Internship 101 - What You Need to Know 2018 - AMA WA
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Internship 101 –
What You Need to Know
2018
1
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 1
Contents
Welcome to the Medical Profession .................................................... 2
Welcome from AMA (WA) Doctors in Training (DiT) Committee........... 3
Welcome from AMA Council of Doctors in Training Chair.................... 5
WACHS Intern....................................................................................... 6
Excuse Me Doctor................................................................................. 7
Intern-ship: Tips for Smooth Sailing..................................................... 8
Golden Rules for Interns – From Those Who Have Been There!.........11
Salary Packaging Explained................................................................12
The AMA: A One-Stop-Shop for Doctors in Training –
Professional and Industrial Services....................................................13
Entitlements – What You Need to Know..............................................14
Doctors in Training – Salary Rates Guide............................................16
Your Payslip..........................................................................................17
Prescribing 101....................................................................................20
Internship 101 – Junior Doctor Wellbeing........................................... 22
Looking after your Mental Health and Wellbeing.................................25
Weighing up the Benefits – The Value of AMA Membership...............27
AMA (WA) Junior Doctor of the Year
(Dr Camille Michener Legacy Award).................................................. 29
5 Reasons to Join AMA (WA)...............................................................31
Contacts.............................................................................................. 32
2
2 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Welcome to the Medical Profession
Starting out in the medical profession will
be at once the most exciting and terrifying
moment of many of your lives.
Finally, after so many years There has been a lot of focus on You almost always get more out
of study, learning and exams, junior doctor wellbeing over the than you put in...
you get the opportunity to put last few years and for good reason.
AMA Membership is really important
your skills and knowledge into Our profession can be tough and
for all doctors as the AMA is the only
practice (whilst at last earning unrelenting at times and for some
body able to look after you in almost
some money...). Thankfully, for the challenges can seem to great to
any aspect of your professional life
you and your patients, that will bear. The workplace has changed
and provides many services that will
happen under the watchful eyes over the years and although you
help you navigate the years ahead.
of more senior doctors who have will work less hours than interns in
The AMA also works hard to put
years of experience on top of the the past, the pressures exist and
the medical profession on the front
medical knowledge that you have the guaranteed career pathways of
foot in the media and on public
accumulated. the past are no longer so clear. You
health issues and I hope that you
must look after yourself and your
On behalf of all doctors in WA, I will all be proud to continue your
peers. Don’t be afraid to ask for help
would like to welcome you to our AMA membership throughout your
as it may not be obvious to others
profession. The reality is that your careers, as I have.
when you are struggling.
learning is only just beginning. The
For most doctors I know, although
quest for improving our skills and If you don’t have your own GP
they may grumble from time to time
knowledge is one of the defining its a great time to find one. You
about their lives and some aspects
aspects of Medicine and for good are probably very healthy, but it
of their careers – they don’t regret
doctors it never ends. is amazing how quickly that can
their choice of profession. We have
change once you get immersed in
Now is the time for you to learn a great job and we get to work in a
work and the other challenges of
how to take responsibility for the very good health system.
life and every doctor needs to have
wellbeing of your patients and for
someone to look after them. If you Welcome to Medicine and good
the continuation of your learning
don’t know who to see, the AMA luck!
journey – there is no longer anyone
maintains a list of GPs happy to look
looking over your shoulder telling
after other doctors.
you what you have to know or do. Omar Khorshid
I would also urge you to stay President
Some of you have already decided
engaged with your profession
on your path – that’s great! For the
– you can get involved with the
rest – there is no hurry. Get out
RMO societies, the AMA DiT
there and try your hand in different
Committee, the JMO Forum and
areas. There is amazing breadth
many other groups as you progress
of opportunity in Medicine and a
through your training. For me,
special niche is available for all of us.
these interactions have been very
rewarding over my career and they
have provided me the foundations
to become a better doctor for my
patients and the leadership skills to
make a difference in our profession.
3
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 3
Welcome from AMA (WA) Doctors
ge
in Training (DiT) Committee Dr M ic
h ae l P a D r R ebe
cca Woo
d
DR MICHAEL PAGE & DR REBECCA WOOD, Co-Chairs DiT Committee
Congratulations on surviving medical school! Now starts a career that is both
challenging and extremely rewarding.
Internship is an amazing time – 3) Don’t forget your own learning. 5) Get involved!
you’re seeing patients, making As mentioned in tip 2, the focus The AMA (WA) DiT Committee
decisions and getting paid for it! in internship is different from has a proud reputation of being
People know you’re on your ‘P’ your time spent learning as a the strongest local advocate for
plates so they give you lots of med student, but that doesn’t hospital-based DiTs across the
support, plenty of guidance and a mean you know it all. Remember; country. We represent DiTs from
gentler roster. Everyone will also it’s OK not to know – that’s why internship through to trainee
want to give you tips on how to get we surround you with lots of registrars and tie in with the
through internship. We hate to miss support. Make sure you get to RMO Societies at each hospital
out, so here’s ours: intern teaching/grand rounds/ to ensure we have a good
departmental teaching. Seek understanding of ‘on the ground’
1) Be nice!
out learning opportunities on issues at all sites. The Committee
This is the year you create your
the wards and ask your seniors is open to any DiT member of the
reputation. Everyone will talk
for feedback on how you’re Association, so come any share
about you – you just won’t know
progressing. This will keep you in your opinion on the important
it. Learn names. Say hello,
good stead for the years to come. issues facing WA DiTs.
goodbye and thank you (even if
they’re telling you something you 4) Join the AMA Again, on behalf of the DiT
didn’t want to hear). As you hit the wards you’ll quickly Committee and the AMA we’d like
realise there’s more to being a to congratulate you on completing
2) Be organised.
doctor than the day-to-day care your studies and embarking on your
Internship is less about how great
of patients. Play your part in the medical career. Being a doctor is
your medical knowledge is and
bigger picture by belonging to a privilege few get to experience.
more about your ability to get
the peak medical group – the No doubt there’ll be plenty of
things done. Know your patients
Australian Medical Association. challenges ahead, but with those
and their pertinent results. Have a
You’ll have seen the AMA challenges will come opportunities
system for keeping track of your
advocate for patients, hospitals to both grow professionally and
jobs. Communicate the plan with
and doctors on a daily basis in to grow the profession, and we’d
others. Often this will also involve
the media, but what you haven’t encourage you to take an active part
practicing tip 1.
experienced yet is the individual in your RMO Society, the PMC JMO
advocacy the AMA provides for Forum and the AMA DiT Committee.
its members. Should you have With your help we can continue our
a problem with pay, leave or tradition of strong DiT involvement
anything else, you’ll always have in 2018.
your Association in your corner.
