PGPPP – Sending junior doctors out into the big bad world

Aust GovtAbout seven or eight years ago, some smart cookies came up with a grand plan, called the PGPPP. They had managed a trifecta.

First, they’d come up with a solution for the escalating problem of there being too many medical graduates for too few hospital jobs: namely, send the junior docs into general practice.

Second, the program would create new and challenging jobs for administrators. Trying to get private GPs, public hospitals, Medicare and GP training organisations to communicate and work effectively together would require not only a magic wand, but would also generate more administrative hours than one could poke a stick at, and enough hot air and paperwork to significantly increase Australia’s collective carbon footprint.

Third, and most importantly, they had an alliterative name. Prevocational General Practice Placements Program — P, G, triple P. With such a rollicking, rhythmical ring, the program was surely guaranteed to be a hit.


Yes, there is nothing that health authorities like better than a catchy initialism. The lettering was new but the concept of sending underprepared junior doctors out into the big bad world of Medicare-controlled private general practice was not. Public hospitals have been doing it for years.

I was a junior doctor at the turn of the century. Keen on rural general practice, I volunteered for two five-week rural relieving terms, and at only 14 months out of medical school, was sent to run the hospital and the general practice in a one-doctor town in country Queensland. There was no pharmacy, no radiology and no handover.

The practice medication cupboard had been locked and the key hidden, as the doctor’s dispensing rights didn’t extend to me. The trouble was that items such as aspirin, Maxolon, Ventolin and adrenaline had also been locked away. The only medication available was methadone: I found a half-full bottle in the doctor’s top desk drawer. Hmm.

A particularly nasty gastroenteritis epidemic swept through the town during my stay, depleting the hospital’s meagre supplies of IV fluid and anti-emetics. One memorable Sunday, sick as a dog myself with gastro, I’d dealt with a farmer’s compound fractured leg, a child with severe facial lacerations and an inebriated fellow with haematemesis, when a teenager presented with symptoms of meningitis. It took five hours for the retrieval team to collect her. As I sat waiting, dehydrated and nauseated, watching her Glasgow Coma Scale drop steadily, I had an epiphany: this is not particularly enjoyable.

My second term was not much better. On the upside, a particularly traumatic sequence of events gave me the impetus to take up writing to debrief. I later penned a story loosely based on the incidents, What Would the Coroner Think?, which earned me an OzDoc award in 2008. I subsequently translated it into a short film that is used in medical education throughout Australia.

Wondai pharmacy

I’ll always be grateful to Queensland Health for throwing me in the deep end before teaching me to swim. It might have turned me off rural general practice but it sure gave me great writing material.

Thank goodness the creators of PGPPP didn’t adopt that sink-or-swim approach. Bureaucracy notwithstanding, its heavily supervised and structured general practice attachments are educationally sound and proving beneficial all-round. Not so good for dinner-party horror stories, though.

Published in Australian Doctor on 15th Sept, 2011:  On Placement Programs