Issue 31 / 13 August 2012

In 1999, I was involved in lobbying for the establishment of the first Practice Incentive Program (PIP) for Australian GPs ― the Teaching Incentive.

It was very exciting that the government of the time had finally realised that good general practice teaching was worth rewarding. But what’s happening with this incentive now leaves me really puzzled.

During a period when we have a record number of medical students, it seems illogical not to increase this payment. For what would be a small financial outlay of doubling the $100 per 3-hour teaching session to $200, we are running the risk of compromising the exposure of all our medical students to a crucial element of health care.

Good general practice educational exposure in diverse settings provides the foundation for all students to consider this career option, or to at least gain some understanding of the nature of clinical care in the community.

For many students who follow hospital specialist careers this may be their only community exposure. Where else can you experience team-based care, a diverse clinical mix and a rich array of patients all in one day?

The recently released Health Workforce Australia document indicates that the greatest growth over the past 10 years has been in specialists-in-training (9% to 13%) and largest fall has been in GPs (41% to 35%).

There have been concerted efforts to increase the number of GP prevocational and vocational training places, with a doubling in places. It is unclear if this will translate into a greater percentage of medical students wanting to become GPs in the future.

Worldwide, there is evidence that strengthening primary care with a quality general practice workforce will create more equitable and efficient systems. It is illogical not to expose all medical students to general practice.

With the increase in the number of medical graduates from 1200 in 2000 to an expected 3786 in 2014, more general practices are needed to train our medical students. I have heard anecdotal reports of medical schools offering their own incentives for practices to accommodate students. Some medical schools have had to decrease students’ general practice exposure.

There is already an inequitable distribution of resources for teaching in general practice when you compare funding for rural clinical schools to the PIP payment for outer urban and urban general practices. This inequity is likely to worsen under the current PIP guidelines with the potential that more non-rural practices will opt out.

Eighty percent (almost 3800) of PIP-registered practices do not take medical students. This is an untapped rich educational resource. Health Workforce Australia has just spent millions of dollars establishing much needed new training sites across Australia but has specifically steered away from looking at how to work within the PIP model. It is short-sighted not to look at how PIP can be used more strategically in its planning.

Teaching medical students does cost time and money and these losses need to be compensated. The cost of teaching in public hospitals is now being debated, as the Independent Hospital Pricing Authority introduces its new model of activity-based funding, but failure to appropriately support the already established and successful PIP general practice educational model seems to indicate a loss of perspective.

There is a perception that the increase in medical students has created a perfect storm that our health system is struggling to manage. We need to train all these students to meet our future health care needs. Establishing and appropriately resourcing new general practice training sites for these students could turn a perfect storm into a perfect opportunity to draw more GPs into our educational teams. Doubling the PIP must be supported.

Professor Justin Beilby is Executive Dean of the Faculty of Health Sciences at the University of Adelaide

Posted 13 August 2012

7 thoughts on “Justin Beilby: Perfect storm or missed opportunity?

  1. Jonathan says:

    The medical schools take $29709* per student per year from the Commonwealth (that’s ~$30million per year for Monash Med alone!).
    Yet they put almost none of this back into teaching. Citing funding difficulties, Monash has cut Simulation-Based Critical Care training almost by half, and this year conducted their “rural week” on campus in the city!!
    And yet, most medical teachers receive no pay for their efforts. So where does the money go?
    Medical Deans, you’re being paid to deliver high-quality medical eduction, so get used to the idea that you might have to spend some of your budget to do it!!

    *Ref: HECS-HELP Handbook 2012: http://studyassist.gov.au/sites/StudyAssist/HelpfulResources/Documents/2

  2. Rolo says:

    I totally agree. My practice is involved in teaching at all levels from medical students to PGPP to GP registrars. The level of fundings for medical students is terrible & on a business model there is no reason to get involved, hence the low take up by practices mentioned above. The government & univerities need to be aware of these barriers to education, not just rely on our good will to take their students virtualy for free (or at a loss). It is a ridiculous state when there are more students than ever but none of the funding makes it out of the universities.

  3. Gerard Gill says:

    All the professors of general practice in the country would support a PIP increase of 100% as proposed by the AMA. However given the poor state of general practice buildings the current major barrier is the lack of space in which to house practice nurses, medical students, PGPPPs and registrars all competing for the same room. The other barrier is an unhappiness of patients to see students as the consultations take longer.
    What I perceive we need is a new business model for provision of GP accommodation. As the current baby boomer population of business owners retires from general practice over the next decade (this group will not be wanting to invest in bricks and mortar as they cannot liberate this to support their retirement lifestyle) we need new entities to provide GP accommodation particularly in rural and outer metropolitan areas for our part time more mobile younger GP workforce.
    This need appears to be totally off anyone’s agenda.

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  4. Pete B says:

    Part of what Gerard Gill said was …..
    “What I perceive we need is a new business model for provision of GP accommodation. As the current baby boomer population of business owners retires from general practice over the next decade (this group will not be wanting to invest in bricks and mortar as they cannot liberate this to support their retirement lifestyle) we need new entities to provide GP accommodation particularly in rural and outer metropolitan areas for our part time more mobile younger GP workforce. This need appears to be totally off anyone’s agenda.”
    In part I agree – and the tragedy is/was that Govt ideology overrode all our protestations re the so-called superclinic idea, where that money could have been much better targeted by going where appropriate, allowing uptake of funds by the existing practices to expand/modernise etc to accommodate this teaching and more multidisciplinary team approach to primary care, and only building new structures where none existed before in identified areas of need. But they didn’t listen – they never do. Additionally, as others have mentioned, the remuuneration for teaching is abyssmal, and many, myself included, reluctantly gave up teaching because sheer financial pressures in the end precluded it, even though we love to do it. Love does not pay the bills sadly.

  5. Dr Scott says:

    Has everyone forgotten the oath they took? Hospital physicians don’t seem to have but perhaps the GPs need to have a look back at the Hippocratic Oath:

    “To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.”

    You have a responsibility to teach without charging, just as those who taught you did.

  6. Jonathan says:

    Dr Scott: Unfortunately your argument is a few decades out of date. Most current hospital doctors paid for their eduction, their teachers were mostly paid (albeit not enough), and they have never taken the Hippocratic Oath. So there is actually not a single valid point in your post.

  7. Peter B says:

    Like he said. Great ideal, but sadly no longer possible. Back in those days Drs were one of the privileged in society and their status and income reflected that, allowing for their largess. Relativity has been totally reversed in economic terms these days. Now it’s the fat cat CEOs and bureaucrats and sundry others who just play with other people’s money, who are the highly paid ones. Dedication, lengthy study, and true skills doesn’t seem to cut it any more…

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