About 40 years ago, I shared lunch at a restaurant
in London with our then federal Minister for Health. He asked me how I felt
things were among Australian doctors.
I told him of two disaffected colleagues who
planned to leave: one to pursue a career in IT, the other in macrame.
The minister, a staunch adherent of the ‘dry’
persuasion, set his cutlery aside and smiled.
“That’s splendid news! Now they’ll be doing
something productive instead of draining the national budget!”
Of course, flexibility has always been hailed as
one of medicine’s splendid features, allowing doctors to pursue interests beyond
clinical practice — in research, education, politics, journalism, the law,
ethics, religion, administration, management, commerce, literature, art and
music.
Positive opportunities for diversification have
always been there. But what we are seeing now is a different, worrying shift in
medical careers.
After two years of highly stressful work in the
pandemic, doctors are voicing discontent, with a growing number recognising
they are burnt out and need to stop and change direction to protect their own
health and wellbeing.
Read more:
- 'I'm so tired of work, I fleetingly hope for mild
COVID-19 - and a week off'
- GP receptionists quit as patient abuse worsens
GPs are cases in point. In fact, if I were the new
federal Minister for Health, I would be focusing on whether we’re heading for a
‘Great GP Resignation’.
The specialty has been central to Australia’s
successful COVID-19 response, especially in managing widespread community
anxiety and depression, as well as the rising burden of long COVID.
A refreshed awareness has come to us of the
damaging health effects of marginalisation and inequity in our communities.
However, GP numbers have not grown alongside
demand, and many areas of the country (not just rural ones) are reporting
serious doctor shortages.
This is owing to a combination of fewer medical
graduates opting to train as GPs and the Federal Government’s slow squeeze on
the overseas doctors’ pipeline.
This double hit has been compounded by a
pandemic-forced stressful IT evolution in primary care, which has seen GPs
coping with a wholesale shift to telehealth and other digitally altered
practices.
The impact of telehealth alone has been huge. A
recent study by a University of Sydney Master of Public Health student
estimated that more than a quarter (28.8%) of Australians aged 15 and older had
had a telehealth consult between July 2020 and June 2021.1
That’s a whopping 5.8 million people, according to
the Australian Bureau of Statistics Patient Experience Survey.
Many of these consultations have been with GPs. But
while patient satisfaction has been found to be high, we do not know how
acceptable they’ve been to GPs; we have no peer-reviewed research.
However, a recent AusDoc survey found
experiences during the COVID-19 pandemic had negatively affected three-quarters
of GPs’ enthusiasm for their job.
Of the almost 500 GPs and GP registrars who took
the poll, 75% said the pandemic had sapped their love for general practice,
with only 5% saying it had improved their enthusiasm for the role.
And two-thirds (64%) said working during the
pandemic had negatively impacted their personal relationships, including with
their family.
You
wouldn’t blame any GP if, after all this, they upped and left — or at
least reduced their hours.
There are other worrying anecdotal indicators too.
Writing in AusDoc in May, Professor
Simon Willcock recounted how a group of young GPs had told
him they were planning to leave face-to-face general practice because the
demands and expectations were unsustainable.
Many older GPs who are nearing retirement are not
planning on hanging around either, as revealed in the blogs and comments
on AusDoc.
Meanwhile, GPs and doctors in other countries who
are under the same immense pressures have already started to respond with their
feet.
According to the chair of the British Medical
Association England, Dr Farah Jameel, 400 full-time GPs have left the nation’s
health service in the past year.2
That may not sound like a lot — given there
are 28,000 — but the trend is concerning.
More from Professor Stephen Leeder:
- War: The inhuman cost of medical progress
- Should we reopen schools or not? It’s more
complicated than that
And around one in four US physicians intend to
leave their current practice in the next two years, with almost one-third (31%)
planning to reduce their clinical work in the coming year, revealed a survey of
more than 9000 doctors in December last year.3
The situation has triggered big global questions
about the future of the general practice workforce and what changes are needed
to ensure it remains sustainable.
High-level queries include, what do we, as a
society, expect from general practice? What can it uniquely provide? How well
suited are our various forms of care? How do we organise primary care to meet
the needs of different communities?
Also pressing is how will the specialty evolve to
satisfy the legitimately changing expectations of new generations of medical
graduates?
The pandemic and new technologies have unfrozen
established patterns of professional and business behaviour in general practice
— what ways can it adapt and innovate?
Resilience
will be required in spades to manage more disruption, and coming at a time when
GPs are already burnt out, this is going to be extra tough.
But if rethinking what it means to be a GP is required to ensure the job is attractive — and so sustainable — for the future, then we must be ready and prepared to confront it and lend energy to finding the right answer — for patients and practitioners alike.
Professor Leeder is an emeritus professor of public
health and community medicine at the Menzies Centre for Health Policy and
School of Public Health, University of Sydney.
Published in The Medical Observer
20 June 2022
