THE number of Australian GPs willing to do home and nursing home visits could be boosted if more doctors were exposed to both as registrars, new research suggests.
An Australian study published in Family Practice found that young doctors who participated in home visiting during registrar training were five times more likely to be doing them up to 5 years post-graduation compared with those who did not get the training opportunity.
Similarly, those who did nursing home visits as registrars were 11 times more likely to be doing them 5 years post-graduation.
The study was a cross-sectional questionnaire-based survey of recent (within 5 years) graduates of three of Australia’s 17 regional GP training programs. Of the 230 responding graduates, only 48.1% performed home visits and 40.6% performed nursing home visits in their current clinical GP role. Study co-author, Professor Parker Magin of the School of Medicine and Public Health at the University of Newcastle, said the results suggested that it was possible to stem the decline in home and nursing home visiting.
“If we improve opportunities and incentives for doing home and nursing home visits during training, it may increase the rate of new graduates doing them,” Professor Magin told MJA InSight.
“Aside from the health system benefits, home visits and nursing home visits are a wonderful opportunity for registrars to get experience in continuity of care, care of older patients and dealing with multimorbid disease,” Professor Magin said. “These experiences will make the registrar a better doctor and help them pass their exams.”
The study found that 48% of recently graduated GPs performed any home visits and 41% performed any nursing home visits, based on survey responses from 230 metropolitan and regional GPs who had graduated 6 months to 5 years earlier.
The authors noted that this was substantially less than European established GPs, 90% of whom did home visits, according to one study. However, it was more than Canadian GP recent graduates, whose home and nursing home visiting rates were shown to be below 5% and 10%, respectively.
In Australia, concerns have been raised about the increasing reliance on older male GPs to provide nursing home care.
Consistent with this, the latest study found that visiting rates were lowest among part-time GPs – often younger female GPs – and international medical graduates.
“If you accept that home visits are an important part of general practice and essential to continuity of care, it’s not unreasonable to want more GPs to be doing them or expecting a bigger proportion to be involved,” Professor Magin said.
“I don’t think it’s something you could make compulsory or impose top down and enforce, because it’s a complex issue with a whole range of barriers to it.
“The time home visits take is not reflected in the Medicare Benefits Schedule, and the patients requiring home visits are often not those able to afford private fees.”
Sydney GP supervisor, Dr Linda Mann, said remuneration was perhaps the biggest barrier to visiting.
“The pay is terrible,” she said. “We are all reduced to being Medicare item number experts.”
“Only one doctor visit can be claimed, even if two doctors go, so one is at the practice’s cost,” she said.
Still, she argued that all practices that trained registrars should be doing visiting, and it appeared some were not.
“Many newly accredited bulk-billing high throughput clinics have begun to take registrars,” she said. “These do not offer home visiting as a characteristic of the practice, although individuals may not be denied the chance to do so.
“I would support mandatory evidence in teaching practices of a practice-wide, implemented policy indicating the presence of home visiting, nursing home visiting, disability group home support and similar.”
Dr Melanie Smith, president of General Practice Registrars Australia, said that practices appeared to have a range of very different attitudes to visiting.
“Some clinics appear to be reliant on registrars taking up their nursing home workload,” she said. “Other practices are taking on aged care and visiting as a kind of subspecialty.
“Registrars would appreciate the opportunity for supported education to train in nursing homes,” she said. “It’s a really important part of training that hasn’t been explicitly supported by the requirements of training programs as yet.”
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