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‘A cultural issue’: Minister calls for attitude shift to general practice
‘We’ve got to get away from this idea that general practice is somehow a B grade,’ the Federal Health and Aged Care Minister has said.
The Minister for Health and Aged Care Mark Butler has said existing attitudes are a barrier to making general practice more attractive for medical graduates. (Image: AAP Images/ Mick Tsikas)
‘There’s frankly a cultural issue within medicine.’
That is the view of Federal Health and Aged Care Minister Mark Butler, who has conveyed his concern about medical educators deterring would-be GPs in a podcast for The Guardian.
In an interview considering the implications of the Strengthening Medicare Taskforce report, he told The Guardian’s Political Editor Katharine Murphy he wants attitudes to change.
‘I speak to GPs and medical graduates all the time about their experience of being in a hospital and expressing to a consultant who might be supervising them, expressing an ambition to be a GP, and being told, “Why would you want to do that? You could be an anaesthetist, you’re smart enough to be a cardiac surgeon, why do you want to be a GP?” he said.
‘We’ve got to get away from this idea that general practice, the backbone of our healthcare system, is somehow a B grade.’
Minister Butler made the remarks as he addressed the prospect of GP shortages.
‘We think it’s hard to see a GP now, [but] when you look at the pipeline of new GPs 5–10 years down the track, if we don’t turn that around our primary care system will be in enormous strife,’ he said.
‘And that will place even more pressure on the hospital system that some of those structural challenges – an older population, more complex chronic disease – are already placing on them.’
During a discussion that ranged from the COVID-19 response in aged care to the prospect of voluntary patient enrolment, the Minister challenged the view of general practice as an easy option.
‘Managing overwhelming demand for good mental health support, complex chronic disease, lots of comorbidities – that’s hard work,’ he said, as well as acknowledging the ‘additional pressure’ of managing a general practice.
Introducing a longer consultation rebate – one of the tangible recommendations of the Strengthening Medicare Taskforce report – is one possible solution to help address an outdated system, he stated.
‘The system really is set up for procedures,’ Minister Butler said. ‘In the old days, you’d do yourself an injury, get an infection, you’d go to a doctor, there’d be a procedure, and they’d get a rebate for it.
‘And that’s really the emphasis of the system rather than on the consultations that underpin really good chronic care. So how do we shift the balance to that sort of care?’
Minister Butler also acknowledged the pay gap between general practice and other specialists – again neither committing to increasing Medicare rebates, nor entirely ruling it out.
GPs have consistently raised Medicare rebates as one of the most pressing factors affecting the viability of general practice. In the RACGP’s most recent Health of the Nation survey, only 3% of respondents said they believe the current MBS rebate is sufficient.
‘There’s no question, there’s their salary difference and … we need to think about some of those issues,’ Minister Butler said.
‘There are other conditions of employment that particularly public hospital employees enjoy that you don’t get, particularly while you’re training [to be a GP].’
He pointed towards the recent program announced in conjunction with the Tasmanian State Government to make rural GP training more attractive, and repeated a commitment from politicians at different levels of government to prioritise healthcare reform.
‘It’s really complex,’ he said. ‘The premiers and chief ministers have raised in cabinet the need for there to be a focused strategy on building the general practice workforce, making it more attractive for medical graduates to go into.’
RACGP President Dr Nicole Higgins agrees that the negative attitudes referred to by Minister Butler need to stop – and that the appeal of what she describes as ‘an incredibly satisfying career’ be allowed to shine through during medical studies.
‘The experience for doctors when they go through medical school and hospital training is often one where general practice is seen as a second-rate choice,’ Dr Higgins told newsGP.
‘I love general practice, it is intensely rewarding professionally.
‘I love the relationships that I have with patients and their families, the continuity of care.’
It was an aspect of healthcare also referenced by the Minister during the podcast.
‘I speak to lots of GPs, lots of medical students, they want to be general practitioners because there’s huge reward in it – [I’m not] not talking about money particularly, but huge reward from the connection to community,’ he said.
‘They get the idea that you have this … sometimes lifelong relationship with a family, from when they have a little baby to the baby growing, right through childhood and adolescence and dealing with the health challenges that you see moving from young adulthood into middle age.
‘This is something that GPs talk to me all the time about.
‘There is a little bit more control over your work–life balance. You work long hours but being a hospital doctor means you work shift work.’
Dr Higgins said she is fortunate that her studies brought her into contact with strong general practice advocates who emphasised the rewards of the specialty.
‘I was lucky enough that I went through Monash at a time where we had [Professor] John Murtagh and [Professor] Steve Trumble, and champions of general practice leading medical training,’ she said.
However, the RACGP President also pointed towards research carried out in the UK which indicates denigration of general practice is an ongoing problem that needs to be addressed.
A separate study using student feedback found that positive views about general practice were expressed in medical education but also noted the impact of disparaging remarks.
‘This will clearly have a negative influence on students’ perceptions of the specialty as a career choice,’ the authors of the Newcastle University study wrote.
There is no place for such attitudes in medical education, according to Dr Higgins.
‘What needs to happen is that universities must embrace and celebrate general practice as a career of choice,’ she said.
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