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'Elite' university students shun general practice

Medical graduates from the top-ranked ‘elite’ universities are avoiding general practice, with fewer than one in six University of Oxford medical graduates applying to become GPs, official data has shown.

Data released by the GMC reveal that only 16% of Oxford graduates choose to enter general practice, followed by St George’s Hospital Medical School with 19%, the University of Edinburgh at 22% and the universities of Bristol and Cambridge with 25%.

The GMC analysed graduates over three years, from 2012 to 2014, and their figures are a blow for the Government’s target of 50% of medical graduates entering general practice by this year, and follow disappointing results from the first round of GP training recruitment, which showed that one-third of places remained unfilled.

They also follow a series of rows between GP leaders and medical school deans, who have been accused of telling undergraduates that general practice is a ‘second-class’ career option, while the RCGP has met with medical school leaders to discuss a ‘toxic anti-GP’ culture.

GP leaders have said that the figures are ‘distressing’, and it is up to universities like Oxford to put more of a focus on promoting general practice.

The figures revealed that not a single university saw 50% of its medical graduates apply to become GPs.

University of Leicester medical students were most likely to want to become GPs, with close to half (45%) of its medical students applying to train as GPs, followed by Keele University (44%), then the University of East Anglia (43%).

The number who went onto be offered a place and accepting it was lower, including 28% for students from Leicester and East Anglia, 24% for Keele, 11% for Oxford and 14% for Cambridge.

But Professor Azeem Majeed, professor of primary care at Imperial College London, which saw just over a quarter (27%) of its medical students apply to GP training in the first intake, said medical schools were not to blame for poor GP recruitment generally.

He said: ‘I think [variations between medical schools] has always been the case and I think people who blame medical schools for problems with GP recruitment are probably attacking the wrong target.’

He added that it was more likely that it is ‘the job itself that is the problem’, with increased workloads at a time when income was falling.

However, he said that his own institution had stepped up its game in a bid to promote the profession recently, including hiring more GP lecturers.

GPC education and training subcommittee chair Dr Krishna Kasaraneni said that the newer medical schools, such as Keele and East Anglia, tended to put more emphasis on general practice, and more focus was needed on ‘medical schools like Oxford where less than 20% of their graduates end up being GPs’.

He added: ‘It is not about educating doctors who are more suited to general practice than other specialities but it is about ensuring that they have balanced exposure to general practice as well as other hospital specialities so that they can make an informed decision about their future careers.’

But he added that Government targets for 50% of medical students to choose general practice was completely unrealistic.

Dr Kasaraneni said: ‘None of these universities have hit that target, not a single one. So when politicians are making these pre-election pledges they need to realise they are promising what no medical school has ever delivered.’

A spokesperson for the The Medical Schools Council said that it ‘recognises the need for a workforce which reflects society’s current requirements - and the difficulty of responding quickly to urgent needs in particular specialties’.

They added: ‘MSC fully supports the recommendations in both the Tooke Report and the Shape of Training Review that there should be broad based core training before later specialisation as required.’

Dr Maureen Baker, chair of the RCGP, said: ‘It is disappointing and distressing to see the huge differences in medical students taking up general practice depending on which university they attend. All medical schools have a duty to promote the opportunities and challenges of a career as a GP.’

Dr Tim Lancaster, director of clinical studies at the University of Oxford, who is also a GP, said: ‘We do not agree that it is undesirable that there is variation between schools in the proportion of graduates entering different career paths. Oxford unashamedly selects students who have the potential to benefit from a course which places strong emphasis on the understanding of biomedical research.’

 

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Readers' comments (40)

  • The use of the phrase " ending up as Gp's " says it all.

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  • Ending up alcoholic . Ending up destitute . Ending up dead . Does " ending up " have a negative connotation ?

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  • Hi - thanks for the comment. We have taken it on board and changed it.

  • Dr Lancaster hits the nail on the head. DOI GP, not from the Universities above but not afraid to admit to variation in students at different institutions (although I am surpised at the George's stats....)

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  • As above, Dr Lancaster's assertion is sensible. The amount of GPs conducting clinical research is comparatively small (as a proportion) to the amount of hospital Consultants that do - many specialities strongly encourage a PHD before CCST whereas in General Practice this is obviously quite rare.

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  • Well done Edinburgh.I remember the figure there used to be as high as 50%.Clearly some sense has been knocked into the young brood.

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  • those universities attract highly academic high achieving perfectionist control freak types so its not surprising they dont want to do something as vague touchy feeley and generalised as GP. After all you have to be able to realate to people where they may get on better with books and computers.
    Enough sterotyping?
    May also be all the irritating tick boxing, government scehemes, admin and stuff that detracts from just dealing with the patients presenting complaint as were trained to.

