The Federal Government released the Strengthening Medicare Taskforce report earlier this month. Here, GPRA President, Dr Karyn Matterson, talks about the missing piece – reform that is needed to attract and retain more doctors to the general practice specialty.
Much of the discussion about addressing the crisis in general practice has focused on what can be done to bolster our underfunded Medicare system.
As a GP I support moves to fund our neglected Medicare properly. The Commonwealth’s Strengthening Medicare Taskforce report includes some positive aspects but more action is needed if we are to secure the viability of general practice.
As the president of the peak body representing GPs in training, junior doctors and medical students, l am concerned that fixing Medicare will not be enough to make general practice an attractive career choice for junior doctors. I urge the Federal Government and policy makers to look further to consider what must be done to attract more junior doctors to this specialty.
The government can start by making two key policy and investment changes.
The first is to supplement all GP Trainees wages which are paid by GP practices investing in the future workforce. This supplementation serves to top-up GP trainees’ salaries to achieve parity with their hospital trainee colleagues and will attract more medical graduates to the specialty.
The second is to fully fund International Medical Graduates (IMGs) and reduce the red tape that prevents them practising medicine. IMGs are a vital part of our GP workforce, especially in rural and remote Australia, but do not receive enough support as they undertake training in Australia.
Figures from the Medical Deans of Australia and New Zealand tell us that less than 15 percent of medical graduates are choosing general practice as their preferred career. Last year the Federal Health Minister Mark Butler called this the most terrifying statistic in health care.
Junior doctors see that general practice is undervalued and underfunded so, increasingly, they are choosing to work in other specialties.
Junior doctors saw the heroic efforts of our frontline workers during the pandemic: GPs responding to the urgent call to action to deliver mass immunisations and ongoing treatment, and the specialist GPs who established respiratory clinics. Junior doctors want to be part of this incredibly rewarding work, yet they simply cannot afford to switch to the GP specialty because they won’t be paid enough when they enter the training program.
GPs in training are concerned about the current state of Medicare. But they are also worried about other systemic barriers that have contributed to this declining interest in the general practice specialty.
GPRA regularly surveys GP trainees. They consistently tell us that pay and employment conditions during their training years are their biggest concern. GPs in training earn less than registrars who choose other specialities and remain in the hospital system to complete their training.
Our analysis shows that on average, junior doctors take a 12 percent pay cut when they finish their in-hospital training and begin their first year as a GP in training.
At General Practice Registrars Australia (GPRA) it is our strongly held position that GPs in training should receive a base-rate salary that is at a comparable level to their hospital-based colleagues and their leave entitlements must be improved. Specifically, GPs in training do not have access to portable benefits such as paid parental leave, accrued annual leave or long service leave. A profession that recognises work-family balance will attract more doctors to deliver vital primary care for patients.
GPs in training are a critical part of community-based health care. After four to six years of medical school they train in the hospital system for a minimum of two years, gaining experience in general medicine and specialties such as emergency medicine; they go on to complete compulsory placements at GP practices as part of their training. When they arrive at a practice as a trainee, they are ready to see patients; they are an asset, bolstering practices’ consulting capacity.
They often cover after-hours and weekend shifts, and they are frequently the doctors attending aged care homes to provide care. They also tend to be enthusiastic, unjaded and eager for experience working with different cohorts of patients.
At a time when Australia is recognising the central role that GPs play in supporting the NDIS, Australian and Torres Strait Islander communities and ageing populations, it does not make sense to overlook GPs in training. Losing more junior doctors to other specialities will have many implications for our communities, especially the most vulnerable Australians.
There are many positives about general practice, and I recommend it to junior doctors. It is the best specialty there is. As GPs we often see individual patients over weeks, months or years – “cradle to grave” medicine – allowing us to provide holistic continuity of care and build relationships. We can pursue our special interests by completing extra training in sub-specialties and we work together in a supportive environment.
But general practice is at a crossroad. There has never been a more critical time for the Federal Government to step forward and directly support training in the specialty of general practice.
Yes, fix our broken and neglected Medicare system. But attempts to solve Australia’s GP workforce crisis will fail unless inequitable employment and pay conditions for GPs in training are also addressed as a priority.