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13 Sep 2022, by Amy Sarcevic
A decade ago, half of all medical graduates expressed an intention to enter primary healthcare, but in recent years this figure has plummeted to just 15 percent.
With an already struggling workforce, this shortfall represents a major crisis, according to Dr Konrad Kangru of the RACGP – a speaker at this year’s National Health Workforce Summit.
Amid gross inequities in remuneration between primary and tertiary settings, and dwindling numbers of skilled migrants, Dr Kanrgu believes better pre-vocational opportunities could help entice workers into the sector.
While Federally-funded training opportunities, like the John Flynn Placement Program, already exist, he believes such programs should be better – and more greatly – utilised.
“At present, we are not in a strong position to appeal to graduates – we are losing numbers in droves and can’t replace them from overseas like we used to. The workforce is overloaded and the morale of the sector is in crisis,” said Dr Kangru ahead of his speech at the conference.
“We also have tough competition, with far more enticing opportunities in hospital-based training pathways. The fee-for-service structure in general practice means that doctor remuneration in primary healthcare comes no way near to what a junior doctor will see in a hospital and there are far weaker industrial mechanisms [in general practice] to support them. General practices will never meet the conditions a state health department can offer.
“Against these challenges, however, I believe good pre-vocational training programs can make a real difference. It can show junior doctors just how rewarding a career in general practice can be and better support them into the profession.
“Given the funding structure for general practice, it’s a big change for junior doctors to, all of a sudden, be responsible for the money they generate. The right pre-vocational training could adequately prepare them and make that less daunting.”
AMC prevocational framework
The Australian Medical Council (AMC) has laid the foundations for better GP training, having recently completed its pre-vocational framework.
This comprehensive review of the ‘National Framework for Pre-vocational Medical Training’ has made improvements to the training environment and assessment criteria for PGY1 AND PGY2 programs.
For example, more opportunities for feedback based on observed clinical practice, mandated term supervisor training, and strengthened well-being standards. Additionally, better outcome statements and standards for Aboriginal and Torres Strait Islander people.
Dr Kangru applauds these new measures and says channelling more graduates into these programs should now be a priority.
“It’s important we utilise our pre-vocational training programs fully and give more graduates a taste of life in general practice.
“I am sure they will like what they see. General practice offers better flexibility, more freedom for interstate migration and, often, more attractive working hours than hospital based roles.
“Without first-hand insight into this career pathway, a graduate is more likely to be enticed by the better remuneration in tertiary settings.”
He also believes training programs should be modernised – and not just be about box ticking.
“Yes, we need to adhere to the pre-vocational framework. But quality training is about so much more than compliance. We need to think about how we can develop a 21st century solution that is appealing to a new generation of graduates,” he argued.
Improved entitlements
Beyond pre-vocational opportunities, Dr Kangru suggests improved entitlements could enhance the appeal of a career in primary healthcare – specifically ‘entitlement portability’ and a ‘one employer’ model.
“Under a ‘one employer’ model, if a GP registrar is moving between training posts, their maternity leave, superannuation, and sick leave could follow them around and be protected. That is hugely appealing and may even be more valuable to some people than higher remuneration.
“It could also give general practice a competitive advantage of hospital-based career pathways, which are inherently more restrictive. A registrar working for a state health department might have a much tougher time migrating interstate,” he said.
Further opportunities and barriers
Dr Kangru is due to present on day 2 of the National Health Workforce Summit, hosted by Informa Connect, where he will talk more about the opportunities and barriers for people entering primary healthcare. He says this discussion is well overdue.
“For so long general practice has been calling for reform. More than ten years’ of inactivity has led us to where we are today.
“Interstate migration was a ‘band-aid’, but when that froze up during COVID-19 it exposed a deep wound. We now need to think collectively about how to heal that wound – not simply replaster it,” he concluded.
The inaugural National Health Workforce Summit will talk place 27-28 October at the PARKROYAL Darling Harbour in Sydney.
RACGP Chief Executive Karen Price is also due to present and will expand on this commentary.
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