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Why don't med students and junior docs want to be GPs any more ?

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Original post by Jerrymed
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.


It might be something to do with recruiting new medical students. I think they are prioritizing traits such as empathy which often comes with timidness and a willingness to fall in line.
I don't want to become a GP because I would rather work in a hospital setting, I feel like theres no challenge to a GP's career, you set up a shop and you see patients for the rest of your life. Your practice won't really change.

I am interested in research and I really like seeing rare pathologies, and diagnosing patients and the intellectual aspect of medicine.

I have a friend who desperately wants to be a GP, but the main reason is the lifestyle.
I am a 2nd year, but with experience of GP placements. It is really appealing to me. The hours are sociable. A massive attraction to me is the sheer *diversity* of general practice, where you are dealing with every system and incorporate psychosocial and public health elements into your practice. At this stage, I couldn't imagine just narrowing down my breadth of knowledge to one single system. I love the challenge of history, examination and diagnosis in a short period, the responsibility of being the first port of call, and the relationships you build with patients over many years.
Original post by plrodham1
Out of curiosity what was it in the end that made you switch from surgery/obgyn?


Burn out? I loved the good old days. 84 hour weekends.. That's Friday am to Monday evening oncall the entire weekend. And no it wasn't a Mickey Mouse job. That was as the senior sho covering a regional Cardio thoracic unit where I essentially was responsible for all hdu patients. The icu was covered by the senior registrar oncall. Or the 128 hour weeks when my colleagues were on annual leave. That's Monday Wednesday Friday Saturday Sunday oncall for 24 hours and I worked 8 to 5 Tuesday Thursday too. Or the 14 hour shifts covering labour ward 7 nights in a row that came around every 5 weeks. Believe me you guys these days have it easy :wink:. Yeah after 10 years of that I kinda lost the will to live.
(edited 9 years ago)
Original post by Okorange
I don't want to become a GP because I would rather work in a hospital setting, I feel like theres no challenge to a GP's career, you set up a shop and you see patients for the rest of your life. Your practice won't really change.

I am interested in research and I really like seeing rare pathologies, and diagnosing patients and the intellectual aspect of medicine.

I have a friend who desperately wants to be a GP, but the main reason is the lifestyle.


Ignorance is bliss.. No challenge. Let's see.. 120 patients a week on average in 10 minutes slots covering the entire spectrum of medicine. Patients who present with hidden agendas. You do know GPs deal with 80 percent of patient consultations in the NHS with little over 10 percent of the budget right? Believe me if you think being a GP isn't a challenge then try it for a year or two. There's a reason why a lot of GPs take early retirement ;-)
Original post by RosaPonselle
Ignorance is bliss.. No challenge. Let's see.. 120 patients a week on average in 10 minutes slots covering the entire spectrum of medicine. Patients who present with hidden agendas. You do know GPs deal with 80 percent of patient consultations in the NHS with little over 10 percent of the budget right? Believe me if you think being a GP isn't a challenge then try it for a year or two. There's a reason why a lot of GPs take early retirement ;-)


I think its a challenge in terms of workload as well but I think there are more opportunities for change if you worked in a hospital.
Original post by RosaPonselle
Ignorance is bliss.. No challenge. Let's see.. 120 patients a week on average in 10 minutes slots covering the entire spectrum of medicine. Patients who present with hidden agendas. You do know GPs deal with 80 percent of patient consultations in the NHS with little over 10 percent of the budget right? Believe me if you think being a GP isn't a challenge then try it for a year or two. There's a reason why a lot of GPs take early retirement ;-)



This is a response I've noticed frequently from GPs/GP trainees and med schools...

I don't think Okorange was suggesting that GPs don't work hard or don't get the short end of the stick at lot of the times, rather, I think he/she was implying that the specialty doesn't align well with the specific challenges he/she is seeking in a medical specialty.

I don't get why such a statement so frequently meets with criticism. I sometimes feel that I have to suppress any hint that I am disinterested in a career in GP or else be viewed by my med school as a medical student resistant to being 'molded into shape' by the training process. I think it ties in with what others have said about a drive to increase throughput into GP (my med school feels overwhelmingly GP-centric in its curriculum (I'm very junior though - maybe a false perception)). I certainly agree that the application process (in my experience) is massively weighted towards picking up potential future GPs - there was a MASSIVE bias towards exploring empathy, etc, over exploring academic potential.

