Dear fellow GPs: Are we our own worst enemies?

On the health of our profession: Are we our own worst enemies?
 
Dr Ayman Shenouda
 
On career choice
 
High quality placements in general practice is key to combating current trend which sees medical students turning away from our speciality.
 
But this too will fail if all they see is the effects of low job satisfaction whether it be remuneration, recognition or hours of work. 
 
This only reinforces the already impaired image internalised by both medical school culture and attitudes from role models – dominated by hospital doctors where our training system direct them.
 
And workplace culture really is everything. Unconscious bias is the hidden obstacle we really need to deal with if we are going to turn this around.
 
We need to ensure that what they see dispels some of these myths and allows them to make a more informed choice.
 
On career choice - we are currently sitting at 15% of final-year medical students (2018 cohort) stating general practice as their preference.[1]
 
Educational reform to help shift mindsets and ensuring exposure more realistically aligns towards workforce need would go a long way toward shifting these results.
 
But there’s so much more to this stat and we have more power than we think – pay differential aside.
 
On our role
 
So, what more can we do to ensure they resist the pull of the hospital-based specialisms?
 
Firstly, as a discipline we are not helping by talking down our profession.
 
I find discussions with some of my fellow colleagues frustrating when we ourselves are not pushing the value of general practice.
 
We focus on a lack of quality, on those providing sub-optimal care an of 5-minute medicine. The business of making money as rebates drop in value every minute after the six-minute mark.
 
Members feel they are not adequately remunerated for the job they do but still contribute to this vibe of a lack of quality.
 
Positive role modelling
 
We know positive role modelling is key. This is really the only pull factor that remains in our control. And it starts with the power of talk.
 
Clearly it is more difficult to control badmouthing between disciplines.
 
This obviously affects students’ career choices. And there is more we should be doing collectively – across the medical colleges - to stop this.
 
Do we know what they want?
 
But first, do we know what do Gen Y doctors really want from a medical career?
 
One survey[2] showed that if they were interested in a career in general practice, it tended to be because it fit well with a desire for work and lifestyle balance. Is that still something we have on our side with our recent survey showing more GPs reporting they have an excessive workload[3]?
 
Doctors do differ by generation and if you were a recruiter you would say there’s a good fit here.
 
Gen Y graduates want to constantly learn new skills, be challenged intellectually and both professionally and continually achieve.[4] Dealing with uncertainty and undifferentiated nature of symptoms encountered most certainly sets you on a course for continuous learning.
 
Achievement is an important one and this is where we come in.
 
Talk about our achievements
 
We need to convince medical students that general practice is exciting and real medicine happens here. We need to find a better way to tell our discipline’s story.
 
We need to celebrate the achievements of general practice - state what is positive about our profession.
 
It’s true that preventive medicine takes time to be seen.  But we have plenty to be proud of here.
 
Public health
 
On our public health achievements alone – on immunisation and disease illumination, cervical screening, and reduced smoking rates.
 
Our immunisation achievements are world–leading. We’re set to become the first country in the world to eliminate cervical cancer. And, we’re a pioneer in tobacco control with fewer people dying due to smoking.[5] 
 
It is in these achievements that we should be most proud as without the dedication of GPs this would not have happened.
 
Chronic disease
 
And with multimorbidity on the rise, our work in managing chronic disease also needs to be highlighted.
 
General practice provides the majority of care to patients with chronic illness. Most GPs manage patients with multiple health concerns.
 
Mental health
 
Our work in mental health with most now occurring in general practice.
 
Mental health remains the most common issue managed by GPs and is showing an upward trend (from 61% in 2017 to 65% in 2019)[6].
 
Talk more on our achievements
 
Clearly, we’ve achieved a lot. General practice is no longer a gatekeeper – it is the cornerstone of our health system.
 
We’ve done this despite having to find workarounds within a suboptimal health system designed to combat acute care of single conditions.
 
On the health of our profession we seem to be our own worst enemies. It’s time to turn this around and focus on the areas where we still have influence.
 
We have so much to be proud of and I think we should start focusing on the key role we play in keeping Australians healthy.
 
 
Unpacking the stats
 
This is clearly not a new issue here but the continued underinvestment shows in the stats predicting a very grim future of health unless we can turn this around.
 
No doubt this will continue to decline unless we see real action through more investment in general practice.
 
When you place the career choice stat alongside the other standouts for general practice it’s easy to see why there is such disinterest.
 
In terms of total health expenditure – general practice is at 7.4% of total health expenditure. This is despite general practice being the most accessed part of the health system.
 
But then there’s the pay differential. Remuneration as it stands is certainly not going to get them there either.
 
Average GP’s annual earnings amount to slightly more than half that of other medical specialists – and this gap has widened in recent years.[7]
 
Then alongside stats that give an all too real glimpse of the workload we face. It is clear continued underinvestment is starting to bite hard and most visible through increasing workloads.
 
We saw this when tested in a recent survey that showed 29% of GPs either disagreeing or strongly disagreeing that their work–life balance has improved over the past five years.[8]
 
​
[1] AusDoc.Plus. Medical students shun general practice Published 4th October 2019.
[2] Ipsos Healthcare Survey. published in August 2012.
[3] RACGP. Report. Health of the Nation 2019. Available at: https://www.racgp.org.au/general-practice-health-of-the-nation
[4] GRB UK. Understanding Gen Y as a recruiter. Available at: https://www.grb.uk.com/recruiter-research/generation-y
[5] PHAA, Top 10 public health successes over the last 20 years, PHAA Monograph Series No. 2, Canberra: Public Health Association of Australia, 2018Great
[6] The Royal Australian College of General Practitioners. General Practice: Health of the Nation 2019. East Melbourne, Vic: RACGP, 2019.
[7] University of Melbourne, Monash University. Medicine in Australia: Balancing Employment and Life (MABEL). MABEL Wave 10 survey. Melbourne: MABEL, 2019.
[8] EY Sweeney. RACGP GP Survey, May 2019. Melbourne: EY Sweeney, 2019