Is general practice vocational training at risk?

To the Editor: It is fitting for the Journal to recognise the crisis facing Australian general practice (7 July 2003).

Every thinking person in the profession knows general practice needs to alter course if it is to survive. They are not lulled by the widely touted sophistry of practice accreditation, vocational registration, “cookbook” talk of disease management and other distractions.

However, nothing in the contributions gave me hope for the future of general practice and the community it serves. To paraphrase, Australian general practice is really a specialty, requires postgraduate training as long as that of rocket scientists and needs to be even more dependent on government involvement. It had also better look more like a specialty by doing some research.

General practice training may suit the training industry and government, but does not look like producing better doctors. The product looks like a medically qualified hybrid between a social worker and a case manager, something that may titillate government but does not appear to impress the rest of the profession.

General practice training relegates to the past the absolute necessity of acquiring the sharpest clinical skills as a diagnostician, and fosters instead the mantra of “better communication skills” and, worse, a disdain for core knowledge.

The political nature of this training does not appear to fool potential entrants, who are shunning general practice, nor does its professional façade fool some of our more astute medical leaders.1

But the plight of general practice is posing a hidden danger to the whole profession. The move away from core knowledge in general practice has inspired a “dumbing down” of the profession that is now influencing undergraduate medical education. Under the guise of “problem-oriented learning”, core knowledge is being seriously neglected, such that physiotherapists and nurses will soon be better trained than medical graduates.

I believe grassroots general practitioners (not their myriad representatives) need to rebel against government involvement in their professional training (ie, the Royal Australian College of General Practitioners) and reaffirm their “medicalness”. We can not be professionals and have governments determine our future, as suggested by Kidd of the RACGP.2

Australian general practice should look now to the august independence and academic robustness of the Royal Australasian College of Physicians to give us a new flag — not one of specialty, as we are not specialists, but one of independent professional standards and allegiance.