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

Background: Ensuring sufficient supply of general practitioners (GPs) is critical for servicing increasing healthcare demands. Heightened by pandemic conditions, chronic shortages of GPs persist globally. Whilst many factors reinforcing general practice specialty choices are known, system-level understanding of GP career decision-making influences across medical training requires investigation.

Aim: To explore specialty choice rationales 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 GP specialty choice rationale. Within Australia, medical specialty training choices are typically made after both university medical education and mandatory one-to-two year prevocational (hospital-based) training is 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. Large gaps in GP career information were highlighted throughout medical training for many participants. Overcoming negative medical narratives about general practice was necessary for most in choosing a GP career. However, positive experiences with GP communities or work created insights into the broad flexibility of GP person-specialty fit.

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.