At the end of every workday as a busy GP, I feel like I have run a marathon. No – like I have sprinted from case to case. From my current vantage point (I’m on maternity leave) I’ve had time to wipe the sweat from my brow and take a long drink. And what I can see is a health sector that is imploding around us.
Reports of ambulances ramped for hours, bloated elective surgery waitlists, and the decline in care standards across the board fill our newsfeeds daily, no matter which state or territory we are in. And at the epicentre of the issue is the missing GP. Where have they all gone?
One quarter of all GPs plan to retire within the next five years.Credit:Getty Images
Primary care is the bedrock of our health system, and GPs are our labourers. We are central cogs in the machine that is healthcare. If we get jammed, the rest of the system grinds to a halt. We are now seeing this in action after decades of neglect.
Wondering why emergency departments are struggling to meet capacity? It is not just because these people could not get a same day appointment with their GP; part of it is because there is a rise in chronic conditions as our population gets older. We do not have enough GPs managing this chronic care – which is what we do best as GPs. Without a competent GP, these patients get sicker and sicker, very slowly, eventually getting to a crisis point where they have no choice but to be admitted for high-level care in our hospitals.
We hear of patients at emergency departments waiting for hours – half a day or more to be seen – and from there are being treated in dimly lit hallways in the hospital bowels. As a once junior doctor who has been on the other side, I remember feeling overwhelmed watching the triage list grow and grow, knowing there was nothing we could do but churn through patients as fast as we could. We often only provided a band-aid solution to patch them up, a broken system haemorrhaging.
A well-functioning primary care system can help fix all of this. Many of the presentations I saw back then – lacerations, sore throats, chronic back pain, undiagnosed pregnancies, mental health deteriorations – can be managed in a fraction of the time at an even smaller fraction of the cost. As our fearless leader, President of the Royal Australian College of General Practitioners Karen Price recently pointed out, general practice provides 177 million services a year to 24 million people, but receives only 7.4 per cent of the entire health budget. You see, money makes the world go around – and this includes healthcare.
Ambulances “ramped” outside Royal Melbourne Hospital in May.Credit:Nine News
Common sense hasn’t yet prevailed in the ivory towers from which funding is allocated. Fancy hospitals and new MRI machines get more votes than a GP tinkering in their 3 x 4 metre consultation room.
They say the work of a good GP is invisible. It is also immeasurable. It is difficult to ascertain the cost of a life saved by detecting a cancer early enough to avoid repeated hospital admissions, or by managing the diabetes that prevents the strokes/blindness/arterial disease, or by holding one’s trauma in the consult room with weekly check-in sessions just to show that someone cares. We don’t have KPIs for this work.
My heart aches as I read the comments section in my local mums’ social media group. The mythical GP is turning into just that. We cannot do it all – be your chosen GP always available for urgent fit in appointments, at no cost to you, at all hours, for all the time in the world that you need. For seemingly simple tasks, that are almost never as simple as they think.
And this is why the GP-bashing continues. The public finds it hard to understand what we actually do beyond writing prescriptions and medical certificates.
Just like in other industries, there are some bad eggs. Those that nod for five minutes and send you on your way. Those whose eyes glaze over when anything complex or controversial pipes up. They open the door, non-verbal cues showing that when they’re done, you’re done.
What concerns us as a profession the most is the claim that others can work at their “top of scope” to fill the void. Again, this is a clear undermining of what GPs actually do. Pharmacists – who I respect as colleagues in the primary care team – have recently been given the go ahead to prescribe a whole range of medications like antibiotics for issues like urinary tract infections. I’ve heard nothing about antibiotic stewardship – something drilled into us throughout medical training – nor has the clear conflict of interest been declared. Doctors are not allowed to own pharmacies or sell medications, as our treatment choices could be influenced by the profit we could theoretically gain. But somehow pharmacists, at their top of scope, can become play doctors, without the more than a decade’s worth of training GPs go through, without the consequences of poor treatment decisions, without the omnipresent red tape.
Shortages of medications, including fundamental antibiotics like amoxicillin, will only get worse without GPs making the decisions. For we all know that most viral upper respiratory tract infections do not need antibiotics. But they are a quick fix, they get the patient out of the room, they keep them happy. But if we refuse, we are the dumb GPs who did nothing.
GPs are also leaving the profession in droves. According to the recent RACGP’s “General Practice: Health of the Nation 2022″ report, one quarter of all GPs plan to retire within the next five years, and only half of all current GPs intend to still be practising in 10 years time. This is spine-chilling stuff. So many of my colleagues have jumped ship – to cosmetic training or other specialties, to nonmedical careers. There is an ever-dwindling group of us who are left, specialist primary care physicians who stubbornly refuse to give up the field we so love.
The cradle-to-grave medicine that spurred me to enter general practice is never going to change. What will change, however, is how this care is delivered. If general practice continues to be eroded, your care will continue to fragment, a cacophony of voices echoing in the void of a healthcare system left shattered. The once leader of these voices – the GP – will be nowhere to be seen. This has to be recognised, prioritised, and stopped.
You deserve better, and we know that. We need you to speak out for us before we are all gone.
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