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At the heart of general practice since 1960

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)

  • well written piece... you would be wise to trust your instincts and give general practice a very wide berth.
    If I had my time again I wouldn't touch it with a barge pole.
    John Glasspoole is always spot on with his analogies... general practice as a "cesspit" is about as true as it comes.

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  • Here Here. RIP general practice.

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  • You've made the right choice.Keep away from general practice.It's the anal canal of medicine.

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  • Very insightful piece. Follow your gut instincts and aim to be respected and always remember exactly why you went into and what you want out of being a doctor.

    See your medical degree as a passport to the world.

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  • Bob Hodges

    That's an insult to a***holes that is.

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  • Before every GP commits self harm. i think the article is interesting. But there is no reason to have chips on your shoulder.

    Anyone can be snobbish and try and look down on colleagues. Its cheap and easy.

    Primary care does not need to justify its existence. Spend time in India - there is plenty of excellent specialist care - the difference lies in lack of primary care and its associated infrastructure.

    In the US we have pockets of joined up care with lots of fragmented areas. Where primary doesn't exist - dr's adapt - become specialists and earn a lot more with worse outcomes across the region.
    Primary care really matters, and the UK has been the leading light on this for the whole planet.

    What is currently happening is akin to a war crime.

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  • I've been a GP for 6 years, and I really think I made a mistake choosing general practice. I've given up working as a full time partner - the long hours and intense workload just made me miserable and ill.

    I'm filling out forms for a GP locum agency as I write this. At least I'll have some flexibility in my choice of jobs.

    Burn out and ill health - who wants that in their early careers?

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  • it is interesting that quite a few young doctors I meet report they don't get enough medicine in medical school!

    Why is this an issue? what are they learning / tree hugging?

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  • if general practice is a cesspit, OOH is a big dump yard.

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  • I love the idea of General Practice, and it is no doubt an extremely cost effective service, which still has some of the highest satisfaction rates in the whole of the NHS.

    The reality, however is that the service is stretched too thin and the small business aspect is used by the govt for us to work more for less.

    until a fairer model of payment is given, general practice will die a slow and torturous death.

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