Why don't med students and junior docs want to be GPs any more ?
There is an article on this in this week's BMJ p22 and rapid responses to it are here http://www.bmj.com/content/349/bmj.g6245/rapid-responses. Not sure how much you can see if you aren't a BMA member. Admissions tutors, GPs, academic GPs and hospital docs have all given opinions but some opinions from med students and junior docs would add to the debate if anyone can be bothered or has a strong opinion on the issue.
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I want to be a GP (I'm still doing A levels though) 
I think the reason why people don't is because of the lack of time you get with patents and the quotas that a GP must meet. GP practices are also run as a business and have to make money, so that tightens things up even further.
I think the reason why people don't is because of the lack of time you get with patents and the quotas that a GP must meet. GP practices are also run as a business and have to make money, so that tightens things up even further.
I have the man flu, but here are some of my sniffly thoughts.
Firstly, I'm not sure I agree with one of the points raised in the responses...
GEM students are more likely to become GPs, not less. Considering most will be older than the average medical student upon graduation and quite a few will already have settled down (or will be thinking of doing so in the nearer future than many of their 22/23 year old colleagues), GP actually represents a more attractive option to these students, something previous studies have indicated:
http://www.ncbi.nlm.nih.gov/pubmed/11328515
http://careers.bmj.com/careers/advice/view-article.html?id=20007442
Furthermore, considering the first cohort of GEP doctors graduated in 2004 and will only have gained their CCTs in the last year or so, is there any evidence to support the claim that these students are more likely to be attracted to private medicine?
I'm not sure what can be done to improve recruitment - what doesn't help however is GPs (in common with the rest of the NHS) getting a pasting from the media and the government every other day.
As for how general practice is represented (or not, as the case may be) to prospective medical students...
Many of the websites offered positive commentaries by students or had worthy initiatives to widen access. Most of the schools provided videos specific to medicine, and almost all attested to the social attractions of the institution, referred to the (sometimes “famous”) hospital and its “wards,” and offered the possibility of “research.” A few mentioned general practice, though not at length—except the Brighton and Sussex website, which includes a video on the interaction between one practice and the school.
More typically, a slogan would assert “superb teaching and research facilities,” with a picture of a surgeon in an operating theatre. I received no general impression that half of all medical students would end up becoming GPs. Indeed, I saw this only in the small print on one school’s website, which said that “approximately half of all UK medical graduates work in general practice.”
Universities and medical schools are businesses nowadays and they advertise to their potential consumers accordingly. What were people expecting? Since the late 1990s, successive governments have been pursuing the agenda of privatising higher education and turning it into yet another free market enterprise. Students (and their £9K pa) won't be drawn to a university if the prospectus places a great deal of emphasis on the 8 week GP block in a boring inner city practice. They will be more drawn to lots of pictures of the shiny new PFI teaching hospital though.
(In case anyone was wondering where I stand personally: I don't wish to be a GP, I am a hopeful EM gunner).
Firstly, I'm not sure I agree with one of the points raised in the responses...
I think several things have changed in the past 40 years. One of these is the growth of graduate entry medicine. Many students entering medicine via this route have spent several years doing an academic course like Biomedical Science and are more interested in staying in academic medicine than the more people centred medicine of general practice. The larger amount of debt generated by 2 degrees attracts some to private medicine which is less common in general practice.
GEM students are more likely to become GPs, not less. Considering most will be older than the average medical student upon graduation and quite a few will already have settled down (or will be thinking of doing so in the nearer future than many of their 22/23 year old colleagues), GP actually represents a more attractive option to these students, something previous studies have indicated:
http://www.ncbi.nlm.nih.gov/pubmed/11328515
http://careers.bmj.com/careers/advice/view-article.html?id=20007442
Furthermore, considering the first cohort of GEP doctors graduated in 2004 and will only have gained their CCTs in the last year or so, is there any evidence to support the claim that these students are more likely to be attracted to private medicine?
I'm not sure what can be done to improve recruitment - what doesn't help however is GPs (in common with the rest of the NHS) getting a pasting from the media and the government every other day.
As for how general practice is represented (or not, as the case may be) to prospective medical students...