It's strange - mention that you're not particularly excited by surgical specialties/medical specialties/path/rads, etc, and nobody bats and eyelid... Express a disinterest in a becoming a GP and suddenly you're on the end of a knee-jerk reaction. I've never seen a surgeon get upset because a med student was, using okorange as an example, "...interested in research and I really like seeing rare pathologies, and diagnosing patients and the intellectual aspect of medicine" and therefore would never dream of pursuing surgery over, say, pathology.
Reply 47
Avatar for Jerrymed
Jerrymed
The impression I get when talking to UK medics and from what I've experienced, is that the system values service provision over academic excellence. Hence the coercion of junior doctors and students into GP training by medical schools and the govt.

What always sticks with me is that doctors/GP's in the UK are not recognized as highly skilled professionals with internationally transferable skills but are just seen as public service health workers (no offence to nurses and physio's btw). I see that's changing now with British medics realizing that they've been getting a raw deal when compared to their peers in the US, Canada, Australia, Middle East.

Until General practice ceases to be a fall back option (by increasing the pay significantly, toughening the entry requirements to be in line with other specialties and cutting the admin red tape) there will be nothing to draw people in.

Unless Doctors/Gps value themselves why should anyone else?
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.



I totally disagree with this "all medics are alpha personality Ben Carson-super-surgeons in waiting" stereotype. It's just simply not true. I agree that plenty of med students like the idea of being some high flying consultant but very few go on to translate that into the kind of box ticking hard graft that gets you to those jobs. Also, plenty will be put off as they progress through the course and realise the kind of lifestyle changes that result from pursuing a certain career path (surgery and female doctors starting a family for example).

This can even be noticed in FY1/2 where many will get into CST only for the ST3 bottleneck to hit them like a brick wall (as a mature grad student I have watched several relatives and friends go through training pathways and it does become readily apparent that actually a lower percentage of med students than you'd think actually posses those box-ticking do-or-die personality traits necessary for success in competitive specialties).

No offence to anyone at Keele intended, but the example comparison is a bit misleading. Keele is heavily GP-centric (or so I believe) and, again no offence intended, they draw from a very different pool in comparison to Cambridge.

Original post by Asklepios

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)


But is that not getting away from what a GP actually is? I.e. a 'general' practitioner? Should we be creating all those academic posts and sub-specilaties etc just because it cheers people up rather than through actually need?

I agree that we need to make primary care a more attractive place but we need to address the large issue of why the system is broken rather than just make it more lucrative to work within that broken system. Extra pay, needless academia, sub-interests, etc, isn't a solution.
(edited 9 years ago)
Original post by Okorange
I think its a challenge in terms of workload as well but I think there are more opportunities for change if you worked in a hospital.


Sorry.. we'll have to agree to disagree. Secondary care treating existing medical problems. Primary care preventing medical problems. Which has the greater opportunity to effect change?
Original post by harryflashman



This is a response I've noticed frequently from GPs/GP trainees and med schools...

I don't think Okorange was suggesting that GPs don't work hard or don't get the short end of the stick at lot of the times, rather, I think he/she was implying that the specialty doesn't align well with the specific challenges he/she is seeking in a medical specialty.

I don't get why such a statement so frequently meets with criticism. I sometimes feel that I have to suppress any hint that I am disinterested in a career in GP or else be viewed by my med school as a medical student resistant to being 'molded into shape' by the training process. I think it ties in with what others have said about a drive to increase throughput into GP (my med school feels overwhelmingly GP-centric in its curriculum (I'm very junior though - maybe a false perception)). I certainly agree that the application process (in my experience) is massively weighted towards picking up potential future GPs - there was a MASSIVE bias towards exploring empathy, etc, over exploring academic potential.

It's strange - mention that you're not particularly excited by surgical specialties/medical specialties/path/rads, etc, and nobody bats and eyelid... Express a disinterest in a becoming a GP and suddenly you're on the end of a knee-jerk reaction. I've never seen a surgeon get upset because a med student was, using okorange as an example, "...interested in research and I really like seeing rare pathologies, and diagnosing patients and the intellectual aspect of medicine" and therefore would never dream of pursuing surgery over, say, pathology.


