Number of junior WA doctors studying to be GP increases but health professionals warn no easy fix to shortages

The number of future GPs training in Western Australia has increased for the first time in several years but experts warn a lack of hands-on experience is pushing junior doctors away from general practice. WA has 15 per cent fewer doctors per person compared to the eastern states and more GP “deserts” than any other State or Territory. The Pilbara, Kimberley, and Esperance are among the GP “deserts” in WA, where there are too few GPs to ensure everyone can get the care they need. And for patients in metropolitan areas, waiting times and a lack of bulk billing leave many struggling to find a doctor. But industry experts say there could be light at the end of the tunnel — with an uptick in doctors choosing to train as a GP. The latest Royal Australian College of GPs report showed a 31 per cent increase of future doctors training in the State this year, to 194, exceeding the overall national lift of 19.8 per cent. Curtin University GP clinical education director Lewis MacKinnon noticed a similar trend, saying there had been a recent increase in junior doctors interested in general practice. “The last 10 years there was an overall downward trend with concerns about remuneration and financial uncertainty,” he said. “Unlike hospital trainees, GP registrars have a lot more variable income and traditionally have lost employee benefits when they’ve moved into general practice training. “That’s recently been addressed, to some extent, with improvements in the Medicare rebate and rural incentive payments but also a move to a single employer model, whereby trainees have a standardised package that’s a bit more predictable for them. “I have recently seen an uptick in career interest . . . a lot of GP trainees are currently reporting very high satisfaction of the training suggesting they’ve got the right support, workload can be manageable, and training is very positive.” University of WA head of GP discipline Nahal Mavaddat said UWA medical students choosing to go into general practice was above the national average. Nationally only 10.5 per cent of medical students reported general practice as their preferred speciality in 2023 compared with 13 per cent in 2022, according to the RACGP. “We know over the past decade there has been a reduction in interest for students to choose general practice as a speciality but at UWA we’re doing quite well,” associate professor Mavaddat said. “We’ve got more than the average number of medical students going into general practice.” She said there had particularly been an “increase of interest in going and becoming a rural generalist” — a medical practitioner trained to provide comprehensive healthcare, including general practice and emergency care, to rural and remote communities. Bipartisan support to incentivise junior doctors to choose general practice has offered further hope with both Labor and the Coalition promising the training of 2000 more GPs each year by 2028. The election commitment would also provide junior doctors who need to leave the public hospital system to undertake GP training with an incentive payment of $30,000 as well as 20 weeks paid parental leave and five days study leave per year. RACGP WA chair Ramya Raman said the expansion of GP training would ensure more Australians can access care. “Over the past two years, since the RACGP took the lead in delivering GP training, feedback has been consistently outstanding. Our GP registrars consistently rate their training experience highly, including supervision, curriculum, and workplace environments,” she told The Sunday Times. “Expanding GP training will ensure more Australians can access care from a specialist GP where they live. That’s vital, because there’s no substitute for the care you get from a GP who knows you and your history. “We’ll continue to work with all governments to make general practice a top career choice for doctors, including in our rural and remote areas.” But Dr MacKinnon warned a lack of hands-on experience since a cut to Federal Government placements was still steering a lot of junior doctors away from general practice. “A lot of junior doctors when they’re deciding about a career, they don’t actually get to have an experience in general practice, which is quite unusual,” Dr MacKinnon said. “They will get to try working in an emergency department or a medical ward but they don’t actually get to do the job of a GP in a junior capacity. “You can imagine that’s another huge risk for them to take a job that they’ve got absolutely zero familiarity with.” That was the case for GP in training Grace Giraudo, who was only exposed to general practice as a medical student. “In medical school we had a little bit of exposure, that was quite early on, but that was about it,” she said. “It was one rotation with the GP and the rest of it was of it was all hospital medicine so it was pretty limited.” Dr Giraudo began to specialise in hospital medicine but a stint in remote WA changed her mind. “I got to work with GPs, and to me, they were an example of a real kind of generalism. They were able to do really everything and manage a whole raft of different medical conditions and at different severities,” she said. “I was really inspired by that — I thought this could be the career for me.” Samantha Hodges, who also made the leap to general practice after already starting as a medical registrar, said being a GP was a rewarding career but students don’t know this without hands-on experience. “Students’ experience of GP placements is probably sub-optimal,” she said. “We don’t get the opportunity as junior doctors. There’s no opportunity currently to do any community placements and get GP exposure. “That is something that would be amazing to see come back in and allow junior doctors to have that try before you buy experience and I’m sure we would see an uptake in GP training as a consequence of that.” Dr Hodges said she hoped extra incentives would cause doctors to make the same leap she did. “General practice is the only specialty in medicine where we really get to practice whole person medicine, and you get that continuity of care and that longitudinal care with your patients as well,” she said. “It’s also amazingly family friendly — I can now choose my hours, get leave when I want, work between 8am and 5pm and be home for my kids.” Jian Ong is among the doctors who chose to train in rural and remote regions — now working as a locum doctor in northern WA including in Fitzroy Crossing, and the Tiwi Islands. He said without having that desire to go rural he wouldn’t have got the same placement experience. “For my very last term in medical school, it was a rural GP and I did it in the midwest,” he said. “I told myself I would come back to Geraldton as an intern, which I did. I did have metro placements in general practice, but I guess (as a) rural GP, there’s a lot more freedom to get hands-on experience. “What you are exposed to initially in intern years would be hospital-based specialities so a lot of people tend to defer to them. “Due to my rural interest, it sort of opened up the opportunities along the way, which probably most other residents in the hospital system wouldn’t get experience in.” Despite a lack of current placements for junior doctors, Dr MacKinnon hopes uptake will improve even more as he is working on re-implementing similar training with a pilot program set to run late this year. “The placements program was very well regarded by participants and by host clinics and actually probably led to a surprising amount of conversion to general practice,” he said.