My mother would come home after a grueling session in general practice frustrated and exhausted. ‘Never become a GP!’ was the essence of her advice to me on these occasions. Also, that I should become a piano teacher. She warned of ungrateful patients, obstructive bureaucrats, lack of respect from the general public and a high stress working life.
However, she is still a practicing GP. And here I am, also a GP. I didn’t set out with the intention of following in my mother’s footsteps, nor to be contrary in doing the very thing she advised me not to. I ‘came down with’ the usual idealistic aspirations and ideas of self-sacrifice. I wanted to be a grassroots generalist, delivering babies, being on call and charging to the rescue, working for MSF in regular stints.
And whaddya know! I can see first hand that everything my mother said was true! There are days when I churn through a difficult caseload, run late, deal with complex medical and social problems while under fire, try to keep my cool in the face of angst and direct verbal attack (with varying degrees of success), wrestle with bureaucrats, conquer a tower of paperwork… then pull into the drive at 7.30pm having missed the baby’s bath and bedtime. Those are the days when I wonder why anyone would be a GP.
Do I regret doing general practice, or even doing medicine in the first place? Absolutely not. It has been a rich and for me, an inevitable journey. I would have regretted not doing it. However there have been times I have thought of giving it all up. When this happens, after extensive rumination I invariably come to the conclusion that no, it really is exactly what I want to be doing. It does take its toll though, and for me the cost of working full time in general practice was too great. It is a wonderful thing to be always available, to shoulder the load at your practice and provide ongoing care, be a proceduralist, work in the sticks, save the world. However, it is something I have concluded is not a good idea for me. So I work four sessions a week and supplement it with procedural work, teaching and writing.
The most rewarding aspects of general practice for me are as follows: being the first port of call, knowing a bit about everything, seeing a vast array of personalities at all ages and feeling useful.
The least rewarding aspects are as follows: being the first port of call, having to know a bit about everything, seeing a vast array of difficult personalities and feeling useless at times.
Jokes aside- general practice is not an easy job. It is not the field to enter as a default option, when you conclude that other specialties are too difficult. Considering the amount of knowledge required, the responsibility and the high workload, it is a poorly remunerated profession. The income of a general practitioner is no longer as attractive as it once was, in part due to the slow to increase Medicare rebates, the expectation of bulk billing and the rise in indemnity premiums. It is no wonder medical graduates are opting to train in other specialties, though general practice is where the bigger need lies. The government has tried to increase the availability of GPs by simply opening more medical schools, without measures to make general practice a more attractive option for our junior doctors.
The Australian GP is reliant on the MBS to make a living. Giving good, thorough care is less financially rewarding than churning through fifty patients a day. We are not paid for our time. The hours of paperwork at the end of the day is considered by Medicare as ‘part of the consultation’. If you add up the time you spend caring for the patient without that patient in front of you, our hourly rate is even lower than it first appears. I have decided to give good care and be paid less rather than ‘adequate’ care and be paid more. Does this sound fair to you?
Of course this could change if GPs just charged whatever we wanted, include charges for phone calls, reports, printing and copying, checking results, hours spent mulling over diagnoses- but we are a compassionate lot. I will bulk bill a pensioner, a child, someone who is very sick (kind of as thanks to them for seeing me for a truly legitimate reason), someone who I think deserves a break… So I don’t complain about my earnings. I just don’t expect to make a good living this way.
The GP can feel under appreciated. Patient, community and government expectations of us seem to ever increase, while the level of respect and appreciation drops.
Allow me to provide some examples.
A forty year old lady comes to see me about her shoulder pain and when we have dealt with that, we talk about a bunch of other problems too. Twenty-five minutes later as I do the ‘stand-to-usher-them-out’ hint that the consultation is nearly over, she asks:
‘Can you bulk bill me today doctor? It’s just that I had to pay the chiropractor $300 today’.
Yes I know. I should have charged her $300 as well. But being a big softie and not wanting to run even later by arguing, I bulk billed her. As I will forever regret.
‘Well what’s causing my pain then?’ asks a patient, who has no fathomable diagnosis.
(I resist handing her the line my mother used to hand us as kids- ‘sometimes things just hurt.’ She was right).
‘I don’t know that we’ll ever know. The important thing is we have ruled out anything serious and we have found good ways to manage your pain.’
‘Well I want to know what’s causing it. I’m going to see my (insert naturopath, tarot card reader, osteopath or alternative spirit guide here).’
‘Well, I’m sure they will tell you what’s causing it, whether they know the answer or not. Then charge you $300 plus GST, plus $80 for their home remedy diluted in a billion parts water to be dropped onto your shoes eleven times a day’.
I’m making this up. I don’t say all this stuff. Maybe I should…? That would deal with my problem of having too many patients to look after…
Anyway I have a lot of examples and I know examples are fun to read. However, I am weary following a grueling afternoon in general practice. Never do this job! Become a piano teacher!
Though, as it was making time to counsel a severely depressed patient that caused me to run late, I did not resent running late today. She needed her GP, and I was happy to be that.