Work intentions and opinions of general practice registrars

To the Editor: The work intentions and opinions of general practice registrars are important in estimating the future supply of Australian general practitioners. Declining popularity of general practice has led to entrenched, long-term shortages (especially in rural areas),1,2 with 700 new entrants annually — well short of the 1100–1200 required to meet community needs.3 Between October and December 2008, we mailed questionnaires to 147 GP trainees (69% women) registered with Western Australian General Practice Education and Training, asking about their career intentions and opinions. Ethics approval was obtained from the University of Notre Dame Australia Human Research Ethics Committee.

The response rate was 61% (89/147). Seventy respondents were women (79%). Median age of respondents was 30 years (interquartile range [IQR], 28–35 years). Most had graduated in Australia (82%, 73/89) and most between 2000 and 2006 (83%, 74/89). Twenty-nine per cent (26/89) made their career choice in the first 2 years after graduation, while others decided in their third year after graduation (26%, 23/89), or later (24%, 21/89); medical school was the next most common stage at which respondents made their choice (20%, 18/89). Forty of the 89 registrars (45%) were working eight or less sessions per week; 34 (38%) were working more than eight; and 15 (17%) had not yet started work.

Registrars favoured rural, outer metropolitan and metropolitan areas equally as practice locations (Box 1). Becoming a practice principal was not a priority, probably reflecting respondents’ current training status and uncertainty about the future. Low numbers were planning to undertake home, nursing home or hostel visits.

Using a five-point Likert scale, respondents rated flexibility and better lifestyle of general practice as major influences on their career choice (median score, 5; IQR, 4–5). Appraisal of own skills and aptitudes (median score, 4; IQR, 3–4) and intellectual influences (median score, 3.5; IQR, 3–4) were other important factors. Twenty per cent had converted from another specialty. Reasons for changing specialty included work demands and stress (50%) and career flexibility, lifestyle and family reasons (33%); in previous research, these were found to be key determinants favouring general practice as a career option.2

Obstacles to general practice selected by respondents were, in descending order of frequency: increasing bureaucracy, workforce shortages, the poor image of GPs and poor remuneration (Box 2).

Increased exposure to general practice via rural clinical schools and clinical attachments as a medical student and pre-vocational doctor has been shown to be a positive influence on future GP career choices.2,4 We found the first 3 years after graduation were the most important in making career decisions, supporting earlier research5 and highlighting the potential benefits that exposure via the Prevocational General Practice Placements Program (PGPPP) brings to general practice. Suggestions that the PGPPP be open to Australian medical graduates in their first and second postgraduate years2 deserve support.

Despite survey limitations of sample size and an over-representation of women registrars, our findings reflect the views of 60% of current WA GP registrars. Fifty-one per cent planned to retire at 65 years or above, and 44% planned to retire before then, with the rest unsure. Involvement of experienced GPs in health care delivery is also waning (as we outline in Retirement intentions of general practitioners aged 45–65 years).6 Recruiting and training new doctors in sufficient numbers to replace retiring experienced colleagues is critical in redressing the balance and meeting future workforce demands. Strategies to make general practice a more attractive career option for new doctors deserve increased priority if general practice is to remain a competitive discipline.

2 Factors considered by general practice registrars to be obstacles to general practice* (n = 69)

* Percentage frequencies of the 69 participants who gave answers to the open question “What do you see as the major obstacles to general practice in Australia?” When more than one response was given by an individual participant, each response was coded and counted separately.