The future of general practice

In its new discussion paper on the workforce and workload crisis – ‘Shaping the Future’ – the ICGP has taken an important step in aiming to build a clear ‘pipeline’ between enrolling in medical school and becoming a GP.1
International experience has found that involving medical students in general practice from an early stage in their studies helps to inspire young students to want to become GPs. Research from other countries such as the UK, Canada and Switzerland 2 has shown that ensuring that student doctors spend time in family practice can help encourage emerging GPs to choose this specialty as a future career.
In its report, the College has outlined an ambitious target of laying down and supporting a clear career pathway from medical student to family practitioner.1
Most Irish medical schools appear to have been actively endeavouring to develop that link. Recently published research in the Irish Medical Journal quantified the relationship between the time spent actively studying general practice during student life at six medical schools and the likelihood of graduates from each the of six medical schools applying for GP training posts. The authors, however, found a marked difference between the six medical schools in their success in inspiring student doctors to want to become GPs. Only one medical school provided 18 weeks of GP learning, while all the others provided between three and four weeks, with one school providing eight weeks.2
Homogenising medical schools to ensure that adequate time is provided for student doctors to be taught in a general practice setting may well help to increase and retain future GPs in Ireland. However, a medical student who has 18 weeks of GP undergraduate learning today might not get to open the doors to their own practice for another 10 years,1 leaving a major gap awaiting to be filled in the primary care service.
The College workforce report estimates that just over 40% of GPs are aged over 60, and therefore bound to retire quite soon. Who will replace them? Women will! Of all registered doctors in 2017, 41% were female. But between 53% of doctors aged 25-34, in other words, the next generation of GPs, are female. This trend is likely to continue, as most international research on medical graduation reveals that an increasing majority of future GPs will be women.
Should the ICGP therefore be actively promoting general practice as a ‘nice job for a woman?’. A dominant theme expressed by female medical students is a sincere concern about how to plan pregnancy, and how to combine family life with a career in medicine. This anxiety does not cease when women graduate to become GPs. Concerns about letting a practice down or being tied down to a business while recovering from childbirth will put talented women doctors off becoming GPs.4
Research on UK medical graduates found that having children is a major influence on specialty choice, especially for GPs.4 Ensuring that general practice is a great job for a woman will mean that our College will need to continue its ambitions to inspire students to become GPs. It must ensure not only that the structure of training posts is securely female-oriented, but must continue to influence the culture and profession of general practice to ensure it is oriented to engage women.
The contractual impracticalities of doctors’ out-of-hours commitments must be restructured to facilitate women GPs. Also, the health, social and intellectual needs of women doctors must be prioritised at all levels of stakeholder engagement in the plans for our specialty to develop a sustainable workforce for general practice in Ireland. 

References

1. Irish College of General Practitioners. ‘Shaping the Future’. October 2022.
2. Murphy A W et al. 2022. Supporting medical students towards future careers in general practice : a quantitative study of Irish Medical Schools. Irish Medical Journal. Vol 115. 9: 671.
3. Irish Medical Organization. 2017. IMO position paper on women in medicine.
4. Lambert TW, Smith F, Goldacre MJ. Combining parenthood with a medical career: questionnaire survey of the UK medical graduates of 2002 covering some influences and experiences. BMJ Open. 2017 Aug 23;7(8):e016822. doi: 10.1136/bmjopen-2017-016822. PMID: 28838899; PMCID: PMC5629622.