Opinion
Consultants of sting: Attitudes towards primary care in dire straits
As a final-year medical student, Sasenie Jayanetty shares her insights on the future of general practice from the perspective of a next-generation doctor.
University of Tasmania medical student Sasenie Jayanetty.
As I have been embarking on the final year of my undergraduate medical training, deciding on my future career path has been a constant deliberation in the confines of my mind.
Will I be a neurosurgeon performing intricate 10-plus hour surgeries? Or will I be an interventional radiologist chemo-embolising a liver lesion through a femoral artery? Or will I be a neurologist with a special interest in Parkison’s Disease? Or will I be a respiratory physician? Or an anaesthetist?
A gynaecologist? A pain specialist? Maybe a paediatrician?
Or will I be ‘just a GP’?
Growing up in a regional town in New South Wales, the local GP was the port of call for many in need. A beacon in the community that dealt with the complaints of any and all that walked through the sliding doors of the sole medical centre in town.
From the straightforward and simple like formulating an asthma care plan, diagnosing reflux or excising an early BCC, to the confronting and complicated like de-escalating a suicidal patient from a mental health crisis to managing a child in acute DKA.
In my eyes, GPs were truly the Swisse army knives of the medical system – ready to face whatever, whenever.
To find out that this is not the commonly accepted way of thinking in the healthcare sector and the broader public was a baffling realisation that dawned on me as I progressed through my clinical placement years in hospitals.
GPs seem to be the defenceless punching bags of the medical world that all other specialties land their hurtful uppercuts on.
‘Of course a GP made this referral’, ‘Do GPs manage anything these days?’, ‘Another GP who’s done more harm than good!’ are all platitudes I’ve heard mumbled from the mouths of consultants, registrars, interns and nurses as they roll their eyes and bitterly scoff at their notes.
Though on the surface it seems like a throwaway criticism, the damaging attitude it carries is profound; especially in the minds of the vulnerable patient, their family members and the impressionable medical students joining them in the treatment room.
This seemingly harmless microaggression triggers a monumental cascade of detrimental effects. It breeds distrust and undervaluing of primary care in the psyches of both the public and the emerging generation of junior doctors.
This has been a well-documented issue in general practice for a considerable amount of time.
In a 2008 study on enhancing general practice as a career choice, testimonials from registrars and medical students highlighted the misconceptions about GP that has existed for decades; ‘General practice was somehow seen as an inferior type of choice’, ‘I feel like they don’t get a lot of respect from the rest of the medical profession’.
Nearly 20 years later, after reflecting on my own experiences and conversing with my colleagues about their future career choices, these sentiments still ring resoundingly true.
‘What’s the point of studying for this long to only do GP?’; a phrase too commonly repeated in the clinical school.
Other potential reasons that consolidate the lack of appeal in GP include the overwhelming time pressure of short consults, unfair remuneration in terms of Medicare rebates, sizeable pay cut when joining the program compared to registrar jobs in other specialties, decreased ability to receive multi-disciplinary support, and the overall lack of prestige in the medical community.
On the whole, interests of medical students in joining primary care are plummeting astronomically fast.
A survey conducted on medical graduates by Medical Deans of Australia and New Zealand found that in 2017 only 16.7% of final year students listed GP as their first preference. This had dropped to 14.7% in 2021 and to 13.1% in 2022.
This is a stark contrast to the outlook of those who graduated 20–30 years ago, wherein which nearly half the cohort had considered GP in their highest preference as a career path.
Over 80% of Australians visited a GP in the last year with 96% of those aged over 85 years old making up a considerable amount of that percentage.
More than 160 million GP attendances were billed in the 2022-23 period. That’s nearly 500,000 appointments per day.
With a growing and ageing population on the rise in Australia, these numbers are only going to increase. General practitioners are going to become a desperate necessity in both urban and regional towns.
Without enough junior doctors going into general practice, the primary care sector of the nation will crumble. This can manifest in the forms of longer waiting times, higher costs for consults, decreased access to resources for those in rural areas, and increased burden to the healthcare system due to higher hospital admissions.
So, what can we do to fix this? Is it too late?
There is no solution that will resolve the issue at hand overnight, but interventions can be implemented to hopefully replenish the interests of junior doctors in general practice.
A little can certainly go a long way in terms of attitudes we have towards GPs in medicine.
Unlearning negative sentiments on primary care and repainting it in a light that highlights its importance will cause less people to think of GP as an inferior career choice.
Medicine is fundamentally a team sport; cooperation and harmony at a multi-disciplinary level is a must. These inter-speciality relationships must be nurturing and symbiotic, not breeding grounds for resentment and competition.
Otherwise, patient care will be sorely compromised, and the future of healthcare will be clouded in a veil of uncertainty, with threats of privatisation and inaccessibility seeping through the cracks.
Fairer financial compensation is another factor that can motivate the upcoming generation of doctors to be redirected towards primary care. This has already been put into action to some degree with the increased Medicare rebate scheme in 2023, offering a 34% increase in major cities and 50% increase in regional towns for standard bulk-billed consultation rebates.
Though this is certainly a start, it is undeniable that more needs to be done. Increased rebates are simply a Band-Aid on a bullet wound without providing proper parity of working hours regulation, accounting for the lack of salary benefits and maternity leave in comparison to their in-hospital training colleagues.
It seems the tides are slowly yet surely beginning to change.
In 2024, the RACGP reported that 91% of their new GP training places were filled, with 114 incentivised training placements successfully filled in areas of workforce need – many of which had not had a registrar for many years.
Hearteningly, interests for rural generalism among junior doctors have also risen considerably, as it now takes 6th place overall in recent graduates’ career pathway first preferences.
As I approach my graduation, I am still incredibly uncertain about what the future holds in terms of my trajectory as a doctor, which has left me excited and simultaneously petrified of entering this new chapter of my life.
Medicine has always been something I have held in high regard, admired deeply and felt drawn towards strongly.
Though I understand that there are indisputably more pressing issues in the healthcare sphere that requires urgent attention, to know that I am about to enter a sector where there is much infighting and unpleasantness; in a field renowned for its rectitude and nobility, has been an off-putting experience.
I want to advocate for a less hostile work environment, for a health system that places society’s most vulnerable at its centre and not the egos of higher-ups, for a career that fosters good patient care and safe professional boundaries, instead of one that constantly belittles and treats unfairly those that play such a pivotal role in it.
I hope attitudes towards general practitioners change and fair reformation in the domain of primary care comes swiftly, before it reaches a point of no return as more and more are deterred away from it for a plethora of varying reasons.
And I hope more people think about the dedication, care and significance involved in general practice before they ever again dismiss a doctor for being ‘just a GP’.
I know I certainly will.
Sasenie Jayanetty is a final-year medicine student at the University of Tasmania.
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