Journey to the South
Saw Ling Toh, Neurology Registrar
Published online: 30/1/17
I was fortunate to be offered the Association of British Neurologists (ABN) Australasian Fellowship in 2015. The fellowship consists of a 12 month clinical neurology training period in Australia. It counts as a year in my neurology training accreditation towards CCT. I was given the opportunity to choose my preferred location out of the pre-selected hospitals, and I decided to go for Box Hill Hospital in Victoria, Australia.
With the fellowship in hand, along came the mammoth task of sorting out all the necessary visa applications, medical registrations, essential documents and moving! It took me a few weeks to get linked in with the HR department at Box Hill Hospital, who were very helpful in guiding me through the entire process.
The first step was to obtain verification of my medical degree by applying for Primary Source Verification via the Australian Medical Council (AMC). This is a compulsory process for all international medical graduates outside of Australia. Once approval was achieved, I was able to apply for provisional medical registration with the Australian Health Practitioner Regulation Agency (AHPRA). Visa application was not complicated, as everything was done via the Australian immigration website. The entire application process set me back a few hundred pounds.
I arrived in Melbourne just five days prior to my starting date. I was greeted by glorious warm sunshine as it was summer in January. I was fortunate that a family friend offered me his spare bedroom while I looked for a place to rent. Setting up a bank account was pretty straight forward. Jet lag was a major problem for me for the first two weeks there.
The Training Structure
The junior doctors changeover in Australia occurs in February, which was when I started. The first day of work was similar to anywhere else really; completing different forms, applying for the ID badge, car parking permit, orientation and brief summaries of the ward/hospital policies.
Box Hill Hospital is one of the seven hospitals for Eastern Health that covers East Victoria. It is the tertiary referral centre for all other hospitals in Eastern Health and a university teaching hospital. The hospital underwent major refurbishment in 2014.
The neurosciences department is mainly based at Box Hill Hospital, with both inpatient and outpatient services. This hospital runs a 24 hour stroke thrombolysis service, neurodiagnostics, neuropsychology, neuroradiology and outpatient clinics. There are usually 20-25 inpatients at any one time. The clinics cover MS, stroke, general neurology, neurocognitive and epilepsy.
A neurology consultation service and outpatient clinics are provided at Maroondah Hospital, which is a district general hospital. The movement disorder outpatient clinic is delivered at Wantirna Health, which is a smaller hospital unit mainly for palliative care and medicine for the elderly. Neurosurgery services are undertaken in collaboration with Royal Melbourne Hospital, Austin Hospital or St Vincent’s Hospital within Victoria.
My rotation consisted of four-monthly blocks. I started off with two blocks at Box Hill Hospital, which were the general neurology block, followed by stroke. My last four months were based at Maroondah Hospital and Wantirna Health. My role as a registrar was similar to the UK. There were daily morning ward rounds, with the charge nurse and allied health professionals. Consultant ward rounds were conducted twice weekly. I would go around with the junior doctors on the other occasions. The general neurology block includes inpatient consultations; either telephone advice or reviews, and general neurology clinics.
My stroke block was definitely the busiest as Box Hill Hospital is an active stroke thrombolysis unit. Ward rounds were constantly disrupted with acute stroke calls, which need to be attended urgently at the emergency department by the stroke team. All stroke cases were discussed with the stroke consultant on duty who was easily reachable with a phone call. I recall thrombolysing up to four patients within normal working hours on one occasion.
On calls were usually 1 in 3 to 4 depending on how many colleagues were on leave, and includes out of hours stroke thrombolysis. The on calls were generally busier. I was called back after midnight on numerous occasions, mainly for acute stroke calls. All registrars on the on call rota are entitled to a half day off once a week, which was helpful in catching up with rest.
There were many different teaching sessions, covering a wide range of neurology curriculum topics throughout the year. There were weekly neurology grand rounds and neuroradiology meetings. There was also monthly “Brain school” conducted via video conferencing. For trainees in Victoria only (like me), there were monthly early morning teaching sessions, starting at 7.45am, that ran at different locations in Victoria.
Differences and New Experiences
The Australian health care system differs from the UK because both government and private health care coexist. Medicare Australia provides universal health care and is partly funded by an income tax surcharge of a person’s taxable income. Certain exemptions do apply, of course. An extra Medicare surcharge applies to individuals with higher incomes who do not have the appropriate level of private health care insurance. My understanding of this was that it was to encourage individuals who can afford it to take up private health care insurance, and reduce demand on public hospitals. Medicare entitles residents to free treatment as a public patient in a public hospital. For outpatient services, residents could receive free or subsidised treatment from specialists, depending on the method in which the specialists charge for the services provided. Medicare will cover a certain percentage of the service provided by specialists. The patients would have to pay for the balance, unless they have private insurance that could help cover the charges incurred.
Interestingly, ambulance services, whether emergency or not, within Victoria are not covered by Medicare. Therefore, anyone who uses the ambulance service will need to pay for the service, except for
patients who have arranged for ambulance cover with a health insurance fund or hold certain exemption cards.
Just like in the UK, neurology registrar jobs are competitive. However, the training programme is shorter. It runs over three years, with two years spent in core training posts, and one year in a non-core training post, which may include research or subspecialty clinical work.
Time sheets. This was new to me. Salary in Australia was paid every two weeks. All doctors have to fill in a time sheet fortnightly to ensure the correct amount is paid. The time sheet records were particularly important for the out of hours on-call times as one is paid according to the hours that you are in the hospital.
For me, being actively involved in the stroke service was a valuable experience. I gained so much confidence in assessing acute stroke patients, carrying out thrombolysis and referring on for endovascular clot retrieval when indicated. The stroke block also helped sharpen my skill in interpreting acute CT brain imaging including vascular and perfusion scans.
On top of that, I continued to build on my general neurology knowledge and experience throughout the year.
Life Outside Work
Melbourne really lived up to its reputation of being one of the world’s most liveable cities. There were many things to do and see. Everyone was friendly and upbeat. Despite the many late nights, early morning calls back to the hospital and sleep deprivation, I felt I had a good work and life balance. I suspect that the weather played a huge part in it. The milder winter months and hot sunny summer allowed me ample opportunities to engage in different outdoor activities.
I am a huge foodie. The food and coffee culture in Melbourne was amazing. The food was interesting, as it comprised of inventive fusion cuisines. There were endless cafés along the Melbourne laneways and food markets to tempt any appetite. Seafood was extremely fresh and affordable there. Imagine freshly shucked oysters for AUD 1 each at the fish market daily!
Food culture aside, Melbourne also has multiple art and design markets held over the year. It was great fun visiting these markets and getting myself immersed in all the creativity.
I thoroughly enjoyed my experience in Melbourne. I would recommend anyone who is keen to work in Australia to not hesitate. Yes, the application and moving process might be tedious…but the entire experience was unforgettable, eye opening and absolutely worth it.