Changing the narrative of general practice for the better

, writes Tish Sivagnanan.

I chose to pursue a career in medicine because it resonates with my fundamental values: service, science and adventure. And I'm not alone in this decision. Many medical students are driven by the desire to contribute to humanity and make a difference in the lives of others.

On my first day of medical school we were guided through an activity that asked us to write down what type of doctor we wanted to be.

My answer: an empathetic, engaging and energetic doctor.

Yet, my journey as a medical student and as a patient has led me to reflect upon the current state of our health care system.

I find myself questioning whether I am part of a system that truly values, prioritises and enables high quality health care for everyone — a system where I can make my younger self proud.

Workforce concerns

There has been a longstanding geographic and specialty-based maldistribution of health care workers in Australia that has increasingly placed pressure on our health care system.

An underappreciated and undervalued primary health care workforce has exacerbated these pressures resulting in the realities we face today.

General practitioners are struggling to keep services accessible in the community, and doctors in the hospitals cannot keep up with growing health demands.

On my recent relocation to Far North Queensland, I came face to face with the challenges of our current health care system.

I found myself in a situation where I had two options: either wait for a week to secure an appointment at a bulk-billing clinic or pay a significant fee to see a doctor the next day.

Given the urgency of my medical needs, I opted to pay the fee and see a GP promptly.

However, this experience made me realise that if I had lacked the means to afford the fee, I would have been compelled to seek assistance at an emergency department for a situation that could have been adequately addressed within a community setting.

A systemic problem

No one person, organisation or institution can be blamed for the situation.

Our failings within our health care system can be attributed to the discordance in decision making by the various stakeholders within the health ecosystem.

However, we all have an onus of responsibility to work towards sustainably fixing the pitfalls of a system that is failing to serve all its people, with no one left behind.

If we do not take tangible action to address the deficits and shortcomings of our health system at every stage of clinical education and service pipeline, we are inherently facilitating the demise of universal health care within our nation.

Numerous reports have consistently highlighted the disproportionate impact of limited health care access on individuals residing in low socio-economic areas (here, here and here).

As recently as April of this year, the Royal Australian College of General Practitioners confirmed the closure of more than 60 practices within the past four years, exacerbating the plight of vulnerable patients who are most likely to bear the brunt of these closures.

To actualise a society built on the belief that access to health care is a human right, we must act and reverse this trend.

The vital role of GPs

General practices are the most widely used health service.

Data from the Australian Bureau of Statistics shows that in 2017, eight in ten people accessed GP services.

The benefits of having a regular GP are paramount from having a homebase to coordinate your health care needs to consulting a doctor that knows you as an individual, tailoring treatments to best suit you.

Continuity of care through a sustained doctor–patient relationship with a GP has been attributed to better health outcomes and increased uptake of preventive health measures.

Hence, there is no questioning the pivotal role of a GP in the health care of an individual.

Stable, functional and well supported general practices are widely acknowledged as the foundation of a system that truly values, prioritises and enables high quality health care for everyone. It is evident that the establishment of a strong and robust primary health care system is the key to enabling a health system that truly serves its people, a health system that I am inspired to be a part of, a health system we can be proud to promote.

The Australian General Practice Training Program summarises the career by stating that, “Being a GP is not just a highly rewarding, challenging, and flexible career, it's the most important role in Australia's healthcare system.”

Anecdotally, the benefits of a career in general practice are often quoted to be the lifestyle, satisfactions of building long term partnerships with patients, and the ability to practise general medicine while subspecialising in various skills and areas.

On paper, general practice simply sounds like the dream career! However, currently only just over 13% of medical students show interest and/or intention to pursue general practice upon graduation.

A lack of support, appreciation and understanding of general practice has informed a perception of the GP role as an isolating, lacklustre career with little to no recognition, dissuading many medical students and junior doctors from pursing this career pathway.

Recent steps to address these concerns have seen the Australian Government establish and extend trials for the Single Employer Model and a tripling of the Medicare incentive, to institute tangible action in changing the narrative of general practice.

These are welcome steps in immediately ensuring the presence of a health care system that can provide for its most vulnerable people.

Moving forward, we must ensure that sustainable solutions are developed to address the disinterest and prevalent beliefs that exist among health professionals and society at large.

The steps taken in the past six months guide me to believe that I am part of a profession that has recognised the need for radical change.

Whether it be through structural reform to medical education or a rebranding of the primary health care system, there is no doubt that the next steps are multifaceted and will likely challenge the status quo of medical education, training, and the health workforce.

So, to be an empathetic, engaging and energetic doctor … I haven’t lost hope yet!

Tish Sivagnanan is President of the Australian Medical Students’ Association and a 5th year medical student at James Cook University, with a passion for health advocacy.  

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners. 

If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.