Teaching and Knowledge Exchange
Written by Dr Rob McEvoy
Monday, 01 February 2016
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The award reads ‘2015 RACGP General Practice Supervisor of the Year’, and Margaret River GP Dr Cathryn Milligan is the proud recipient. We phoned when she was manoeuvring her car, with accompanying ‘beeps’, in a local car park. She earned the award by mentoring general practice registrars and medical students and inspiring them to a career in general practice (with two graduate GPs staying on to work in her practice). What has her 10 years of 1-2 registrars each year taught her?

Husband-Mark-Leavesley-Dr-Cathryn-Milligan-RACGP-Melb-Convention Dr Milligan with husband Mark Leavesley at the RACGP award ceremony“Aside from their youth, they bring their training from the hospitals, so their protocols are quite crisp and up-to-date. I find that useful to bounce off. I teach them how to use protocols as guidelines rather than rules. It works well,” she said, adding relatively advanced skills are required where she works.

“Some may not work as fast as others but they have usually done two or three years in the hospital system and have done some rotations, so their fundamentals are quite sound when they get here – they just need to refine that to general practice.”

Talking to Cathryn you get the idea that she learns a lot while teaching.

“It’s quite a collegiate environment and they are never working alone. They know they can pop their head out and ask someone. The things that stump them are things like rashes that you don’t usually see in hospital, and gynaecological problems. But I’m quite astounded at how good they are.”

Cathryn is the sole principal at Margaret River Surgery, having just bought out another doctor. She says the people she works with are professional and committed, so they take ownership on a professional level. She has been at the practice for 19 years.

While many equate Margaret River with ‘lifestylers’, she is still learning from the registrars about work-life balance.

“I watch and learn from them. We all work only four days a week but we all do anaesthetics, obstetrics and ED – we take time off after being on call. The younger ones haven’t done the hours we did when training and they just get tired and don’t want to do what we think is quite normal, which helps us think it through.”

She takes registrars at all points of training. Most of her consulting is women’s health and obstetrics. With no surgeon in town and the Bunbury surgeon no longer visiting for elective caesareans, the time is ripe for an advanced GP obstetrician to move there.

The generational differences – she admits she is old enough to say that – shows itself strongly in the registrar’s IT skills, with many routinely touch typing. Registrars do a lot of online training, travel less (which helps them) and manage some group teleconferencing and Skyping from Margaret River, although she feels face-to-face with trainers in Perth is important.

The health consumer complaint of doctors too distracted by computer screens is overrated, she said.
Milligan-Cathryn-Dr-Nov15 1 balancedDr Milligan in her garden

“I used to write notes. You have to look at both, whether typing or writing notes, so patient time is just a time management thing.”

Because the practice takes medical students as well, she has noticed that since the universities changed to postgraduate intakes, quite a few are a bit older and have had careers before, and the extra life experience is good for their general practice work.

She is waiting to see things trickle on to the GP registrars.

She is used to any fishbowl effect that a doctor living and working in a rural town gets. In fact, she says living in the community makes rural practice “quite inspiring”.

“And I feel more represented by the college. They are developing a profile which is important. They are trying to provide a voice as well as the AMA – the AMA is the go-to organisation for government but ACCRM, Rural Health West, RACGP, RDA are all good and seem to work together. The profile of general practice is improving.”

She admits that although the isolation has decreased thanks to emails and other good communication tools, rural practice remains busy, which makes it harder for full time country GPs to get involved in the community.

 

“I think you have to be prepared to step back from clinical practice a bit to be involved in organisations.”

“I feel I’ll have a presence here for a long time. I like to be busy and I have multiple interests. I do like my work and haven’t put a time frame on it but imagine I will start to cut back in five years.”

Her four children have all left home but being on-call one weekend in three means she gets to Perth about once a month to see the family.