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Gold, incentives and meh

'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)

  • "I Give It A Year"

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  • Please could people writing such articles state how many frontline clinical sessions they are doing per week.
    It would help to understand the enthusiasm.

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  • Just facts. In NI where I work, GP % of NHS funds has fallen from 11 to 5.5% in 12 years. Pay per consult has fallen from 12 to 6, profit per patient year has fallen from 80 to 60 pounds. Consultation rates have gone up from 4 to 6/ year in the same time. We now see 90% of all NHS consults as opposed to 78%.
    To some, there has been no better time, no better job. Fine. Not to me. It is just completely so awful each day with 40+ patients to see. Obviously, some people love that, but does the average doctor?

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  • Err, if your struggling to cope doing nine clinical sessions a week then take a look at your lifestyle, cut some expenses from it and cut down the hours you work. I have no sympathy for some of my colleagues who tell me they have to work nine sessions a week when they have a brand new BMW, expensive holidays/house, go for constant meals out etc

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  • Took Early Retirement

    Do I regret it? Noooooo! By working hard, Mrs and I were able to get out at 57.5 and now travel the world as we wish, and for as long as our health holds up. (For as we know, that can change in an instant.) It means we also don't have to jump when some moron with a clipboard tells us to, nor do we have to obey the commands of people in CCGs, who work there as they cannot do they day job and would scream and run a mile if someone told them that they had to!

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  • It's not quite that easy. Within a practice, the sessions still have to be covered and recruitment being what it is, the reason one "has" to work 9 sessions might well be to keep the practice going. Spending some of the hard-earned cash on a comfortable car (which will help with the visit round) or on relaxing holidays can make it a bit easier to keep going while waiting for all these new GPs and funding that the politicians keep promising....

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  • @Francis Roe | GP registrar07 Nov 2016 7:59pm.

    Does the practice your rich GP colleagues work at have any openings? I do 8 sessions a week but can't afford a brand new BMW, expensive holidays/house or constant meals out.

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  • Although I am a portfolio GP and now only work 5 sessions in my practice (with one being a Training session), I can still see there is a huge tension between personal and professional resilience.

    I work like this in order to look after myself. And financially, the sad reality is that my practice sessions are the lowest paid compared to my other roles.

    However, to advocate this as a long term solution for the profession is both short sighted and flawed. And to blame the negative PR for general practice for its recruitment crisis is naïve.

    We have to tackle the root causes of the overwork and under-recruitment which are patient demand and underfunding.

    Telling someone to work less than 9 sessions does neither.

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  • I already work 4 sessions but it is still too much.

    It takes me the rest of the week to recover from the intensity of those two days.

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  • 7/8 session partner for 2 years here. I think its a great job. I worked in the private and 3rd sector before becoming a doctor. GPs are the front line of the NHS. There is good clinical medicine. We get to know our patients and make a big difference daily. There are plenty of opportunities to develop special interests. The danger is burnout but that applies to every area of medicine. The BMA has a good form. https://web2.bma.org.uk/drs4drsburn.nsf/quest?OpenForm

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