‘They have an enormous impact’: Call for more supervisor support

For the RACGP’s National Director of Clinical Training Associate Professor James Brown, it is almost impossible to overstate the importance of GP clinical supervisors.
 
Beyond his leadership role, Associate Professor Brown is a long-term GP who set up a teaching practice in Trafalgar in Victoria’s Gippsland region.
 
Now also with a PhD on the GP supervisory relationship, he arguably has a unique insight into the way they shape the work of aspiring GPs.
 
‘We know that the quality of the supervision that doctors in training receive has an enormous impact on their future practice,’ he told newsGP.
 
‘Supervised practice is core to GP training, the key activity, I would say.
 
‘Registrars are learning as they work, so they’re undertaking clinical practice and they depend very much on access to supervisors for on-the-spot clinical supervision as they consult.
 
‘That’s both for their clinical decision-making for patient safety, but also for their own safety, particularly emotional, psychological safety.
 
‘Our registrars in their first six months find it a very challenging environment to be new to and they depend very much on their supervisors to assist them and to support them in that work.’
 
Unsurprisingly, Associate Professor Brown strongly backs a recent call for greater supervisor support from the National Council of Primary Care Doctors (NCPCD), a coalition of general practice organisations including the RACGP.
 
In a joint statement, the group calls for clinical supervision to be formally recognised and properly resourced, and for supervision expectations to align with clinical governance.
 
It also urges for pay gaps to be addressed ‘so supervision is not financially penalised compared with direct patient care’, along with investment in supervisor capabilities, particularly in rural, regional and remote contexts.
 
For Associate Professor Brown, the intervention is important and timely with more doctors moving into general practice, as well as shining a light on an area he feels is undervalued.
 
‘As we increase our training numbers, we need more supervisors, particularly rurally, and we need to ensure that doctors who are contemplating being supervisors are not facing being out of pocket,’ he said.
 
‘What it’s pushing is the clinical supervision, which is supervision as the doctor works, so having access to support and advice as they’re seeing patients – that’s distinct from structured education supervision where there’s time set apart for conversations about the work.
 
‘This is real-time supervision and it’s been underappreciated.
 
‘It’s been considered something that can just happen on the fly with no appreciable impact on the supervisor, but it does have an appreciable impact on the supervisor. They get interrupted from their own patient flow. It has an impact on the supervisor’s work and also the supervisor's income.
 
‘At the moment, there isn’t distinct recompense and support for that activity of supervisors. They get payments for their teaching, but they don’t get actual payments for their clinical supervision.’
 
The statement outlines the conditions for ‘highly skilled’ clinical supervision work to take place effectively.   
 
‘It relies on trusted relationships, frequent communication, and timely feedback that supports safe, independent decision‑making,’ the NCPCD said.
 
‘These relational and professional elements take time and resources, and they work best when practices can provide both robust educational supervision and clinical supervision. Despite its centrality, the system does not consistently recognise or support the full scope of clinical supervision.’
 
Warning that supervisors face both opportunity costs and red tape, the statement also highlights infrastructure issues, including space, technology and workflow, that have an impact on the quality of supervision – an issue it says is particularly acute when demand for services is high.
 
‘For rural generalists, supervising time and resources are further constrained by the need to provide clinical care across multiple settings, including primary care and emergency services,’ it warns.
 
Associate Professor Brown also believes shifting business models are having an effect.
 
‘Now that many practices are owned by corporates, supervisors don’t necessarily have a direct interest in the income from the practice,’ he said.
 
‘One of the reasons practices host registrars is for the clinical services they provide. That doesn't support a supervisor who isn’t part of the ownership.’
 
He echoes the NCPCD calls for help to make it more viable for practices to deliver supervision.
 
‘I know as a recent practice owner the impost of hosting registrars for the room that they take and for the extra administration can be unattractive, so that needs to be addressed,’ he said.
 
It is also an issue going beyond general practices, Associate Professor Brown believes.
 
‘I could wax lyrical about supervisors for hours,’ he said.
 
‘I think that we need to look at supervision across the spectrum. It’s not just for our registrars, but it’s for pre-vocational doctors and also for medical students.’
 
Along with the RACGP, the statement’s co-signees include the Australian College of Rural and Remote Medicine, the Australian Medical Association, the Australian Indigenous Doctors’ Association, General Practice Registrars Australia, General Practice Supervision Australia and the Rural Doctors Association of Australia.
 
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