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Has general practice lost its appeal?

Medical graduates are increasingly shunning general practice for specialist disciplines, according to a new report from the Melbourne Institute.

Looking at data from Medicare along with a ten-year study of 10,000 doctors, the report found the number of young doctors taking up general practice has declined in real terms over the past few years.

At the same time, for every junior doctor going into general practice, close to ten are opting for a specialist discipline.

“Money does matter,” says Professor Anthony Scott, who heads up the Health Economics Research Program at the Melbourne Institute lead author of the report.

“Specialists are paid two to three times what most GPs are, and that’s the route junior doctors want to take. Often it is those who can’t become specialists that move into general practice.”

The report also finds GPs are increasingly dissatisfied with their work and job-life balance in their profession.

Job satisfaction fell by 1.5% between 2013 and 2015, reversing a previous upward trend. Coincidentally or not, 2013 is the year the federal government instigated the Medicare rebate freeze.

That freeze also led to a decline in real terms of Medicare revenue per full-time equivalent GP.

However, total GP hourly earnings have increased at double the rate of real wage growth in the economy. The report authors say it’s not clear why, considering the decline in Medicare revenue, but it may be down to practice efficiencies or income from other sources.

And despite the Medicare rebate freeze, the proportion of services that are bulk-billed has continued to climb, with 86% of services in the last quarter of 2016.

The shape of general practice is changing, too, with a decline in the number of GPs owning their own practice. Correspondingly, practice sizes are increasing, with a wider range of services provided by a range of health professionals.

Almost half of GPs worked in a practice with six or more GPs in 2008, climbing to 61% by 2015.

Another striking change in general practice, and indeed in medicine generally, is the rise of the female doctor. In ten years, from 2005 to 2015, the proportion of doctors who were women went up from 33% to 40%. Over 60% of GPs under 35 are now women, which is 11% higher than for specialists.

And yet female GPs earn around 25% less than their male colleagues, even after accounting for the fact that they tend to work fewer hours. Being a mother further penalises women, who earn $30,000 a year less if they have children. By contrast, men with children earn $45,000 more than their childless male peers.

You can read the full report here.

Professor Scott’s views on junior doctors’ motivations for opting for general practice are not necessarily those of doctorportal.