Justin Beilby: Perfect storm or missed opportunity?

In 1999, I was involved in lobbying for the establishment of the first Practice Incentive Program (PIP) for Australian GPs ― the Teaching Incentive.

It was very exciting that the government of the time had finally realised that good general practice teaching was worth rewarding. But what’s happening with this incentive now leaves me really puzzled.

During a period when we have a record number of medical students, it seems illogical not to increase this payment. For what would be a small financial outlay of doubling the $100 per 3-hour teaching session to $200, we are running the risk of compromising the exposure of all our medical students to a crucial element of health care.

Good general practice educational exposure in diverse settings provides the foundation for all students to consider this career option, or to at least gain some understanding of the nature of clinical care in the community.

For many students who follow hospital specialist careers this may be their only community exposure. Where else can you experience team-based care, a diverse clinical mix and a rich array of patients all in one day?

The recently released Health Workforce Australia document indicates that the greatest growth over the past 10 years has been in specialists-in-training (9% to 13%) and largest fall has been in GPs (41% to 35%).

There have been concerted efforts to increase the number of GP prevocational and vocational training places, with a doubling in places. It is unclear if this will translate into a greater percentage of medical students wanting to become GPs in the future.

Worldwide, there is evidence that strengthening primary care with a quality general practice workforce will create more equitable and efficient systems. It is illogical not to expose all medical students to general practice.

With the increase in the number of medical graduates from 1200 in 2000 to an expected 3786 in 2014, more general practices are needed to train our medical students. I have heard anecdotal reports of medical schools offering their own incentives for practices to accommodate students. Some medical schools have had to decrease students’ general practice exposure.

There is already an inequitable distribution of resources for teaching in general practice when you compare funding for rural clinical schools to the PIP payment for outer urban and urban general practices. This inequity is likely to worsen under the current PIP guidelines with the potential that more non-rural practices will opt out.

Eighty percent (almost 3800) of PIP-registered practices do not take medical students. This is an untapped rich educational resource. Health Workforce Australia has just spent millions of dollars establishing much needed new training sites across Australia but has specifically steered away from looking at how to work within the PIP model. It is short-sighted not to look at how PIP can be used more strategically in its planning.

Teaching medical students does cost time and money and these losses need to be compensated. The cost of teaching in public hospitals is now being debated, as the Independent Hospital Pricing Authority introduces its new model of activity-based funding, but failure to appropriately support the already established and successful PIP general practice educational model seems to indicate a loss of perspective.

There is a perception that the increase in medical students has created a perfect storm that our health system is struggling to manage. We need to train all these students to meet our future health care needs. Establishing and appropriately resourcing new general practice training sites for these students could turn a perfect storm into a perfect opportunity to draw more GPs into our educational teams. Doubling the PIP must be supported.

Professor Justin Beilby is Executive Dean of the Faculty of Health Sciences at the University of Adelaide

Posted 13 August 2012