Wodonga – Federation Clinic
Federation Clinic in Wodonga is an AGPAL accredited practice and has been honored with national awards including the RACGP/AGPAL Victorian Practice of the Year and the AGPAL Quality Innovation Award. It is a regional medical Practice with ten general practitioners as well as registered nurses, a nurse practitioner and counselling services.
The clinic provides services in women’s health, men’s health, child & adolescent health, aged care services, immunisation, obstetric care, chronic disease management and minor surgery and wound care. The three supervisors are Dr Phillip Steele, Dr Fiona Christie and Dr Geoff Williams.
DR PHILLIP STEELE
Practice Principal and Co-Founder, Dr Phillip Steele came to Wodonga in 1982 under the Family Medicine Program, completed his GP registrar training and joined one of several practices servicing the town at that time. Dr Steele has special interests in Obstetrics and Paediatrics having completed training positions in the UK prior to commencement in Wodonga.
Dr Steele recalls there was strong GP involvement in the running of the local Wodonga hospital at the time and recognises this as one of the fundamental differences in practice over the past three decades. GPs admitted patients to each ward, put drips in children, performed lumbar punctures on babies and many other procedures. There were GP Surgeons, GP Anaesthetists and GP Obstetricians.
The rapid growth of the Albury Wodonga region in the 1980’s necessitated the expansion of health facilities to meet the increasing demand. Phillip partnered with two local practitioners and in 1988 planned and built Federation Clinic – a purpose built general practice located in the rapidly expanding suburb of West Wodonga.
DR FIONA CHRISTIE
Having completed her Advanced Diploma in Obstetrics, Practice Principal and Registrar Supervisor Dr Fiona Christie, commenced at Federation Clinic as a Registrar in 2004 for her first GP term.
Fiona grew up in rural Victoria, completed her medical degree in Melbourne, worked and travelled overseas, obtained further qualifications, but always knew she wanted to practice in a rural area. Learning she was able to practice obstetrics and finding Wodonga a large enough centre to provide employment for her partner, the decision to stay was made.
“Coming to Albury-Wodonga was very exciting for me. I had a great passion to get back and provide health care to people in the country. There was such a lack of GPs in the country at the time I finished training.” said Dr Fiona Christie
Fiona is a GP Obstetrician and has special interests in Women’s health and Paediatrics. In addition she is a Registrar Supervisor for MCCC, and teaches Medical and Midwifery Students.
When discussing the significant changes that have occurred during her time at Federation Clinic, Fiona recognises the onset of technology as being significant, but the expansion of the medical workforce, especially GP numbers, has produced the biggest change. Lack of GP’s in the region in her early time at Wodonga made the work load stressful, with the demand for GP’s far outweighing the supply.
“When I first came I had a constant sense of drowning – we couldn’t keep up with the demand. There were never enough GPs in town and getting good quality Registrars to come and work here was very difficult.” said Dr Christie
The expansion of the medical workforce as the number of doctors in the town grew and the emergence of larger practices impacted in positive and negative ways. Fiona explained there is now less pressure to see unsustainable patient numbers. This affords more time to ensure practitioners are truly optimising quality of practice, involvement and development of GP training and time for professional development and self-care.
Both practitioners identify an over-riding philosophy and priority of the practice is to maintain a true family practice and not to grow too big. This is important as it enables them to focus on creating optimal working conditions and to maintain an excellent quality of practice in a community environment. Practice emphasis is that they ‘support each other in providing excellent care for their patients, practice self-care and, as a practice, teach care for each other’.
“That’s a goal of ours – that we never grow so big that our practice loses the feeling of being part of a community where you look after each other.” said Dr Fiona Christie
TRAINING REGISTRARS KEEPS THE PRACTICE MOVING FORWARD
Along with the growth of Wodonga, the practice has grown – this has coincided with the evolution of formalised GP training. Federation Clinic has been involved with the Bogong Regional Training Network since its inception in 2002.
“Our growth has happened alongside the growth of Bogong as a training organisation and the nature of GP training has become much more organised and structured.” said Dr Phillip Steele
As a Registrar Supervisor and educator with a focus on training as an integral part of everyday practice, Dr Steele has supervised, mentored and supported many Registrars to Fellowship through Federation Clinic.
“Phillip is very good at supporting junior doctors. He has mentored so many Registrars over the years and he just has a gift for it. I was one of his Registrars and many others have also benefited from his support and wisdom.” said Dr Fiona Christie
Dr Steele was a founding member and Director on the Board of Management of Bogong Regional Training Network for eleven years (Chairman from 2006-2011). He has been committed to the delivery of GP training and derives personal satisfaction in the fact that Registrars describe their time at Federation Clinic as an important factor in making their decision to become general practitioners.
In describing why the commitment to registrar training is a priority, Dr Steele recognises that it’s not a one way street. One of the reasons his time with registrars is enjoyable is because he learns from them and the ongoing supervisor training he and other partners participate in, enhances the professional development of the entire practice.
Having been a recipient of the training and support offered at Federation, Dr Christie recognises the value of this expertise and enjoys the opportunity to support and train the next generation.
