Thread by @exortho

Yes, we are. I am one leaving the profession.

It’s not the pandemic: I have deliberately avoided working in GP during the pandemic.

It’s the lack of appropriate remuneration, respect and time to do our work as we need that has burnt me out 🧵/2

https://twitter.com/brookmanknight/status/1490420686749257732

When I work as a locum GP anaesthetist or in Emergency I get paid 33% more than GP for less than half the number of patient interactions & I am far less exhausted. More money for less cognitive stress? Tough decision (not). /3

I’ve just worked my first day in GP for over 18 months. It took minutes to remind me why I am seeking a career change.
I love the work.
I love the sense of helping people.
I hate the time pressure. 10-15 min to provide top-level healthcare to complex patients? Impossible. /4

The Medicare system means GP clinics rely on throughput for income. F2F interactions were mandatory: now telehealth is permitted but paid at lower rate.
It is impossible to earn an income as a GP that aligns with hospital doctors unless patient care is cut short & compromised /5

- meaning if I want to keep up w appt book I can’t ask the extra questions, give the explanations, provide the public health advice that I have been trained to give.

I am penalized if I take another couple of minutes.
The system rewards mediocrity and cookie-cutter care /6

With every consult I have a choice: provide the quality of care I want to give & be paid less ‘cos fewer ppl seen, or cut every corner and make a decent living tho’ still way less than my hospital specialist colleagues.

The moral injury of this choice accumulates over time. /7

GP is the poor cousin of medicine.
“Just a GP”
The poorest paid specialty.
The specialty with the highest % of women. Coincidence? Unlikely.
Also the foundation of entire health system especially for preventative health that keeps people in their homes and out of hospital /8

The aged care discussion currently being had (listening to #TheDrum right now) also has to be had for general practice.
GPs are burnt out and fed up.
Why would medical students and junior doctors choose GP?
Well, they don’t. Very few are. There is a crisis in the pipeline /9

- in fact, it’s happening right now. Rural towns are heavily reliant on locums, lacking permanent doctors and continuity of care.
General practice is dying and is becoming addicted to higher-paid locums who work for twice as much on a fixed daily rate. /10

I know: I am one of the locums. I prefer to be paid well for my time & effort. I’m reluctant to commit to a permanent role, to be taken for granted by all levels of government, by profession & even by patients themselves.
Part of me wants to: but it makes no financial sense. /11

So what to do? Who knows, but giving greater respect to GPs through more time and better remuneration to provide the care we want to give would be a start. Medicare reform is critically needed.

Meanwhile I will continue my sad but inevitable move to a new non-medical career. End