Way to miss the whole point of the original statement and rebuttal. Oko's statement didn't read like he didn't like the challenges.. just a really bad generalization that a GP career is not challenging and his reply to my rebuttal suggests he realised it was a little too general.

It's patently obvious that if you don't like the challenges a particularly specialty brings then don't do it. That wasn't the point though.

As for the massive bias towards empathy as opposed to academic potential.. well when you're picking from a pool of candidates all of whom are intelligent enough to get into medicine, I think you can assume academic potential. However, if you think medicine is not about empathy above all else, then you're going to be a pretty crap doctor no matter how intelligent you might be. At the end of the day, medicine is about being able to understand the pain and fears your patients have. Heal the wound, cure the illness but let the dying spirit go. Without empathy, all you are is a technician trying to heal the physical but you will miss healing the spirit or mind of the patient. At the end of the day what we can do should be constrained by the patient's wishes.. not the other way around. Hence the importance of empathy.
Very interesting to read the opinions on this thread. I'm also a final year, so I've not had my foundation years to 'put me off' hospitals yet... but I've got to say, the only thing about GP that appeals to me is the lifestyle.

The article suggests that people don't get enough exposure to GP placements or that the medical schools are somehow responsible... I feel like we get loads of exposure to GP, relative to everything else. As for the medical school dictating our careers, I'll admit where I am they're always banging on about the 'scientist-doctor' and all that, but realistically very few of us are going to go into research. People still want to be clinical doctors, on the whole. We're continually told 50% of us will be GPs.

GP just isn't interesting as a job to enough people to fill its requirements. I found my placements quite boring, partly because it lacks the buzz of a hospital and mostly I think because I miss being part of a team and doing practical tasks. The fact it's constantly being given a bad reputation and even the lifestyle sounds dangerously like it might be stripped away within the next few years... it doesn't help. There are still plenty of people in my year planning on GP, and I've also met lots of disenchanted specialty doctors planning the leap into GP as well, mostly because they're fed up of the lifestyle and the long training time.

Personally I think what they should look at is - why did current GPs become GPs in the first place?? What was it about 'way back when' that was different, where did the appeal used to be?

One last thing I would add is that GPs themselves often tell you as a student NOT to become a GP - or they'll tell you the best thing about being a GP is all the time they spend NOT being a GP, in their other job doing _____! Then the medical school GP people talk it up so much that it just comes across as a bit desperate. No other specialty (bar Psychiatry) spends loads and loads of time telling you why you should join that specialty and why it's so amazing. They rely on the specialty to talk for itself, and display an interest and excitement in what they're doing, and if you like it great, if you don't then fine. And the stuff the GPs talk up is stuff like the lifestyle (fine by me) but then after that it becomes wishy-washy stuff about communication, empathy... I mean, I see these twin skills everywhere, not just in GP. The idea that GP has exclusive rights to communication skills or being nice to patients is rubbish, you need those for everything! Ironically some GPs (my own, for instance) have horrific communication skills. Then they whip out all these statistics about how many people get seen by GPs, gatekeeper roles and so on, and that doesn't really help either. GP doesn't really have much to sell itself with, has been my conclusion thus far. The idea of being a business owner or involved in some kind of CCG management is also a turn-off (for me), rather than an attraction.

I've still not written off GP, and I don't have any prejudices against it as a hard job... but if I'm going to do a job, I'd rather do one I feel some interest in or a passion for. GP needs to find some kind of 'spark' to sell itself on. Even just GPs seeming to enjoy their jobs would be good! I've only ever had one GP who really loved what he was doing, and he was actually a super inspiring guy.
(edited 9 years ago)
Original post by RosaPonselle
Way to miss the whole point of the original statement and rebuttal. Oko's statement didn't read like he didn't like the challenges.. just a really bad generalization that a GP career is not challenging and his reply to my rebuttal suggests he realised it was a little too general.


It did to me. To paraphrase: "I want the challenge of a career with research, academic rigour, and I like pathology. I don't want to be a GP because it wont give me that challenge and there's little scope to shape the career path to include those challenges".

Original post by RosaPonselle

...However, if you think medicine is not about empathy above all else, then you're going to be a pretty crap doctor no matter how intelligent you might be. At the end of the day, medicine is about being able to understand the pain and fears your patients have. Heal the wound, cure the illness but let the dying spirit go. Without empathy, all you are is a technician trying to heal the physical but you will miss healing the spirit or mind of the patient. At the end of the day what we can do should be constrained by the patient's wishes.. not the other way around. Hence the importance of empathy.



