After completing my VTS training and qualifying as a GP, my parents congratulated me. My dad asked me politely a quite pivotal question: ‘So when are you going to specialise?’ I was not put off by his question as back home the title ‘general practitioner’ is a title held by any doctor who finishes his internship and is waiting to get specialty training.
I graduated from Sudan, which is a former British colony that adopts the old UK medical jobs hierarchy system. I had to explain to my father that I am a specialist, as I finished specialty training in family medicine in the UK.
The said question and answer made me think, why are GPs not recognised as specialists in the UK? And why is there a separate register in the GMC for GPs instead of recognising us as consultant family physicians?
As we all know, consultants achieve their status by going through a rigorous undergraduate selection process, postgraduate training, undertaking tough Royal college exams, and going through lengthy specialty training programmes. So why are GPs the only ones who are left out of achieving this status?
This inequity can be traced back to the beginning of general practice as we know it today. General practice took shape in the late nineteenth century and the beginning of the twentieth century. At that time, GPs were perceived inferior to their hospital colleagues. According to Dr Julian Tudor Hart, GPs were men who failed to become specialists and were unable to work in a hospital or to use its resources without going through their consultant colleagues. Due to this history, our colleagues and some of the public considered GPs as lazy, less knowledgeable and less hardworking. In my experience, some of this attitude still exists in the eyes of our hospital colleagues, even today. One can argue how much of these false impressions are due to the name!
The best motivational quotation that helped me to overcome my own struggle with the above negative statements was: ‘Everybody is a Genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.’This simple statement by Matthew Kelly has changed my perception completely. I now feel that when my clinical knowledge and skills are measured by the number of open heart surgeries that I performed, or the number of brain tumours which I removed, I would feel like a failure but, hold on! These are not my areas of expertise. I learned to look at my profession in the scope of my competency in dealing with patients holistically, managing multi-morbidities and treating all patients without restricting myself to one anatomical system, gender, age, or pathology.
Now let us go back to the name ‘general practitioner’, break it down and analyse it. Firstly, the word ‘general’ is a bit misleading as it does not reflect the fact that we are specialists in managing chronic diseases, acute non-life threatening illnesses and multi-morbidities in the primary care setting. This includes a wide variety of physical and mental health conditions in both genders and in all ages.
Despite sharing this wide spectrum with A&E, we are still known as ‘practitioners’ while they are called ‘consultants’ by the end of our prospective training.
I think it is time to move away from the perception that we are the jack of all trades and master of none. In fact, like any other specialties we work within our limits, refer patients when dealing with conditions that are not within our expertise and receive referrals from colleagues when they are seeking our help in managing chronic illnesses or when dealing with a condition that they have less knowledge about.
The second half of the name which I do not like or agree to, is the word ‘practitioner’. I did not go to medical school and work hard all these years to lose my title as a physician/clinician. For so long you are known as a doctor then the day you are fully qualified you get called a practitioner.
The reason why this is important is in the definition itself. As stated by Wikipedia a consultant is defined as an expert or an experienced professional in a specific field and has a wide knowledge of the subject matter. On the other hand, a practitioner is defined as someone who is qualified or registered to practice a particular occupation, profession or religion. Clearly the word ‘practitioner’ does apply more to traditional healers, yoga or other fields that rely more on practice rather than full and comprehensive training and assessments as in the field of medicine.
My vision for the future of general practice is also shared by the RCGP. I recently read an article on the RCGP website, calling for GPs to be recognised and added to the list of specialists and for the status of GPs to be equal to that of their colleagues in secondary care. It also added that the UK is lagging behind comparable countries as 24 out of 28 EU states, Australia, the USA and Canada all recognize Family medicine as a specialty in its own right.
So, what would the change of the title from general practitioner to consultant family physician achieve?! Well, it will surely reinstate the status that we all aspire to achieve as consultants, while improving the recruitment rate and morale among doctors who are pursuing specialisation in family medicine. It will also reflect and recognise the journey of family medicine since it started until it became a well-established specialty. This includes the foundation of the RCGP in 1952 and the subsequent introduction of VTS training and college exams to improve and monitor the professional excellency of primary care physicians.
I believe that a simple change would go a long way. It is time to upgrade our title to consultant family physicians which will reflect and recognise the journey of general practice from an outcast and undervalued field of medicine to the fully established, respected and exciting specialty of family medicine. We should all, as primary care physicians, stand up for ourselves and demand to be recognised as consultants and to end the discrimination culture and second class treatment by other specialties and organisations like the GMC. If this proposal gets approved it will mean that future generations of family physicians will not have to endure the same injustice we all had to go through by denying us a consultant status for more than 100 years.
1. Tudor Hart, J (1988) A new kind of doctor – Chapter 4: New ideas in old structures [via Socialist Health Association].
2. Kelly, M (1999) The rhythm of life: Living every day with passion and purpose. ISBN 0743265254
3. RCGP and BMA (2016) Joint statement: GPs must be recognised as specialists in general practice