Medical deans say GP funding and pay review ‘urgently needed’

Jolyon Attwooll

12/09/2023 3:30:18 PM

The recommendation is among 23 suggestions in a position paper advocating for a ‘skilled, sufficient and sustained’ general practice workforce.

GP with mother and child
Medical deans have said general practice needs to be an attractive career proposition for graduates, as well as a sustainable career option.

The deans of 24 medical schools have called for GPs to be fairly funded and paid in comparison with other specialties in a newly released position paper that describes ‘necessary reforms’ for the future of general practice.
The recommendation is among a series of proposals outlined by the Medical Deans Australia and New Zealand peak body in a 32-page document, The Doctors our Communities Need: Building, Sustaining and Supporting the General Practice Workforce in Australia and New Zealand.
The authors state that their work describes steps required ‘to build the skilled, sufficient and sustained GP workforce Australia and New Zealand needs’.
Their paper highlights existing workforce challenges, including concerns about the number of GPs nearing retirement, a growing population with an increasing burden of chronic disease, as well as a declining interest in general practice as a career path among medical students.
‘General practice is a diverse, rewarding and intellectually rigorous medical vocation, and needs to be recognised as such by prospective GPs if the workforce is to grow,’ they wrote.
‘It needs to be an attractive career proposition for graduates and a sustainable career for GPs.
‘It therefore needs to be appropriately valued and supported by funders and the whole medical profession.

The authors pinpoint funding and pay as ‘the most obvious area where reform is needed’ saying that reviews for the remuneration of clinical, teaching and training work are ‘urgently needed for both registrars and Fellows’.
‘GPs need to be fairly remunerated by government health funding policy and programs,’ they state.  
‘Further work should be done by government and health services to ensure GPs’ income is commensurate with other specialists, including registrars, early career GPs, and GP leaders.’  
They recommend a review of the Medicare schedule to ensure appropriate GP compensation, and state that GP registrar salaries should be at parity with hospital-based registrars. They also suggest that options to participate in research, teaching and professional leadership be made more available to GPs and supported in such a way as to not cause loss of revenue due to time away from patients.
RACGP President Dr Nicole Higgins said she appreciates the insight and recommendations in the position paper.
‘It’s very welcome that medical deans, who play such an influential role in shaping the primary care workforce that our communities need, recognise so clearly the challenges facing general practice today,’ she told newsGP.
‘Being a GP is the best job in medicine – we just need the correct supports in place to make sure it stays that way.
‘General practice has had years of neglect and stagnation, but I believe we are starting to move in the right direction.
‘More needs to be done to restore general practice to its rightful place, however, not least with payroll tax changes threatening to undo any progress that has been made.’
According to the Medical Deans peak body, part of the solution to address existing disparities could be found through encouraging ‘new and team-based models of care’, with ‘multiple mechanisms used concurrently to balance the limitation of any one approach’.
Other recommendations fall under four separate categories:

  • Student recruitment
  • Learning for and about general practice
  • Learning in general practice
  • Supporting graduates to progress to practice
For student recruitment, the deans suggest that medical schools should place more emphasis on applicants with traits ‘predictive of future GP career choice’.  
They also contend that general practice ‘should be a visible and central aspect to the training of all medical students and early-career doctors’ and that students and early career doctors should do more clinical learning in primary care.
Noting that training capacity in primary care ‘is currently severely constrained by space, time and the funding model’, they are particularly critical of an existing education model that is ‘heavily dominated’ by the hospital sector.
This, they argue, ‘is substantially impeding our ability to prepare our future doctors for their role’.
Instead, the Medical Deans advocate a set-up ‘that recognises, values and drives learning in community-based healthcare settings’, noting that is where most healthcare takes place.
‘Learning for and about general practice can only be effective when it includes practical and positive work integrated learning opportunities in general practice and primary care settings,’ the peak body states.
‘Primary care funding reform must include teaching and training – it cannot be an add-on.  
‘There must be a more appropriate match of the investment in teaching, training and research in primary care with that made in tertiary hospitals.’
In a theme previously covered by newsGP, the deans additionally suggest medical schools should have a policy of ‘zero tolerance’ regarding the use of derogatory language about general practice.
‘The hidden curriculum is a well-known and influential phenomenon, and often feeds and fosters negative portrayals of GPs, resulting in a detrimental impact on students’ career choice, as well as impacting on patient care and outcomes,’ they wrote.
‘Attention needs to be given to ensure all inter-specialty interactions within medical learning environments demonstrate the collegiate respect and professional courtesy expected of students and doctors.
‘Inter-specialty respect should also be expected in all patient-facing settings, as derogatory language across or between specialties can negatively impact on patient care.’
In a poll that ran earlier this year, 86% of newsGP respondents said they had witnessed general practice being denigrated during their studies.
Dr Higgins has said she would welcome 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 previously told newsGP.
‘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.’
That latter point too is addressed in the recent Medical Deans document.
‘A postgraduate training system which exposes postgraduate doctors to [a] far broader range of healthcare settings, including general practice, and community and primary care, will keep general practice a viable option for these doctors as they plan their vocation,’ their position paper states.
‘This will also produce doctors across all specialties with a better, more realistic understanding of general practice and primary care, which will only yield benefits.’
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Dr Malcolm Moore   13/09/2023 9:47:26 AM

A lot of these suggestions are necessary and well-founded. However, the elephant in the room is that many non-GP specialists are overpaid for treating a much smaller number of conditions. Students and new grads know this and, naturally, find it very attractive. It's daunting to have to know something about everything - to earn less money. This genie won't be put back in the bottle. Governments wouldn't ever want that fight but GPs shouldn't be scared to call it out.

Dr Andrew Leslie West   13/09/2023 12:49:20 PM

I have been in rural general practice for many years (40). Along the way I have asked many medical students and junior doctors their aspirations in their careers. Sadly, very few say GP, and when asked why, the common answer is that it is perceived as being unexciting, mundane or clerical. Perhaps I am being bold to disagree with the deans of medicine, but railroading graduates within 2 -3 years into community practice I think is a mistake. I believe it should be taught as a specialty, taking 5 years of post-graduate experience in hospitals, rural and remote practice in clinics and country hospitals. They should be paid as registrars. Call this a specialty, be it RG or whatever acronym, upgrade the perception of GP with commensurate financial reward and with government coercion reduce the Hex fees if they go into rural practice. Denigration, like racism, is a cultural perception, to eliminate this the training needs to be comparable to specialization.

A.Prof Christopher David Hogan   13/09/2023 1:49:06 PM

This is an amazingly revolutionary statement particularly about the selection of students suitable for General Practice rather than rely on exam scores. This process started several years ago but it is nice to see it uniformly accepted.

Dr Jasmin Lea MacIntyre   13/09/2023 2:22:00 PM

Maybe they need to look at how they pay their own clinical staff too?

Dr Susan Margaret McDonald   13/09/2023 4:00:47 PM

How come it's taken so long for the medical academics to add their voice to the cries from general practice. As it is, general practice is dead. Shame on you!
It will take a huge and very expensive revolution to start anew which must be done if Australia wishes to have a modern, equitable and cost effective medical system for all.
A fat load of good a truck load of specialists are when people can't get a diagnosis or get access them.
Academics need to move out of their comfort zone and get their hands dirty by advocating much more STRONGLY & EFFECTIVELY