Intended for healthcare professionals


Secondary care doctors denigrate general practice in front of medical students, study finds

BMJ 2017; 359 doi: (Published 27 November 2017) Cite this as: BMJ 2017;359:j5517
  1. Abi Rimmer
  1. BMJ

Placements in secondary care expose medical students to negativity about general practice, researchers have found.

A report by the Royal College of General Practitioners and the Medical Schools Council said that better collaboration was needed across primary and secondary care to stop students being put off becoming GPs.1

The report was based on research conducted by Shift Learning, a market research agency, which sent an online survey to UK medical students through deans, heads of schools, and education leads. The survey received responses from 3680 students in 30 UK medical schools, representing 9.4% of the total medical student population.

It found that 70% of medical students had come across negativity towards general practice in clinical settings. Nearly four fifths (79%) said that they believed that doctors and other staff they encountered in placements had negative views of the specialty.

Respondents described being warned against becoming GPs by secondary care doctors. One respondent said, “[A] consultant in obs and gynae said, ‘Don’t you dare think about going into general practice—have some aspiration, for God’s sake!’”

Another student said, “One cardiologist seemed worried that I want to be a GP and informed me that I needed a lot of patience as a lot of consultations ‘aren’t proper medicine.’”

Commenting on the findings, Helen Stokes-Lampard, chair of the RCGP, said that “archaic” perceptions of general practice held by other clinicians needed to change quickly.

She said, “We are consultants in general practice, just like consultants in any other medical specialty—and we must all work together, across medicine, to break down any perceived hierarchies.”

The research found that students were also exposed to negative views of general practice within medical school. Three quarters (75%) of respondents said that by their fifth year of medical school they had encountered negativity towards the specialty from academics, clinicians, or educational trainers.

One student said that a lecturer “told us that half of us would end up as ‘just GPs’ as if it is a substandard speciality.”

Another said, “The whole cohort at the introductory lecture at the beginning of the medicine degree got told that if you don’t know what specialty you want to go in by year four you will end up just as a GP. The ‘JUST a GP’ theme has been carried on throughout my medical school career.”

The research found that 91% of medical students thought that their peers also had a negative view of general practice.

The RCGP and the Medical Schools Council said that more needed to be done early on in medical education to help students build “resilience” to denigration and misconceptions about general practice. And they said that the government needed to tackle GPs’ concerns about their working life as a matter of urgency.

The report called for general practice to be placed on the shortage occupation list—the official list of jobs for which not enough UK workers are available to fill vacancies—to make it easier to recruit GPs from other countries. “The government should also make protecting the rights of EU GPs to work in the UK post-Brexit a priority during negotiations,” the report said.

Stokes-Lampard said, “Dedicated GPs are the bedrock of the NHS, and without them our health service would fall apart. But we just don’t have enough GPs—we need thousands more—and there is no excuse for some of the negative attitudes our medical students are being subjected to.

“We’ve had promises to expand the GP workforce in England, and we need equivalent pledges in Scotland, Wales, and Northern Ireland. But if the denigration shown in this report continues, it will make it nigh on impossible to fulfil any aspirations to expand the GP workforce.”


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