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Views And Reviews Acute Perspective

David Oliver: Making less popular medical jobs more attractive

BMJ 2018; 362 doi: (Published 10 July 2018) Cite this as: BMJ 2018;362:k2936

Re: David Oliver: Making less popular medical jobs more attractive

The landscape of medicine has been constantly evolving for general medicine to become a specialty in its own right. With the broad skills required to delicately balance multi system and high complexity patients, facilitate effective team coordination, and judiciously manage access and flow of patients, it can now also be considered one of the most fulfilling. With the recent bottle-necks in subspecialties from increasing numbers of medical graduates along with slower growth in accredited positions, many trainees now undertake dual training that includes general medicine while they endeavour to enter specialties of their primary choice (1,2). Although this may at the outset appear as a backup option, many subspecialty colleges now regard trainees with increased general medical experience as highly desirable. Increasing numbers of patients are aged and have complex multimorbid conditions that would have otherwise required management decisions from several specialty teams (3). Subspecialists also hold the additional generalist expertise and dual training qualifications in high regard and organisations can reap benefits from a rostering standpoint due to greater skillmix.

Although general medicine programs can accommodate multiple training pathways, the next phase may be to encourage subspecialty trainees to undertake additional training in aged care. Merging the acute and aged care programs and promoting green light protocols to geriatric, rehabilitation and community based care are examples where further upskilling of a dual trained workforce can occur. Blurring the margins between acute and aged medicine and subspecialties increases the attractiveness of traditionally less regarded positions. The potential of an improved patient experience as well as reduced healthcare costs may result through continuity of care by multi-skilled physicians.

1. Fox GJ, Arnold SJ. The rising tide of medical graduates: how will postgraduate training be affected. Medical Journal of Australia. 2008 Nov 3;189(9):515-18.
2. Schwartz MD. Health care reform and the primary care workforce bottleneck. Journal of general internal medicine. 2012 Apr 1;27(4):469-72.
3. Watson DE, McGrail KM. More doctors or better care?. Healthcare Policy. 2009 Aug;5(1):26.

Competing interests: No competing interests

21 July 2018
Kevin Rajakariar
Medical Registrar
Vikas Wadhwa, Clinical Director of Integrated Services
Eastern Health
8 Arnold Street, Box Hill, Victoria, Australia