Institutional snobbery prevents general practice from being a desirable career choice

Originally published 1/5/15

http://bjgp.org/content/65/634/253

I have to admit that I only considered a career in general practice with reluctance. This now seems ridiculous, as embarking on GP training has been the best decision I have ever made. Throughout medical school and foundation training I was convinced that my career path lay in surgery, however, a last-minute decision, involving the consideration of lifestyle and career progression, meant that I ended up training as a radiologist. But after merely 3 months in the programme I resigned, primarily because of the lack of patient contact as well as my need to engage in meaningful relationships and daily interactions with patients and other healthcare professionals.

So, I was left with a decision. What area of medicine would allow me to fulfil this yearning for patient contact combined with my love of a clinical conundrum? There are many specialties which offer this, so I decided to locum within various specialties to find out which one worked for me. After 18 months I was still none the wiser, and that’s when it dawned on me; there was one area of medicine which offered everything I wanted in a career, and wouldn’t force me to commit to just one specialty for the rest of my life. So why was it so difficult for me to consider being a GP?

The problem begins at medical school; students have little exposure to general practice, and never gain a full understanding of the work of primary care doctors. The amount of time spent in hospital heavily outweighs time spent in a GP practice, and this continues into foundation training, where general practice can be completely avoided. Furthermore, from my experience, although I met lovely, approachable GPs, there were few demonstrating a passion for their job, and I rarely recall being encouraged to consider this career path. This differs wildly from the attitude of specialists who seem to live for their job, and are seriously keen to encourage juniors into their specialty.

Another powerful deterrent is the media portrayal of GPs, often describing them as overpaid, underworked, bad clinicians making unwise decisions and putting patients’ lives at risk, while poorly managing practices and the NHS budget. Rarely do you read a positive story about patients’ experiences of their GP, but rather there are numerous accounts of missed diagnoses and greedy doctors earning £250 000 per year. It takes a brave young person to put themself in the middle of this media storm when such controversial things are being said about your colleagues.

Having got over these hurdles, I nevertheless felt that general practice could have been a feasible career choice, but something was still holding me back. I made the decision to apply for the VTS scheme despite my reservations, but it was only during my hospital-based placements that the source of my apprehension became clear; I began to notice the institutional snobbery regarding GPs. Comments such as ‘its such a waste’, or, ‘you’re too good’ were banded about regularly by specialists when they learned that I was a GP trainee. Such statements are intended to be complimentary, but it belittles general practice, and one’s decision to become a GP. Why are GPs considered as less intelligent, less skilled, or less valuable than secondary care doctors? Why are the broad knowledge, expertise in communication, and the juggling of minimal resources to get the best for your patients not skills enough to earn the respect of specialists?

The world of medicine can, in its very nature, be extremely competitive, and juniors often have a need for approval from colleagues and senior staff. So, for me, this is the most significant barrier to choosing a career in general practice. How can you choose to spend your life doing a job that is not respected by your colleagues?

The solution lies in more education about general practice, not just for students, but for all doctors, and in turn, to breed a mutual respect between different specialties and an understanding of the skills and qualities that each of us can offer. Only then, can we stand up and proudly state ‘I am a GP trainee’.

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