AMA(WA)
Intern Cocktail Function
Tuesday 27th February 2018
6pm
4
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 5
Welcome from AMA Council of Doctors in
Training Chair
AMACDT: Your Voice, Your Organisation
DR JOHN ZORBAS,
Chair, AMA Council of Doctors in Training
Congratulations! On behalf of the Australian Medical Association, please let me join the
enthusiastic chorus of people who have welcomed you to the profession of medicine, and
applaud you on surviving medical school.
Chances are that you and I have The doctor in training is often Healthcare needs doctors who
never met, but our futures are drowning in a sea of mandatory are passionate about the health of
now intrinsically linked and that’s training and paperwork, unable their patients to advocate for the
why I’m talking to you now. I’m to spend the time they need to protection and advancement of a
the Chair of the AMA Council of with their patients. Healthcare world class healthcare system.
Doctors in Training. We’re a council is now too big to ignore, with Your transition to internship is not
of your Federal AMA, which works governments no longer able to “fix the time to calm the fires of the
together with your State AMA. it tomorrow”. Training pipelines are passion that I’m sure brought you to
We have representatives from all everyone’s problem and nobody’s this job in the first place.
States and Territories, and we also responsibility, with a workforce
And that brings us to you. You’re
have representatives from all of the that finds itself in oversupply
the newest member of a proud and
training colleges across Australia. and undersupply simultaneously.
dedicated profession, and you’re
We deal with issues that affect all Increased pressure in the workplace
a powerful one at that, because
of the doctors in training across leads to toxic cultures, increased
you’ve already got more time than
Australia, from internship right up rates of absenteeism and less
every doctor ahead of you. Your
to fellowship. That’s a lot of doctors sustainable workloads. And yet the
profession needs you, the same
to represent, and a lot of issues to system still works, because of the
way your patients need you. Your
advocate on. Major issues for CDT dedicated healthcare professionals
involvement is critical in advancing
at the moment include our work who care so passionately about the
to the next stage of medicine and
on doctor health and wellbeing, patients that they treat.
to the future of healthcare. Every
the continued advocacy for safe
This passion is one of the reasons successful profession needs a
working hours in medicine, a
that it truly is a privilege to be a peak representative body to lead
renewed push for flexible work
doctor. It’s a well-worn cliché, but it forward, and in medicine that
arrangements across the country,
you do get to help some amazing body is the AMA. Not the medical
support for Indigenous trainees and
people in their hours of need. You’ll board. Not AHPRA. Not the medical
a fierce call for the protection of
work with outstanding colleagues defence organisations. It’s the AMA.
education and training conditions
and learn from some of the most So, what are you waiting for? Find
in the pre-vocational space (that’s
inspiring teachers a profession can your voice inside your AMA and
you now!).
even hope for. None of this happens inside your profession. Become a
But do you want to know the biggest by accident, of course. Healthcare member today and get in touch with
issue? It’s that your profession is incredibly complex, and there are your State AMA doctor in training
needs you. Now, more than ever. plenty of people with very strong committees and subdivisions. Be
Having trained in the system for the opinions on how the system should part of the conversation, and take
past few years, you of course have or shouldn’t work. ownership of your new profession!
had a chance to see the way the
Congratulations once again, and
practice of medicine is changing in
may the best of your past be the
the modern healthcare landscape.
worst of your future.
5
6 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
WACHS Intern
DR KATE NUTHALL
Intern, Bunbury Regional Hospital
There are some obvious advantages Sometimes as an intern it might
In 2017 the WA country
to doing your internship in a regional feel like you’re on the receiving end
health service had its first
area; you can leave work and be of everyone’s bad mood, but that
cohort of full time interns, at the beach fifteen minutes later doesn’t mean you should stoop to
meaning that Bunbury and and you can duck down to Margs that level and be rude to a nurse
Albany would have five for a weekend lunch at a winery. or intern.
full year interns, with other We’ve been incredibly lucky in that
If you’re a WACHS intern or just
interns rotating for terms the five interns in Bunbury have all
doing a rural rotation, make the
from Royal Perth and Fiona become really close and we’ve been
most of it. Play a sport, meet some
Stanley. an exceptional support for each
new people, try surfing or refine your
other. We’ve had brilliant interns
I’d made the last minute decision wine tasting skills. The people who
and registrars from Royal Perth and
to preference WACHS and it’s a work in rural and regional hosptials
our RMO’s are a fantastic group.
decision that I’ve not regretted. come with some fascinating stories
Internship can be really challenging
I’ve always been interested in rural and skills and you will learn a whole
at times when you’re dealing with
medicine and the idea of spending lot. Working rurally comes with
difficult patients and personalities,
my intern year in a small hospital some unique challenges, but also
but having a fantastic group of
appealed to me. some great rewards.
people to laugh with makes a huge
My first rotation was in general difference.
medicine. It was a fantastic place
Being in a smaller rural hospital
to get to know the ins and outs of
means that it’s easier to get help
the hospital in a close-knit team
when you need it – you either know
where I was able to work closely
with registrars and consultants. I
the person on the other end of the Being in a smaller rural
phone or one of the other interns
was closely supervised but I was
does. This means that people are
hospital means that it’s
also given the opportunities to put
in chest drains and perform lumbar
generally really kind and supportive, easier to get help when
but it also means that you’re
punctures. We worked closely with
more accountable – being rude to
you need it – you either
some incredible physicians who
made the effort to teach us. Being
someone will only come back to bite know the person on the
you. I think that this advice applies
rural means that it truly is rural
if you’re rural or metropolitan. If you
other end of the phone
medicine – the range of pathology
I’ve seen this year has been
can’t treat your co-workers with or one of the other
compassion and respect you’re
fascinating.
not going to be able to find any for
interns does.
your patients.