“Registrars teach us while we teach them. They often have more up to date knowledge and we provide that long term experience which can put it into context.” said Dr Fiona Christie
As a regional practice, Federation Clinic is testament to the success of having medical students transition from high school through the Rural Medicine Program, to rural internship, postgraduate training, and ultimately to rural practice. Federation Clinic acknowledges the positive impact of ‘locally grown’ practitioners on workforce recruitment and retention in the regional / rural setting.
Dr Christie noted as a result, there has been a significant increase in the number and quality of locally produced Registrars applying for practice and that the hard decision can be about who to choose amongst a group of excellent candidates.
“It feels that we are coming out of that struggle to find high quality Registrars – … now we are able to choose between good quality people. It’s a really positive change for General Practice in the region.” said Dr Christie
A WHOLE OF PRACTICE APPROACH
Practice Manager, Nicole MacDonald started her administrative career as a trainee medical receptionist in general practice more than 20 years ago.
Nicole reinforced that the selection, support and training of Registrars involves a whole of practice approach. She described that in the initial interview stage, the team at Federation Clinic makes an effort to provide the registrar candidate with a broad view of the practice and what it has to offer, as well as an understanding of its’ philosophy and operational style. Nicole acknowledges this can be a challenging thing to achieve in the limited period of time spent in the interview process but maintains it has been critical to a successful selection process and finding the “best fit” for both the Practice and the Registrar.
“We can teach skills, we can fill gaps in learning. It’s critical to get the personality fit correct, in alignment with the ethos and personality of the Practice.” said Nicole MacDonald
In welcoming new registrars and their families to the broader community, Nicole is proud of the mix of support provided by various members of the team including reception, nursing, medical and administrative staff.
“It’s not just about looking after the Registrar – it’s also about looking after their family. We regard that as a critical part of what we do… We try and do as much as we can to help people become familiar and get settled in the region …. Particularly those coming with partners and children… our local experience plays an important role in assisting Registrars select a placement that fits with their long term goals.” said Nicole
To facilitate a smooth start in practice for registrars, Federation Clinic has developed extensive orientation and induction processes around the clinical, operational, and financial structure of general practice, including many areas in which Registrars may not have had previous experience in.
MENTORING LOCAL YOUTH
Federation Clinic has a long history of mentoring local youth. In the past, high school students have been employed on a part time basis. Currently the practice hosts a Gap Year placement. Dr Steele explains:
“Year 11 and 12 students would work shifts after school for a few hours. There would be four or five students taking a day each throughout the week. They would learn the skills of being a receptionist, including how to answer the phone, cleaning and infection control principles and processes, how to scrub surgical instruments and bag ready for autoclaving etc. Along the way, if they were interested in the medical side of things, there were many hours spent sharing knowledge along the way.” said Dr Phillip Steele
As a result, local students have taken on roles in administration, nursing, allied health and medicine.
The practice also supports training of medical students from the NSW University, Rural Health School Albury Wodonga Campus.
As Registrar Supervisors, both Doctors have a strong commitment to being available and ensuring support is accessible to their Registrars.
‘We have worked to make sure that the Registrars know this is a supportive community. We encourage them to ring us whenever they need to… Phil spends many evenings here counseling registrars at the end of the day. Supporting Registrars has always been a strength of our practice.” said Dr Fiona Christie
FLEXIBILITY, RETENTION AND SUSTAINABILITY
With its long term commitment to medical students and providing GP Registrar training, Federation Clinic has been successful in retaining many of its’ registrars as long term members and partners in the practice.
“When you think about who’s here in this practice – there are only two doctors out of ten, who either are not in training or who were not trained here.” said Dr Phillip Steele
This commitment has meant the community of Albury Wodonga has benefitted by the provision of a long term, sustained, medical workforce, to meet the needs of the population.
Practice Manager, Nicole MacDonald recognises workforce flexibility as another key factor to sustainability. She describes having observed a significant shift in General Practice from a workforce which was previously largely full-time to one which is now more commonly part time, with this change offering both Registrars and Practices a greater degree of flexibility.
“With a larger and more diverse workforce, the way we carry out teaching, education and support within the Practice has had to change. The result of this is a flexible and adaptive Practice team.” said Nicole.
Nicole explains that operationally this has its benefits and its challenges but in the long term it is beneficial for Practices as a whole because it promotes a sustainable workforce. The support of workplace flexibility provides team members with an increased opportunity to maintain a work life balance.
TRAINING THE TRAINERS
On a personal level, both practitioners describe a significant philosophical commitment to training the Registrars to become educators themselves.
Federation Clinic encourages the Registrars to become involved in teaching. Registrars present cases to each other and small group presentations cover a range of topics. Participation in regular clinical meetings where Registrars present difficult cases is expected and registrars support medical students as part of the teaching program.
CARRYING ON THE LEGACY
Dr Phillip Steele, Dr Fiona Christie and Dr Geoff Williams acknowledge the contribution to Registrar Training made by their former partner, Dr Peter Francis who was instrumental in setting up the first RACGP teaching practice in Wodonga in the 1970’s. He provided countless hours of mentoring and training to both Phillip and Fiona as well as many other registrars and students over the years.
Federation Clinic’s focus on delivering quality practice, providing ongoing registrar training and supporting continued professional development continues that legacy – the recognition of the value of general practitioner education and training.