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Critical GP shortage in NT sign of wider student crisis


Michelle Wisbey


28/08/2023 4:33:47 PM

Only 14 people have enrolled in GP vocational training in the territory this year, according to the Menzies School of Health Research.

Wide shot of Alice Springs in the dark.
Just 13% of students list general practice as their first preference of specialty for future practice, and most would prefer to work in cities.

The race is on to entice young doctors back into general practice in the top end, with the Northern Territory suffering an 80% drop in new GPs in just seven years.
 
The drop, laid bare in a new paper from the Menzies School of Health Research, is contributing to an already dire workforce situation in the NT, which has the lowest per capita rate of full-time equivalent GPs in the country.
 
To help resolve the issue, the RACGP took part in a Primary Healthcare Workforce Summit in Alice Springs with Federal and local ministers, as well as other stakeholders, to develop a plan where ‘no patients anywhere in the territory are left behind’.
 
The Summit resulted in a seven-point plan aimed at increasing GP numbers and overcoming maldistribution through the introduction of:

  • tax relief incentives for GPs
  • a ‘portability of entitlement’ scheme allowing doctors to retain employment entitlements when changing locations
  • a gradient for Aboriginal health salary support, recognising remoteness through a higher rate
  • a two-year structured training pathway in the territory for GPs in training
  • an injection of funds for capital expenditure to upgrade existing housing and build new facilities
  • funding for international medical graduates who are not yet registerable as a GP in Australia to train in remote areas
  • recruiting up to 10 GPs in training from interstate to work in the NT.
RACGP Northern Territory Chair Dr Sam Heard welcomed the plan, saying he cannot wait to put it into action.
 
‘Boosting GP numbers isn’t easy; however, I’m confident that if we work together and urge government to have the right programs and policies in place, we can achieve our targets,’ he said.
 
The plan mirrors what was found in the Menzies School study, in which researchers interviewed 50 NT senior medical students, junior doctors, GP registrars, GP supervisors and stakeholders.
 
Those conversations offered an invaluable, firsthand insight into the specialty, with many respondents exposing the ‘widespread negative messaging’ surrounding general practice.
 
Today, just 13% of students list general practice as their first preference of specialty.
 
Almost 80% said they would prefer to work in a capital city or major urban centre, while only 2% aimed to work in small communities.
 
To combat this, the study says changes need to begin in a doctor’s early years of practice, with respondents pointing to a lack of exposure to the specialty.
 
‘I went through a six-year [capital city-based university] program … in terms of overall exposure, I’d … had maybe six-eight weeks,’ one interviewee said.
 
‘I ended up sitting in a seat in the corner of this GP’s consult … there wasn’t a spare room for me to consult in… I distinctly remember I did one blood pressure and one urine dipstick … I was just like, “oh, this isn’t very enjoyable”,’ another reported.
 
According to Dr Sean Black-Tiong, Chair of the RACGP’s National Faculty for GPs in Training, the system needs to better enable GPs to be involved in student and junior doctor training.
 
‘Unfortunately, the logistics are much simpler for a salaried hospitalist to give a guest lecture, or to have students on the wards when you have multiple junior doctors to share the teaching around with,’ he told newsGP.
 
‘Parallel consulting is a great way for students to get a real taste for general practice, but the reality is, that if there is a spare room in a GP clinic, the clinic will have to prioritise an income generating person in that room.’
 
Many study respondents also found training programs inflexible and impractical, especially international medical graduates, those with partners or children, and older graduates.
 
‘[There is a] lack of flexibility in the fact that they [GP registrars] need to travel, they need to move around,’ one person said was a deterrent.
 
Meanwhile, the abolishment of the Prevocational General Practice Placements Program (PGPPP) in the 2014–15 Federal Budget has also been identified as a turning point.

‘A really big thing we’ve lost is exposure to general practice in the postgraduate years and the hospital years,’ one study respondent said.
 
‘The drop-off does correspond pretty exactly to the cancelling of the PGPPP.’
 
The PGPPP began in 2004, and by the time of its conclusion, funded hundreds of 12-week placements annually for junior medical officers to work in general practice before choosing a pathway and many GPs have long argued for its return.
 
Employment conditions and poorer pay were also strong deterrents for moving into general practice.
 
‘Unless you are about billing, billing, billing, billing … [you are unlikely to] get the same kind of payout, like financial gain out of it as you would in some of the other specialty programs,’ one student said.
 
‘If I become a surgical registrar and I’m based in Royal Darwin Hospital for the next four-plus years, I’ve got the benefits, I’ve got the leave entitlements – everything accumulates – and I’m working towards long service and all of those type of things.’
 
Dr Black-Tiong said these issues point to an urgent need to ‘de-hassle’ GPs.
 
‘Money is often brought up in these discussions but there is more complexity to the issue than “GPs need to get paid more”,’ he said.
 
‘When I speak to people about careers as GPs, they aren’t saying they expect a million dollars a year, the issues relate to the comparative income of GPs declining over the years.’
 
The specialty is also in the midst of an ‘image problem’, with the report finding many students still think of general practice as a ‘fallback’ option, with respondents saying:
 
‘The concept [is] that if you don’t quite have enough intelligence, well you could be a GP.’
 
‘The hospital perception of general practice can sometimes be quite toxic … it is disparaged as a career choice as being … the easy option or you couldn’t get into something else.’
 
Dr Black-Tiong said comments like this are always hard to hear.
 
‘I never felt more valued as a doctor in my career as when a parent sees you then brings their whole family in for subsequent visits because you “passed the test” with mum or dad and now you’re their doctor,’ he said.
 
‘That meant more to my measure of success as a clinician than anything else. 
 
‘I would encourage those considering a career in general practice to think for themselves.
 
‘Don’t be dissuaded by a naysayer who has no idea what they are talking about, get the objective facts, assess how they apply to you, and then make your decision.’
 
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