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 7
Excuse Me Doctor
DR DANIEL DOREVITCH
Intern, Sir Charles Gairdner Hospital
Starting on the wards as a real People will hold it together under
doctor is frightening. Any intern who the guise of coping, but tears in
is super-confident or doesn’t ask for the corridor are never a good sign,
advice/help is being a schmuck, and whatever the situation. Look out for
quite honestly is probably putting each other, and always check in to
patients at risk. ALWAYS ask for see if someone’s not OK.
help – from other interns who’ve
It’s hard to distil some useful The last thing I would say is a
been in the situation already, or
facts out of what I’ve learned particular bugbear of mine, which
from residents, registrars or even
from my first months as an consultants if need be. Don’t ever
relates to creating a healthy and
actual, grown-up doctor. solid work culture in the hospital (of
accept being in a situation where
Some days on the job you which you are now a contributing
you feel ill-equipped to do what’s
feel like you vaguely know member). Doctors and Med Admin
being asked of you.
often seem to be at loggerheads,
what you’re doing, while
The other thing to note is that you’re with ease of access to leave,
others you genuinely feel
surrounded by far more than just troublesome rostering, and overtime
like you’re flying by the seat doctors who can help you. Allied being regular issues of note. The
of your pants, and you still Health by name and by nature, the thing is that med admin staff are
react with surprise when nurses, dieticians, pharmacists just people, doing their job the same
someone calls over to you (your actual best friends and way that you or I are doing ours, and
“excuse me doctor…” guardian angels/saviours as a their contribution is just as important
new prescriber) OT’s, physios and to the running of a hospital as
That said, even in the short time that
speechies have seen it all before. yours. Don’t send condescending or
I’ve been doctoring with an actual
Added to your medical team, they patronising emails. Don’t fume and
‘Dr’ in front of my name (as opposed
are a brilliant source of information rant about them to your colleagues.
to being the bald med student
and are well-used to seeing stress- In short, don’t be a child. Go in
that kept getting mistaken for a
out new interns struggling to make to their office, smile, and make a
registrar), I’ve found a few things
trivial decisions; often really trivial human connection with them. If
definitely make for a better day on
decisions. you do end up having any issues,
the wards as an intern.
discuss them like a grownup. You’ll
This leads me to my next point: look
One of the scariest things about find your future interactions with
after each other, in every sense.
internship is the feeling of being them much more pleasant, and
No-one understands what you’re
expected to know what to do in (shock! horror!) far more productive.
going through as much as your fellow
situations that you’ve never been
interns do, and no-one is more likely I think that’s enough to be getting
in before. You’ll be floored by the
to help you out (no questions asked). on with. Your internship is a time of
tiniest medication timing question,
Help out your friends with a tricky new challenges, where you’ll find
stressed by the smallest catheter
cannula, and they’ll scratch your that in some ways you’re prepared
logistics issue, and freaked out by
back with the set of bloods that is for doctoring, and in other ways you
any minor patient dietary query. Will
keeping you on the wards long past are truly, woefully, not. You’ll have
any of these things kill your patient?
your bedtime. Always volunteer to do some of the most terrifying and
Not even slightly. Does it still feel
a discharge summary for someone or most rewarding clinical experiences,
like you’re being asked a question
pick up their shift if they’re desperate but I guarantee you that by the end
more challenging than any OSCE?
to make it to a friend’s wedding/ you’ll look back on the timid new
100% yes.
family gathering. Karma will reward intern you were in January 2018, and
you, I promise. Lastly, make sure be amazed how far you’ve come
to keep an eye on your friends’ and what you’ve learnt.
mental health.
Enjoy! It’s truly a new beginning
for you.
8 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Intern-ship:
Tips for Smooth Sailing
DR SARAH NEWMAN
GP Registrar, DiT Committee,
DiT Welfare Sub-Committee Co-Chair,
Dr Camille Michener Legacy Award – 2017 AMA (WA) Junior Doctor of the Year
2017 RACGP GP Registrar of the Year
All aboard the Internship! –
for first time sailors, you are
still getting sea legs. Despite
studying all the maps, the
concept of sailing into the
great unknown can be
frightening. Sometimes you
will feel you are frantically
swimming just to stay afloat.
But here are a few tips from
seasoned sailors, often learnt
the hard way (apologies
for the excess nautical
references)
Pleasure Cruise
Firstly, don’t underestimate how
exciting and fulfilling this career
is. You worked long and hard to
attain this, with the bonus of a
disposable income. But life is about Apply your own Lifejacket
experiences – so enjoy the journey. first
Take pride in your work and be As a doctor the tendancy is to This means take your holidays (when
willing to learn. But take time to prioitise everyone else’s welfare, you can), make time to eat well
enjoy the space of not studying. but looking after yourself is critically (not just chips and gravy) and find
Have a joke, laugh with your important. Burnout leads to medical time to exercise (not just walking to
colleagues – it builds camaraderie error and poorer patient outcome, radiology).
and team spirit. It also helps let alone puts your mental and
Also, you are not ONLY a doctor
debrief – If we didn’t laugh we’d physical health at risk. Outside this
– you might be a mother, friend,
cry. Remember though sometimes nautical analogy, think of yourself
musician, amateur darts champion,
feeling emotional and overwhelmed like a formula-1 vehicle – refined for
DIY handyman or all of these!
comes with the territory. Don’t bottle peak performance at the highest
Work-life balance improves
it away, talk with your friends and stakes. But you have to look after
professional performance, career
colleagues, chances are you are not the engine.
satisfaction, reduces burnout and
alone.
