Registrars: some advice before you fly solo

FOR the last few years at this time of new beginnings, I have dispensed some advice for interns (here, here, and here).

Those interns have now grown up and should not be forgotten. They are now senior residents or registrars; they are almost ready to fly solo!

By the third, fourth or fifth year navigating the system, registrars know their way around the hospital; know what forms are for what; have a handle on how to get things done; have an idea what specialty training they want to undertake; and know the places to get good coffee and other sustenance.

They would also know the pecking order of the consultants, the hierarchy of the trainee doctors, the names of the juniors and the nurses, and possibly even the medical students attached to the team.

Clinical and career advice for doctors at this stage of training is freely available in a number of places (some references are listed at the bottom of this article). However, I propose to those at this level of their career to think about a few concepts that do not usually appear in general advice on the internet, and are not commonly offered by their seniors. These suggestions in fact remain invisible to many doctors until well into the senior years, leading to frustration, regret and lack of fulfilment in mid-career and late career.

Pharmaceuticals Benefits Scheme (PBS)

A prescriber number is issued to doctors upon registration and forms a part of the prescribing system in Australia.

Young doctors stand to save a lot of time and effort if they order their own PBS prescription pads, rather than having to write their names, address and prescriber numbers on each script on generic hospital prescription pads. It also makes life a lot easier for pharmacists.

Now is a perfect time to familiarise oneself with the different state and federal prescribing rules, particularly the PBS. Time and time again, community GPs and pharmacists need to correct hospital scripts that fail to comply with PBS rules.

Spending some time with a pharmacist to discuss the rules may assist this process.

Medicare Benefits Schedule (MBS)

As time goes on, young doctors get exposed to work opportunities outside of their teaching hospital settings. This may be structured as part of a training scheme, or it may be more individual, such as locum work or private consulting.

Before undertaking any work outside of the teaching hospital, it is important to have a grasp of the MBS. A provider number is usually required for most work. Rules that govern who may possess a provider number take into account stage of training, geographical location and residency status. Initial applications for provider numbers can take some time, whereas additional numbers are usually quicker.

It is imperative to have an understanding of item numbers relating to different services. Failure to use the correct numbers may result in patients being out of pocket or the provider needing to refund monies to Medicare.

Private practice versus public practice

The two are not mutually exclusive.

The cosiness of getting paid a salary, super and leave entitlements leads many young doctors to elect a career in a salaried position.

While private practice does come with more red tape, it does permit more earning potential as well as more autonomy over one’s time and movement.

The beauty of the Australian system is that doctors can do a blend of public and private.

Associations

Most trainee doctors join a college by the third or fourth year, as it has become hard to maintain consistent work in the Australian medical system without being on a training scheme or possessing a fellowship.

Colleges are mainly about education, training and standards. Some colleges are expanding their roles, venturing into member services and industrial relations; however, this remains controversial and differs from college to college.

In my experience, it is wise for doctors to join one or more professional organisations that can provide assistance and advice in a whole range of areas, including professional, industrial and financial. Such organisations also provide opportunities for networking and social interaction with colleagues.

Insurances

It is said that in life, death and taxes are inescapable. To this list I would add insurances!

In a risk-averse and heavily regulated society and economy like Australia’s, we need all sorts of insurances.

While hospitals cover their junior medical officers under government insurance arrangements, it is wise for doctors to take out their own private medical indemnity insurance. As doctors become more experienced, some potential insurance matters may slip through the cracks of the government insurance. Your private medical defence organisation is also a source of professional advice and risk management.

Young doctors should think seriously about their own health insurance. Income protection insurance and life insurance are also worth considering, especially if they are signing up to mortgages and other loans.

Equipment

Many junior doctors rely on equipment they find at work.

It may be worth considering a small stock of quality equipment to have at home or in the car, for when duty calls unexpectedly.

Journals

Whether on paper or online, a consistent and reliable supply of good medical information is always necessary. The hospital IT and library services hold an abundant supply of resources. However, as doctors progress through their training, the need for information becomes more specialised and needs to be tailored to the individual. Therefore, now is a good time to consider investing and subscribing in some quality journals.

Wishing you a wonderful continuation of your careers!

Dr Aniello Iannuzzi is a Visiting Medical Officer at Coonabarabran District Hospital, a GP, and a Clinical Associate Professor at the University of Sydney and University of New England. He is Chair of the Australian Doctors’ Federation.

Some resources for registrars:

• https://onthewards.org/tips-on-being-a-good-registrar/
• https://www.avant.org.au/news/being-a-good-registrar/
• https://medicguild.com/articles/hey-its-the-surg-reg-how-to-survive-your-first-day-as-a-registrar/
• https://www.rcemlearning.co.uk/foamed/good-spr/
• https://www.servicesaustralia.gov.au/pb229
• https://www.servicesaustralia.gov.au/hw019
• http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.