Many of the websites offered positive commentaries by students or had worthy initiatives to widen access. Most of the schools provided videos specific to medicine, and almost all attested to the social attractions of the institution, referred to the (sometimes “famous”) hospital and its “wards,” and offered the possibility of “research.” A few mentioned general practice, though not at length—except the Brighton and Sussex website, which includes a video on the interaction between one practice and the school.
More typically, a slogan would assert “superb teaching and research facilities,” with a picture of a surgeon in an operating theatre. I received no general impression that half of all medical students would end up becoming GPs. Indeed, I saw this only in the small print on one school’s website, which said that “approximately half of all UK medical graduates work in general practice.”
Universities and medical schools are businesses nowadays and they advertise to their potential consumers accordingly. What were people expecting? Since the late 1990s, successive governments have been pursuing the agenda of privatising higher education and turning it into yet another free market enterprise. Students (and their £9K pa) won't be drawn to a university if the prospectus places a great deal of emphasis on the 8 week GP block in a boring inner city practice. They will be more drawn to lots of pictures of the shiny new PFI teaching hospital though.
(In case anyone was wondering where I stand personally: I don't wish to be a GP, I am a hopeful EM gunner).
(edited 9 years ago)
I think the reason why there are less medical students/junior doctors wanting to become GPs is two part:
Firstly, medicine tends to attract very ambitious and hard-working applicants - even more so in recent times with the increasing competition for places which selects for the ambitious/hard-working phenotype. Unless they are really passionate about primary care, most of these people will want to be high flying consultants in big teaching hospitals. This is backed up by one of the figures in the responses - 11% of Cambridge (which probably attracts the some of the most ambitious amongst medical applicants) graduates become GPs whereas this is 30% for Keele graduates.
Additionally, I think primary care is becoming a less attractive care due to social perception. In the past, being the community doctor was a very well respected position and "doctor" pretty much meant GP but now people think more about hospital doctors. Even now, you see elderly patients have a lot more faith and trust in their GP compared to hospital doctors whereas this is less so in younger patients.
The article and some of the responses suggest modifying the university selection process to select for 'potential GPs,' and I think it would be reasonably feasible to execute this if we gather data on personality characteristics of medical students who choose to become GPs. But I'm not sure whether it would be fair to discriminate against applicants because they want to be an academic transplant surgeon instead of a GP, but I guess this is open to debate. What I think would be better is to make primary care a more attractive speciality choice by offering things like more scope for academic work, sub-specialist interests etc.
(2nd year medic - not that inclined towards primary care, but we'll see)
Posted from TSR Mobile
Firstly, medicine tends to attract very ambitious and hard-working applicants - even more so in recent times with the increasing competition for places which selects for the ambitious/hard-working phenotype. Unless they are really passionate about primary care, most of these people will want to be high flying consultants in big teaching hospitals. This is backed up by one of the figures in the responses - 11% of Cambridge (which probably attracts the some of the most ambitious amongst medical applicants) graduates become GPs whereas this is 30% for Keele graduates.
Additionally, I think primary care is becoming a less attractive care due to social perception. In the past, being the community doctor was a very well respected position and "doctor" pretty much meant GP but now people think more about hospital doctors. Even now, you see elderly patients have a lot more faith and trust in their GP compared to hospital doctors whereas this is less so in younger patients.
The article and some of the responses suggest modifying the university selection process to select for 'potential GPs,' and I think it would be reasonably feasible to execute this if we gather data on personality characteristics of medical students who choose to become GPs. But I'm not sure whether it would be fair to discriminate against applicants because they want to be an academic transplant surgeon instead of a GP, but I guess this is open to debate. What I think would be better is to make primary care a more attractive speciality choice by offering things like more scope for academic work, sub-specialist interests etc.
(2nd year medic - not that inclined towards primary care, but we'll see)
Posted from TSR Mobile
(edited 9 years ago)
over-worked, too many patients, not enough consultation time, attacked by the media and government ... the NHS is under massive strain financially, politically and existentially ... general practice is bearing the brunt of this and many are leaving a sinking ship (e.g. retiring early).
although it is comforting to think that general practice dose not appeal to people because of high ambitions and negative social perceptions, as the poster above suggests and an opinion that is typical of pre-clinical students and the general public, the reality is sadly different.
although it is comforting to think that general practice dose not appeal to people because of high ambitions and negative social perceptions, as the poster above suggests and an opinion that is typical of pre-clinical students and the general public, the reality is sadly different.
