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The more I learn about general practice, the worse it looks



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