Choosing general practice as a specialty

Very topical in the news right now are the recruitment rates of trainees into the specialties of general practice and psychiatry.  In the post Amber Appleton Amber  an NIHR Academic Clinical Fellow and GPST4 talks about her experience of choosing general practice and the experiences of other trainees. 

When I began as a GP Academic Clinical Fellow (ACF), I wanted to do something different and was keen to conduct my own research project. I had the idea for it not that long ago when I applied for my current GP training post, and at the same time I also applied for psychiatry training.  I struggled to choose between these two specialties, and although I did not choose psychiatry my interest has never dwindled. I still remember the day I became interested in psychiatry as a medical student when I was taught by an inspiring psychiatrist. Because of this, I wanted to find out what made others choose psychiatry and to explore whether it was also related to their medical school teaching experiences.

By designing and seeing through my own project, the research, teamwork, organisation and communication skills I have gained from the experience have been profound. Marta Buszewicz has supervised me along with Surinder Singh, both of whom have provided invaluable support and guidance throughout the project, which has really nurtured my learning throughout my ACF post.

So, to give a bit of background to the rationale behind the project…

One in four people in the UK will experience a mental health problem each year. The first person they may talk to is their GP who sees most of the people with mental health problems in the community, and then those with the most complex or severe cases may be referred to a psychiatrist if indicated. The overlap between psychiatry and general practice is especially significant as approximately a third of GP consultations are for mental health problems.

As a result, both GP and psychiatry are essential for ensuring good patient care and there is an on going need to recruit competent doctors into these specialties – throughout the UK. Unfortunately, both psychiatry and general practice have been experiencing real recruitment problems with one in three training posts in both GP and psychiatry currently left vacant.

I was interested in exploring some of the factors before, during and after medical school, which ultimately result in trainees choosing a career in psychiatry. I was hoping that this information might help to improve the way these specialties are taught at medical school, which could encourage more doctors to sign up to this important specialty and also potentially improve attitudes amongst all future doctors towards mental health problems.

I designed a web-based survey to explore the views of psychiatry trainees nationally, followed by conducting qualitative in-depth interviews with a group of 21 purposively sampled London psychiatry trainees. The whole research team analyzed the interview findings.

Many trainees said their attitudes had changed after being taught psychiatry at medical school and that the placement influenced their career choice, although the quality of the teaching was very important and some people had not had such good experiences.  A significant number of those interviewed described how doing a Foundation job in psychiatry (a 4 month post in the first two years after graduating from medical school) had had a significant impact on their career choice. Currently only around half of junior doctors do a Foundation year post in psychiatry, but this is under review. Most trainees felt positive about the idea of teaching about physical and mental health problems together during the curriculum, rather than separately (as has quite recently been introduced at UCL Medical School), but it was thought very important that this shouldn’t dilute the amount of psychiatry teaching overall.

One of the main barriers trainees described that they had to overcome when choosing psychiatry was stigma from colleagues/peers and family members. One respondent described the response she received when speaking openly about considering applying for a career in psychiatry.

P5 Female ST7:

I said: “I’m thinking of actually applying for psychiatry as well as general practice.” And she (Foundation year two supervisor) said: “What a shame.”

The “badmouthing of general practice and psychiatry” has been highlighted in a recent BJGP paper (1) as a subtle but important factor influencing graduates’ career choices: quite simply why would a junior doctor choose a specialty looked down upon by other members of their profession?

The psychiatry trainees interviewed had attended a range of UK medical schools and provided a range of recommendations for improving the way psychiatry is taught at medical school, as well as suggesting other strategies to improve recruitment to the specialty.

Summary of the key findings:

1. Medical school placements in psychiatry should be introduced early and integrated throughout the curriculum to help prevent negative attitudes developing.

2. Positive role models and mentors were described as key and there should be greater visibility of prominent psychiatrists within medical schools.

3. Barriers to choosing psychiatry that were described included: the stigma still associated with mental illness and feeling ‘not a proper doctor’, as well as the emotional stress and responsibility involved with decision making in psychiatry.

Recommendations:

• Outreach projects into secondary schools
• Buddy schemes and mentors should be offered widely
• Negative attitudes at medical school towards specialties such as psychiatry and general practice need to be challenged
• More Foundation posts should be offered in psychiatry

Recruitment into the twin specialties of psychiatry and GP continues to be problematic and the key messages from this paper suggest that appropriate interventions are needed at all stages, i.e. before, during and after students’ time in medical school.

The full published paper is now available from BMC Psychiatry 

1. Baker, M., Wessely, S., & Openshaw, D. (2016). Not such friendly banter? GPs and psychiatrists against the systematic denigration of their specialties. Br J Gen Pract 2016; 66 (651): 508-509.