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What sort of GP do you want to be?

Career options

There are several ways of working as a GP once you're qualified – and now's the time to decide which is for you, says medical careers expert Professor uth Chambers

As a GP registrar you should have a pretty good idea of what kind of work you hope to do as a GP and therefore what type of career options are open to you once qualified. Your training in general practice will show you how different GP practices are, and the effects of location on the nature of the practice – from inner-city life to rural settings.

Starting off as a partner, locum or salaried GP?

You could opt to become a partner in a practice, or alternatively, a salaried assistant or GP locum for a while. If you expect to follow your spouse or partner round the UK, or work overseas, it makes sense to become a salaried GP or locum GP. When you move on you won't have the responsibilities to hand over as a GP partner would for the running of the practice, nor a financial share of the practice premises.

You might decide to become a salaried GP or GP locum while you are waiting for your dream partnership to be advertised. GP partnerships seem more difficult to come by these days; probably because if an existing group of GPs take on an additional or replacement partner they sacrifice some of their profits, so instead they employ a salaried GP or even two practice nurses.

You should not enter into a partnership lightly. Becoming a partner requires more commitment to the development of the practice than if you are salaried. You will probably be making a financial commitment if the practice has its own premises, maybe buying in after a probationary period. If one of the GP partners becomes sick, you can expect to work extra hours or even days to cover their absence if there is no locum cover.

As a GP partner you're in it together; if the profits go down because of extra investment in staff or less income, your share of the profits will fall correspondingly. If your profits soar, your income should rise proportionately – all depending on the practice agreement and how long you will wait to gain parity with the other GP partners. All being well, that extra commitment of being a GP partner will lead to a higher salary than if you were a salaried GP or GP locum (see box

below).

An academic GP career?

You may hope to combine being a GP with an academic career. This kind of post might be arranged by a university jointly with a PCO or practice. The academic part might involve teaching undergraduate medical students for say, three sessions per week; or undertaking research for maybe five sessions per week. The rest of the time might be spent as a salaried doctor employed by your PCO or maybe as a partner in a local practice.

The tenure of such an academic post is likely to be for a fixed term of two or three years depending on the source of funding. It can be difficult to set up this kind of joint post if the university's part of the salary is less than the clinical portion of the salary. So the PCO might have to make up the shortfall in the university salary level by pump priming the post, and this will tend to be for a fixed term.

The doctor may have obtained funding for the academic part of the post from a national charity such as the Wellcome Trust – www.wellcome.ac.uk; this could happen if the doctor has an academic qualification – maybe a PhD from before they trained in medicine, or a postgraduate certificate or masters degree in research or medical

education, gained while in postgraduate training.

Become a GP with special interest?

Medical students and junior doctors have a great deal of interest in the possibilities

of becoming a GP with a special interest

(GPSI) in a clinical field, say dermatology. But the opportunities for such posts are limited to those that the local service needs, where a supportive consultant will provide some sort of supervision and continuing education. The GPSI will be an integral part of the delivery of the local service for patients by hospital consultants and GPs. You would expect that the GPSI is an experienced GP as well as being competent in a particular clinical field – so this is unlikely to be an option for a newly qualified GP.

You can find out more about GP careers and opportunities from the RCGP website (www.rcgp.org.uk) or BMJ careers (www.bmjcareers.com). If you are starting out as a salaried GP or locum, consider joining the National Association of Sessional GPs (NASGP) (www.nasgp.org.uk) or a local peer group if there is one run by the NASGP or deanery.

Ruth Chambers is director of General Practice Education, West Midlands Deanery and Professor of Primary Care at Staffordshire University. She is author of several books on career planning and development, including Career planning for everyone in the NHS (Radcliffe Publishing; Oxford, 2005).

References

1 Cited in United Kingdom Conference of Educational Advisers (UKCEA) Workforce Survey Report, November 2005

ComparAtive clinical earnings of gps

• Average annual GP income: £103,000 (England); £90,000 (Scotland); £80,000 (Wales)1

• Typical locum rates per day session: £350 [£250-£550] (England)1

• Typical salaried GP pay rate: £70-75,000 pa full-time maybe including a half-day session for continuing professional development or service development

• Typical pay, GPSI session: £250 per 3.5-hour session as self-employed GP; less if employed status

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