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The more I learn about general practice, the worse it looks

Third-year medical student Christopher McKee explains why he has turned his back on general practice

I am a student on the coveted ‘Foundations of Primary Care’ course. To do the course, you first need to win a place at university and it’s well known that medicine is difficult to get into. Up to 18 students apply for each place and the selection process makes us highly competitive, and sensitises us to notions of prestige.

In our future careers as doctors, we will all want to talk to patients, understand their lives and find out how they feel. We want to help. We’re constantly told how important GPs are because more than half of us will end up being one of them.

But the gap between studying primary care and finding it exciting seems unbridgeable at the moment.

As the BMA finds that GP morale is still falling, it’s little wonder that so many medical students have backed off from entering the profession.

When I asked more than 50 medical students about what they’ve learned so far about general practice, a fourth-year student summed up many of our thoughts on the subject when he admitted: ‘Learning about the foundations of primary care put me off general practice.’ 

We want to be dynamic, high profile, cutting edge doctors, and the thought of qualifying to become a ‘family doctor’ leaves many of us cold. Students often see the role as an easy way out.

And general practice lacks glamour. We want to be George Clooney dashing around the hospital saving lives, not Martin Clunes slurping tea.

‘My experience suggests that there is a considerable stigma associated with general practice. Students who aspire to be GPs are seen as failed hospital doctors,’ a second-year medical student from Liverpool told me.

In a 2013 survey, 65% of students admitted they think GPs have an image problem. And articles from consultants, swearing that ‘GPs are part of the NHS’s problem’, are not much of a turn-on either. Medical students want to be prized, rather than despised, for our work.

Anti-GP culture

RCGP chair Maureen Baker talked about the ‘toxic’ anti-GP culture in universities and in my experience, this problem is seeded and watered in secondary care. Hospital doctors view themselves as higher up the pecking order and we often hear them criticising GPs for ‘passing on’ patients, being ‘out of their depth’ or ‘barking up the wrong tree’.

Most of our education is based in hospitals and over time we become poisoned by this toxic message.

‘There is no respect,’ a hospital consultant told me. ‘It hasn’t changed at all since I was at medical school. Twenty years ago there was a culture of disrespect, and there is still a culture of disrespect.’

This cultural segregation of community and hospital medicine may result from their different ideologies. Hospital colleagues are shielded from harsh economic realities whereas general practices are small businesses, which (in an ideal world) are run for profit.

The problem is we don’t get enough medicine in the five years of medical school, let alone learning how to manage and run a successful business. No wonder a third-year medical student told me: ‘The business side to general practice puts me off. The idea of having responsibility, not only for patients, but for staffing and costs scares me.’

Filling out forms and ticking boxes for QOF aren’t reasons why students choose to do medicine. We don’t want to jump through hoops, survive inspections or attempt to follow the Government’s latest half-baked schemes. We want to make sick people better.

And ironically, it’s the very shortage of GPs that has been in the nail in the coffin for the GP workforce. The number of unfilled posts in the profession has quadrupled in the last three years and one in eight training posts go empty. Some 73% of GPs say their workload is unsustainable and nine out of ten GPs regularly work beyond their normal hours. More than half of GPs reported their morale to be ‘low’ or ‘very low’. These are hardly encouraging statistics, which medical students we can’t help but take to heart.  

The thought of working as a GP is a grim prospect. With still two years to go before I qualify, I can’t see my mind changing. I’ve already turned my back on general practice.

Christopher McKee is a third year medical student at the University of Aberdeen

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Readers' comments (83)

  • I think this article sums up working in General Practice very well:

    Why was the 2004 contract offered in the first place - 1) no-one wanted to really work as a GP due to the poor conditions, something had to be done
    2) Our OOH work was undervalued on purpose and it was a no brainer to relinquish it.
    3) no-one thought GPs worked as hard as they did and no-one thought we could organis ourselves.

    These things come round in cycles, feast and famine, feast and famine and no-one ever learns or takes heed of the warning signs early enough, even if they are well signposted warning signs.

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  • if you read today's article on J.Hunt : he is advising GP to treat damp and prescribe lunch clubs! previously a libdem MP suggested astrology: fit that in medical teaching. Idiots.
    I can summarise GP in one sentence:

    GP is excellent and rewarding but the politicians are ruining it

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  • I never bad mouth General Practice to our medical students. I have high respect for my GP colleagues. Not everyone in Hospital Medicine is a pillock!

    But medical students do not seem to fancy it. In part we may be selecting the wrong people at entry, but also I think Foundation Doctors are forced to choose a career speciality too soon, after a few years of Hospital Medicine Doctors are often better prepared and more able to see the advantages of General Practice. The grass is always greener...

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  • This article is absolutely spot on.

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  • How terribly sad! General practice is also full of positives, full of job satisfaction and patient interaction! If medical students want respect, glamour, high power and dynamism then I suggest a role in the US drama greys anatomy or ER! I see none of these aspirations in primary or secondary care. I see hard graft, occasional sadness and periods of self doubt all paid for by working to a gold stand in health care and positive patient interaction. Respect was said to be earnt, sadly the negative spin by the Govt & media means no matter how good you are some people will not respect you! The old chestnut of 'not enough medicine or nursing from the education providers' raises it's head again. That hasn't changed in thirty yrs despite radical curriculum changes. I only hope the new graduates will have an open mind & see General practice as a dynamic, rewarding & fulling role. But I am not convinced !

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  • Follow your instincts but being praised is not the best reason to be a doctor.
    In secondary care you will perhaps have greater freedom to practise medicine ethically; keeping patient rather than the cost at the centre of medicine.
    By the way in my 8 years of practice as a GP I have never had any consultant talking disrespectfully; some junior doctors had. Few years of experience will generate respect for general practice.

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  • Sure General Practice is difficult. Challenging indeed. You need to have a high level of Medical knowledge and an interest in creating your own working environment . BUT... you get the patients you deserve , and you can develop your own interest within a wider medical environment . I find it challenging, stimulating and rewarding and many of our Fy2's have chosen GP land after a time with us . Our Registrars seem to enjoy it too.. Perhaps we should be proud of an excellent and enjoyable branch of medicine , unfettered by stifling hierarchies of hospital management .

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  • Trainee docs are self-centred, narcissistic and immature - good luck to them.

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  • Alison Glover

    don't despair, fun general practice with all the joys we trained for exists in New Zealand. Any burnt out GPs or students really excited by primary care should explore further. I am now a partner in NZ and wouldn't have it any other way.

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  • After reading this article I was relieved to see John Bell's more positive comments. The politics of Healthcare has damaged more than the general publics opinion of the NHS service if other doctors do not respect the work undertaken by GP's.
    Incidentally I worked with my own 'Doc Martin' and would put my life in his hands before a detached self opinionated hospital based graduate. The job is demanding and challenging and obviously undervalued

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