eMJA     The Medical Journal of Australia

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Worldwide, there is a new phenomenon — dispirited doctors.¹ They are afflicted with a debilitating disease characterised by disinterest, disillusion and despair. The roots of this disease are embedded in the havoc wrought by constant change and uncertainty, and the inevitable clash between doctors' professional and personal ideals and the changing circumstances of their practices.

Australia has not escaped this disease. That it is endemic in Australian general practice is evidenced by reports of GPs' discontent and despondency.^2,3 They see themselves as overworked, undervalued, unsupported and over-regulated. They are no longer in control.^1-3

This issue of the Journal, celebrating Family Doctor Week, explores some of the crucial challenges facing Australian general practice as it arrives at a defining fork in the road. How GPs and their leaders respond to these challenges will determine whether Australian GPs continue down the road of despondency, or choose a road of renaissance and rid themselves of this malaise.

First, there is the accelerating trend to corporatisation of Australian general practice, and for this issue of the Journal we sought out an eclectic array of views on this development. Catchlove explores the triggers for and potential outcomes of corporatisation;⁴ Sprogis suggests alternative corporate models;⁵ Fitzgerald examines ethical dilemmas;⁶ and Mott provides a pragmatic consumer perspective.⁷

The corporate sector's aggressive invasion into general practice comes as no surprise. It is symptomatic of a global movement in which governments, chanting the mantra of cost containment and consumer choice, have abrogated their public roles and responsibilities to the private sector.⁸

Moreover, as doctors seek "the right balance in life: enough money and enough time off",⁹ medicine is increasingly regarded less as a vocation and more as a job. Any job that promises professional satisfaction in the provision of high quality care, with the added bonus of more time for partners, family and friends, is undeniably attractive. These are the human appeals of corporate practice, which unquestionably has other benefits both for the profession and the community. But clouding these benefits is the uncertainty of the long term effects on professional autonomy and discretionary practice. Crucial questions need to be answered, such as the content of and compliance with corporate codes of conduct, and the precise nature and impact of corporate-doctor agreements. Then there is the uncharted impact on healthcare delivery and funding of vertical integration of general practices with diagnostic and specialist services, hospitals, pharmaceutical suppliers and health insurance organisations.

Ultimately, what will be the attractiveness of such seamless healthcare coverage to governments? These are all questions for the future, but the consequences of unbridled corporatism for our profession are unlikely to be entirely benign. As Milton Friedman, a Nobel Prize laureate in economics, once observed ". . . there is one and only one social responsibility of business — to use its resources and engage in activities designed to increase its profits . . . ".¹⁰

Second, there is the challenge of general practice research and education, which has received little attention in the corporatisation debate. One of the defining characteristics of a viable medical discipline is its capacity to enrich itself through research, and this is sorely deficient in Australian general practice, and contributing in part to the malaise. The reasons for this impoverishment include: