The peak body for medical schools has put out a refreshingly practical report with achievable goals to increase the number of GP trainees.
When it comes to promoting general practice to med students, there are about a million small changes that can help – more exposure, less badmouthing – but only one big thing: remuneration.
Released yesterday, a new report from Medical Deans Australia and New Zealand contains 23 recommendations designed to lift the dwindling number of applicants for general practice training.
Australia hasn’t managed to fill its 1500 GP training places since 2017, and each successive year has seen a further drop in the number of training places filled.
“The critical situation in general practice and primary care is an opportunity for us to create the teaching, training and research system in the primary care sector able to develop the doctors our communities need,” MDANZ wrote.
Some recommendations have been heard many times before: medical schools should offer more flexible training because GP trainees are more likely to be carers, GP registrars should have similar salaries and entitlements to their hospital-based colleagues and the government should give extra funding to training practices to support the administrative burden of taking on students and registrars.
Others are perhaps more novel, like the recommendations to take a zero-tolerance approach to derogatory language being used toward general practice and to generally encourage collegiality between specialties as well as a call for a funded GP clinician researcher pathway.
The major throughline of the report was changing the way medical students perceive general practice as a specialty by increasing exposure both to general practice work and to general practitioners as teachers.
“There are too many instances of doctors, other health professionals, media, government, colleges, universities and other stakeholders talking general practice down and this has an impact of the way students and early career doctors see and feel about the vocation,” the report said.
This attitude, also known as the “hidden curriculum”, is widely understood as one of the major reasons students are discouraged from pursuing general practice.
RACGP rural chair Associate Professor Michael Clements said that while he had never experienced tutors or lecturers who explicitly talked down general practice, many medical schools and non-GP clinical teaching staff failed to give the specialty its due respect.
“If we want more and more medical students to be choosing general practice as a vocation, they need to be exposed to it,” he said.
“And that’s not just exposed through placements, it’s exposed through mentors and teachers, and exposed through the junior doctor years as well.”
The MDANZ report said it was “vital” that junior doctors retain meaningful connections with primary care through prevocational training.
“The absence of visible and positive GP role models in postgraduate years has been identified as a barrier for junior doctors to choose GP training programs,” it said.
RACGP president Dr Nicole Higgins told TMR that there were disparities in the general practice experience across different medical schools and that national consistency was important to any reform.
“It’s important that we can actually demonstrate the depth and the breadth of general practice over different career options that exist within it,” she said.
A major roadblock to increasing academic GP staff comes in the form of fee for service; because GPs aren’t remunerated for time they don’t spend directly in front of a patient, the report acknowledged, their capacity to embrace things like teaching, research and profession leadership are stymied.
In fact, low GP remuneration is a consistent block to many of MDANZ’s recommendations, so much so that it labels it as “the most obvious area where reform is needed”.
Many practices, for instance, do not have the funding for additional “parallel consulting” rooms that would allow students to have a permanent dedicated teaching space.
“GPs who supervise medical students and registrars often do it at their own cost and time and it takes them away from their own patients,” Dr Higgins said.
“It’s important that we recognise the skills, the knowledge and the time that those supervising doctors take to invest in the next generation of doctors.”
ACRRM president Dr Dan Halliday also welcomed the report, noting that any issues which exist in cities are more acutely felt by people living in rural and remote areas.
“The report’s call to work toward parity in early career salary and entitlements, as well as opportunities to train rurally during medical school and prevocational training, are points we strongly agree with,” he said.