You cannot drive full throttle improves patient outcomes. Nurture
constantly, you need pit stops to that other part of you that sustains
maintain condition and prevent your passion for your job. Make time
faults before a problem. You also for outside interests and your non-
need the highest quality fuel, and a medical friends to get perspective
supportive pit crew. and help remind you what is really
important.INTERNSHIP 101 – WHAT YOU NEED TO KNOW 9
I know when you were studying you Still waters run deep Lifesaver
thought you were busy…it’s about to Something I have found very useful Related to mindfulness – kindfulness
get a whole lot worse! Your off time is the concept of mindfulness. is approaching life with a friendly
is precious – This means if people It relates to a non-judgemental and forgiving view. We doctors can
eat into your “you” time – you should attention to the present moment, be very uncivil, made worse by the
be compensated – so claim your and can involve meditative pressures of the job.
overtime and don’t feel pressured to techniques of breath and body
stay after hours – that’s what cover But we are all in this together – offer
awareness. It is increasingly being
is for. Schedule time for what’s to help others, lend a supportive
applied in the medical setting with
important in your life, including life shoulder, give praise freely.
encouraging results.
admin and sleep. Buy someone a coffee, or bring
The application is focusing on what
cake for your ward – baking will
“
is happening now, and not worrying
get your everywhere. I don’t quite
about the future, or ruminating on
believe in karma, but those who
the past. I am terrible at this, but
Buy someone a coffee, treat others with kindness tend to
leaving work worries at work allows
or bring cake for your space to recharge and make the
start receiving it back.
ward – baking will get most of my off time. Bon voyage sailors – remember
your everywhere. I don’t At work, it has taught me to avoid
to look after yourself to avoid sea
sickness, scurvy and falling over
quite believe in karma, the highly addictive urge to multi-
board!
but those who treat others task, something proven to be
with kindness tend to start associated by more errors and
inefficiency.
receiving it back.
So instead, try mono-tasking – that
means no more eating your lunch
and doing a discharge summary
while on the phone to the med reg
and recharting the PRNs.
Clinical Excellence Specialist Workforce Capacity
Office of the Chief Medical Officer
Medical Workforce Branch Program (SWCP) summary sheets
Email: medicalworkforce@health.wa.gov.au
The SWCP summary sheets have been developed to provide
an overview of the WA medical workforce based on the SWCP
2015.
Each SWCP summary sheet provides the following information:
The projected workforce 2015 to 2025
Projected consultant supply and demand 2015 to 2025
Workforce distribution 2015
Trainees and new fellows
Consultant age distribution 2015
Workforce planning and risk rating 2015 to 2025
The SWCP summary sheets should be read in conjunction with
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INTERNSHIP 101 – WHAT YOU NEED TO KNOW 11
Golden Rules for Interns –
From Those Who Have Been There!
Join the AMA. The AMA is the • Professional Services Review If you believe you have something
only organisation that effectively Committee investigations to say, then say it. Some Seniors
advocates for the profession as • Hospital inquiries don’t like being questioned, but often
a whole. Doctors in Training are they’re the ones who need it most.
Keep copies of documents such
particularly vulnerable because they
as your contracts of employment, No task is beneath you. Helping
don’t join organisations and are by
overtime and call back claims, tie a patient’s shoe laces, fetching
nature a fragmented workforce.
payslips and rosters and, of course, them a glass of water, holding
The AMA is the only organisation
your leave application forms. their hand when they cry. You are
that will effectively advocate for
It will enable you to cross-check a fellow human being first and a
you on issues like Intern places,
issues and the AMA will need this doctor second. Be kind, patient and
training places, changes to
information should it be necessary compassionate.
training programs and issues
to pursue matters on your behalf. It’s OK to be nervous – being
with your employer.
Check your payslips. Doctors nervous reminds you that you
Join an MDO. As a Doctor in
in Training have discovered many are taking care of people who are
Training, you are covered by the
errors in their fortnightly payslips sick, and you can’t be nonchalant
State Government’s Medical
and the AMA has advocated about it.
Indemnity Policy in relation to
on behalf of members to rectify Step back from time to time and
medical negligence claims made
those errors. realise how amazing your job is.
against you that arise from the
provision of medical services to Help out your fellow Interns – You get to help people at the times
patients in the public health system. swap shifts with them if you are able they are most in need. Medicine is
However, there are a number of and you will be repaid with the same challenging, stimulating, complex,
exemptions that are not covered when you need it. and most of all, very rewarding.
by this indemnity arrangement,
Treat your patients like people, Take responsibility for your
such as:
not collections of diseases. actions. If you haven’t ordered a
• Coronial investigations test or performed an examination –
• Medical Board inquiries When you’re in your patient’s
admit it.
• Royal Commissions presence, don’t talk about them
– talk to them. Educate your Take the time to establish rapport
• Disciplinary proceedings
patients. This is part of helping them and trust with patients, their
medically. families and your colleagues
throughout the hospital system.
Don’t be afraid to ask for help.
Having your own top-up If you don’t find it with the first If you’re sick take sick leave.
person you ask, ask someone else. If you come to work, you will be
medical indemnity insurance expected to perform at 100%. If you
is essential and gives you Respect each other. Be sure to
can’t, you will only cause yourself
respect all your fellow doctors and
the security of knowing and your patients grief and you may
treat them all equally regardless of
that you will have your own gender, race or age.
also infect your colleagues.
independent representatives If you encounter problems in the
Care about your patients, but
providing you with workplace, don’t let it fester.
care about yourself too. Take time
Talk to a trusted senior colleague,
assistance, support and for lunch/coffee/a breath of fresh air!
your peers, hospital administration
legal advice. Lack of experience doesn’t mean or the AMA. Our Doctors in Training
lack of talent. Ignore those who Committee representatives and staff
limit your abilities. Be the best are there to assist members with
MDA National
doctor you can be. workplace issues.
www.mdanational.com.au12 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
7
What is Salary Packaging?
Salary packaging is a process where
you restructure the way you take
your salary in order to save tax.
This process can effectively convert
Salary Packaging Explained
Salary packaging can be a great way for doctors to get
ahead financially but many don’t get around to organising it,
or simply don’t realise how much they are missing out on.
HERE’S AN EXAMPLE:
An employee at a major hospital, earning approximately $70,000 per
year who chooses to sacrifice $10,000 out of their annual salary will get
a total yearly tax saving of $3,450! (Based on the individual income tax
your current cash salary into a
rates 2016/2017)
‘package’ which includes both cash
salary and payment of other benefits.
