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A bright future for RVTS in new era of training

With College led GP training now a reality, RVTS is playing an important role supporting RACGP and ACRRM during the transition phase and beyond.

We continue to provide our world class workforce retention programs in rural, remote and First Nations communities, ensuring registrars can remain in their communities while they undertake advanced GP or Rural Generalist training.

RVTS CEO, Dr Pat Giddings, spoke recently with Patrick Daley about why he sees a bright future for the organisation in the new era of College led training.

RVTS CEO, Dr Pat Giddings.

Smiling down the Zoom link from his RVTS office in Albury in regional NSW, Dr Pat Giddings talks proudly about the high level of respect with which RVTS is held in the corridors of power (and health policy) in the nation’s capital.

“RVTS has been – and continues to be – a good news story” he says.

“Ours is a Commonwealth-funded program that has consistently been delivering great outcomes.

“We have consistently been meeting our targets on workforce retention, filling all our training positions, and doing it all within budget.

“We're a great example of how effective a rural health workforce retention program can be.”

RVTS is still going strong, and it is a message that Pat is keen to get out there.

“A lot of people have assumed that with regional training organisations (RTOs) being subsumed in the move to College led training, RVTS must have gone the same way…but we are still very much here, and our role is as critical as ever” he says.

“We continue to provide accredited General Practice (GP) and Rural Generalist (RG) training for both ACRRM and RACGP, and we’re getting great outcomes for their registrars.

“A registrar training with RVTS has about an 80% chance of gaining Fellowship at the end of their time with us. About 10% of our registrars leave the program before Fellowing (usually due to family commitments) but, of those who stay, 90% attain Fellowship – we think that’s a pretty good outcome!”

Pat emphasises, however, that RVTS also plays a vastly different role to that of the Colleges.

“For ACRRM and RACGP, College led training is really about attracting newly minted doctors into GP and RG careers, whereas our role is primarily one of workforce retention” he says.

“Our key focus is to retain doctors in rural, remote and First Nations communities by providing them with access to advanced GP and RG training, and getting them through to Fellowship – so it’s a very different emphasis, but one that dovetails nicely with what the Colleges are doing.

“The College training models also tend to focus more on training registrars via multiple, shorter-term placements around the country, while a key aspect of our program is to keep doctors in the one community for the entirety of their Fellowship training.

“In this way, we play a complementary role to the Colleges…and between us we are able to provide multiple training options that work for different doctors at different points in their career.”

Pat says that with Commonwealth funding in place until 2025 and strong demand for its programs, RVTS can bring stability to GP and RG training at a time of significant change in the GP training landscape.

“We’re getting great outcomes, our registrars are continuing to progress successfully to Fellowship, and we are keeping more doctors in rural, remote and First Nations communities.

“Since our inception, we’ve trained around 500 doctors through to Fellowship. They have worked in approximately 400 rural, remote and First Nations communities – that means pretty much every small town across Australia has had the services of an RVTS doctor at one time or another.

“We’re currently training just over 100 doctors across most states and territories, primarily in MMM5 (small rural towns), MMM6 (remote) and MMM7 (very remote) locations.

“Additionally, our Targeted Recruitment program – which offers training towards Fellowship as a ‘carrot’ to entice doctors to some of the hardest to fill locations across Australia – has assisted with the recruitment of 20 doctors across 24 locations since 2018, so this has been a huge success story for us.

“There are big challenges involved with the move to College led training, and it will take a number of years for the new system to be bedded down – so as a well-established training and workforce retention program, we are a stable contributor to the current GP and RG training landscape.”

RVTS has been a strong supporter of the move to College led training, saying it is an important opportunity to shape a new chapter in GP and RG training in Australia.

“We all hope College led training will have a positive impact on the number of junior doctors who opt for a career in General Practice or Rural Generalism” Pat says.

“Under the new model, the consistent promotion of General Practice as a respected medical pathway should be much more achievable – and Rural Generalism is the most exciting thing that has happened in GP Land in decades. It has effectively created a new and exciting profession within Medicine, which should be very attractive.”

Pat believes College led training will also see RVTS’s role dovetail even more with the Colleges into the future.

“Both RACGP and ACRRM are represented on our Board and are member organisations of our not-for-profit company that run our training, so we’ve had close relationships with both over many years.

“They recognise the special role we play, and the significant experience we’ve gathered over the years in delivering a remote supervision model.

“When we started out as an organisation, remote supervision was not considered mainstream, but it is now embraced by both Colleges as an important option for providing registrars with supervision in locations where it is otherwise difficult to do so.

“We can see continued collaboration going forward and it’s really our intention to support the Colleges where we can under the new model, particularly in those settings where it can otherwise be very difficult to deliver education and provide supervision.”

RVTS has always played a key role in training International Medical Graduates (IMGs) through to Fellowship – and with a continuing reliance on IMGs in rural and remote communities predicted for many years to come, demand on its training programs will almost certainly increase.

“We continue to face significant workforce challenges in rural, remote and First Nations communities, and we will need to recruit more IMGs to those communities in the future” Pat says.

“That will mean a continuing need for workforce programs like ours that support IMGs to work in more remote settings while undertaking their advanced GP or RG training.

“Australia owes a great deal to IMGs – they have been the mainstay of rural general practice for 20 or 30 years.

“More than 50% of Australia’s rural and remote medical workforce now comprises doctors who have received their primary medical qualification from overseas.

“It’s important we recognise the vital role they play in delivering medical care to people in rural and remote Australia, and continue to support them.

“While our program not only supports IMGs in attaining Fellowship, we are highly valued by this group and we play a key role in retaining them in rural, remote and First Nations communities.”

Pat adds that policy makers, rural communities and the medical sector itself must drop the expectation that a rural doctor’s recruitment can only be considered a success if they remain in the one community for their whole career.

“We’ve got to be realistic – times have changed” he says.

“The days of rural communities having a mainstay rural doctor who has worked there for 40 years, often on-call 24/7 for 52 weeks of the year, is really a thing of the past.

“You can’t expect people to do that nowadays. It doesn’t happen in the city and it shouldn’t be expected in the bush either.

“If we can get five years’ service from a doctor in a rural town, at a time in their life when they want to work rurally, then we are doing well…the alternative is a string of locums, no continuity of care, and much greater expense.

“For RVTS, simply retaining a doctor in their rural or remote location for the duration of their training is a success. Most RVTS doctors have been working in their community for an extended period prior to being accepted into our program, and then train with us for 3-4 years, so that’s a total of 4-5 years in the one location – and that’s great!

“About 40% of our registrars then stay in their location one year post Fellowship, and about 20% are still there two years post Fellowship. We consider this to be a very successful outcome, and those doctors who stay on even longer are icing on the cake.”

Following a recent journey to Canberra, Pat is optimistic for the future of Rural General Practice and Rural Generalism.

“While in Canberra, I was fortunate to attend the Rural Doctors Association of Australia’s annual politicians forum at Parliament House, and they convened a panel discussion featuring four young Australian-trained doctors who have chosen Rural Medicine as their career path” he says.

“It was wonderful to see what talented young doctors we are producing here, and hopefully we’ll see more of these doctors pursuing careers in Rural General Practice and Rural Generalist practice under College led training.

“These are exciting times for Rural Medicine, and I am looking forward to seeing what collectively we can achieve.”