Future GP workforce: Strategies to get ahead of the crisis curve

Ayman Shenouda

18/01/2019 3:40:18 PM

Examining a recent discussion warning that supply is set to worsen due to recruitment failures and the impacts of casualisation.

Dr Shenouda believes a cohesive national strategy is required in order to get ahead of the GP workforce crisis curve.
Dr Shenouda believes a cohesive national strategy is required in order to get ahead of the GP workforce crisis curve.

There are some key issues impacting this discussion 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; 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. We know that GP 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 in front of the issue
In order to get ourselves ahead of the GP workforce crisis curve, a cohesive national strategy is required. Building the GP workforce of the future will certainly need a much stronger national policy focus to both recruitment and retention planning than we have seen in the past.
A longer-term vision is required: half promises set within short-term electoral cycles will not build the health system our patients deserve.
Valuing general practice as a specialist discipline sits at the heart of the issue.
Exposure to professional negativism 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 doctors’ specialisation choices. This means we need to work on the perception of primary care as distinct from, and of lower status than, secondary care.
Where to direct our efforts
Making decisions about a medical career is a complex process and much of that occurs during the early postgraduate years and, during this time, most people’s influences or role models will be from within the hospital system.
This is the time doctors are making important career decisions and where positive exposure to general practice needs to occur.
Understanding career choice determinants is important and there is an abundance of literature around this notion.
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 junctures.

future-gp-workforce-tile-(1).pngGreater funding, Dr Shenouda says, is vital to strengthening the future of primary care.
Other factors at play
Beyond recognition, it is important to highlight that there are other factors that significantly impact 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 that 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 place restrictions on the value of care we can provide as specialists.

GP workforce action plan
It is clear 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 the 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.

casualisation funding GP workforce primary care

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Sam   22/01/2019 10:04:43 AM

I think the RACGP would be well advised to ditch the entry exam (CAAKT, I believe it's called) as it's such a crude and blunt tool in identifying good potential clinicians. Its introduction is a massive step back into the dark ages for the RACGP.

Jimmy   22/01/2019 10:59:33 PM

Many hospital staff actually value the role and expertise of GPs. Unfortunately the RACGP training program instills in their trainees, "you are not a specialist", frequently in workshops, education materials, and clinical supervision including ECTV and supervisors.

Dr Raymond Yeowm BA MBBS   22/01/2019 11:22:39 PM

".....include a targeted strategy which financially incentivises GPs into training and practices where they are most needed....." ….a laudable aspiration but I won't be holding my breath for any govt to be providing more $$$

Louis Fourie   23/01/2019 8:51:43 AM

Hi there,
I feel this article says what has been said for the last 9 years I have practised in Australia. In spite of this it is my understanding, reading articles in the news, that the RCAGP supports the changes in care plan funding!? Why not stand up to the government and say NO, that may have more effect than countless articles about the same issue, that hasn't changed in 9 years - how important GP practice is to the system and how more needs to be done to make everyone realize it. If we say NO and stand up for ourselves people will realize it without us having to write LONG articles about it.

Dr Joveria Javaid   23/01/2019 3:04:05 PM

The alarming rate at which the medicare item numbers are being axed , and surgical item numbers are down graded, I am seriously thinking of changing my profession and become a tradie. It is not worth the mental stress and the relentless study you have to do to maintain your professional status. This is the only profession now a days where our pay scale is going down day by day . Not a good incentive for future generation.

Michael Connellan   24/01/2019 11:31:24 AM

This article sounds nice, but I do not see a single solid plan to improve the GP workforce, especially in rural areas, where the lack of GPs is about to reach a critical tipping point. All the talk of the last 20 yrs has actually amounted to about nothing. The encouragement of IMGs has simply delayed the crisis of local medical graduates not interested in working outside metropolitan areas. And until the RACGP seriously work with government to coerse, or insist that doctors move out to areas of true need, the communities in rural areas will suffer ongoing and worsening health outcomes. The time frame for this is urgent, i.e in the next five years. I won’t hold my breath for RACGP and gov’t action, given the examples of the last 20 years !