Salary packaging doesn’t change Details No Salary
Package Package
the amount you’re entitled to, just the
way in which you get paid. Salary 70,000 70,000
The first step involves giving up a Less: Amount Sacrificed – 10,000
portion of your regular cash wage
each pay period. Don’t panic! Taxable Income 70,000 60,000
It’s a sacrifice that reaps rewards. Tax Payable 15,697 12,247
By reducing your cash wage each
pay cycle you are entitled to a Net wages paid by hospital 54,303 47,753
reduction in the amount of income Add: Reimbursement of amount sacrificed – 10,000
tax you pay on your wage.
Total $54,303 $57,753
Next, you convert the amount of
cash salary that you have sacrificed
into other benefits such as rent In WA, there are two packaging providers who administer the arrangement on
payments, car lease, utility bills – behalf of your employer and yourself. Specific information about how to sign
this makes up the difference for the up and what can be packaged can be obtained from these providers.
amount of cash salary you sacrificed
out of your regular wage.
The result is that you still get the Need more information?
same total amount of salary, but pay HCN 6444 5000
less tax – leaving more money in hcn@health.wa.gov.au
your back pocket! Paywise 1300 132 532
info@paywise.com.au
What About Fringe www.paywise.com.au
Benefits Tax?
Fringe Benefits Tax is specifically Smart Salary 1300 476 278
designed to tax salary packaging www.smartsalary.com.au
arrangements.
If you’re considering salary
packaging, make sure you
seek advice to make sure your
arrangement is exempt from Fringe
Benefits Tax or the resulting tax
bill will most certainly wipe out any
potential savings.8
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 13
The AMA: A One-Stop-Shop for
Doctors in Training – Professional
and Industrial Services
Membership of the AMA gives you Agreement Negotiation • Disputes which arise during the
access to a comprehensive range of The AMA’s proud history course of your employment;
professional and industrial services of negotiating significant • Accessing your industrial
including: improvements to salary rates, entitlements including leave;
• Political advocacy allowances and employment • Underpayment and overpayment
• Award negotiation conditions has benefited salaried of salaries;
• Local industrial representation practitioners over many years, and • Assistance with disciplinary
• Member-only seminars, you will now be a beneficiary of the processes; and
workshops and events work of our dedicated staff. • Complaint handling processes.
• Member-only communications, During 2016, the Association held
some specifically written for negotiations for the next round Member Exclusive Events
junior doctors of Industrial Agreements to cover and Seminars
• Social and networking events all salaried medical practitioners. Confirmed dates for these events in
• Commercial benefits The 2017 Interns were the first 2018 will be available on the AMA
year group in Australia to receive (WA) website: www.amawa.com.au
Political Advocacy 3 year appointments. As an Intern, • Intern Cocktail Party
The AMA advocates on behalf having satisfactorily completed your • Interview and CV Skills
of Doctors in Training (Interns, internship and achieved general Workshops
Residents and Registrars) on registration you will progress directly • Medico-legal Seminars
a wide range of public hospital to a Resident Medical Officer.
• Volunteering and Working Abroad
issues. Our priorities for 2018 In addition to 3 year appointments • Intern and RMO Application
include the availability of training the AMA (WA) has successfully information evenings
positions, junior doctor access to negotiated:
leave entitlements and flexible work Clinical topics including:
• Salary increases of 1.5% per year
arrangements for trainees. • Sports Imaging
for three years;
• Paediatric Imaging
Specific to Doctors in Training, • Easier access to Professional
• Updates in Breast Cancer
the AMA will be seeking to remind Development Leave including as
Screening and Management
governments, the media and the single days;
public of significant shortages • Renal Medicine
• Rostering improvements
within the WA medical workforce including longer roster periods • Immunisation
and the consequent need to ensure and longer notice periods; New events monthly. Keep an eye on
that sufficient training positions • Attendance at mandatory training your emails and the AMA (WA) events
are available to provide career will be included within non – page for notifications of additional
pathways for Doctors in Training clinical duties; topics and events:
who can ultimately fill the gaps in • Improved clarity for progression www.amawa.com.au/events/
the workforce. The AMA continues through salary increments; and seminars/
to advocate on behalf of DiTs in
• No night duty before witness or
relation to employment entitlements Member Only
jury duty.
and is closely monitoring resourcing Communications
for the new Perth Children’s
Local Industrial AMA members receive:
Hospital to ensure that the needs
Representation • Medical Journal of Australia
of Doctors in Training are met in the
Industrial officers can provide • Medicus
establishment of new facilities.
specialist advice and assistance to • Australian Medicine
junior doctors on a range of issues
• Industrial Updates
including:
• Med e-link
• Contracts and offers of
• DiT Slack
employment;9
14 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Entitlements – What You Need to Know
What are the ordinary • Hours worked on Saturday shall What is a meal allowance
hours of work under the attract a penalty of 50%. and when does it apply?
Agreement? • Hours worked between midnight A practitioner who works more
A full-time practitioner’s ordinary Saturday & 8am Monday shall than 10 hours (exclusive of breaks)
hours of work are an average of attract a penalty of 75%. or is required to work overtime
40 hours per week. Rostered hours • Hours worked between 12 which means the practitioner takes
worked shall not exceed 75 hours midnight at the commencement a meal away from the usual place
in 7 consecutive days and not more of a public holiday and 8am on of residence is entitled to a meal
than 140 hours in any 14 day period. the day after a public holiday allowance of Breakfast $10.80,
shall attract a penalty of 150%, Lunch $13.30 and Dinner $15.95 and
Practitioners shall be rostered for
or if agreed, a penalty of 50% supper $10.80. (NB: These rates are
a minimum period of 3 hours and
with time off in lieu of the public updated from time to time).
can be rostered for a maximum of
holiday worked.
15 hours for a day shift. However,
What are the parental
Practitioners starting work after
How do I calculate the leave provisions under the
12 noon shall not be rostered for
applicable penalty rate? Agreement?
more than 12 consecutive hours.
