Feature

Who’d be a GP now?

As the government announces plans to recruit 7,000 more doctors, Sylvia Myerson talks to GPs in training about their changing attitudes to the job

In the ‘X’ generation, according to one analyst, ‘a job is taken with the sole intention of staying only for a limited period of time. The intention is usually to raise enough funds to partake in another, more meaningful activity.’

I selected four GPs to begin a pilot study of current attitudes to work among trainees. Three of these were London academic training scheme GPs at the Royal Free Hospital School of Medicine and the fourth was a woman involved in training recent graduates on a scheme which aims to persuade GPs to work in her area, West London.

The trainee GPs did not want permanent jobs for the next 30 years. They all required a lifestyle with greater flexibility. Diana, a young doctor with a small baby, said: ‘Some people still want to be full-time principals — there are a few of them — but most want less commitment than that. It still feels like a huge step. I don’t want to think this is my job for life or this is my life mapped out for ever.’ Diana’s perception of patients’ attitudes was, ‘I think that families have changed, the demands from general practice have changed; most people want instant access to someone who will be competent, they don’t feel they need instant access to someone they know terribly well who brought them into the world’. She suggested that continuity, although still important, was no longer the most important requirement. ‘The fact that your GP is fresh and refreshed and enjoying themselves is much more important,’ she added. ‘I enjoy my patient contact and I think I can build up a very strong relationship with people over a matter of months — they are a significant part of my week now — I enjoy it because it’s limited. It’s quite different to doing it everyday.’

A similar attitude was reflected by Leon, another young LATS registrar: ‘I personally know that for me after five clinical sessions a week I can’t maintain the emotional energy and interest in patients that I want to be able to, I can’t maintain that while seeing 100-200 patients a week or 40-50 in a day, five days a week.’ Leon disagreed slightly with Diana’s perception of continuity of care. He argued that doctors did lose some contact when they worked part-time. ‘However, if I did more of it everything suffers. I have so little energy for individual patients, for me half-time is right. If I were a GP working full-time I wouldn’t see my children at all.’

Martin, a 30-year-old GP, had previously worked in an inner-city London area before opting to do an MSc in primary care and work part-time in general practice. ‘I’m not sure I can actually sustain full-time practice for the next 35 years.’ And again: ‘I want to do general practice but also maintain an interest by doing something else, hopefully this will be doing an academic career. I now actually enjoy going back doing sessions because I’ve had a chance to think about things. You have an opportunity to look up things you see which are interesting.’ Martin felt there may be a downside to working part-time: ‘I don’t think I’m as good at diagnosing the rashes as I was, you are not as up to date.’

Financially there were problems due to these changes of work practice. For Martin, ‘if I’d gone straight through and now been full-time, I’d be 25-50 per cent better off but I haven’t huge financial responsibilities — it must be a real deterrent to people with young children.’ Diana also noted, ‘it restricts you enormously financially, your earnings are pretty limited, but that’s something I’m prepared to let go of if I’ve more control over my life. You have to manage your finances more accurately but even if you pay me twice as much I don’t think I want the commitment.’ She added, ‘I don’t want to get like doctors in their 50s and 60s who are completely burnt out — I want to enjoy it.’

These ‘X’ generation GPs’ attitudes are taken seriously by Anita, an older doctor, who is part of a scheme targeting ‘recent young graduates’ in an attempt to persuade them to work in her area of west London. She said: ‘I think it’s important that young doctors know that it’s not a matter of that you just finish your training and you become a principal and you stay there for the next 35 years.’

She added: ‘I don’t know quite why it has changed. When we (her husband is also a GP) went into general practice all the best people wanted to be GPs, then the new contract (1990) came in and the feeling was “Oh, general practice is a bad move now”. A lot of medical students think it’s easier now to become a consultant, everything will be fast track, why go into general practice?’ She laughed and added ‘Consultant jobs aren’t what they were, it’s not an easy life.’

When Frank Dobson thinks about another 7,000 extra doctors, does he realise that doctors’ work, and their attitudes to work, are not what they used to be?