Are we heading for a 'Great GP Resignation'?

 

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.

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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

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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.

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More from Professor Stephen Leeder:

• War: The inhuman cost of medical progress
• Should we reopen schools or not? It’s more complicated than that

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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