Future GP workforce: The strategies needed to get ahead of the crisis curve
Dr Ayman Shenouda
A recent GP workforce discussion in the Herald Sun has warned supply is set to worsen over the next decade due to recruitment failures and broader impacts brought about by casualisation.
There are some key issues impacting here and at this point in the election cycle, it is a good time to highlight precisely what has led us to these recruitment failures and how to fix them.
We know what the path to a sustainable health system looks like and it involves a solid commitment to properly fund general practice and primary care.
If we want to design a system around patient needs then it is in primary care where we must focus our health reforms.
We have strong evidence to support this. We know that general practitioner supply is significantly associated with better population health.
Countless studies have confirmed this – the most notable being those from Starfield and Shi – yet successive governments have failed to put in place an action plan to realise these benefits.
Getting ahead of the crisis curve
In order to get ourselves ahead of the GP workforce crisis curve, a cohesive national strategy is now required.
It will certainly require a much stronger national policy focus to both recruitment and retention planning than we’ve seen in the past in order to build the GP workforce of the future.
A longer-term vision is what is required: half promises set within short-term electoral cycles will not build the health system our patients deserve.
At the heart of the issue is valuing general practice as a specialist discipline. The fact is that there is a lot of devaluing happening.
Professional negativism exposure during training, which seems firmly entrenched within the hospital-based specialties, is very much part of the problem.
We have to find a way to ensure general practice is high on the list in junior doctor’s specialisation choices.
To do this, we need to work on the perception of primary as distinct from, and of lower status than, secondary care.
When to direct our efforts
Medical career decision making is complex and much of that occurs during the early postgraduate years.
This is one or two years after graduation and for most their influences or role models will be from within the hospital system.
This is the time that doctors are making important career decisions and where positive exposure to general practice needs to occur.
Understanding the career choice determinants is important and there is an abundance of literature around this.
I would like to see a strategy that prioritises general practice and primary care with targeted attraction policies that trigger at those key decision points for junior doctors.
We need to work with other specialties to address professional negativism and find ways to provide more GP role models at these critical points in career decision making.
Other factors at play
Beyond recognition, it is important to highlight that there are other factors impacting significantly on our profession.
These not only limit our ability to attract doctors to our specialty but are adding to professional dissatisfaction among the current GP workforce.
Whether it is in its financing, remuneration or barriers to integration with the broader health system these are key capacity issues which persistently impact on our specialty.
We can already see that the Medicare Review Taskforce’s proposed revamp of GP items is set to place a whole new set of restrictions.
This combined with the impacts from the Medicare freeze and a persistent lack of investment in primary care is what makes our specialty a less attractive choice.
These all contribute to the pressures of working in the current health system and places restrictions on the value of care we can provide as specialists.
GP workforce action plan
It is clear that GP workforce reform would need to see more funding to strengthen primary care.
It would need less bureaucracy and significantly more funding to support patients with complex care needs for a system aligned with the multimorbidity in the community.
It would require a sustained effort to lift the profile and prioritise supports to encourage junior doctors towards careers in general practice.
We’re doing more to ensure the training occurs in primary care but that effort is diminished if all they see is a system in crisis.
There is a need to include a targeted strategy which financially incentivises GPs into training and practices where they are most needed.
But overall, we need to strengthen the role of generalist within the health system.
A high-performing health system built on integrated models of care must prioritise primary care and GP leadership.
We need to see a comprehensive GP workforce action plan prioritised by the major parties at the 2019 federal election.
Dr Ayman Shenouda