If a practitioner works hours which A practitioner who is the primary
Practitioners cannot be rostered to
would entitle that practitioner to care giver is entitled to 14 weeks
work split shifts.
payment of more than one of the paid parental leave, which is
How is overtime paid? monetary penalties payable (i.e.: included in the maximum 52 weeks
public holidays, overtime, on-call unpaid parental leave after 12
Paid hours in excess of 80 hours
and call back, shift and weekend months continuous service.
in any two week pay cycle shall be
work) only the highest of any such
paid at the rate of 150%.
penalty shall be payable. What are the long service
Paid hours in excess of 120 hours leave provisions under the
in any two week pay cycle shall be How much notice is the Agreement?
paid at the rate of 200%. hospital required to give A practitioner shall be entitled to
for rosters? 13 weeks long service leave after
What rest break Practitioners shall be given a ten years continuous service in the
entitlements apply under minimum of 14 days’ notice first instance and for subsequent
the Agreement? and where possible 21 days’ service after each 7 years of
A practitioner shall be entitled to a notice, of rosters prior to their continuous service.
paid rest break of 30 minutes within commencement. Except in cases
each rostered period of duty. If a of emergency, or if the practitioner Payment for Public
roster period exceeds 10 hours then agrees, rosters shall not be Holidays
the practitioner shall be entitled amended during their currency. Hours worked on a public holiday
to a second paid rest break of 30 shall attract a penalty of 150%, or,
minutes. How much sick leave am if the practitioner and employer
I entitled to? agree, at the rate of 50% and the
What penalty rates apply A full time practitioner shall be practitioner shall be entitled to a day
under the Agreement? entitled to 80 hours sick leave per in lieu for the day worked.
• Hours worked between 6pm and year which shall accrue from year
If a practitioner is rostered off duty
12 midnight on any weekday shall to year. Sick leave in excess of two
on a public holiday, the practitioner
attract a penalty of 20% consecutive days shall be paid upon
shall be paid as if it was an ordinary
• Hours worked between 12 receipt of a medical certificate or
working day, of if the employer
midnight and 8am on any weekday reasonable evidence of illness or
agrees be allowed to take a day off
shall attract a penalty of 25%. injury.
in lieu at a mutually agreed time.INTERNSHIP 101 – WHAT YOU NEED TO KNOW 15
What are the call-back Please note that when you are paid
entitlements under the for a call back you will be deducted
Agreement? the on call allowance for the
Practitioners who are ‘called back’ corresponding hours.
to work shall be paid a minimum of
3 hours as follows: How much Professional
• For any work between 6.00am Development Leave (PDL)
and midnight at the rate of 150%. am I entitled to?
• For work on Sunday between A DiT is entitled to 3 weeks of PDL.
6.00am and midnight at the rate One week of PDL is accruable
of 175%. (i.e.: if not used in that calendar year
• For any work between midnight it will accrue to the next year).
and 6.00am at the rate of 200%.
The other two weeks are non-
• If the call back period exceeds
How much annual leave accruing leave (i.e.: must be applied
three hours, the practitioners
am I entitled to? for in the calendar year in which it
shall be paid at the rate of 200%
A full-time Practitioner shall be accrues).
for each additional hour.
entitled to a minimum of 160 hours If you do not apply for the leave, you
annual leave on full pay after 52 If a practitioner completes the work
will lose it. If however, you apply for
weeks continuous service. The they were recalled for they are not
the leave (we recommend you do
entitlement accrues pro rata on a obliged to remain at work for 3
this early on) and the employer is
weekly basis. A practitioner may hours. However, if a practitioner is
not able to authorise that leave, it
also accrue a maximum of 40 hours called out and recommences work
will accrue to the next year.
additional leave associated with within 3 hours of starting work on a
performance of on-call or working previous recall, the practitioner shall What are the notice
ordinary hours on Sundays/ Public not be entitled to a further minimum provisions under the
holidays. 3 hour payment. Agreement?
Payment for ‘on call’ practitioners • For contracts of 12 months or
What are the on-call commences from the time the less – 4 weeks’ notice.
entitlements under the practitioner starts work. For those • For contracts of more than
Agreement? not on call, call back shall be paid 12 months but equal to or less
Practitioners at or below Registrar from the time the journey back to than 2 years – 6 weeks’ notice.
Year 4 (previously cited level 13) work commences. • For contracts of more than
rostered ‘on call’ shall be paid an
2 years but equal to or less than
hourly allowance of $11.51 (from
3 years – 8 weeks’ notice.
1/10/2017). No practitioner shall
be required to be on call more • For contracts of more than
frequently than one day in three. 3 years – 12 weeks’ notice.
The responses detailed above are provided as a general guide only
and must NOT be taken to be a definitive statement of the Agreement.
Whilst every attempt has been made to ensure the contents of this
summary are accurate, AMA (WA) and its Officers expressly disclaim
liability for any act or omissions done in reliance on the information
provided or for any consequences whether direct or indirect of any
such act or omission.10
16 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Doctors in Training –
Salary Rates Guide
Base and PDA Public
Overtime Shift Loading
(1st pay period on or after 1-Oct-17) Holidays
Hrs >80
Fort- and Hrs Hrs
Pay Hourly nightly 120 in
Level rate PDA PDA fortnight fortnight 20% 25% 50% 75% 250%
Intern 1 $77,319 $37.05 $5,657 $216.88 $55.58 $74.11 $7.41 $9.26 $18.53 $27.79 $92.63
RMOYr1 2 $85,052 $40.76 $5,657 $216.88 $61.14 $81.52 $8.15 $10.19 $20.38 $30.57 $101.90
RMOYr2 3 $93,557 $44.84 $5,657 $216.88 $67.25 $89.67 $8.97 $11.21 $22.42 $33.63 $112.09
RMOYr3 4 $102,912 $49.32 $5,657 $216.88 $73.98 $98.64 $9.86 $12.33 $24.66 $36.99 $123.30
Registrar Yr1 5 $108,057 $51.78 $9,899 $379.51 $77.68 $103.57 $10.36 $12.95 $25.89 $38.84 $129.46
Registrar Yr2 6 $113,461 $54.37 $9,899 $379.51 $81.56 $108.75 $10.87 $13.59 $27.19 $40.78 $135.94
Registrar Yr3 7 $121,970 $58.45 $9,899 $379.51 $87.68 $116.90 $11.69 $14.61 $29.23 $43.84 $146.13
Registrar Yr4 8 $128,069 $61.37 $9,899 $379.51 $92.06 $122.75 $12.27 $15.34 $30.69 $46.03 $153.44
Registrar Yr5 9 $134,472 $64.44 $9,899 $379.51 $96.67 $128.89 $12.89 $16.11 $32.22 $48.33 $161.11
Registrar Yr6 10 $141,169 $67.65 $9,899 $379.51 $101.48 $135.31 $13.53 $16.91 $33.83 $50.74 $169.13
Registrar Yr7 11 $148,256 $71.05 $9,899 $379.51 $106.57 $142.10 $14.21 $17.76 $35.52 $53.29 $177.62
Senior 12 $159,376 $76.38 $14,142 $542.19 $114.57 $152.76 $15.28 $19.09 $38.19 $57.28 $190.95
RegistrarYr1
Senior 13 $167,344 $80.20 $14,142 $542.19 $120.30 $160.39 $16.04 $20.05 $40.10 $60.15 $200.49
RegistrarYr2
Composite Salary (Base +
PDA) 1st pay period
on or after 1-Oct-17
Intern $82,976
AMA (WA) Pay
Resident Medical Officer $90,709– $108,569
Calculator –
Registrar $117,956– $158,155
Our Guide to your
Senior Registrar $173,518– $181,486
Fortnightly Pay
* PDA – Professional Development Allowance Think your pay may be incorrect?
All figures used in the above example have been rounded to two decimal places and should be Utilise our Pay Calculator to get
used as a guide only.
an estimate of your income for
that particular fortnight.
Visit www.amawa.com.au11
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 17
Your Payslip
As an Intern, deciphering your payslip may seem like the
least of your worries. However, the AMA (WA) recommends
that you check your payslip each fortnight to ensure that you
are being paid correctly.
Use the mock-up below to familiarise yourself with the payslips. The diagram
also highlights the areas you need to keep an eye on each fortnight.
NORTH METRO AREA HEALTH SERVICE
Employee Name Emp No: CGNM123456
Waldron, Mary Payroll Date Address
Send to
11/01/2018 14 STIRLING HIGHWAY
WALDRON, MARY
NEDLANDS WA 6009 The Intern base salary
14 Stirling Highway
NEDLANDS WA 6009 ABN No: 123456789101
is $77,319 as at
1 October 2017
Are your base hours correct? Check against your Period No: 536
roster. The AMA (WA) advises that you keep HR Contact:
copies of your rosters in case of any pay dispute. HSS PAYROLL SERVICES Full-Time Salary
Telephone: 1300 553 927 $77,319.00
1. TAXED EARNINGS This Pay Year to Date 4. TAX This Pay Year to Date
Hours Rate Description Amount Description Amount
71 37.0539 BASE HOURS 2,630.83 TAXATION 920.00
12 11.51 O/CALL M/OFF 138.12
3.0 55.5808 O/T 1.50 166.74
Have you been paid appropriately
9.0 37.0539 P/HOL OBSERV 333.49
for public holidays?
9.0 7.4108 PENS 20% 66.70
Have your shift 10.0 18.5269 PENS 50% 185.27
penalties been
8.0 27.7904 PENS 75% 222.32 Professional Development Allowance for
calculated correctly?
0 0 PROF DEV ALL 216.88 Interns is $216.88 as at 1 October2017
0 0 SMART SALARY –384.48
Total 3,575.86 3,575.86 Total 920.00 920.00
2. UNTAXED EARNINGS This Pay Year to Date 5. DEDUCTIONS This Pay Year to Date
Description Amount Description Amount
TOTAL 0.00 TOTAL 0.00
*Untaxed Earnings Total 0.00 0.00
3. TOTAL TAXABLE EARNINGS This Pay Year to Date 6. SUPERANNUATION This Pay Year to Date
3,575.86 3,575.86 Super Contributions Amount
NEW GESB SUPER WS6 339.71 339.71
7. NET PAY 2,655.86 2,655.86
GENERAL INFORMATION: LEAVE Balance Calculated Leave Type
DISBURSEMENTS (BANKED) ANNUAL LEAVE 0.15 W
Bank Account Amount LONG SERVICE LEAVE 0.00 W
CBA Mary Waldron 2,655.86 MED PRACT AL ADDIT LVE 3.00 H
PROF DEV LV ACCRUING 0.15 H
Are your leave balances
PROF DEV LV NON-ACCRUE 80.00 H
accruing each fortnight?
SICK LEAVE – FULL PAY 3.06 H
Are any deductions in leave correct?
TOIL PUBLIC HOLIDAY 0.00 H
Leave Balanced displayed are subject to audit
COMMENTS
The legend below explains the most commonly used codes you may find on your payslip.