I think something the vast majority of people fail to realise when they're saying "not enough medics become GPs!" is that GP isn't some kind of magical thing separate to the usual speciality job consideration and ruminations - it's just another medical speciality with it's own positives, negatives and draws on particular personalities. It just so happens that there's more of them needed.
It may be that there are not enough medical students that have it in their blood to become a GP, so all this kind of discussion isn't helpful. It isn't the medical speciality for them - and making people feel guilty for disliking a specialty isn't really helpful. I think most of the really deep thought of "oh recruitment!", "oh subliminal messages!", "oh poorly taught!" bypasses this issue. People might just not like the day to day job, or the medicine, or whatever.
All this flashy advertising that's been mentioned before with a picture of an operating theatre in the prospectus rather than a GP practice wouldn't really matter I don't think - I doubt medical students would make their mind up then and there on a specialty. In my opinion and [citation needed], the only reason you see more people pick "exciting medical specialities" or "exciting surgical specialities" is that there's more of them, each different with their own little draws and people find they are excited about one of them in particular. I know plenty of people that have the same excitement about GP, which is fine, it's the thing that they enjoy.
GP is it's very own specific type of practice which is a difficult skill to master, and I think most medics do appreciate that. Knowing just enough about basically every condition in medicine to ask the poignant features, red flags and then link that with all the social-psycho stuff is difficult, as well as juggling with money and gatekeeping. That just might not suit some people and they'd rather see the same condition in clinic forever or do the same operation.
It may be that there are not enough medical students that have it in their blood to become a GP, so all this kind of discussion isn't helpful. It isn't the medical speciality for them - and making people feel guilty for disliking a specialty isn't really helpful. I think most of the really deep thought of "oh recruitment!", "oh subliminal messages!", "oh poorly taught!" bypasses this issue. People might just not like the day to day job, or the medicine, or whatever.
All this flashy advertising that's been mentioned before with a picture of an operating theatre in the prospectus rather than a GP practice wouldn't really matter I don't think - I doubt medical students would make their mind up then and there on a specialty. In my opinion and [citation needed], the only reason you see more people pick "exciting medical specialities" or "exciting surgical specialities" is that there's more of them, each different with their own little draws and people find they are excited about one of them in particular. I know plenty of people that have the same excitement about GP, which is fine, it's the thing that they enjoy.
GP is it's very own specific type of practice which is a difficult skill to master, and I think most medics do appreciate that. Knowing just enough about basically every condition in medicine to ask the poignant features, red flags and then link that with all the social-psycho stuff is difficult, as well as juggling with money and gatekeeping. That just might not suit some people and they'd rather see the same condition in clinic forever or do the same operation.
Original post by Beska
I think most of the really deep thought of "oh recruitment!", "oh subliminal messages!", "oh poorly taught!" bypasses this issue. People might just not like the day to day job, or the medicine, or whatever.
Has anyone shown that more advertising or "better teaching", whatever that is, increases recruitment onto the the GP VTS programme? All of these seem ambitious, but untried and possibly ineffective methods to improve recruitment without improving pay and conditions, the one thing we know does really work.
people still apply for GP training , it is just many are rejected in at selection process at a time they are trying to increase the numbers. if they wanted to fill then they just have to adjust who they accept and this they have to do if they want to fill it so i do not really think applications is the reason at all.
the real problems are :
- increasingly women going into it just to work park time when finished
- many new GP will just do locum work / urgent care centres (~£100 per hour)
- old GP are all retiring now, many try to take early retirement but no GP i have ever seen has ever worked past 60.
- increased numbers of GP too late
hospital training is bad at the moment, especially CMT and surgical training, and A&E is basically a war zone where all the trainees fly off to australia as soon as they can. i honestly dont think GP training needs to worry. many people i have known run to GP after getting no teaching at all in the job and failing PACERS 3 times or surgeons that cannot get registrar post.
the real problems are :
- increasingly women going into it just to work park time when finished
- many new GP will just do locum work / urgent care centres (~£100 per hour)
- old GP are all retiring now, many try to take early retirement but no GP i have ever seen has ever worked past 60.
