Abstract
BackgroundThe UK, like many high-income countries, is experiencing a worsening shortfall of general practitioners (GPs) alongside an increasing demand for their services. At the same time, factors influencing junior doctors’ decisions to apply for GP training are only partially understood and research in this area has been hampered by the difficulties in connecting the datasets that map the journey from student to qualified GP. The UK Medical Education Database (UKMED) has been established to ameliorate this problem by linking institutional data across the spectrum of medical education from school to specialty training. Our study aimed to use UKMED to investigate which demographic and educational factors are associated with junior doctors’ decisions to apply for GP training.MethodsStudy data, provided by the UKMED Development Group and accessed remotely, contained longitudinal educational and sociodemographic information on all doctors who entered UK medical schools in the 2007/2008 academic year and who made first-time specialty training applications in 2015. We used multivariable logistic regression models to investigate two binary outcomes, namely (1) application to GP training, possibly alongside applications to other specialties, and (2) application solely to GP training.ResultsOf 7634 doctors in the sample, 43% applied to GP training possibly alongside other specialities and 26% applied solely to GP training. The odds of applying to GP training were associated with particular demographic factors (being female, non-white or secondary educated in the UK increased the odds of application) and educational factors (non-graduate entry, intercalation and above-median academic performance during medical school all decreased the odds of application). After adjusting for these factors, both the medical school and the foundation school attended were independently associated with the odds of applying to GP training.ConclusionsOur findings suggest that the supply and demand imbalance in UK primary care might be improved by (1) efforts to attract greater numbers of female, non-white and UK secondary-educated students into medical schools, and (2) targeting resources at medical and foundation schools that deliver doctors likely to fill significant gaps in the workforce. Further research is required to better understand inter-school differences and to develop strategies to improve recruitment of GP trainees.
Highlights
The UK, like many high-income countries, is experiencing a worsening shortfall of general practitioners (GPs) alongside an increasing demand for their services
43% (3307/7634) applied to GP specialty training and 26% (1954/7634) applied solely to GP specialty training. Among those applying to multiple specialties, the majority (60%; 1353/2244) applied to GP training
Rates of application to GP specialty training varied by the medical school (25–60%) and by the foundation school (32–56%) that doctors had attended (Additional file 2: Table S2)
Summary
The UK, like many high-income countries, is experiencing a worsening shortfall of general practitioners (GPs) alongside an increasing demand for their services. Research into the factors associated with medical students’ specialty choice has indicated that decisions to apply for postgraduate training programmes are shaped by a multiplicity of factors and that medical career decision-making is a dynamic and complex process that is not yet fully understood [9, 10]. Survey-based research in a number of countries has focused on identifying both the individual characteristics (sociodemographic, academic and attitudinal) and institutional factors that are associated with self-reported (intended) career preferences of both medical students and early-career doctors [14,15,16,17,18,19,20]. Further work is needed to evaluate the extent to which independent factors are associated with actual applications to GP training, to differentiate their relative strengths, and to detect interrelationships between hypothesized predictors
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