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A faulty production line

'Do you regret choosing to be a GP?'

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I didn’t take a breath before I heard myself answering the question above: ‘Not for one moment’.

Our daily interactions, virtual conversations and unconscious signals might be carrying more weight that we realise

I almost surprised myself. But as soon as I said those words aloud, I knew that I meant them.

This was a few weeks ago, at a student ‘speed-mentoring’ evening at the RCGP with 50 medical students. I was a last-minute stand in, and hadn’t given it too much thought. I certainly didn’t expect to spend the rest of my week reflecting on it.

Only a week before I had read Maureen Baker and Simon Wessley’s piece in the BJGP, imploring for an end to the ‘bad-mouthing’ of general practice and psychiatry in medical schools. I must admit, it didn’t particularly resonate with me at the time. Surely that was something of the past? I didn’t remember much of that being around in my medical school days. And when it did happen, I’d just dismissed it as harmless banter.

But speaking to those students about the choice that loomed on the horizon, one that would shape the rest of their lives, changed my mind. I was shocked when one of them admitted to me that general practice was 'seen as the cop-out option'. Another student explained how her friend remarked she was 'aiming low' and was 'cleverer than that'.

There was clearly more truth to the GP bashing than I had realised. And a little bit of digging later led me to some surprising stats: last year, GMC data showed that just 16% of medical students at Oxford were considering general practice, compared to 45% at Leicester Medical School. What’s behind that discrepancy? Are similar comments being muttered behind closed doors there?

I was left that evening with two very different emotions. Firstly, an acute sense of guilt at how little I had done to actively seek opportunities to bang the primary care drum. To my surprise, many of the questions I was asked that evening were simple misconceptions that I wouldn’t have predicted, and that were easy to dispel, such as: 'how are you treated in your hospital rotations as a GP trainee?', 'do you feel isolated being in a room in your own all day?', and 'how easy is it incorporate some hospital work or a special interest?'.

Secondly, I was left with a renewed sense of pride, purpose and clarity in my career choice that has stayed with me since. And a realisation that, whilst I too had felt unnerved standing at that same junction, I had chosen the right path for me. The reasons I had then had held true: I love that I keep every chapter of those medical school textbooks open in my mind, I feel privileged each day to be trusted to hear people’s stories, and I feel challenged like never before at being the first port of call to manage undifferentiated presentations.

During medical school, I came across more happy GPs than any other specialty. And that is still true. And as Dr Nick Harding, chair of NHS Sandwell and West Birmingham CCG, reminded me recently, general practice is still one of the best career choices to if controlling your own destiny is important to you.

I gave the students both sides of the story. But when it came down to it, and I was forced to articulate my view in a single moment, I had never been more sure that the rewards outweigh the pressures.

That night, I took myself back a few years and put myself in their shoes. The critical decisions we make at those junctions in our career are modelled by our view of the world. And with so little exposure and experience, the view those students form is modelled on the one projected to them. We shouldn’t underestimate our role in shaping that projection and in sending signals through the noise, through the time they spend with us in our practices, through stories in the press, and through conversations on social media.

I understand the calls that by focusing on ‘fixing the job, the recruitment crisis will fix itself’. But I wonder if, by depositing so much of our time in lamenting the pressures today and perseverating on the need to rescue tomorrow, we deplete the energy left to invest in looking over our shoulder. To invest in the very people who are looking at us so intently day in and day out, and taking their cues from what they see.

At the end, I asked a small group of them how they felt now. Four of the seven said they had started out on the fence, but were now sure they would choose general practice. 

It might not be many, but it hadn’t taken much. And imagine if the student that had previously said her friend was 'aiming low' now saw more of her peers choosing general practice? I could see the potential for turning the tide.

System-wide initiatives to increase the workforce will clearly take time to bear results. But in the meantime, our daily interactions, virtual conversations and unconscious signals might be carrying more weight that we realise.

And my biggest worry is that, if we're not careful, they could play a part in undoing the very problems we are trying to fix. 

Dr Nishma Manek is a GP trainee in London. You can follow her on Twitter @nishmanek

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Readers' comments (24)

  • Great as usual Nishma - I too am always surprised at myself defending my career choice when people ask - and can never work out if it's my own sunk cost fallacy, or genuine belief in the end point of this training. The Pulse comments section is a wee bit of an echo chamber (though one I'm obsessed with and find difficult to tear myself away from) which I think amplifies the negativity.

    I do have the genuine belief that the foundation programme in it's current form does enough to aid GP recruitment, in presenting hospital medicine in such an intolerable form that GP seems like an attractive escape. If they just improved conditions of general practice - pay, workload, crown indemnity etc, instead of focusing on anecdotal criticism of medical school culture, then people would happily make the leap to GP.

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  • If its that great Nishma why have you opted out of true coal face practice and are now working as the National Medical Director's Clinical Fellow?

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  • The happiest GPs are the ones who have got out

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  • I hope you are feeling the same in 15 years doing full surgeries twice a day at least 3-4 days per week (as most of us are forced to do). It's really not a very nice job. Sorry for letting the truth get in the way of the College magic positivity fairy dust.

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  • Every GP I know is looking for ways to get away from the coal-face grind - whether by teaching/training, doing some other sessional work or locuming so they don't have to deal with all the admin after a session. Many are looking for private work instead.

    We are no longer the miners - we are the tool.

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  • Yes, I did for the last five years in practice and then I left last year aged 49yrs just fed up with the unrealistic expectation of patients, politicians and the media. If you only do a couple of clinical sessions I guess it would be bearable but try nine clinical sessions a week for 22yrs and you would be as fed up and disillusioned as I was at the end. Now I enjoy Monday mornings catching up with business (non-medical) and casting an eye on what the non-clinical GPs are writing about on Pulse, rarely disappointed and this article confirms that.

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  • Azeem Majeed

    Thank you for your article Nishma.

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  • It's an interesting question which I'm sure we all ask ourselves.
    Early 50s, 9 sessions a week for 24 yrs.
    The hours are so long and the job so risky, I don't think I would choose the same path.
    There are absolutely NO perks working as a GP in the NHS - remember when we used to get drug company sponsored trips and a few meals out - shock horror, unethical I know. Then this all stopped. But is was fun. There is no FUN any more. Nothing to look forward to.
    Consultant get 2 week paid trips to attend conferences abroad.
    GP colleagues are too stressed and mired in their own problems.
    If I had my time again, I would have done a PhD in entomology or marine biology in the sunshine at UCLA and indulged my passion for photography.

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  • It's ironic how the comments above exemplify the exact point being made in the article...

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  • May be the best thing about doing GP training is the ability to get off the NHS conveyor belt. Qualify 3 years post foundation training get your CCT then plot your career path be that in the coal face in a traditional practice, working in the OOH setting, locuming between the two, prison, media, private sector, going abroad or what ever take's your fancy. Id rather be where I am now 2 years post qualification with options ahead of me rather than stuck in a hospital on call carrying a med reg bleep whilst thinking about when I should do my PHD to make my CV more competitive for consultant posts that aren't in the arse end of nowhere. If 30 years of 9 sessions a week are such a ball ache I would say to students - chill out there are other ways to pay your mortgage

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