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General practice ‘denigrated’ to most students: Poll
Survey results highlight the imperative of ensuring the ‘incredibly rewarding’ aspects of general practice are clear during medical studies.
More than 1200 poll respondents said they had encountered negative attitudes towards general practice during their medical studies.
More than four in every five newsGP readers have encountered negative attitudes towards general practice during their medical studies, according to a new survey.
Of 1428 respondents to a newsGP poll last week, 86% said they had experienced general practice being denigrated while studying.
RACGP President Dr Nicole Higgins said the results are a source of concern and would like to see the ‘incredibly rewarding’ aspects of a career in general practice emphasised during medical school.
‘Doctors going through medical school and hospital training can sometimes get a sense that general practice is a second-rate choice, and that really couldn’t be further from the truth,’ she told newsGP.
‘It is a career with huge rewards and challenges.
‘I love general practice, it is so professionally fulfilling, I say the same to anyone who asks.
‘There are so many things I love about being a GP, from the clinical challenges to the relationships that I have with patients and their families.’
Chair of the RACGP’s National Faculty for GPs in Training, Dr Sean Black-Tiong, believes the issue is more systemic than connected to the outlook of university medical educators.
‘Generally, the attitude is positive and the good clinicians have a great deal of respect for the good GPs on a personal and collegiate level,’ he told newsGP.
‘The issues arise at the systemic level where the denigration comes from systematically being treated without respect.’
According to Dr Black-Tiong, healthcare administrators and policymakers rely too much on ‘coercive bureaucracy’ and ‘fail to respect the experience and knowledge of highly trained GPs’.
That, combined that with the way he thinks the healthcare system ‘incorrectly values quantitative procedural work over and above high value clinical care and time spent with a patient’, has a clear impact on the way general practice is perceived, he says.
‘This procedural favouritism then idolises the specialties and sub-specialties that are focused on low-time, high-turnover procedures that generate exorbitant income for an individual and the perception that they are more valuable due to having the highest income,’ Dr Black-Tiong said.
‘That any individual doctor earns over $500,000 per annum is absurd. No individual doctor is worth double or triple the value of another based on specialty.
‘And yet this is what the system conveys, that a full-time GP, or physician or paediatrician, doing non-procedural work earning less than half that of a high turnover surgeon, or anaesthetist or other procedural specialty is less valuable and remunerated less.
‘There needs to be a rebalancing to reduce the extremes of the wage disparity in medicine.’
Dr Sean Black-Tiong says healthcare administrators and policymakers do not respect the experience and knowledge of highly trained GPs.
Like Dr Black-Tiong, Dr Higgins has positive recollections of her medical studies, having previously told newsGP she was fortunate to have strong general practice advocates during training.
‘I was lucky enough that I went through Monash at a time where we had [Professor] John Murtagh and [Professor] Steve Trumble and [other] champions of general practice leading medical training,’ Dr Higgins said earlier this year.
Nonetheless, research carried out in the UK shows denigration of general practice remains a problem – and the results of the newsGP poll indicate that Australia is by no means immune.
She would welcome the introduction of a ‘no denigration’ policy among health professionals.
‘“No denigration” calls on others to respect the time and hard yakka that it takes to become a GP, and respect the expertise of other specialties – not just doctors, but all health professions – as well,’ Dr Higgins said.
‘It takes at least 10 years to become a specialist GP and governments, medical and health professions often don’t understand the complexity of what we do.’
Federal Health and Aged Care Minister Mark Butler also raised the ‘culture issue’ within medicine in a podcast with The Guardian earlier this year.
‘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.’
Tish Sivagnanan, the President of the Australian Medical Students’ Association, addressed the topic in MJA’s Insight+ last month in an opinion piece entitled ‘Changing the narrative of general practice for the better’.
‘The steps taken in the past six months guide me to believe that I am part of a profession that has recognised the need for radical change,’ she wrote.
‘Whether it be through structural reform to medical education or a rebranding of the primary health care system, there is no doubt that the next steps are multifaceted and will likely challenge the status quo of medical education, training, and the health workforce.’
While Dr Higgins urges universities to encourage general practice as a career of choice, she also believes tackling wider systemic issues are key to addressing negative perceptions.
‘Medicare has been neglected for years and years, meaning general practice has also been critically underfunded, and the gap between GPs and other specialties has got wider and wider when there should be no gap at all,’ she said.
‘The Federal Budget in May was definitely a positive step, but there is still more work to be done.’
Dr Black-Tiong points to a predicted shortage of shortage of GPs – analysis carried out by the Deloitte consultancy suggests there will be a shortfall of 11,392 full-time equivalent GPs by 2032 –and says patience will be needed for change.
‘Access to GPs reduces the cost on the health system in the long run by creating an efficient point of entry and wayfinder who can also provide early intervention and prevention,’ Dr Black-Tiong said.
‘If we want the health system to be viable into the future it needs to be primary care focused, with the tertiary system there as the safety net for the medical issues that we cannot prevent or mitigate.
‘Rather than a $3 billion hospital trying to catch the overflow of delayed presentations, we need the money going into nationwide general practice to reduce hospital attendances and preventable diseases/complications.
‘This will take time to come to fruition and the issues we see at present are the result of primary care neglect for decades gone by.’
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