- increased numbers of GP too late
hospital training is bad at the moment, especially CMT and surgical training, and A&E is basically a war zone where all the trainees fly off to australia as soon as they can. i honestly dont think GP training needs to worry. many people i have known run to GP after getting no teaching at all in the job and failing PACERS 3 times or surgeons that cannot get registrar post.
Actually, GP isn't unpopular at all, it's the most popular specialty in medicine. Have a look at the competition ratios for medicine specialty training, GP had the most applications by far, followed by core medical, then core surgical, then anaesthetics.
Now it's true that some of those people put GP down as a backup option, so it has a lower uptake of offers than other specialties, but the point remains that plenty of people like GP enough to consider doing it for a career. The problem is that there are twice as many posts to fill as the 2nd biggest specialty (CMT), and 5 times as many as the 3rd biggest (CST).
EDIT: Regarding the italic sentence, having looked it up, even if you just take 1st choice specialty into account rather than applications made, GP is still the most popular, albeit by a much smaller margin (pretty much level with CMT).
Now it's true that some of those people put GP down as a backup option, so it has a lower uptake of offers than other specialties, but the point remains that plenty of people like GP enough to consider doing it for a career. The problem is that there are twice as many posts to fill as the 2nd biggest specialty (CMT), and 5 times as many as the 3rd biggest (CST).
EDIT: Regarding the italic sentence, having looked it up, even if you just take 1st choice specialty into account rather than applications made, GP is still the most popular, albeit by a much smaller margin (pretty much level with CMT).
(edited 9 years ago)
re. selecting for/teaching for increased GP recruitment, the Dean at Oxford fielded a question on this at a talk a few months ago. Although he took the notion that Oxford 'traditionally' produces more academics/hospitalists at face value, he said that actually in the late 80s/early 90s, the percentage of the cohort going into GPland peaked in the mid 20s ("better pay, better working conditions", for those who were wondering...).
When we talk of a 'GP recruitment crisis', what we're actually talking about is how to manage chronic ilness in North East England (70% fill rate), the East Midlands (71%), Wales etc. as opposed to London (98%), which I think is a subtly different question to answer. Would local contracts work?*
*I freely admit I'm in way over my head here, but I'd be interested to know why it could or couldn't work. I watched a documentary once on the Discovery Channel about truckers in Australia that got paid A$100,000s because they trucked in the middle of nowhere...
When we talk of a 'GP recruitment crisis', what we're actually talking about is how to manage chronic ilness in North East England (70% fill rate), the East Midlands (71%), Wales etc. as opposed to London (98%), which I think is a subtly different question to answer. Would local contracts work?*
*I freely admit I'm in way over my head here, but I'd be interested to know why it could or couldn't work. I watched a documentary once on the Discovery Channel about truckers in Australia that got paid A$100,000s because they trucked in the middle of nowhere...
Original post by pgreg1
many people in this thread speaking from conjecture, statistics and ideas ... talk to GPs and you will find the reason
But GPs aren't the people deciding whether or not to become GPs.
Original post by Asklepios
I think the reason why there are less medical students/junior doctors wanting to become GPs is two part:
Firstly, medicine tends to attract very ambitious and hard-working applicants - even more so in recent times with the increasing competition for places which selects for the ambitious/hard-working phenotype. Unless they are really passionate about primary care, most of these people will want to be high flying consultants in big teaching hospitals. This is backed up by one of the figures in the responses - 11% of Cambridge (which probably attracts the some of the most ambitious amongst medical applicants) graduates become GPs whereas this is 30% for Keele graduates.
Additionally, I think primary care is becoming a less attractive care due to social perception. In the past, being the community doctor was a very well respected position and "doctor" pretty much meant GP but now people think more about hospital doctors. Even now, you see elderly patients have a lot more faith and trust in their GP compared to hospital doctors whereas this is less so in younger patients.
The article and some of the responses suggest modifying the university selection process to select for 'potential GPs,' and I think it would be reasonably feasible to execute this if we gather data on personality characteristics of medical students who choose to become GPs. But I'm not sure whether it would be fair to discriminate against applicants because they want to be an academic transplant surgeon instead of a GP, but I guess this is open to debate. What I think would be better is to make primary care a more attractive speciality choice by offering things like more scope for academic work, sub-specialist interests etc.