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  • If I were a medical student today, I would not consider general practice.
    If i was a very high flying oxford graduate who wanted a high flying career I would discount GP out of hand. What possible incentive would there be?

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  • totally agree with Nick Marotta, the type of character churned out from the 'elite' universities are devoid of character and interpersonal skills. Being able to relate to and empathise with patients is imperative in general practice. Let those highly intellectual folks with delusions of grandeur remain behind closed doors in an academic context or in the operating theatre!

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  • Would be interesting to see some context and a bit more of an in depth look at this i.e is this unusual for elite universities like Oxford? How has the position changed across all Universities over time?

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  • Students now realise that by the end of their training there will be no general practice to enter. I could be wrong but I think the next 5 years will prove my point.

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  • this makes total sense and i'm pleased that medical graduates are doing their homework and properly evaluating their career choices.

    General Practice has become incredibly difficult and is set to get a lot worse - so it's no surprise that sensible graduates are avoiding it.

    I'm assuming that the group that wants to do General Practice must really want to do it and are willing to take on board the risks - it's a shame if they are doing it as they feel they have no choice as they are really going to hate it :(

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  • The RCGP needs to keep it's coffers full.Just ignore all it's propaganda and stay away from General Practice.You'll be allright.

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  • Oxbridge is 'elite' in what way?

    Signed

    Amused Scottish Graduate of the University of Aberdeen

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  • The T test, the one which gives P values in research results panned: ' false discovery rate problem' http://rsos.royalsocietypublishing.org/content/1/3/140216
    The whole 'Scientific Evidence' issue could be decimated if this theory is anywhere near accurate.

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  • 3 possibilities:
    a) Oxbridge graduates really are brighter, and therefore less gullible and can see how bad the prospects are (doubt it);
    b) those universities are preferentially admitting students who are poorly suited to the specialised type of work GPs do, managing risks, businesses, people, etc;
    c) University staff are guiding them away from GP-land. Possibly with good insight!

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  • Nhsfatcat

    It's a game show- Who Wants to be a GP?
    a) Yes
    b) No
    c) Maybe
    d) As a last resort.

    50/50 gets rid of Yes and Maybe
    Phone a friend gets rid of No
    Ask the audience, they would have asked for an appointment, the coughing major would have been sent an ambulance by 111 , so it leaves 'As a last Resort' which of course is the incorrect answer and wouldn't lead to a million quid either.

    I do not need to make the analogy with the game show 'Pointless' -to obvious
    And Family (doctor) Fortunes: Our survery said XXXX

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  • I strongly resent the implication that GP is a career for those who don't understand biomedical research. while at med school the last thing I wanted to be was a GP. I was very academic and wanted to be a surgeon. I changed my mind after house jobs.
    I would love to be an academic GP, and I still love research and the geeky side of Medicine, as well as people.
    Negative stereotyping and the idea that GPS are second best is almost everywhere :the media, A&E, the medical reg on the phone when you make a referral....and so on. An enormous amount of work is needed to change this.

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  • "I strongly resent the implication that GP is a career for those who don't understand biomedical research"

    No-one is claiming that GPs don't understand biomedical research, but surely you must acknowledge that it is harder to undertake (and less frequently undertaken) in the Primary Care setting?

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  • St George's elite? Hahahaha!
    Hardly - they let me in with the lowest A level grades. Things must have changed in a couple of decades.
    And there lies the problem - the obsession with four A stars at A level - you don't need to be super intelligent to be a good doctor. You need people skills and oodles of common sense.

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  • I think that we may be making heavy weather of this. The brighter the student - the less likely they are to be conned into going into general practice. I would not make the same mistake again!

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  • The obsession with A stars at A'Level is part of it. Large numbers of potentially good doctors are not getting places, and it would seem from where I stand that entrance criteria are set to accept highly academic candidates only, without taking into consideration that the types of job (and the skills required) vary considerably across the profession. As long as undergraduate clinical education is predominantly hospital based the myth of GPs as failed hospital doctors will be perpetuated. As it is we are actually the cleverest doctors who now do the most detective work. We need specialists to advance medical care and more than ever we need excellent generalists. The generalists have to be as well supported as in hospitals though otherwise the job will not appeal to bright young doctors, and there has to be a career progression that is meaningful. If you have achieved your goal at 30-35, the only thing left is burnout

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  • General practice is a hard job to do well but it is easier than other specialties to get into. Those at the highest performing universities are amongst the most competitive and competitive doctors. Is it really surprisingly this self-selecting group of high achievers are preferentially entering the most competitive medical specialties? Someone tell the thought police that they cannot control what clever university students think. If they want more GPs they need to make the job better.

