Square pegs vs round holes – a mismatch between what new doctors want and how they see general practice careers
A significant concern in relation to current workforce problems in UK NHS general practice is a persistently low level of recruitment to general practice (GP) training posts and long-term GP employment. With more than a third of GPs considering leaving within 5 years and insufficient trainees to fill the gap, the Department of Health launched a £10m strategy intended to achieve 50% of new graduates entering General Practice.While reports confirm which specialist programmes are fully subscribed and where unfilled posts remain, they offer no indication of the basis for doctors’ preferences or the contexts of their decisions. Without detailed knowledge of these background factors it is difficult to develop strategies to re-shape career choices to better match NHS workforce needs.
This paper reports on a survey involving doctors completing Foundation training (F2s) at English Foundation Schools. Over 800 doctors (>12% F2 cohort) supplied details of their 2016 training intentions and completed Best Worst Scaling (BWS) choice experiment exercises to elicit; (i) the relative importance of selected job attributes to F2 doctors, and (ii) the extent to which they (dis)associate those attributes with a career as a GPThe BWS exercises facilitated ranking of recognised job attributes for all respondents and for multiple sub-groups with cross-referencing for demographic, educational and experiential data and their chosen specialisms.
Ranking revealed that a good work-life balance, working as part of a team and having control over where one works were the most desirable job characteristics. A good work-life balance was more than twice as important as recognition or job security, more than 5 times as important as being involved in research and more than 7 times as important as having a good chance of promotion.Attributes which were important to F2 doctors but not associated with GP work included; working as part of a team, having special knowledge or skills, working in an exciting job and recognition. Undesirable job attributes which were strongly associated with GP work included working in a community-based role, managing a clinical service and working alone. Regarding specialism selection, General Practice was the 1st preference of 20% of respondents, 2nd preference for 9% - substantially below the 50% target. Intentions to proceed immediately to a UK specialist training programme at 59%, were broadly in line with recent trends.
Increasing the flow of trainees into GP careers requires development of strategies which will close the current gap. By contributing greater understanding of how F2 doctors express their work preferences and indicating how these differ from what they perceive available for GPs, this study identifies key factors which must be addressed to increase recruitment.