To the Editor: The article by McGrath and colleagues summarised neatly the challenges facing medical education in Australia.1 One solution suggested by Crotty for meeting the training needs of medical students at a time of increasing student numbers and decreasing numbers of hospital inpatients is to move a greater proportion of medical education into the community.2 Internationally, many medical schools are adopting a more community-based curriculum,3 while in Australia, students are spending a greater proportion of their time in general practices and other community settings.

However, community-based education should not come cheaply. Many general practitioners have been hosting students in their practices for years, and are motivated to do so because of an interest in education and the stimulus provided by students in keeping up-to-date.4 Rarely are they solely involved because of remuneration. While there are payments for teaching, these do not reflect the time and loss of earnings that GPs incur in providing attachments.

If GPs are to be asked to be more involved in the undergraduate curriculum, there should be a true costing of the process. GPs who teach students are often involved in vocational training of GP registrars and, from this year, in supervising interns in general practice through the PGPPP (prevocational GP placement program). I am concerned that we are approaching full capacity, and that finding quality GP placements for all these students and junior doctors will become very difficult. One solution for practices that provide a substantial amount of training would be to pay them enough to employ an extra doctor either to carry the teaching load or free up others to do so. However, even if there was the funding for this, at present, there is a shortage of GPs to provide patient care, let alone education.

There certainly needs to be a rethink in relation to the prestige given to clinicians who teach, adequate training in education for clinical tutors, and the necessary resources to provide good learning experiences. Not only do I believe that all medical students should have the opportunity to work and learn within general practice, but that all junior doctors should have at least one attachment in the community. GPs will need support, training and space to offer this, and we should not continue to rely on their altruism to support medical training.