Young GPs and transforming primary care

Abstract

When I was young, I wanted to become a physician because I was interested in human beings and curious to know more about the biology and psychology of these creatures. If you are interested in people, there is no better job than that of a GP. Many young medical students share my enthusiasm for their career, yet few of them would like to specialize in general practice. As a teacher of medical students, I have noticed that during the first years of study general practice seems to be a possible choice for them, yet the longer the studies continue, the more a good many of them prefer a career in a narrower, hospital-based specialty. A recent article in this journal surveyed fifth-year medical students’ opinions on general practice [1]. While students respected GPs’ versatile and challenging work, they were concerned that the work was too hasty and pressing. The majority of the students (82%) considered that the most important aim of the GP's work is to identify serious diseases in order to refer patients for specialized care, which means that they overlooked the GP's important role in public health, i.e. the aim of better health for all people. Another concern among medical students was that GPs have to deal too much with non-medical problems. Bureaucratic duties such as sickness certification take up a large part of a GP's day, and GPs often consider these tasks problematic [2]. We need a continuous discussion about which jobs GPs should and should not do. As generalists, we are needed for many different tasks; however, not all of them are considered efficient use of the GP's time nor do they contribute to achieving the main aims of the GP's work. In Helsinki, the general practice training has been updated to help young doctors cope with the current challenges of primary care. General practice courses now get more positive feedback than before, and the number of young doctors wanting to specialize in general practice has increased. Nevertheless, young doctors who choose a career in primary care still face several barriers. The shortage of primary care physicians seems to continue, and young doctors often tend to leave after their mandatory period in general practice. In Finland, a primary care reform has been planned for several years, and one initiative was launched in 2012. However, it is based on municipalities as organizers of primary health care, and the initiative is strongly linked to a parallel reform of the number of municipalities. Few believe that this reform is going to solve the problems of primary care in Finland. GPs play a decreasing role in the leadership of primary care. High demands and limited resources challenge their role as primary care leaders, a similar situation to what was lately described in rural primary care in Norway [3]. Recently, three enthusiastic young physicians described their vision of future primary care in an editorial in the New England Journal of Medicine [4]. They emphasized multi-professional teams, quality-improvement cycles, patient groups, and the use of new technologies in communication with patients. Some of these ideas, such as teamwork and focus on quality, seem familiar in Scandinavia. Many countries, including the United States, Norway, and Finland, are simultaneously carrying out primary health care reforms. Despite the challenges, the many good practices and innovations in primary health care in Scandinavia are important models for the current reforms. Times are interesting for the transforming of primary care systems. The number of young physicians who choose a career in primary care serves as a good measure for the success of transformation. A journal like this plays an important part in letting us read and write about the importance of primary care and the successful innovations that are made in the few well-functioning systems. All this knowledge is useful for the GPs who are taking the lead in re-imaging the future of primary care.