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?

"Do you have what it takes?"

As a general practitioner, you see all age groups from newborn to elderly. You will see people with any illness, disease, or problem.’ (Anonymous)

The above statement really depicts what GPs do on a daily basis. They are the front line of our medical system. They have to be well-equipped to deal with whatever comes through their consultation door. This is important to take note of, because patients visiting their GP, present with their own unique set of signs and symptoms and often do not have a referral letter that details their medical history.

The breadth of knowledge that GPs require during their day to day consultations is astounding. From acute to chronic, GPs are involved with the prevention, diagnosis and management of a great variety of medical conditions. Although referral to other specialists may be sought, the majority of cases are handled by GPs. When specialist care is organized, it is the GP who integrates the opinions of multiple specialists, and develops an appropriate management plan for the patient. It is also the GPs role to assist in monitoring the patient during their course of treatment and beyond, and to initiate any further actions when necessary.

It’s no wonder why GPs are the busiest individuals of the medical profession. Without them, our health system would surely collapse. This is what makes General Practice, an exciting and adventurous career option, but at the same time, a challenging and intellectually stimulating one too. It involves hard work, excellent time-management, aptitude, intelligence and interpersonal skills… the complete package really.

Apart from a stimulating and challenging career, General Practice provides a range of different options to suit individuals that are interested in taking this vocational pathway. Training programs have been designed to ensure that trainees can develop into competent unsupervised GPs, in an urban or rural setting, or both, which several current registrars have decided to do. General Practice offers a great deal of flexibility with work hours and allows individuals to combine work, family and lifestyle to make it a rewarding career. The two GP colleges, RACGP and ACCRM also offer trainees with the chance to ‘up-skill’ in a variety of advanced training programs such as anesthetics, obstetrics, surgery, paediatrics and emergency medicine, provided you practice at a rural post. You end up with your fellowship along with a graduate diploma of your chosen special interest. This permits you to be a GP that can perform the advanced skills that you have been trained in, such as performing a Caesarian.

So it really comes down to this, do you feel like you are capable of the skills required in General Practice? If you are, does the following list excite you about your future medical career?

Being a diagnostician
Staying away from hospital bureaucracy
Being part of the frontline of the Australian medical system
Having the flexibility to combine work, family and lifestyle
Involved in the process of continuity of care

If you answer ‘Yes’ to both, I highly suggest you consider General Practice!

P.S. While writing this article, I gained inspiration from reading the GP profiles on MMC :)

Radiation Oncology Training in Victoria

Vacancies commencing in 2009

Applications are invited from suitably qualified medical practitioners for registrar training in radiation oncology in Victoria, commencing in early 2009.

Radiation oncology is a clinically and technically challenging oncology sub-specialty, for which training is undertaken under the auspices of the Royal Australian and New Zealand College of Radiologists (RANZCR). The duration of training is five (5) years. 2009 will see the introduction of a new RANZCR training Curriculum for Radiation Oncology. Further detail on the new RANZCR Curriculum and assessments is available at www.ranzcr.edu.au

Radiation oncology registrar training in Victoria can be undertaken at the William Buckland Radiotherapy Centre (Prahran and Traralgon), Austin Health (Heidelberg and Ballarat), Andrew Love Cancer Centre (Geelong) and Peter MacCallum Cancer Centre (East Melbourne, Bendigo, Box Hill and Moorabbin). All these radiation oncology departments participate in a single, combined selection process for new trainees.

Registrars entering training in 2009 may be expected to move between training centres from time to time, to gain the best possible radiation oncology training experience and ensure exposure to all the necessary learning opportunities to allow you to satisfy the requirements of the RANZCR Curriculum. Subject to receiving a satisfactory annual review of progress, trainees will be offered a suitably accredited position for the next year of training, taking into account the specific appointment policies of individual health service providers.

From February 2009 onwards, there are various vacancies to commence training at the Andrew Love Cancer Centre, the William Buckland Radiotherapy Centre or Peter MacCallum Cancer Centre.

General enquiries regarding the training program in Victoria should be directed to Dr Matthew Seel (2008 Convenor, Victorian Joint Training Committee) on (03) 96561004 or
matthew.seel@petermac.org. Enquiries regarding the specific details of employment and training experience at an individual training centre should be directed to the Director of Training of that department.

Further information about the application process should be directed to Ms Mary Toye, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, Melbourne 8006. Phone: (03) 9656 1004.

Applications close at 4.00pm on Thursday 17 July 2008

Interviews are scheduled for Friday 29 August 2008. Candidates short-listed for an interview will be notified of the interview details.