What to Expect When Starting GP Training

The transition from hospital-based work to general practice training is often the most significant challenge in a registrar’s career. Hospital training typically focuses on episodic, acute care within a high-resource environment where diagnostic closure is often immediate. In contrast, general practice is longitudinal, dealing with undifferentiated illness and complex chronic disease management.

Embracing Clinical Courage

Hospital training often encourages ‘clinical caution’, where junior doctors defer to senior specialists. In general practice, registrars must develop ‘clinical courage’. This can be defined as the ability to take initiative and push boundaries to extend clinical skills while managing patients independently. This requires a move away from the hospital culture of relying on immediate investigations for every presentation. Instead, registrars must learn to use time as a diagnostic tool, employing ‘watchful waiting’ strategies.

Managing Uncertainty

Uncertainty is intrinsic to the general practice encounter, where symptoms are frequently vague and guidelines may not apply to complex multimorbidity. In the hospital, a patient presents with a specific complaint requiring a full work-up; in general practice, the goal is often to manage the patient’s immediate concerns while ruling out serious red flags. To navigate this, registrars must master ‘safety-netting’, which involves providing patients with specific advice on what to watch for and when to return if symptoms change.

Expectations: Supervision and The Business of General Practice

While autonomy increases, support remains structured. The RACGP Standards generally mandate a maximum ratio of three registrars to one supervisor to ensure patient safety.

• Entry Phase: During the first four weeks of GPT1, registrars require 100% onsite supervision, with every case reviewed until the supervisor deems the registrar safe to practise with less direct oversight.¹
• Progression: Supervision requirements taper as competency grows. By the ‘Consolidation’ phase (GPT3), supervisors must be available to contact 80% of the time, though physical onsite requirements decrease.¹

Workload management is critical. In the first term (GPT1), the recommended patient volume is often two patients per hour, gradually increasing to four per hour in later terms.² It is vital that patient volume matches the registrar’s training needs; too few patients limits clinical exposure, while too many can compromise safety and learning.

Unlike the public hospital system, general practices are private businesses that must remain financially viable. Registrars must quickly adapt to the concept of private billing, mixed billing, and bulk billing.

• Medicare Reality: It is essential to understand that Medicare is a patient health insurance scheme, not a doctor payment system.
• Employment Status: Under the National Terms and Conditions for the Employment of Registrars (NTCER), registrars are employees, distinguishing them from many established GPs who operate as independent contractors.
• Informed Financial Consent: The RACGP Standards require practices to transparently inform patients of potential out-of-pocket costs.

Common Anxieties

“I feel isolated compared to the hospital team environment.”

Isolation is a frequently reported stressor. Registrars often move from a bustling hospital ward to a single room, eating lunch alone while colleagues are busy. To combat this, it is vital to actively engage with peer networks, such as registrar faculties or liaison officers, and participate in regional workshops.

“How do I manage time when patients have a list of problems?”

Time management is a core skill that takes time to develop. Registrars should prioritise the ‘list’ of problems early in the consultation.³ It is acceptable and often necessary to ask patients to return for a separate visit to address non-urgent complex issues, rather than rushing through a laundry list in a single standard appointment.

“What if I don’t know the answer?”

Not knowing is a normal part of general practice. Registrars are encouraged to use a ‘Call for Help’ list to identify clinical problems that warrant immediate supervisor input. If you feel a ‘sense of alarm’, seek help immediately.³ Furthermore, looking up appropriate sources of information in front of the patient is generally well-regarded and does not negatively impact patient confidence.

Summary

• Shift Focus: Move from the acute, resource-heavy hospital mindset to one of longitudinal care and managing uncertainty through safety-netting.
• Understand Supervision: Expect intense supervision initially (100% onsite), transitioning to greater autonomy as competency is demonstrated.
• Respect the Business: General practice is a private enterprise; understanding billing models and informed financial consent is essential for practice viability.
• Prioritise Wellbeing: Combat isolation by connecting with peers and acknowledge that seeking help for clinical uncertainty is a strength, not a weakness.

References

1. The Royal Australian College of General Practitioners. AGPT practice and supervisor handbook [Internet]. East Melbourne (Vic): RACGP; 2023 [cited 2025 Dec 11]. p. 14. Available from: https://www.racgp.org.au/getattachment/97cf9414-bceb-4b9a-808f-2105c74e678a/AGPT-practice-and-supervisor-handbook.aspx
2. The Royal Australian College of General Practitioners. AGPT registrar training handbook [Internet]. East Melbourne (Vic): RACGP; 2023 [cited 2025 Dec 11]. p. 40. Available from: https://www.racgp.org.au/getattachment/6ca9b926-e804-4776-8e37-f34822f00990/AGPT-registrar-training-handbook.aspx
3. Morgan S, Chan M, Starling C. Starting off in general practice – consultation skill tips for new GP registrars. Aust Fam Physician [Internet]. 2014 Sep [cited 2025 Dec 11];43(9):645-8. Available from: https://www.racgp.org.au/afp/2014/september/starting-off-in-general-practice-consultation-skil