Those of us who wear spectacles consider "20/20 vision" utterly desirable. The "2020 vision" presented here,* however, is a nightmare that we must strive to avoid.

The story of Dr Zen suggests that several important values have been lost to general practice. Having once been a positive career choice for many medical graduates, in 2020 the discipline is at the bottom of the heap — training in general practice is for "beggars" who miss out on other schemes. No longer valued by other members of the healthcare system, nor practising with any degree of independence, nor able to advocate for her patient, Dr Zen is just a binary drone, condemned to the restraints of protocol-driven diagnosis and algorithmic management. Such reductionism was rejected long before 2020 as a foundation for general practice1 and other branches of medicine.2 Can our elegant craft of hypothesis testing and revision survive alongside the brutishness of digital diagnosis? The primary focus of her attention is the third party paying for her time — what patient would appreciate that? Her clinical independence is severely compromised by the control the Ease manufacturer imposes on her therapeutic decision making. Dr Zen has no supportive collegiate contact, and her supervisors are the sort of managerial bureaucrats who thrive in environments from which general practitioners have been removed. What inspiration for medical students and vocational trainees would Dr Zen's role provide?

Dr Zen's Fellowship of the Royal Australian College of General Practitioners still marks her as being competent to practise as an unsupervised GP anywhere in Australia, and she demonstrates this by moving easily between her outer urban push-button practice and the challenges of practice in an inner urban slum (presumably the future Toorak or Darling Point). At least her apparent comfort in working as part of a primary care team with a nurse practitioner makes it sound as though she has been trained in accord with the CanMEDS 2000 principles,3 which describe the GP as a collaborator among other things.

The strength of GP training in Australia has long been its "enhanced apprenticeship" model, the only logical way to impart the values and skills of general practice. This combination of supervised training and needs-focused education allows registrars to practise in a real environment alongside carefully selected supervisors, while receiving relevant teaching from those supervisors and professional medical educators. Although vocational training for general practice has undergone major changes in the past two years, this model has continued. Our approach to training the doctors who will join us in general practice has a huge impact on the future of the profession. So where could we be in the year 2020, and how many of the positive values of the past will carry through to the future?

The CanMEDS principles, updated, were incorporated by 2020 into a completely integrated curriculum for general practice that guides GP education from undergraduate study through to retirement. This curriculum has enough breadth to address all the disciplines that Dr Zen employs, ranging from population health, evidence-based practice and information management to business management, clinical governance and disaster medicine. Just as importantly, it has the depth to be relevant in any of the contexts in which GPs work, be that in Aboriginal health, a Muslim community, a rural area or the Antarctic. Information technology is a tool in the hands of the competent practitioner, but never a substitute for the practitioner's "presence". Nor does real time access to guidelines and algorithms substitute for the vast amount of knowledge about a patient that the GP acquires through careful communication.

Dr Zen's Fellowship is not the endpoint of her formal learning. She will add a number of graduate certificates, a graduate diploma in preventive women's health, and a master's degree in cognitive behavioural therapy to her brass plate over the next decade. The Corporation values the role of the competent medical generalist, incrementally rewarding Dr Zen for the extra competencies she acquires, uses and maintains throughout her career. An exciting career path with the Corporation includes opportunities to contribute to its quality assurance, research and development program and to its education and training program. As part of its commitment to succession planning, continuing professional development activities form part of Dr Zen's paid contractual arrangements. Her work in the nurse-practitioner clinic is supported by a contract with the government. She enjoys this aspect of her life — different challenges, different demographics and a different team. But her commitment to quality patient care is just as strong.

No taxi shifts for this alternative Dr Zen. Her income is sufficient, her work occupies four days each week by her choice and she has time for her children, friends and social activities.