BASE HOURS PENS 75% O/CALL M/OFF
Base hours – as a full time employee this ought to be Penalty of 75% for hours working between midnight On call allowance for junior doctors
80 hours per fortnight (minus any observed/worked Saturday and 8am Monday P/HOL OBSERV
public holidays) U/R O/T 1.5 Public holiday (observed) when rostered off duty on
PROF DEV ALL Overtime (unrostered) for hours worked in excess of 80 public holiday, paid as if the day was an ordinary
Professional development allowance hours per fornight paid at 150% working day
PENS 20% U/R O/T 2.0 SLFP NO MC
Penalty of 20% for working between 6pm and Overtime (unrostered) for hours worked in excess of Sick leave with no medical certificate on full pay
12 midnight on any weekday 120 per fortnight paid at 200% SLWOP NO MC
PENS 50% O/T 1.5 Sick leave without pay with no medical certificate
Penalty of 50% for hours worked on a Saturday Rostered hours worked in excess of 80 hours
per fortnight paid at 150%18 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
NORTH METRO AREA HEALTH SERVICE
Employee Name ABN No: 123456789101
Waldron, Mary Payroll Date Period
11/01/2018 522
Date From Date To Description Units Rate Amount
PRIOR PERIOD TAXED EARNINGS
TOTAL 0.00
CURRENT PERIOD TAXED EARNINGS
Check your hours for
29/12/2017 BASE HOURS 9.00 37.0539 $333.49
each shift are correct
30/12/2017 BASE HOURS 9.00 37.0539 $333.49
31/12/2017 BASE HOURS 9.00 37.0539 $333.49
01/01/2018 PUBLIC HOLIDAYS (OBSERVED) 9.00 37.0539 $333.49
02/01/2018 BASE HOURS 9.00 37.0539 $333.49
02/01/2018 PENALTIES AT 20% 4.50 7.4108 $33.35
03/01/2018 BASE HOURS 8.00 37.0539 $296.43
03/01/2018 PENALTIES AT 50% 8.00 18.5269 $148.22
04/01/2018 BASE HOURS 8.00 37.0539 $296.43
04/01/2018 PENALTIES AT 75% 8.00 27.7904 $222.32
05/01/2018 BASE HOURS 8.00 37.0539 $296.43
08/01/2018 BASE HOURS 9.00 37.0539 $333.49
08/01/2018 PENALTIES AT 20% 4.50 7.4108 $33.35
09/01/2018 ON CALL ALLCE – MED/OFF 12.00 11.5100 $138.12
10/01/2018 BASE HOURS Did you receive all 2.00 37.0539 $74.11
10/01/2018 PENALTIES AT 50% overtime owing to you? 2.00 18.5269 $37.05
10/01/2018 OVERTIME @ 1.50 3.00 55.5808 $166.74
29/12/2017 11/01/2018 PROFESSIONAL DEVT ALLOW $216.88
29/12/2017 11/01/2018 SMART SALARY SP FIXED -$384.48
TOTAL $3,575.86
TOTAL TAXABLE EARNINGS (SECTION 1) $3,575.86
PRIOR PERIOD UNTAXED EARNINGS
TOTAL 0.00
CURRENT PERIOD UNTAXED EARNINGS
TOTAL 0.00
TOTAL UNTAXED EARNINGS (SECTION 2) 0.00
As an AMA (WA) member service, our Industrial Team can provide one-on-one assistance relating to identified salary
and entitlement errors (including underpayment and overpayment).
If you are experiencing problems in rectifying pay errors, you can have the issues dealt with by following these steps:
• Check that your pay is correct/establish there is an error by utilising the Pay Calculator on the AMA website;
• Having established that there is an error, approach your hospital payroll to verify the error and seek their assistance
in correcting the error. Be sure to follow up any verbal contact in writing;
• After having verified the error with hospital payroll, seek payroll assistance in having the error corrected by HCN.
If hospital payroll does not/is not willing to assist you, approach HCN directly and seek a correction of your payroll
error. Be sure to follow up any verbal contact in writing;
• Keep records of all contacts made or attempted with hospital payroll and HCN;
If you are not able to make any progress after having followed this process, please contact the AMA (WA) Industrial
Team on 9273 3000 to assist you or email mail@amawa.com.au.It’s here...an unsurpassed
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20 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Prescribing 101
Not much changes between your last day as a medical student and first day as an Intern –
apart from the title! There is no profound change in knowledge base or skill set.
But your most important accessory is your pen. Black or Blue is best. Avoid other colours unless you want to battle it
out with a pharmacist.
Now you prescribe because you have to, so here are some quick tips to help get you scribbling safely.
The Medication Chart A Legal Order Prescribing Checklist
• Front page – single does For a medication to be given safely 1. Allergies – What are they?
medications (eg resus drugs) in a hospital it must have a legal Could it be a side effect? Will
• Front page – telephone orders. order – if done correctly this will other drugs in that class affect
Utilise this on your ward cover also save you precious time. the patient?
shift when you can’t get to a 2. Admission – Why have they
A legal order consists of:
patient straight away. Don’t been admitted? If they have
PATIENT – Check the label (and
forget to ask about allergies been admitted with syncope
if you start a new chart, place a from postural hypotension then
before prescribing.
sticker on it). withholding their antihypertensive
• Inside of medication chart
ROUTE – IV/PO/inh. This will may be necessary.
– Variable dose medications depend on whether the drug is
(most commonly gentamicin) 3. Bloods – Do they have any
bioavailable for the given route. renal or liver dysfunction? Is
• The patient’s regular medications For example, naloxone is not it iatrogenic? Eg Flucloxacillin
• Back page – PRN medications. bioavailable via oral route. Some causing liver dysfunction and
Do your colleagues a favour and drugs come in multiple oral worsening renal function due
put some pain relief, anti–emetics formulations i.e. Oxycodone TABS to Vancomycin. So you need to
and aperients for all your patients vs CAPS (S8 prescriptions need to adjust the dose due to impaired
on admission. When prescribing be very specific!). renal function?
PRN medications, you should DRUG – Use generic names 4. Check Obs – This may prompt
also include an indication in the (it helps everyone out). you to withhold or commence
space provided. DOSE – With correct unit of new medication.
measure. If you use (ii) then you 5. DVT – Do they need prophylaxis
The Anticoagulation Chart must write the strength of the tablet or do they need anti–coagulants
• DVT prophylaxis should next to the name. withheld? Most surgeons have
be considered in every their own preferred anti–coagulant
TIME/FREQUENCY – Date with
hospitalised patient. regime – ask the Registrar.
24 hour times. You must write the
• Common reasons NOT to give times in the boxes provided. 6. Drug Boffins – When stuck or
prophylaxis include; unsure ask the pharmacist. They
YOUR SIGNATURE AND PRINTED
– Bleeding SURNAME – The prescriber must are very approachable and know
– Anticoagulation for be identifiable for an order to more about medications than the
another cause be valid. doctors (unless pharmacy was
• The front of chart – single IMPORTANT TIP – All prescriptions your undergrad – if so everyone
dose drugs, prophylaxis will ask you instead).
should be written in a legible
orders and therapeutic manner. 7. Extra Tests – Some drugs will
anticoagulation orders. require that the patient have a
• The middle sheets – heparin drug level or blood test following
infusion including dosing administration. Eg gentamicin and
strategies for VTE and ACS. warfarin. Don’t forget to submit
the path forms in advance.
• The back sheet – LMWH
recommendations for dosing, 8. Oxygen charts are here to
Warfarin recommendations for stay and need to be renewed
dosing AND reversal. regularly. If your patient has
COPD do NOT give unrestricted
oxygen and aim for sats 88–92You can also read