(2nd year medic - not that inclined towards primary care, but we'll see)
Posted from TSR Mobile
Firstly, medicine tends to attract very ambitious and hard-working applicants - even more so in recent times with the increasing competition for places which selects for the ambitious/hard-working phenotype. Unless they are really passionate about primary care, most of these people will want to be high flying consultants in big teaching hospitals. This is backed up by one of the figures in the responses - 11% of Cambridge (which probably attracts the some of the most ambitious amongst medical applicants) graduates become GPs whereas this is 30% for Keele graduates.
Additionally, I think primary care is becoming a less attractive care due to social perception. In the past, being the community doctor was a very well respected position and "doctor" pretty much meant GP but now people think more about hospital doctors. Even now, you see elderly patients have a lot more faith and trust in their GP compared to hospital doctors whereas this is less so in younger patients.
The article and some of the responses suggest modifying the university selection process to select for 'potential GPs,' and I think it would be reasonably feasible to execute this if we gather data on personality characteristics of medical students who choose to become GPs. But I'm not sure whether it would be fair to discriminate against applicants because they want to be an academic transplant surgeon instead of a GP, but I guess this is open to debate. What I think would be better is to make primary care a more attractive speciality choice by offering things like more scope for academic work, sub-specialist interests etc.
(2nd year medic - not that inclined towards primary care, but we'll see)
Posted from TSR Mobile
some good stuff there, great contribution to the thread.
thank you
As a 2nd year med student, and purely from my own personal viewpoint, I'd say GP is seen as the boring speciality. It's never showcased as being all that exciting and can't really compare to the hospital environment and excitement. The main reasons any doctor would suggest for going into GP is flexible working and decent hours, rather than how thrilling the job is.
I certainly won't be a GP unless it's the only choice I have.
I certainly won't be a GP unless it's the only choice I have.
Original post by joker12345
As a 2nd year med student, and purely from my own personal viewpoint, I'd say GP is seen as the boring speciality. It's never showcased as being all that exciting and can't really compare to the hospital environment and excitement. The main reasons any doctor would suggest for going into GP is flexible working and decent hours, rather than how thrilling the job is.
I certainly won't be a GP unless it's the only choice I have.
I certainly won't be a GP unless it's the only choice I have.
Is this actually the case anymore though?
Original post by Democracy
Is this actually the case anymore though?
From what I've heard/seen, more decent than hospital work at least!
Original post by joker12345
From what I've heard/seen, more decent than hospital work at least!
It depends though. Maybe more decent hours than something like A&E, but there's loads of hospital jobs that are pretty much always 9-5 - pathology and other lab stuff, radiology, routine surgical stuff (Breast, ENT etc)
Original post by Asklepios
I think the reason why there are less medical students/junior doctors wanting to become GPs is two part:
Firstly, medicine tends to attract very ambitious and hard-working applicants - even more so in recent times with the increasing competition for places which selects for the ambitious/hard-working phenotype. Unless they are really passionate about primary care, most of these people will want to be high flying consultants in big teaching hospitals. This is backed up by one of the figures in the responses - 11% of Cambridge (which probably attracts the some of the most ambitious amongst medical applicants) graduates become GPs whereas this is 30% for Keele graduates.
Additionally, I think primary care is becoming a less attractive care due to social perception. In the past, being the community doctor was a very well respected position and "doctor" pretty much meant GP but now people think more about hospital doctors. Even now, you see elderly patients have a lot more faith and trust in their GP compared to hospital doctors whereas this is less so in younger patients.
The article and some of the responses suggest modifying the university selection process to select for 'potential GPs,' and I think it would be reasonably feasible to execute this if we gather data on personality characteristics of medical students who choose to become GPs. But I'm not sure whether it would be fair to discriminate against applicants because they want to be an academic transplant surgeon instead of a GP, but I guess this is open to debate. What I think would be better is to make primary care a more attractive speciality choice by offering things like more scope for academic work, sub-specialist interests etc.
