Stopping the spiral into GP burnout (Full Report)
From the President of the College, Dr Jonathan Fox
Stopping the spiral into GP burnout
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Faced with the stresses and strains of life today, general practitioners are increasingly looking for the work/life balance they advocate for their patients.
This shows quite clearly in a second report from the Royal New Zealand College of General Practitioners, taken from the 2005 membership survey of the College.
In a report that focuses on working conditions and future arrangements, teamwork and remuneration, many GPs are rejecting the “job for life” concept in the face of an environment they see as increasingly hostile, with their skills significantly undervalued.
“I can show you GPs who, like me, love what they do and can’t conceive doing anything different,” said RNZCGP president Dr Jonathan Fox, but
“This data shows the other side of that coin.”
• 623 GPs intend to change their work arrangements in the next five years, half of them self-employed full-timers
• 56% of those signalling change are in the age cohort 31-50.
“That cohort should be the core of a stable workforce,” said Dr Fox. Trends were also emerging as GPs – like industry in general – moved away from the jobs for life concept, given the stresses of modern day general practice.
• In the College’s 2005 survey, just 3.9% of those who intended to change were going to enter fulltime, self-employed general practice. Two years previously, it had been a huge 27%.
o 27% in 2003;
3.9% in 2005
o 7.5% planned to retire in 2003, 17.9% in 2005
o 8% planned to go into the locum role (temporary or fixed term) in 2003, 12.3% in 2005
o GPs choosing a sub-speciality (such as sports medicine, or appearance medicine, 0.7% in 2003, 6.2% in 2005
o Non-general practice medicine, 1.5% in 2003, 10.7% in 2005.
“One of our hallmarks is the GP’s continuity of care for patients; these figures are showing this will come under increasing pressure,” Dr Fox said.
Retirement is the No 1 reason for change, with the care of children and other family members second. Third was the perceived decline in the income potential of GPs in the current primary care environment, while the “other” factors included the lack of job satisfaction and bureaucratic compliance.
Dr Fox, who practises in Meadowbank, Auckland said the College was becoming alarmed at the trends beginning to show up. “If the trend towards part-time and flexible working arrangements (e.g. locums) continues, then New Zealand’s FTE GP numbers will erode very quickly, leaving fewer GP hours to see patients.
“GPs will need to work longer hours to make up, there would be more stress and burnout, and still more retention problems.”
New Zealand relies on the self-employed GP (currently 56%) to deliver primary care locally. The self-employed GP has invested in the infrastructure and human resources necessary to meet the needs of their patients. Declining interest in self-employment or the small business model will increase the risk that currently available primary care will become less viable and sustainable.
“Anecdotal evidence from newly graduated doctors indicates how heavily student debt influences their career path,” Dr Fox said. “General practice finds it very hard to compete when the average income for a GP’s 40-hour week is about $77,500.”
The data median of $96,000 for 1.2 FTEs (full time equivalents) is $41,500 less that for other vocationally registered specialists, particularly those who are part of the collective agreement (MECA) between the DHBs and the Association of Salaried Medical Specialists (ASMS). That median, level 7, is $137,500.
Vocationally registered GPs employed by DHBs under the MECA have a rate of $170,000.
“Believe me, it’s not all about money,” Jonathan Fox said, “It’s more about working conditions and getting cover so we can take time off. But figures like that really burn our people up, particularly when hospital doctors on the MECA also get study leave, annual leave, personal and practice professional development activities; and salaried GPs also have these paid for by their employer.
“Not only do these have to come out of our own pockets, but due to the lack of cover (locums), the self-employed GP may have to forgo time for study and holidays.
“GPs must have time away, to clear the mind, to re-charge the batteries. The alternative is a spiral into burnout.”
The College of GPs is recommending to the Minister of Health that constructive action is urgently required to:
1. Ensure national workforce planning addresses changes in the future working arrangements and the demographic profile of general practice to assist GPs provide quality patient care.
2. Examine and adjust infrastructural and contractual issues within current business models that currently inhibits development and functioning of multidisciplinary teamwork
3. Reverse the trend that is making self-employed general practice the least attractive option by developing new business models that recognise and support the contribution of small business to the delivery of quality primary health care.
4. Commission a stocktake at PHO level that analyses current bureaucratic and compliance requirements for relevance and efficacy in the delivery of quality patient care.
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