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General practice training applications have dipped: What can be done?
Australia’s leading advocates for general practice were recently asked a thorny question.
There have been calls for streamlining of training pathways to avoid registrars having to change employers and locations.
While there are still more applicants for general practice training than positions filled, the numbers have dropped by a total of around 400 since 2015.
So why have the numbers of junior doctors applying to be GPs declined over the last two years?
The question was posed to RACGP President Dr Harry Nespolon, as well as National Rural Health Commissioner Emeritus Professor Paul Worley, Australian College of Rural and Remote Medicine (ACCRM) President Dr Ewen McPhee and other prominent GP panellists at the recent General Practice Education and Training Conference (GPTEC) Future Forum.
Answers ranged from the impending changes to general practice training, to the funding challenges after the Medicare rebate freeze, to the axing of the Prevocational General Practice Placements Program (PGPPP).
Dr Nespolon said he believes the situation will improve once the RACGP officially takes the reins of training pathways.
‘Every year, it seemed there was a change to GP training, and that can lead to uncertainty,’ he said.
‘We hope that now we have training back there will be certainty going forwards.’
Dr Nespolon also said the relatively low remuneration in the early stages of training might be an issue, even though it would be offset during later training years and after Fellowship.
Dr McPhee agreed with Dr Nespolon’s assessment that the training transition period might be a reason for the current drop.
Professor Worley said a key factor of the historic Collingrove Agreement between the RACGP and ACCRM last year, which laid the groundwork for the National Rural Generalist Pathway, was the ‘single-employer approach’ enabling general practice registrars to have confidence of a job for the entirety of their training.
He called for a return to family-friendly training and a streamlining of training pathways to avoid registrars having to change employers and locations.
GP and medical educator Associate Professor Louise Stone said she believes general practice has a problem of representation.
‘One of the great mysteries is what happens in an item 23. It’s hard to describe what we do,’ she said.
‘If it was simple, it wouldn’t have taken 14 years to learn how to do what I do.’
President of General Practice Registrars Australia Dr Sama Balasubramanian told the forum that a key issue is that the system is ‘undervaluing’ general practice.
‘We have to reimagine general practice as the cornerstone of our health system. We need to lobby hard,’ he said.
‘GPs will not back down. We will not be undervalued anymore.’
Australian Medical Students’ Association President Jessica Yang said she would just spend five weeks in general practice over her degree.
‘When you consider how much of healthcare is general practice, why is there so little time?’ she said.
In a later GPTEC session, Department of Health First Assistant Secretary for Health Workforce Faye Holden described the drop in GP applicants as ‘something we need to address’.
‘There are a number of medical specialties where the community need for well-trained specialists [is] disconnected with what junior doctors are wanting to choose,’ she said.
‘There are multiple factors, from how the profession is perceived and funding around that. As training transitions to the colleges and with the Government’s Primary Healthcare Plan, over time, that should start to help.’
Asked whether the Government would consider reopening the PGPPP as a way to give junior doctors more GP experience, Ms Holden said it was a common question.
‘We’re trying to understand why the PGPPP was successful and what’s not being met in the programs taking its place,’ she said.
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