General Practice, a pre-clinical perspective

A pre-clinical perspective isn't much of a perspective, really. I know a lot more now about the medical careers paths available to me than i did before I started medicine, a lot more. That doesn’t meant I know very much now though, just that I’m not quite as ignorant as I once was. I’ll get to learn the real ins and outs of some of the medical careers next year, when I start my clinical years.

In the meantime there are some things that I do know, and some of those things are worth knowing. What I know about General Practice is that it will offer me a great deal of flexibility to do a great deal of different things, which is kind of a big deal. I know of GPs who have enormous amounts of variability in their work, some of them will spend a couple of days working in a family surgery, a couple of days in a mental health or rehabilitation clinic, a couple of days teaching, and still have a couple of days off most weeks. I won't pretend like that lifestyle doesn't appeal to me.

Then there's everything else. Breadth of medical knowledge, diversity of patients, lasting and meaningful relationships with those patients, and extensive management of their conditions; these are the flagships promoting general practice and they're flagged with good reason, these are the things GPs love about their work. Honestly, the direct interaction GPs have with members of their own community at the primary care level is something I simply won’t get anywhere else. There isn’t another specialty where I might be counselling a patient on their mental health in one consultation and then doing something completely different, like diagnosing and helping to manage a type II diabetic, in the next. What’s more, they’ll be patients I know, I’ll know their social background, probably something of their goals and I’d be building lasting relationships which are meaningfully grounded in improving their health.

The generalist nature is also pretty cool, I’ve yet to study something in medicine I haven’t been massively interested in and, as a GP, I could embrace that generalist enthusiasm without having to confine myself to a specialised area of medicine. Then, if there’s something that does interest me a little more than the daily grind, I can work towards gearing my practice toward that area of medicine, if I feel so inclined. The options are seemingly endless, and that’s something I’m bound to appreciate as my career progresses.

Altogether it makes for a pretty convincing argument but there's still, of course, the flipside of the coin to consider. There are two sides to every story and there’s certainly a side to general practice that doesn’t appeal to me.

One part of that side is that GPs are primary healthcare givers. There’s a lot about primary healthcare I like but there’s also a lot about medicine I like that doesn’t come under a GP’s jurisdiction. Certainly there’s a role to play in managing many a complex and interesting disease but the treatment plans and major decisions will mostly be made by specialists who know better. What’s more, for all the complex and interesting diseases a GP will have a role to play in, there’ll be many more other presentations that are simple, and perhaps even tedious.

Coughs and colds, tummy bugs, and in-grown toenails; there’s a lot diversity to general practice, but there’s also a lot of monotony with many presentations that are simply not all that significant. This contrasts starkly with in-hospital medicine where the patients are seriously ill (even if 90% of the same serious illness) and, as time goes on, will become more seriously ill as the government struggles with bed numbers and baby boomers. Doctors are daily dealing with the aspects of very serious medical conditions that require multidisciplinary, highly complicated and further coordinated care. GPs have this aspect to their practice as well, but I don’t think it exists at quite the same magnitude.

Another of the factors that I don’t feel so enthused about is that general practitioners work in small businesses. The opportunity for career progression isn't there like it is with other specialties and at the end of the day someone has to write up the numbers and balance the books. This is a major drawback for me, personally, because a big part of the reason I decided on medicine was because I couldn't stand business. Of course not all GPs have to deal with accounts and running a business but those who own their own practice do and that aspect of the career is something that is never likely to appeal to me. I don’t think I’m alone on this one either, a good many of the GPs I talk to say the paperwork and number crunching they have to do (largely with medicare) is one of the most frustrating aspects of their profession.

So these are some of things that I’m considering when I think about general practice as a career and undoubtedly they represent a very superficial and uninformed version of all the issues involved. That’s ok though, I’ve still got plenty of time to work this decision out. There is one issue, though, that I probably need to factor into this debate; what kind of a choice will I have?

With the coming influx of medical graduates set to flood the junior medical workforce and raise already competitive fellowships to new and quite possibly unattainable heights will I be in a position to secure the training program I want? In reality general practice may represent one of the few career pathways who’s way isn’t obstructed by the ever-increasing demands competition is surely set to place on the application process. This is definitely something to think about because, of the coming medical graduates, most of us must surely end up in general practice even if it isn’t our first choice of medical career

And this is where I start to wonder how other people see the GP dilemma? What are your thoughts? Are you super keen on being a GP? Are you dead against it? What role will competition play in your decision? What role will lifestyle play?