumatology registrars are often untrained and unprepared for private practice.
One NSW final-year trainee, Dr Gemma Winkler, decided to do something to address this training deficiency. She created a handbook, Preparation for Private Practice, as a guide for the most common issues faced by rheumatologists fresh to the private system.
What prompted you to create this handbook?
We are required to do a research-type project for our training program, and I decided to do something a little bit different. Knowing that I wanted to go into mostly private practice, I realised it’s very different to what you’re exposed to in the public hospital training process.
So I surveyed the New South Wales ARA members to get an idea of how to actually practise privately. I wanted to get an idea of what the nuts and bolts are like: how long do you spend with a new patient? How long do you spend with a follow up? How do you arrange injections? Do you do them yourself or do you send them away to a radiology company? How do you dictate letters – do you type them to speech-to-text, use software recognition, or get a secretary to type them up? Things like: is your practice electronic, paper-based or a combination of both?
Then I combined the survey answers with interviews from secretaries about advice they would give to new fellows going into practice and put it together into a handbook.
Where do you see a resource like this fitting in?
Most rheumatology training is done in the public hospital system, and yet there’s only a few hospital jobs. I’d say around 70 to 80% of people would wind up in private practice, but we don’t have any training on it, really.
The idea was that it would be mostly for new fellows going into private practice, but I suppose any person if they are going into a private practice area, whether it be a trainee or not.
When you transition to a private practitioner, there is all this paperwork you have to fill out. For example, to get AHPRA registration as a specialist you have to have Medicare recognition that you are a specialist. While there are Medicare-based programs that help you submit paperwork forms online, they are not very intuitive to use.
So I just tried to outline, step-by-step, how you go about all of these different things.
What did the survey reveal?
It showed that 50% of rheumatologists did not feel ready at the end of their training.
The survey indicated that rheumatologists were far more confident with their actual medical knowledge. The ones that did feel ready said they had a good support group or they had mentors.
But the ones that didn’t feel ready were mostly saying they had no idea about staffing, billing, running a business, the financials of running a small business. For example, the private practices all work on different software programs, and you don’t get any exposure to that until you start private practice. So you are kind of figuring out how to be a consultant on your own. I mean, people have done it for decades and they’ve survived, but you could do it a bit better.
What is missing from the way doctors are currently trained?
The ARA doesn’t even know how many new graduates enter into private practice at the end of their training program. So I think there is scope there to find out how many people enter into a private practice after they finish training. I assume it’s a high proportion, and we should therefore be training our trainees slightly differently to better equip them for entering into that world. There is a lot of interest in understanding the business side of medicine.
What can we do to fix this?
At the moment we don’t have any training on private practice, really. So anything is better than nothing. In NSW, the training committee designs monthly training nights, so perhaps dedicating one training evening to more of the business elements of the private practice side of rheumatology would be good.
Creating online modules that people can sit down and go through themselves – for example, this is how Medicare works, these are the billing numbers that most people will use, and so on.
Something that’s online-based would be good to ensure it is available nationwide.
But beyond that, it would be great to increase exposure to private practice with more registrar positions and compulsory private practice days.
So give us an idea of advice rheumatologists had for new fellows?
Most advised registrars to do things such as:
- join a group practice
- speak to “old timers” or find a mentor
- sit in with a colleague and discuss difficult patients
- do locums to see how other people operate
- stay affiliated to a teaching hospital for meetings
- attend courses on working in or running private practice
- join an early career rheumatologists’ group
- set your work-life balance in stone
To find out more or get a copy of the handbook, email gemma.winkler@gmail.com