Perhaps I've caught you at the end of a bad day... But well done for completely reinforcing the stereotype that GP trainees have a massive inferiority complex and react to even the merest suggestion that an individual doesn't view the specialty favourably. :rolleyes:

I think the above quote clearly outlines one of the key reasons I wouldn't go into GP for all the tea in China and I'd imagine most others who don't want to feel the same. I just can't read it and take it seriously.

If it truly was a case of 'empathy above all else', well, I may as well quit now and go become a Priest. I'll hang around the local hospital empathising away people's cancer FFS.

Empathy is important. No one disputes that. However, I want a specialty where I can make a huge difference directly using knowledge and skills I've developed through rigorous training. I want to meet my patients and empathise with them and hold their hand after I just saved their life using surgical skills I've busted my ass to learn over a decade.

I'm sorry if perhaps I'm being far too blunt... but why can't I just say 'GP isn't for me. Not enough challenge. I demand more from my career. Give me more'?

Say that to any surgeon and they totally get it - even if you don't want to go into surgery. They just pat you on the back and say 'good on ya Lad, shoot for the stars!'. Say it to a GP and it's "if you don't think like me you're going to be a pretty crap doctor no matter how intelligent you think you might be"
(edited 9 years ago)
Original post by RosaPonselle
Sorry.. we'll have to agree to disagree. Secondary care treating existing medical problems. Primary care preventing medical problems. Which has the greater opportunity to effect change?


I don't think you understood what i meant. I meant change for the doctor. GP's see patients every day and that doesn't change for their entire career. Hospital physicians take on different responsibilities over the course of their career. When you look at the careers of academic physicians, they move hospitals, develop niche interests, they often travel to conferences around the world to present papers or cases or discuss with other doctors. I find that interesting and exciting.
(edited 9 years ago)
Original post by Okorange
I don't think you understood what i meant. I meant change for the doctor. GP's see patients every day and that doesn't change for their entire career. Hospital physicians take on different responsibilities over the course of their career. When you look at the careers of academic physicians, they move hospitals, develop niche interests, they often travel to conferences around the world to present papers or cases or discuss with other doctors. I find that interesting and exciting.


You do get academics in primary care as well though


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Original post by Asklepios
You do get academics in primary care as well though


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But don't they mainly do research into primary care outcomes？
Original post by Okorange
But don't they mainly do research into primary care outcomes？


Yeah I guess, but it can be more "scientific" as well. I mean just recently I was at a lecture about the allergy epidemic which was delivered by an academic GP (not an immunologist/allergist).


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Original post by RosaPonselle
As for the massive bias towards empathy as opposed to academic potential.. well when you're picking from a pool of candidates all of whom are intelligent enough to get into medicine, I think you can assume academic potential. However, if you think medicine is not about empathy above all else, then you're going to be a pretty crap doctor no matter how intelligent you might be. At the end of the day, medicine is about being able to understand the pain and fears your patients have. Heal the wound, cure the illness but let the dying spirit go. Without empathy, all you are is a technician trying to heal the physical but you will miss healing the spirit or mind of the patient. At the end of the day what we can do should be constrained by the patient's wishes.. not the other way around. Hence the importance of empathy.


That's an awful lot of hand waving.

If you poll the public on whether they want their doctors selected for intelligence or empathy, they'll say intelligence. I don't buy any of this 'you only need a certain level of intelligence' stuff. The more intelligent you are, the better doctor you will be. Empathy is important, but secondary.
Original post by Okorange
But don't they mainly do research into primary care outcomes？


Not good enough for you? :tongue: Research is more than just lab work.

There are loads of opportunities for research in the community - strongly disagree with the people implying otherwise.
Surely it just depends what kind of research you're interested in. If you're interested in biological mechanisms, drug development and the underlying science, then that's one sort. If you like epidemiology, public health, medical education and statistics, then that's another. Broadly I don't think it's unfair to say the latter is what you've got access to in GP practices and the former on the whole isn't. And that when people say 'research' it's probably a little vague but I think most people are thinking of lab work.

'Not good enough for you' IMO is unfair. It's suggesting that a person's interests are somehow based on arrogance, rather than genuine, although with a smiley face :wink:
(edited 9 years ago)

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