Dr Anand Patel has supervised GP registrar Dr Sujeeth Paulgudi Thiyagarajan over the entire course of his training, even though the two live 400km away from each other.
Despite being based in rural towns that are four hours’ drive apart, Dr Anand Patel has spent the last three years supervising RACGP registrar Dr Sujeeth Paulgudi Thiyagarajan.
The supervisor-registrar pair are taking part in the Remote Vocational Training Scheme, or RVTS, which has so far supported about 500 doctors to obtain RACGP or ACRRM fellowship.
Dr Patel, who lives and works in Mildura, completed his own GP training on the RVTS.
Dr Paulgudi Thiyagarajan, who is now on the verge of fellowship, was working in Mildura when he got the chance to take a training post at an Aboriginal Community Controlled Health Organisation in Echuca.
The pair sat down for a chat with Blood Republic at an in-person RVTS clinical workshop in Brisbane.
What led you both to arrive on the RVTS?
Dr Paulgudi Thiyagarajan: When I initially applied, I was looking to go into general practice.
Primarily my experience was mostly in the hospital setting, where I was training, and I was in the ED training program. And then I thought, ‘I need some work life balance’, and general practice sounded like the way to go.
I was looking for a job opportunity and then I got to know about RVTS.
I had been working in Mildura and then I found out through one of our mutual friends that Anand had been an RVTS registrar. I had never met Anand – it’s sad, that I only got to know Anand after I left Mildura – but I rang him to ask a bit more about the RVTS.
Dr Patel: I was an RVTS registrar myself in 2019 and 2020, it’s a great program.
A few reasons why I chose this is it allows you to stay in one practice where you regularly work throughout your training, so you don’t have to change your practice every six months, like some of the other programs.
The remote supervision is a method where trainees are regularly supported, but they don’t necessarily have to have on-site supervision, which works well for some remote and regional communities where we are not in a luxurious position to have supervisors on the site.
Is remote supervision suitable for everyone around out there? No, definitely not.
But is the remote supervision an excellent idea for someone who has quite a bit of an experience and has already worked in the Australian system and [is unable to take a job] because there is no on-site supervisor available? Those are the kind of situations where remote supervision works very well.
It’s not that they will not have any supervision or support. We have weekly webinars where we will go through the curriculum set by the college and we have two face-to-face workshops [per year] and also, early in the training, one hour every week of teaching time with their supervisor.
And depending on how close the working relationship is between the supervisor and registrar – most of the supervisors will have a very good, close working relationship – they are quite welcome to check on WhatsApp or make a phone-a-friend kind of phone call for any particular patient as well.
I think for someone who has already got quite a bit of experience in Australian system, this is an excellent opportunity.
Dr Paulgudi Thiyagarajan: The requirement [from the RVTS was to be in contact at least] once a week, but I could ring on at any time – 8:30 in the morning or at lunchtime or if I have a patient in my room.
I’m new to general practice. It’s a completely different ball game, working in a hospital emergency department to going to general practice.
I would have had no clue what to do with preventative health, so that was really interesting and challenging to get through, but it was very well supported.
If you can’t get through to your supervisor, there was also a fallback supervisor so you could ring who was on standby, but I never had to go through that.
Anand was always available for me.
Sujeeth, were you already looking at a job in Echuca and then saw the information about the RVTS, or did you take the job in Echuca to be on the RVTS?
Dr Paulgudi Thiyagarajan: I saw a job advertised for that position, and I said ‘well, let me try and apply for this and see how I go’.
And in the position description on the job advertisement, they said that you can train through RVTS program and essentially stay in the same place.
I don’t know much about the AGPT program, but I heard that you have to move around every six months, and I didn’t think that was the best way to go.
And I also had an interest in Indigenous health, so it worked well for me.
Dr Patel: I might add that the RVTS has worked with the Department of Health so that various clinics and locations can apply for a targeted recruitment position.
Targeted recruitment is where a town or clinic hasn’t been able to get many doctors, and usually it happens to be in a more remote town, rather than a regional town.
But if anyone is struggling, they can go through a formal process of advertising a position under targeted recruitment.
Targeted recruitment comes with some extra incentives so [whoever takes the job] essentially have a greater chance of getting into a training pathway, with the ultimate aim of fellowship.
I’ve been Aboriginal Medical Services registrar; I trained as an AMS registrar, stayed behind as a GP there, and through this RVTS program I’ve been helping Sujeeth [to become an AMS doctor].
He has been, many times, a single doctor in that AMS and carrying quite a lot of burden of care.
But it goes to show how important that position is, to have a doctor in the community controlled medical service.
Remote supervision, as I mentioned earlier, is not for everyone.
The RVTS screen rigorously and panel interview as well, so it’s not like anyone who applies gets in, because we have to take safe clinical practice, into account. Only the candidate who has essentially proven that they are safe, and keen to do remote medicine gets in.
It takes a special skill set and mindset.
What do you both like about doing rural and remote medicine?
Dr Paulgudi Thiyagarajan: I’ve gained a lot of skills managing chronic conditions.
It was an amazing journey. Before getting into this program, I wouldn’t have thought I would be treating hepatitis C, for example, and have success with it, or improving quality of life with chronic conditions.
I would have never thought I would have done that. I went from like, “Oh, bye, bye – I’ve seen you, I’ve stabilised you, you go inside, it’s not my problem anymore” [in emergency] to doing everything for patients.
People appreciate your work, and they say “oh no, I only want to see this doctor, I don’t want to see anyone else”, even if there are three other doctors.
That’s nice, when the reception comes and tells you that you’re getting too busy, too famous.
Dr Patel: I think rural medicine is quite challenging and rewarding, for sure. You are not just a number, you are an important part of the community.
And yes, it does come with its own challenges, with the workforce shortage and not being able to be replaced if you go on a holiday or something, but it’s very rewarding.
I think the patients respect good medicine and there’s more collegiality.
In the town where I work, there are, let’s say 40 GPs. Everyone knows everyone, everyone knows their strengths and weaknesses, and everyone’s happy to help.
In regular GP training, registrars move practices every six months, so they essentially change supervisors every six months. But you two have had that registrar-supervisor relationship for three years, and you seem like good friends.
Dr Patel: I told [Sujeeth] even the earlier in the week that yes, technically, the term is a registrar – but we are colleagues eventually, and it does help maintain and develop the relationship.
That’s what I have used to have with my supervisor, who unfortunately left the country, and I’m hoping that’s going be the same case with Sujeeth and me as well.
Dr Paulgudi Thiyagarajan: So long as you keep buying me presents!
Responses have been edited for length and clarity.
