Med school ‘GP bashing’ has workforce consequences

4 minute read

It seems words do have the ability to hurt general practice.

Uni lecturers and clinical teachers who make negative comments about general practice as a specialty may be doing real damage to the workforce, as GP registrar numbers remain low.

While obviously not the sole reason for the decline of general practice training numbers, evidence is stacking up to suggest that the way GPs are talked about by medical school role models is enough to deter some students.

Australian Medical Students Association president Jasmine Davis, who is in the University of Melbourne’s rural medicine pathway and intends to become a rural generalist, is an exception.

“Sometimes when you’re in a hospital setting, [there’s this sense] that general practice is like everyone’s backup career,” Ms Davis told The Medical Republic.

“If you outwardly say, ‘I want to be a GP’, you’re looked at as if that’s not really possible, because people only go into it if they don’t get into the specialty they want, which is just not true.”

A lot of the negativity, Ms Davis feels, comes from the fact that most hospital doctors haven’t spent much time in general practice, something which stems right back to the way medical schools are set up.

“The average student usually gets between eight to 10 weeks in general practice in their whole four-year degree,” she said.

“I know that they’re looking at changing that at my uni – but even at some others, it’s between four to six weeks that you get to do in general practice, contrasting to between 70 and 100 in the hospital setting.”

The consequences of negative attitudes toward general practice were substantiated in a 2021 paper in the British Journal of General Practice Open.

Much like Australia, the UK is having difficulty recruiting junior doctors to be GPs.

The study, which drew from in-depth interviews of around 30 fourth-year British medical students, found that denigration of general practice by non-GP specialists played an important role in how it was perceived as a career option.

A common theme which emerged was that there is an assumption within medical culture that general practice is less challenging and “easier” than other specialties, and that people who choose to pursue it were “soft”.

“It’s just like a whole culture where it’s not taken seriously … I feel like people are ashamed to vocalise it as their career plan,” one student said.

According to the researchers, many of the student interviewees claimed that negative comments about general practice did not affect their perception of it as a specialty, but said that it may influence their peers, especially when it came from an authority figure.

“[Clinical teachers] are what we see ourselves becoming and what we aspire to be,” a participant said.

Students also said that, because comparatively little time was spent learning about general practice as a specialty, it was seen as less important.

“Part of the reason I feel negative towards GP is the standard of teaching … the lectures based on GP were on health beliefs … they were the driest, dullest things … I can see why people perceive it as being a specialty for the less intelligent,” a student said.

The BJGP Open researchers recommended that the UK adopt a zero-tolerance approach to denigration of any specialty by medical school staff, as well as reminding clinical teachers of their authority as a role model.

They also called for more GPs to teach or be otherwise involved in undergraduate medical courses.

GP Supervisors Australia president Dr Nicole Higgins, who is also running for RACGP president, advocates for more positive GP role models at the earliest possible stages of medical education.

“It starts in secondary school with local kids who are thinking about medicine and getting them coming into the practice to do some work experience,” she told The Medical Republic.

“Giving medical students in their first couple of years a great general practice experience is essential to set up their future perception of general practice as a career.”

Dr Higgins’ Mackay practice employs medical, nursing, and allied health students as administrative staff to help give the future medicos a better understanding of primary care.

She agreed with the call for a zero-tolerance denigration policy, but warned that this alone would not fix the crisis in Australia.

“Underlining all of this is the underfunding of Medicare. Until this is addressed general practice will not be valued as a career of choice, no matter how good the experiences are,” she said.

BJGP Open 2021, published January

This article was updated 01/09/22 to correct a misattributed journal title.

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