BJGP: who wants to be a GP? Not very many apparently.

This BJGP paper asked young doctors about their intended future speciality.

The study sent participants questionnaires 1 year and 3 years after they qualified. The cohorts of 2000, 2002 and 2005 were chosen and every doctor from every medical school in the UK was included in the sample. The response rate was 57% after year 1 and 63% after year 3.

The results suggest that the proportion of newly graduated doctors that want to be GPs is only around one-fifth. Yet the Department of Health expects around half of them will end up being GPs. Why the discrepancy? Are young doctors opposed to general practice? Do they regard general practice as a second-rate career choice?

Interestingly, the highest rates of choice of GP as a career were found in the new medical schools (Peninsula, Brighton and Sussex, Hull York, East Anglia and Warwick) at 27.6% and 61.5% in years 1 and 3 respectively. The lowest rates were at Cambridge and Oxford. Only 10.9% of Oxford doctors had GP as a first choice 1 year after graduation compared with the highest figure of 31.4% found at Peninsula.

The authors state (in the slightly elliptical fashion so beloved of authors):

Further study is required to understand the reasons why a career in general practice is wanted by many fewer newly qualified doctors than the NHS needs. Such a study might consider the extent to which the level of choices for general practice in different schools may reflect the different entry aspirations and characteristics of their students; and whether it reflects the degree to which intentions are moulded by undergraduate experiences and the content of teaching and training.

I think it is likely that (ignoring for a moment the influences suggested by the Sutton Trust’s findings) Cambridge and Oxford select some of the most academically gifted students in the UK. I suspect many of these students believe that hospital specialities are the most important medical specialities and they aim for those.

Perhaps one of the reasons they believe that (and perhaps it could simply be true) is that they have old fashioned curricula. There is little in many courses to disenchant medical students of the view that hospital specialities, preferably those found in a tertiary centre, are the pinnacle of medicine. The old-fashioned curricula place a high premium on didactic learning whereas new curricula are highly community-orientated and more likely to encourage students into community medicine options. In addition, the new medical schools have admission policies that are less academically inclined and encourage wider participation and recruitment.

I don’t think many doctors come to general practice as some expression of failure. I’m heavily involved with organising GP placements for undergraduates and we tend to get universally excellent feedback about the placements. Students value the time they spend in general practice.

The adrenalin buzz of hospital medicine fades for most people as time goes by. Every now and then I like to get up early enough to watch the sun coming up over a distant hill but there are only so many times I wanted to do it when gazing from the window of an acute medical ward. It’s easy to start to think that perhaps one’s work-life balance could be adjusted and general practice offers some hope of a satisfying career and a home life.

It remains important to ensure that doctors get good exposure to primary care and community medicine as undergraduates but despite the ongoing imbalances in many curricula I’m not sure it is too worrying that doctors’ early career choices don’t reflect the long-term outcomes. That’s the thing about general practice. It’s a grower.

Lambert T, & Goldacre M (2011). Trends in doctors’ early career choices for general practice in the UK: longitudinal questionnaire surveys. The British journal of general practice : the journal of the Royal College of General Practitioners, 61 (588), 397-403 PMID: 21722447