Medical Careers: Specialising as a family physician
In a continuation of our series on medical careers, we’re focussing on the experiences of those who work in the field of general practice as family doctors. This role is a medical front-line for individuals seeking treatment, where the family doctor is often a first port of call. General practitioners, (GPs in the UK), spend a large amount of time in short individual consultations with patients. The role has inherent variety, and they are responsible for diagnosing and prescribing treatments for diverse illnesses that patients may present with. They also take the decision to refer patients to a specialist. The ability to have a compassionate and holistic approach to patient treatment is required. In this article, we take a deeper look into what’s involved and ask those working in the role about their experiences.
In order to train as a family physician in the UK, you have to complete a medical degree, two years postgraduate foundation training, followed by a further three years of training rotation. The latter normally includes 18 months working in a recognised GP training practice, and 18 months of hospital rotations in fields relevant to practising as a family physician. These can include psychiatry, accident and emergency, elderly care medicine, obstetrics and gynaecology and paediatrics, amongst others. There are a number of exams that you need to pass when specialising, and further details for GP training are available from the Royal College of Physicians in the UK.
The system in other countries varies and our recent article on key stages for medical training, discusses the differences elsewhere in Europe and the US.
Most family doctors spend the majority of their time in short consultations on a one-to-one basis with patients. As such, they must have excellent communication skills coupled with the capacity to absorb information quickly. They require the ability to apply sound clinical knowledge and problem-solve, so they don't take things at face value when seeking a diagnosis. An empathetic approach, whilst being under time pressure is also essential.
"Most family doctors spend the majority of their time in short consultations on a one-to-one basis with patients. As such, they must have excellent communication skills coupled with the capacity to absorb information quickly."
In the UK and the rest of Europe, working hours are limited to 48 hrs a week through an EU directive for a salaried family doctor. This doesn't apply if you become a partner in a practice.
If you work full-time as a GP your patient consultation time normally comprises eight sessions, that equates to four days. Typically, you’ll be expected to arrive around 8am to check paperwork before starting patient consultations. These will go on until late morning, where you’ll consult with 20+ patients. Subsequent to this morning surgery session, most GPs see extra patients who need to be seen urgently or as an emergency that day.
Any time left in the morning is taken up making phone calls to patients and hospitals, or other co-workers at the practice. This can include practice nurses, practice managers, medical secretaries and phlebotomists. Outside of the practice, GPs may also need to be in touch with other healthcare professionals including, pharmacists, midwives, physiotherapists and health visitors. Another routine aspect of the job may involve taking time before an afternoon session starts, to visit patients at home or those in care home.
Afternoon surgery typically runs from 2.30 pm until 6.00pm with patient appointments and any urgent cases afterwards, taking surgery time to 6.30pm - 7.00pm. Some GPs may also have a patient session on Saturday mornings. The average number of patients allocated to any one GP is 1,800 but can vary by practice.
"The average number of patients allocated to any one GP is 1,800 but can vary by practice."
Any remaining time is spent on administration tasks, practice meetings, training, research and special interests. On the whole GP who are partners in a practice will have more administrative work than salaried GPs, who work alongside them. There has recently been discussions in the UK of GPs providing a seven day a week service.
GPs experiences in the role
We interviewed family physicians working in the UK, to help gain insights into the upsides and the challenges of the role. Individuals stated a number of reasons they were motivated into working in general practice. A salaried GP working in Edinburgh, UK, who has been fully qualified for 14 months and who works 7 sessions weekly stated her motivations and challenges as follows:
“The flexibility of GP work, in terms of hours and specialist interest possibilities, was what attracted me to this specialty. The positives of the role include developing my palliative care knowledge, and some aspects of continuity that come with the role. I also like getting involved in training and health promotion to the public. Carrying out research can be very rewarding too."
"The flexibility of GP work, in terms of hours and specialist interest possibilities, was what attracted me to this specialty...I also like getting involved in training and health promotion to the public."
The biggest challenges for me now are needing autonomy, time management issues and lack of team work. The latter may possibly be related to the practice that I work at though.’
In summary here are the positive aspects of the role that were often mentioned from those working in the profession:
- A good variety of work in your day-to-day role as you never know what the next patient will present with.
- The opportunity to work across age groups and diverse types of disease
- Being responsible for the holistic care of patients
- Dealing with patients as people, rather than cases.
- It’s more flexible than other specialties, with options for part-time and flexible work.
- An opportunity to be part of the local community
- The possibility of becoming a partner in a practice.
- There is a shortage of GPs in the UK, so plenty of job openings. (Although, there may be competition to work in specific regions of the country. Regarding the latter, the UK government recently announced an initiative to encourage GPs to work in rural locations or those places struggling to recruit by offering them a monetary incentive of £20K.)
The following are the challenges that the were frequently raised:
- There is a growing workload, with recent changes in policy
- Time management with all the different aspects of the role can be challenging
- Pressures of dealing with complex medical problems and also complex issues, particularly where psychological and social aspects also need to be taken into account, within the standard ten-minute consultation
- There is a burden of keeping up-to-date with the huge range of diseases, treatments, drugs and service changes
- Administrative aspects can be hard to fit in
- A growing concern about funding of GP services in the UK
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