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GPs' mid-career move to Australia

Pressing the 'refresh' button led us overseas to a new practice. By Drs Jane Gall and Derek Wooff

Drs Derek Wooff and Jane Gall are helping establish a rural medical clinic in Shepparton, where medical students will train in rural medicine (Photograph: Author Image)
Drs Derek Wooff and Jane Gall are helping establish a rural medical clinic in Shepparton, where medical students will train in rural medicine (Photograph: Author Image)

Having left the comfort and cold of a rural Scottish town 11 months ago, we have settled well into the Australian way of life and work.

Making this long journey involved us in some ups and downs.

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What did we do?
After 26 years in general practice in Stranraer we moved to work at the University of Melbourne's Shepparton Medical Centre in Victoria, Australia.

If you had asked us 18 months ago, we would not have predicted we would leave family, friends, colleagues and the security of our NHS pensions for a new job in a new country, half way around the world.

We are not 'brave' people in the traditional sense of the word, but we are delighted to report we have no regrets about our unexpected decision.

We are helping establish a medical clinic as part of the Rural Health and Academic Centre of the University of Melbourne in Shepparton. It is a teaching practice actively involved in teaching medical students.

Students from the University of Melbourne can elect to have a one-year rural placement in Shepparton, linking with GPs and the hospital - in a similar way to the Inverness attachment for students from Aberdeen University. Or they can choose a shorter attachment of a few weeks.

Why did we do it?
There were many factors influencing our decision making.

Our children had just left home and were exploring the world. We always encouraged them to use their opportunities so maybe it was time to take our own advice.

We were becoming exhausted by the pressures of 26 years in the same practice, although the familiarity was comforting. More importantly, we spotted an exciting chance to continue our passion for teaching and practising the core values of general practice in a whole new setting.

There was a lot of paperwork to frustrate us in the early planning stages, which was off-putting, but just needed to be done. It took us six months to complete and then we left Glasgow in October 2010, emotional but excited.

Are there care differences?
The financial model in particular was a learning curve as we have started to bill patients. Our clinic charges by way of the 'Bulk Bill' system, allowing the patient consultation to be free at the point of access as the state Medicare system pays.

We both believe care should be free at the point of access so that the most vulnerable are not disadvantaged and can be treated without regard to their financial state.

Most Australian GP practices charge a consultation fee on top of the Medicare rebate. However we feel we have attracted more complex patients who are unable to afford regular review and who had therefore been used to crisis-style management of their conditions.

The subtle and not so subtle differences intrigued us. Patients come in saying they are 'crook' (sick) and looking for care without huge expectation of the GP solving the whole problem.

They seem intrigued by the idea of ongoing, holistic care. In Australia, patients themselves are often the ones co-ordinating care with input from a wide range of allied health providers, specialists and perhaps having a few GP consultations.

Australia is starting to support the fundamental principles of general practice by rewarding 'care plans' for individual patients with ongoing problems. This scheme gives the GP a financial incentive to provide reviews and appropriate management in a longitudinal relationship.

Coming from rural Scotland, we were not familiar with patients using private insurance to access investigations or specialist opinions. This can work well but does carry the risk of over-investigation and over-treatment. The old adage that 'there is no such thing as a normal person, only one who has not been fully investigated' seems sometimes to be true.

GP records are hard to keep in any comprehensive way as patients can easily move around and secondary care information is often lacking. Perhaps our clinic will gradually build up relevant medical summaries, although we rely on patient input for all the appropriate information.

Are there cultural differences?
The cultural diversity here has enriched us. In Shepparton, 53 languages are spoken. There are many immigrants as well as a significant population of aboriginal people.

We are beginning to gain an understanding of the challenge of trying to effect appropriate care for aboriginal people who have such a high incidence of pathology and early death.

We are participating in the 'Closing the Gap' initiative that is trying to address these health inequalities.

Is it worth doing?
Yes, absolutely. This is still the land of opportunity. We have no regrets and feel we have a better work-life balance, including evening grass court tennis and flying lessons.

The work is stimulating, fun, energising and at times challenging.

We stay in excellent contact with friends and family through Skype, email and texting, and have had wonderful holidays when people have visited us.

Another major benefit is the weather - long hot summers and beautiful clear winter days. Cycling to work is a reality and walking out of the clinic at 5.30pm into a hot Australian evening is highly pleasurable.

Why not press your own refresh button and contact us for more information?

 

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