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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 started working life as a Nursing Auxillary. I trained as a Nurse and then worked many years as a Practice Nurse. I am now a GP. It saddens me so much that our profession is in such disarray and that moral is so low. Yes it is tough. Yes it is at times unsustainable and yes we all work far more hours than we are contracted to. However, not a day goes by in my 30yr career when I do not marvel at the privilege of being invited into patients lives and being trusted with private and sometimes terrible worries, concerns or experiences. I would love to feel that I knew a specialty inside out and that is why I kept being distracted from my aim to be a GP by flirtations with A and E and hospital medicine as careers - it all came down to one thing - I like everything and can't choose. GP is one of the last bastions of generality and although not now what it once was, I am still seeing children grow up and have children of their own and despite the daily battle with negative comments, aggressive or rude patients, paperwork and unrealistic expectation (on both sides) I enjoy not knowing what is coming through the door, ability (mostly) to interact with local specialists who are amenable and understanding of my wide based but not necessarily specialist knowledge, working with an awesome team (and I stress TEAM) of colleagues (essential) and the occasional thank you (not expected) that comes my way. General Practice doesn't appeal to everyone but then neither does Hospital Medicine. It doesn't mean you shouldn't consider all of them

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  • You're lovely Dee.happy xmas to you and your team

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  • Like cigarette packets General Practice should come with a warning:IT CAN SERIOUSLY DAMAGE YOUR HEALTH.Keep sane.Keep away from GP.

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  • Ah bless. Don't the students sound young/immature? George Clooney in ER is pretend, chaps. As for Doc Martin, he was actually a surgeon; his transfer to GP was both unlikely and unrealistic but forgiven because the result was funny. In terms of consultants' opinions, I didn't realise such attitudes were entrenched though it might explain Darzi et al thinking they can redesign primary care and certain hospital clinicians - consultants, juniors and nurses - seeming to think GPs are their clerks, phlebotomists and general dogsbodies.
    Basically, we each acquire a body of knowledge. Specialists know a great deal about a small part of medicine but little about anything else. (Yes, I know I'm generalising). Good GPs know a great deal about many things but need specialist advice at times and access to hospital services and treatments at others. We complement each other in caring for pur patients.
    I have great respect for some, not all, consultants and some, not all, GPs. (The "academic" GPs when I was training tended to be of the cardigan variety, for example, and fond of role play). I prefer the breadth of general practice to the potential monotony of a narrow specialty but each to his/her own. The current problems with general practice are, in my opinion, more to do with political interference and media denigration combining to sap morale and not with general practice per se.

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  • General Practice has been denigrated by the Government calling the vocation a business.The National Health in false economy have imposed on GPs as second line treatment in the ever increasing Diabetes Epidemic the cheaper to buy Sulphonyuyureas,which according To endocrinologists including Prof Tony Barnet cause frequent Hypoglycemia >the national Health in another false economy have stopped Glucose testing strip scripts by GPs leading to hypoglycemia induced personal deaths and accidens whith Gps being struck of for not giving sufficient care to Their patients.To be a GP in The UK is to be cursed

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  • Pipin Singh

    Really interesting article and good insight into the views of medical students at present - didn't know so much disrespect still existed towards general practice and would have hoped that this would have fizzled out or heading that way. As a fairly new partner and new trainer, I find it disturbing to see so much hatred towards a career that has an unbelievable amount of opportunity. I at 32 years old totally dictate my own working week and have flexibility to do other thing within medicine that interests me, (teach, write, diabetes and the list goes on) Yes there are a number of challenges within primary care but with that comes opportunity and it seems that a lot of GPs are forgetting this for whatever reason.

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  • I had a friend that got into Oxford to study medicine about 20 years ago. She was told at interview that they nearly turned her down wihtout seeing her because she had put "being a GP" was something she wanted to do on her applcaition form. Certainly back then at least Oxford (and I would guess many other "top" Universities) were actively selection against students that wanted to be GPs. Would be interstesting to see if this is still the case

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  • Let common sense prevail

    This was an excellent piece of writing and it has clearly fostered a great deal of comment. But I would implore you to look at the positives about general practice. We are generalists. We can handle (almost) anything. We can go home every night in the knowledge that we have provided a great deal of help to a large number of people. We can see the benefits of continuity over the years when our patients, and their children, exhibit better 'health seeking' behaviour than when we first met them. We undertake 90% of all consultations in the NHS. We keep nearly everything out of hospital. We don't need to cross-refer to our colleagues very often. We see people promptly and are available to our patients when they need us. Our patients value us.
    This might not be the view you have seen, but do not be misled by the media, and worse still the Dept of Health who, for reasons known only to themselves, wish to undermine and devalue the most valuable part of the NHS. There remains enormous satisfaction in doing our jobs, but this is currently sullied by criticism and lack of realistic resource. We are essentially victims of our own success. Because we are so good politicians rely on us to do everything, without help, immediately and cheaply. We are happy to do that, up to a point. With a little rebalancing of the funding favouring primary care over secondary care (send the money where the work is) we could once again provide a world-class service and be proud of it.
    You are a young man. You should be out to change the world and to embrace the challenges. Don't get frightened off too easily!

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  • Be warned the grass is NOT greener........

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  • Una Coales. Retired NHS GP.

    Another GP has escaped the NHS and made it to Australia. His update today 'Update from me- house rented, job started, car bought, kids' school sorted...it is quite amazing to work in a healthcare system where one is allowed to practice without tick box exercises and grateful patients!! Obviously nothing is perfect but it's surely better.' He has even been allocated one of the 8 staff parking lots in the basement. Life made easier, not harder for a fully qualified and respected GP!

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