Adjunct Professor Janice Bell brings a deep and wide knowledge base to her work as a GP and as CEO of WAGPET.
By Ara Jansen
While she may be a general practitioner, Adjunct Professor Janice Bell considers herself a generalist in life.
Janice has been the CEO of Western Australian General Practice Education and Training, best known as WAGPET for almost 20 years. WAGPET is now winding up, as GP training will now be delivered by the Australia College of Rural and Remote Medicine (ACRRM), the Royal Australian College of General Practitioners (RACGP), the WA Primary Health Network (WAPHA), a to-be-formed First Nations GP Training Committee (FNGPTC) and Services Australia.
Born and raised in Perth, Janice is also deeply connected with New York. Her husband, Kim Lyons, worked in the Big Apple as a young lawyer. When the pair visited in 2006, they fell in love with the city and bought property there, which also allowed them to further explore the northern hemisphere without the constant long-haul flights.
On leaving school, Janice declared she wanted to do medicine. Perhaps this was influenced by having survived peritonitis at 13 from a missed appendicitis, one of the many that didn’t behave according to the textbooks. She was lucky enough that the general surgeon who operated, not knowing what he would find, saved her life, although it was touch and go for several days and took months to fully recover.
The idea of another health professional in the family didn’t impress her mother, who, herself, had been involved. She forbade that path. Instead, Janice got a scholarship to go to university to do arts and education, with a view to becoming a secondary school teacher.
Janice then worked with various helping professions, including community development, mental health, community services (community welfare, child protection and juvenile justice), public health and second chance education. She also set up her own management consultancy, which focused on organisational development and performance management.
New calling
Despite a non-religious upbringing, Janice spent three years studying theology as a trainee minister. Realising she loved theology – learning about how people have understood or found meaning in their lives over millennia – but wasn’t cut out for religious life, Janice was at a career crossroads. A midlife crisis. A counsellor she saw asked her – almost out of the blue – how long had she wanted to be a doctor?
Having avoided or confused the call to study medicine up until then, Janice gave up her secure, well-regarded public service career and went to study medicine at UWA. She was nearly the eldest in her year and received few exemptions for her previous work or degrees.
In the end, she chose to be a GP because while she enjoyed all her rotations in hospital, she recognised she didn’t want to work in such an anonymous, fractured system.
“Mostly I wanted to prevent patients from ending up in hospital when so often that could have been avoided,” she says. “I became a GP in the days when even in the city we did minor surgery, had inpatients in the local hospital and did all our own home and residential care visits. Sometimes, a non-GP specialist would come to my practice and we would see the patient together, decide a plan together. The tertiary hospital emergency department would ring day or night if they were treating a patient of mine and a diagnosis or management decision needed my input.
“I fear that time was eroded by workforce shortages in general practice, the opportunistic growth in scope of many non-GP specialists into GP work and the at-first informal and then formal credentialing that diminished the involvement of primary health care in the joined-up patient journey.”
While a GP she was approached to work with the RACGP training program, then to become a national manager of GPEA, the innovative subsidiary arm of the RACGP, with responsibility for AMC preparation courses, special projects such as the Medicare Plus option for non-GP specialist to work in general practice under supervision and vocational training for WA and SA.
In 2003, she was asked to nominate for the WAGPET board, became vice-chair and was then appointed CEO in 2004. That was 19 years ago and, for most of that time, Janice has continued to practise as a GP.
“What I thought would be a short-term role at WAGPET turned out to be an amazing opportunity and probably the most personally and professionally confronting task I have ever undertaken. I am eternally grateful for that. I can honestly say nothing, and no one, scares me nowadays!
“There was nothing to hate about my job. Ever. Everything frustrating or exasperating was an opportunity to learn and adapt and try something new. It was never boring, and I never felt I mastered it. There was always more.”
In 2011, Janice was awarded the RACGP Rose Hunt medal for services to general practice. She was appointed the inaugural Chair of the Curtin Medical School External Advisory Board in 2016 and an adjunct professor. In 2022 she was awarded an Honorary Doctorate in Medicine for services to medical education, health workforce and general practice.
Listen deep
Janice applies what she has learned from her patients to every aspect of her life and work – to listen and to listen deeply and fully, always 100% in the moment. The human capacity to heal and to harm astonishes her, even a quarter century later.
“There is so much we do not know for all that we do know about health and disease, wellbeing and illness.”
While she admits it may sound quaint, Janice is convinced medicine for most is a calling.
“I don’t think we understand this well enough or explore it fully enough when we select medical students these days. Some tremendous would-be doctors are lost this way, while others who find their way to my door have been quite bewildered to have ended up somewhere they never intended, for better or worse.”
If medicine is not a calling, she says, but merely a respectable, well-paying job, it can be brutal on the ego and sense of well-being.
“We can argue it is the system, which it is to a degree, or the very nature of the task at hand, which it is unquestionably. Especially general practice can be lonely when you’re dealing with the front end of an obscure serious illness or nothing but a passing shadow – time with watchful waiting sometimes being the only difference influencing the outcome.
“We can wait for the system or the wisdom of medicine to change – and it is changing all the time – but if you are going to be a good doctor, you will be rubbing up against life in this way, every day. It is a tremendous gift, no doubt, but not always a comfortable ride.”
When she’s not being fascinated by work, Janice is interested in many things. She has studied Chinese and integrative medicine – two other languages with which to understand the patient experience. An early riser, a couple of hours a day are spent on the Chinese martials arts of qi gong and pa tuan chin. She likes reading, thinking, creating, exploring and simply enjoying life.
“Trying to be in balance with everything and going with the flow is what I aspire to – and being more Taoist, a never-ending intention into action for me. Medicine has been great in keeping it real and staying in touch with what’s happening on the ground. Medicine keeps me humble. Being a GP has never allowed me to think I have arrived – and that’s a gift of medicine – because there is much I don’t know and the more I don’t know, the more the search goes on.”
Equitable care
Janice quotes cyberpunk author William Gibson when she says “the future is here now, but it is distributed unevenly” in answering what motivates her to remain a doctor. Her drive has been and continues to be for safe, quality, accessible and affordable health care for those who need it most.
“It is not only being better clinicians but about being better humans that will make this provision more equitable. There are so many practical and addressable ways I know to resolve this inequity in primary health care. I have worked tirelessly on many fronts towards this more evenly distributed future, even before I became a doctor.
“I admire those around me who are equal to this task and are making a difference on the ground, even as ignorant forces too often dismantle their efforts, sometimes unintentionally. As WAGPET CEO my contribution was through supporting and training doctors to work where they are needed most. We sought to train and support not just any doctors, but compassionate, kind, culturally safe and clinically competent doctors.
“Some of my best days were signing completion of training forms for an ever-increasing number of new fellows each year and watching the majority work in that place that embraced them, both their community and WAGPET. Seeing so many come back to be teachers, supervisors, assessors, educators, and staff is truly gratifying and fulfilling.
“WAGPET may be winding down, but the spirit of collegiality and community-centric medicine lives on. And wherever I can help breathe even more life into that spirit, that’s where I am headed next.”