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  • Even before MTAS junior doctors were changing careers to become GPs after the 2004 contract. Since then conditions have gradually got worse and the low level of GPs is the result. Junior doctors really aren't stupid.

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  • It's more to do with Job Satisfaction than Medical School.

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  • Clever bunch I say!

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  • Una Coales. Retired NHS GP.

    Of the 16% who want to do general practice, how many are using general practice as a ticket to Australia or Canada?

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  • Why does anyone want to be a GP partner - fixing broken roofs, negative equity, responsible for staff redundancy, if the practice collapses [ see Peverly]. If Pev regrets being a GP and he can see clearly, why would you ask anyone to be one? I think it has become a completely hateful job. Pev gets palpitations at night and panic attacks.
    I find it distressing and disturbing that there is no duty of care by any Body to GPs.

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  • General Practice is going down- fast. No Medical School should encourage their graduates to join the cesspit that GP has become. This job is s...!

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  • It applies to those GPs who are generic Gps. Those who changed speciality have MSc, PhD and various research degrees.
    As for taking GP training, I would strongly discourage students which ever the university from.

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  • Back in the 1970's my late father, also a GP, said being a GP was deemed second rate and the profession was at an all time low. Things changed slowly. Feels like the profession has gone back to those dark days again.

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  • constantly undermining GPs, the media and MPs denigrate GPS all the time, soon they will realise the NHS will collapse without them, the consultants in the hospital will no longer have anyone else to dump on, the will have increased work loads to breaking point. I can see a knee surgeon having a clue about managing diabetes and mental ill health all in the same session, a knee surgeon only has to know about a knee , a GP needs to know something about everything in 10 minutes

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  • Is this surprising?
    Nobody applies to oxbridge unless they believe they are exceptional.
    Why would anyone with this opinion about themselves apply to a speciality where they are guaranteed a training place, hardly an elite specialty when so many training places are left empty.
    After they become a consultant in general practice the standard salary is £20,000 less than their hospital equivalents, with no excellence awards to top up. Confirmation in pounds shillings and pence that the BMA or government doesn't rate their value the equivalent of their hospital colleagues.
    Of course this is on top of the daily verbal abuse they hear at the expense of general practice during their time in hospital.
    I'm surprised they had anyone taking up the speciality.

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  • Can't blame them. If they are smart enough to get into an "elite" university then they're smart enough not to go into the travesty that is now general practice.

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  • As a Cambridge student I was at times openly laughed at by my student colleagues for wanting to do general practice. My teachers were equally puzzled, 'But you got a 2:1, why would you waste your life as a GP?' As a PRHO in general practice, I learned a lot more from some incredibly inspiring GP colleagues in that 4 months than I learnt as a PRHO in surgery or medicine. It has been possible to satisfy the Cambridge part of my brain in general practice until the last 5 years, when the job has become impossible. It was the Cambridge 'think for yourself and make up your own mind' education that has enabled me to plot an escape from partnership. General Practice is dying. I loved it but it has nearly killed me and I will be glad to leave it behind. Students are far more savvy than HEE and RCGP give them credit for, and they can read and think for themselves. Only a fool would train as a GP in 2015.

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  • As another Cambridge graduate GP I would consider myself one of the fools that failed to take up the milk round offers for the city or law. Might not have enjoyed it as much but certainly would not be working in my late 40s as I am now.

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  • The elephant in the room is parochialism: you are more likely to receive a training position and a consultancy if you attend an "elite" medical school than if you don't. The students know this, they are anything but stupid. They are realistic and will favour the career option they will most likely accomplish.
    P.S. "elite" medical school graduate for what it is worth

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  • Does it not seem strange that a Consultant has at least 15 minutes and on some occasions an hour or more (Psychiatry) per consultation for one issue when a GP has 10 minutes for multiple issues, forms, QoF, and at the end of the consultation... by the way my daughter has this lump...

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  • Bob Hodges

    The only doctors I've ever met who seem interested in which medical school other people went to, are usually London Graduates for some reason.

    To the rest of us, the concept that some schools are 'elite' is anathema. We all know, from the experience of having 200 class mates in the year, that 'success' is a function of attitude and drive rather than A-Level results.

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  • Highly informative. Who would have thought Oxford has a proper medical school these days?

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  • The Deaneries should restrict the number of non-GP jobs available. Medical students can only choose not to be a GP if other options exist. The need of the country must come first in a crisis like this.

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