(2nd year medic - not that inclined towards primary care, but we'll see)
Posted from TSR Mobile
Firstly, medicine tends to attract very ambitious and hard-working applicants - even more so in recent times with the increasing competition for places which selects for the ambitious/hard-working phenotype. Unless they are really passionate about primary care, most of these people will want to be high flying consultants in big teaching hospitals. This is backed up by one of the figures in the responses - 11% of Cambridge (which probably attracts the some of the most ambitious amongst medical applicants) graduates become GPs whereas this is 30% for Keele graduates.
Additionally, I think primary care is becoming a less attractive care due to social perception. In the past, being the community doctor was a very well respected position and "doctor" pretty much meant GP but now people think more about hospital doctors. Even now, you see elderly patients have a lot more faith and trust in their GP compared to hospital doctors whereas this is less so in younger patients.
The article and some of the responses suggest modifying the university selection process to select for 'potential GPs,' and I think it would be reasonably feasible to execute this if we gather data on personality characteristics of medical students who choose to become GPs. But I'm not sure whether it would be fair to discriminate against applicants because they want to be an academic transplant surgeon instead of a GP, but I guess this is open to debate. What I think would be better is to make primary care a more attractive speciality choice by offering things like more scope for academic work, sub-specialist interests etc.
(2nd year medic - not that inclined towards primary care, but we'll see)
Posted from TSR Mobile
Keele is not a good example to use for this scenario. One of the main reasons Keele medical school was built was to address the primary care issues of the Stoke on Trent area which has below national average levels of health in nearly all categories. Keele puts a lot of emphasis on GP placements and many of the teaching staff are current or former GPs including the school head. A more established and traditional university might be a better example to use.
I think most of the main reasons why there are not enough applying for GP have been mentioned. Most foundation doctors will spend their time in hospitals meaning their exposure to the speciality is limited. This may make them less inclined to apply at the end of foundation training.
Although GP work looks easy to the lay person I think many medical students realise the complexities of dealing with peds, gynae, obs, chronic illness and physcosocial, which make it trickier than some straight up specialties.
(edited 9 years ago)
Original post by Chief Wiggum
But GPs aren't the people deciding whether or not to become GPs.
an astute observation ...
medical students and training doctors speaking to GPs are being told the negatives of the profession and so are influenced in their decision making
As a grad student currently studying in the US I am lucky to have had GP (family medicine over here) placements in the UK and the US. My take on the situation is.....
General practice in the UK does NOTHING to encourage future doctors to seriously consider it as a viable option. Why?
1. It does not promote itself as an individual specialty of note (ie super generalist)
2. Gp practices in the UK are quite drab and boring when compared to the hospitals (the working environment is too laid back and dull - few twenty-somethings want to end up here. Correction , I wouldn't)
3. The Gp's I observed seemed to have no pride in their specialty (they saw GP as a fall back option)
4. Because it is not as competitive as other specialties to get into (eg Medicine, Surgery) other doctors give General practice little respect. (to be fair we have the same problem in the US)
Btw why do doctors in the UK accept being treated like ****?
In the hospitals no one gives you respect (ie Nurses, managers etc)
In society you don't get it (you get paid peanuts)
Your training, foundation? to ??? goes on forever and you still take it.
I was shocked to see doctors spend a whole morning taking blood and never seeing the inside of an OR during my one month surgery elective.
General practice in the UK does NOTHING to encourage future doctors to seriously consider it as a viable option. Why?
1. It does not promote itself as an individual specialty of note (ie super generalist)
2. Gp practices in the UK are quite drab and boring when compared to the hospitals (the working environment is too laid back and dull - few twenty-somethings want to end up here. Correction , I wouldn't)
3. The Gp's I observed seemed to have no pride in their specialty (they saw GP as a fall back option)
4. Because it is not as competitive as other specialties to get into (eg Medicine, Surgery) other doctors give General practice little respect. (to be fair we have the same problem in the US)
Btw why do doctors in the UK accept being treated like ****?
In the hospitals no one gives you respect (ie Nurses, managers etc)
In society you don't get it (you get paid peanuts)
Your training, foundation? to ??? goes on forever and you still take it.
I was shocked to see doctors spend a whole morning taking blood and never seeing the inside of an OR during my one month surgery elective.
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