A meandering path to general practice has helped me see its value, and its joy.
These days I am increasingly asked why I chose general practice – most commonly by GP registrars and GPs.
Sometimes I worry it’s a subtle way of pointing out how haphazard my career is – with my academic roles, clinical practice, writing and leadership positions – and the confusing overall strategy of my pursuits. But that isn’t true; GPs have so many interests and “hats”; I am not unique at all.
When medical students and pre-vocational doctors ask me, I understand their intent. They’re exploring their pathways and wanting to know what attracts doctors to their specialty. Maybe the senior GPs are curious for much the same reason?
Here’s my answer:
At the start of medical school, I wanted to be an oncologist. By the end of medical school, I wanted to be a neonatologist (I even did an honours research year studying Sudden Infant Death Syndrome).
In my internship, I did a vascular surgery rotation that I loved so much, I followed it with a surgical HMO year. I enjoyed nearly all of the surgical terms but not the hours.
Flailing with professional indecision, I did half a year of paediatrics and loved it, then did half a year of obstetrics, then another year of obstetrics because I thought it might be the career for me.
I took a year off to locum and save for a house deposit, before intending to applying for O&G vocational training, but in my locum jobs I found that I loved rural emergency medicine so much I considered doing that, too.
My friends made smooth logical career decisions. One friend followed our intern year with critical care HMO jobs and then applied for anaesthetic training and became a full-time clinical anaesthetist. Another friend did surgical HMO years, then unaccredited surgical registrar years until she started SET training, which she is due to finish soon.
I didn’t know what specialty to pursue even five years following graduation. In that time, however, I completed a Masters in Pain Management, wrote a minor thesis studying global opioid access and availability for cancer and HIV/AIDS related pain, and progressed my academic career. I bought my first house, started medical writing (at the time shared only with friends and family), and took great joy in international travel.
But I was so unsure about my speciality. If I did O&G, I would miss the teenagers; and if I did paediatrics, I’d miss pain management and palliative care. If I did vascular surgery, I’d miss the babies; and if I did emergency medicine, I’d miss the slow medicine of elderly people.
Eventually, a kind geriatrician pointed out that if I loved every rotation and every speciality – perhaps I was a generalist?
I had not meaningfully considered general practice before. Yes, sure, right after my medical school GP rotation, I thought it was the specialty for me, but that only lasted until the next term, when I changed my mind again.
But why, as a doctor, did I not consider this obvious choice? The scope was endless and exciting, and clinical practice would be varied hour-by-hour and day-by-day. I could combine an academic career and clinical practice and still not have to work nights or on-calls. I could remain in Melbourne in my newly purchased home, not forced to rotate away every six or 12 months like my hospital-based friends.
I could see the babies and the teens and the elderly; I could still suture and cut and perform minor procedures; I could have a special interest in pain and palliative care and still not lose access to the rest of medicine. I could follow my patients for years and decades. General practice was perfect for me.
Related
I had forgotten about it as a specialty because I wasn’t exposed to it. I was so deep in the hospital system that I forgot about primary care. I forgot that a primary care specialty– a generalist specialty – existed. I promptly applied for general practice training, and in the second year of the program, started my PhD studying opioid prescribing practices in Australian general practice. It was the exact life that I wanted, but not one that I had considered.
GPs are as diverse as our speciality. Some GPs started medical school with the sole intention of becoming GPs, sometimes to join their family clinic or because the speciality was always appealing. Other GPs have generalist personalities and want to do everything in medicine, like me, so thank god for our generalist specialty.
There are also GPs who moved to this specialty with resignation and reluctance. Perhaps because they applied unsuccessfully for years to competitive surgical specialties and eventually, beaten, turned to general practice. There are GPs who were overseas-trained, and so often were hospitalists in their home country, but practicing in Australia in their speciality was not feasible or possible, so they followed a GP Fellowship pathway in this new land.
I am sorry for those circumstances, and for doctors who “settled” for general practice. That’s a sad way to look at our very rewarding, very skilled specialty.
However, I, too, didn’t plan to be a GP. It wasn’t a career that I considered, because I didn’t know I was a generalist until it was pointed out to me. I love whole-person, longitudinal care. I like looking after the whole car, not just the wheels.
But I know that my friends, brake-pad replacers and glass repairers, would be unhappy in general practice. And some GPs, who once dreamt of being engine specialists, moved to this life against their plans. Regardless, being immersed in general practice can help us see its value. We just need to be exposed to it.
So, for whatever reasons and path led us both here into general practice, I hope you are now as happy as I am.
Dr Pallavi Prathivadi is a Melbourne GP, member of the Eastern Melbourne PHN Clinical and Practice Council, and GP Lead of the RACGP Academic Post cohort support and education program. She holds a PhD in safe opioid prescribing and was a Fulbright Scholar at the Stanford University School of Medicine. She is studying creative writing at Harvard University’s Division of Continuing Education.
