Rich River Health Group
Rich River Health Group in Echuca commenced in 1999 as an amalgamation of three local practices. The centre incorporates 15 doctors (full and part time). There are 22 support staff, including, mental health counsellor, diabetes educator, ante-natal nurse and asthma educator. A pathology service, audiologist and pharmacy are located on site.
A well-equipped treatment room is located within the practice. Nursing practitioners triage emergency presentations to the practice, with GPs rostered to cover these emergency presentations.
In addition, the treatment room is utilised for spirometry, wound management, dressings, immunisations, removal of sutures, etc. Varied minor surgical procedures are performed by a number of the clinicians and include vasectomies, circumcisions, removal of lesions and biopsies.
The practice GPs oversee the intern program at the hospital and host University of Melbourne Medical School students at the practice.
The primary referral centre is Bendigo, one hour by road, or Melbourne.
In 2015 the $65m redevelopment of the public hospital was completed upgrading facilities and bed capacity. Echuca hospital has 113 beds , emergency, HDU, medical, sub-acute, surgical, maternity, paediatric, urology, orthopaedic, ophthalmology, dental, chemotherapy and haemodialysis services. Echuca Regional Health also encompasses a residential aged care service which accommodates 60 residents. Specialists and visiting specialists to the region include orthopaedic and general surgeons, physicians, cardiologists and oncologist.
The emergency department and inpatient admission is covered by the towns GP VMOs who, on a shared roster, are responsible for all hospital admissions. The GPs act as senior supervisors and second on call to the emergency department intern staff on rotation to Echuca. AGPT registrars are incorporated into the on call hospital roster, covering emergency under the supervision of a GP VMO.
REGISTRAR OPPORTUNITIES FOR ONGOING TRAINING
Practice Manager, Mike Mangiameli explained there is a large cohort of medical trainees in Echuca. Many of the AGPT registrars have already been through the region as medical students, hospital interns and registrars. The relationships between the clinic and hospital staff support training as well as social connections.
Mr Mangiameli explained the practice has had a long association with education and training and has hosted registrars and medical students over many years. In the past the practice has generally placed two AGPT GPT 2 / 3 registrars because of the seniority required in covering the treatment centre and the hospital. In 2018 Rich River Health has allocated an additional place for a GPT1 registrar position within the practice and continue to promote and support training as part of their strategy to attract and retain GPs to the practice.
Following the initial orientation, new registrars are allocated a primary supervisor, but the face to face teaching time and daily supervision is shared among the senior GPs, providing a broad knowledge base and practice experience for the registrar to draw on.
Rich River Health supports Advanced Rural Skills Training posts in emergency, anaesthetics and obstetrics and gynaecology which are available through Echuca hospital and in association with Bendigo Health. The practice is keen to support registrar training opportunities across a wide variety of fields. Continuing education opportunities include fortnightly clinical meetings at the practice, ongoing education and training at the hospital and ancillary education opportunities within the hospital and from visiting specialists.
DR ADRIAN WALDRON
Dr Adrian Waldron has been a rural GP for over 25 years. He commenced practice in western Victoria, after completing his medical training in Melbourne, Geelong and the UK. Spending 10 years in Warrnambool, he joined Rich River Medical Group in 2005.
Being a GP obstetrician has been major part of Dr Waldron’s medical practice, but with more doctors in the organisation available to cover obstetrics, he recently retired his obstetric practice for “the young ones to come through”. Dr Waldron continues with ante-natal and post-natal care, neo-natal and paediatric practice and has special interests in emergency, general medicine, minor surgical procedures, aged care and palliative medicine.
Dr Waldron explained Rich River Health has a close relationship with Echuca Regional Health. Senior practice members contributed throughout the planning and implementation of the redevelopment process, work jointly in matters relating to medical workforce recruitment, and Dr Waldron is lead supervisor for the hospital intern program. Dr Waldron is also immediate past president of the Echuca Medical Staff group and explained this group provides both professional and social networks for medical personnel in the region.
Rich River Health provides VMO cover to the Echuca Hospital. Dr Waldron recognises this as a unique training opportunity for registrars and GPs at the practice. Registrars are exposed to a diverse range of acute and sub-acute medicine, both at the practice and the hospital. The practice is happy to support registrars in following advanced rural skills posts and various special interests available in the region.
“Registrars enjoy having the inpatient and emergency role – they see more acute stuff than what you would in a GP practice only.” said Dr Adrian Waldron.
Doctor Waldron described Echuca as a good place to be both personally and professionally. He enjoys being part of a medical community that includes experienced GPs and specialists, registrars, interns and medical students. He explained there are ongoing rotations of health professionals through the hospital, so they are not isolated and have multiple opportunities for ongoing training.
When asked what he values about being a GP, Dr Waldron reflected that his long term involvement with the community, with his patients and with his medical colleagues has been the most significant to him.
“It’s the relationships you develop over time, with your patients and your colleagues…. You are there for your patients from “the cradle to grave”… that’s what makes it worthwhile.” said Dr Adrian Waldron.
DR PETA FIELDING
Dr Peta Fielding is currently a GPT3 at Rich River Health, having completed her intern and registrar training at Bendigo, Echuca and Swan Hill. Dr Fielding grew up in Melbourne and chose rural practice following a GP placement in Lakes Entrance as part of her fourth year undergraduate degree with Monash University Gippsland Rural Health School.
As a GPT3 Registrar at Rich River Health, Dr Fielding was allocated a primary supervisor and explained that each of the senior GPs act as supervisors, sharing the weekly face to face teaching sessions. All of the senior partners are available and are available for assistance as required.
For Dr Fielding general practice in a small centre provides diverse opportunities across a wide scope of medicine. Having fewer personnel and less resources to call upon than her city counterparts, results in the registrar having greater involvement in managing a patients overall care. In addition to GP sessions at the practice, Dr Fielding’s role includes on call as VMO at the hospital, involvement in emergency department cover.
“It is certainly confidence building, interesting and challenging at times! You are expected to do a lot more (than in city centres) and have greater responsibility in managing patient care.” said Dr Peta Fielding.
For Dr Fielding, the exposure and training in Echuca and across the various regional hospitals she has attended, has developed her capacity to independently manage patients. Dr Fielding acknowledged an important aspect of her ongoing training has been developing confidence in her clinical judgement and recognising when it is necessary to seek advice and assistance from more senior practitioners or specialists. Being locally trained assists in facilitating appropriate care for her patients as she is familiar with what specialists and support services are available.
“You come to recognise those patients that are too sick to be managed in general practice. Sometimes you just have to say – we can’t fix this here now, you need to be somewhere where they can fix this!”said Dr Peta Fielding.
The cohort of medical staff at Rich River Health and the number of AGPT registrars in the region act as further support around training and exam preparation. Dr Fielding participates in a skype based, registrar study group, co-ordinated by the registrars and managed out of Bendigo.
Dr Fielding chose general practice because of the variety it presents, but mostly because she enjoys people. She explained she always wanted to know more about the patients she met in the hospital system and what was happening in their lives beyond the brief contact she had with them. For Dr Fielding, satisfaction in general practice comes from personal contact with people and the continuity of care she is able to provide to help manage their health.
“I always wanted to know more! I was curious about people – in the hospital I wanted to know what else was happening with them. I found I was more interested in the long term care of people. That continuity and getting to know the people you come into contact with.” said Dr Peta Fielding.
Dr Adrian Waldron
MBBS Melbourne 1989
Dr Peta Fielding
MBBS Monash 2014
Bendigo Health 2015-16
Swan Hill Medical GPT 1.2, 2017
Rich River Echuca GPT 3.4 2018