General practice specialty decision making: a system-level Australian qualitative study.

Abstract

Background: Ensuring sufficient supply of GPs is critical for servicing increasing healthcare demands. Heightened by pandemic conditions, chronic shortages of GPs persist globally. While many factors reinforcing the choice of general practice as a specialty are known, system-level understanding of factors that influence GPs' career decision making during their medical training requires investigation.

Aim: To explore the reasons for specialty choice through career selection narratives of recently registered Australian GPs, using a system-level perspective.

Design & setting: Semi-structured interviews were selected for in-depth explorations of the rationale for choosing general practice as a specialty. Within Australia, medical specialty training choices are typically made after both university medical education and mandatory 1-2 year pre-vocational (hospital-based) training have been completed.

Method: Interviews were conducted online with GPs who had completed all training in the last 10 years. De-identified and verified transcripts underwent participant checking. Deductive framework analysis, using career counselling constructs, and inductive thematic analysis were performed.

Results: There were 25 participants. Career counselling constructs provided system-level understanding of GP specialty decision-making processes. Many participants highlighted that there were large gaps in information about a GP career throughout medical training. Overcoming negative medical narratives about general practice was necessary for most in choosing a GP career. However, positive experiences with GP communities or work gave insights into the broad flexibility of their person-specialty fit with general practice.

Conclusion: GP work experiences and personal GP connections could counteract prominent negative narratives about GP careers. However, lack of systemic and regular exposure to GPs throughout medical training is a critical barrier that should be addressed through sustained policy and professional interventions.