My name's Ewen McPhee. I'm the I guess the sentinel GP or Practice Principal for Emerald
Medical Group. I'm also a Senior Fellow for Generalist Medical Training and at the moment,
the President of the Rural Doctors Association of Australia.
Well I've been a long term resident of Emerald, I've been a GP here since ninety-two and prior
to that I was a medical superintendent at the local hospital. I've been a GP obstetrician
all that time and I've had the absolute pleasure in delivering babies on babies in Emerald.
So I've very much grown up with this town. Certainly when I came to Emerald I was the
only doctor at the hospital and we had two-hundred deliveries a year. I relied very strongly
on the local GP's who all also had local anaesthetics and obstetrics and we tended to tag team each
other with looking after our own patients. So the training I had back in those days was
done in a major tertiary hospital. In my most couple of years out I went to Charleville
and I had the absolute pleasure of working with a surgeon called Louis Ariotti who was
a there for many years and he taught me much about surgery and about advanced obstetrics
and procedures and I was able to do a lot of anaesthetics with a local surgeon at the
time so it was a fantastic training for rural practice.
Look I think the key thing is somebody who really enjoys country life. Somebody who’s
resilient, and enjoys a challenge but really more and more these days enjoys working with
other people and being supported in a team. Good good country practice these days involves
working with your peers to provide really quality care for your patients.
When you enter into the Australian General Practice Training program it's really important
that you work with your training advisors around choosing the pathway for you and if
you really want to be a GP obstetrician very early in your early clinical years, identifying
that and seeking a placement where you can do your GP obstetric qualification either
or the advanced one which is six to twelve months. Now essentially ACRRM requires that
you do an advanced skills training post for twelve months as part of your four year training
program. And general practice obstetrics GP obstetrics is an excellent advanced skills
training post to do in that place. The College of GPs recognises that advanced skills training
as part of their fellowship of advanced rural general practice which is an extra year onto
your normal GP training. The advanced skills training post itself takes
twelve months. Now what I'm talking about there is the ability to do operative obstetrics
so caesarean section particularly takes the twelve months, there is a six months women's
health type qualification which doesn't allow you to do the advanced surgical obstetrics.
Look the DRANZCOG is assessed by the College of Obstetricians and it obviously involves
examinations and OSCEs to assess your clinical skills and you knowledge.
I think the key thing is to apply to identify your interest through the Generalist Medical
Training, to work with your local hospital to achieve a post and apply through the College
of Obstetricians to be recognised in a training position.
Certainly when I went through it was a very busy job, it was a very exciting job and I
learnt a tremendous amount in that time. Honestly when you apply yourself and you work hard
the assessment is just assessing all the stuff you've learnt during time. So I never thought
it was a heavy load, certainly if you really concentrate on learning throughout your rotation,
the assessment is very reasonable. There's a recognition of the importance of
rural obstetrics of trying to re-open birthing units right across the country. And to allow
women to have their babies as close to home as possible. So the opportunities for GP obstetricians
to provide care to rural women are expanding, certainly in Queensland as we've re-opened
birthing units right across the country, we've seen a greater need to GP obstetricians to
come into those communities and provide those services.
What I've found is most people do need to be very conscious that they have to have an
arrangement with a major hospital. Often the training hospital in which they did their
advanced skills, perhaps go back every one or two years and do a week here and there.
The College of Obstetricians and a lot of clinical credential committees now require
that you demonstrate that you've kept up to date with your fetal surveillance program,
that and the College of Obstetricians particularly offers a yearly up skilling program as well.
So there's plenty of opportunities to keep your skills and what I've found is really
important is that you keep your relationships with your regional hospitals.
What a registrar would expect from training to be a GP obstetrician is that they would
learn how to first of all know their limitations. I think it's very important that when we embark
upon these training that we recognise that we are being trained to a specific scope of
clinical practice. Now what I mean by that is that you need to be able to certainly manage
normal labour very well, you need to understand when things are going wrong and you need to
be able to manage a caesarean section or a forceps or a ventouse delivery and you know
perineal repair so these are the common things that we need to be able to manage. One of
the key roles for a GP obstetricians particularly in a resource poor area is recognising when
an emergency is going to happen. Being able to mitigate or predict responses early so
that you can bring those extra resources in or for example with pre-eclampsia if you identify
it, being able to appropriately transfer a patient in a safe way. So GP obstetrician
is about knowing what you can do in the context of your practice, knowing what the strengths
of your local obstetric unit are and what are the areas in which you really need to
think about early transfer or in our context bringing in the flying obstetrician. So knowing
your limitation and knowing what your strengths are is really an important part of being a
GP obstetrician. When I first came to Emerald back in 1989
I had an opportunity to do obstetrics, I had an opportunity to do anaesthetics, I could
so surgery and I thought why would I go anywhere else in the world when I could have it all,
so I guess for me it was about being a complete doctor and about providing great services
to a rural community. And it's really made a fulfilling career for me as well because
not only do I get to see my patients in my general practice but I get to be with them
during those the wonderful time of birth and also look after the kiddies as they grow up.
And as I've said, some of my patients have never had another doctor in their whole life
and I'm delivering the babies of their babies, which is a really unique experience and I'm
really glad I did obstetrics for that reason.