Do medical students still want to become family physicians?
Piles of administrative tasks, negotiations with health insurance companies, and collaborating with various healthcare institutions in the region. The pressure on family physicians is ever-increasing. Two out of three general practices even have a patient freeze. How do medical students view these developments? “The portrayal of the profession on social media ultimately causes medical students to become less and less enthusiastic.”
Research by insurance company Independer shows that a majority of general practitioners have a patient freeze. One of the reasons for this is an increase in the demand for care, as well as the piles of administrative work involved in being a GP. The Netherlands now has some 15,000 general practitioners, only half of whom still have their own practice.
Yet this healthcare infrastructure does not seem to deter young physicians. A survey of family doctors in training shows that as many as 85 percent would “most of all” like to become practice owners, as reported by professor of family medicine at the Amsterdam UMC, Jettie Bont, to NOS (the Dutch Broadcasting Foundation). And what about medical students? How do they view the evolving specialty of family physician? Do they still want to become general practitioners? Folia spoke with some medical students at the Amsterdam UMC.
The new gatekeepers of medicine
The classic role of the family physician as the gatekeeper of medicine seems to be evolving from health care provider to practice manager. “Dissatisfaction with this is growing among general practitioners, especially because of the increasing burden of administrative and regulatory issues,” says medical student Pien Swart. Swart is still busy with her residencies and is combining her master's with a doctoral program in intensive care. On her social media channels, such as LinkedIn, she sees that more and more family physicians are speaking negatively about these management tasks. “The portrayal of the profession on social media ultimately causes medical students to become less and less enthusiastic.”
Lars de Boer has just completed his internship at a general practice in Alkmaar. He notices that many young general practitioners prefer being an independent practitioner to being a practice owner. “As an independent practitioner, you avoid the complexity of being a practice owner and are kind of self-employed: you have less administration, determine your own hourly rate, and can organize your own schedule. These advantages mean that young GPs also tend to work part time, reducing the effective number of available GPs and creating a potential shortage.
These developments put the practice owner in a bind. “With the increase in administrative tasks, the lack of permanent staff, and the increase in demand for care due to an aging but more demanding patient population, they are no longer getting around to the tasks they went into the profession for, namely, medicine,” Swart said. So it is not entirely out of the blue that there has been a 30 percent drop in the number of practice owners since 2012.
Residencies are all-important
In medical school, students are introduced to the various medical specialties during their residencies. Once they have seen all the specialties, the last step is the final residency, generalist family medicine.
Medical school at the UvA seems to allude to the increasing demand for care and developments within general medicine. “Recently the medical internship has been extended by three or four weeks,” Christian Petit says. Petit has yet to start all his residencies. Swart adds, “I think this is partly because people consider it an especially important specialty, but also because of the increasing demand for care.”
Petit is in his waiting period, the time before medical students start their residencies. “During the waiting period, many students take a temporary job at a general practice. I find that this exposure during their studies is very important to generate interest in family medicine.”
When asked if they want to become family physicians, the students are ambivalent. “The family medicine profession is noble, beautiful, broad, and diverse, offering the opportunity for in-depth contact with patients. But current developments create huge pressure on family doctors, which does not benefit patient care. So I don’t know yet,” Petit said. Swart does not initially want to become a general practitioner. “Before I draw any conclusions, I would very much like to wait until my residency. Right now, anesthesiology is number one, which entails working with different anesthetics.” De Boer isn’t one hundred percent sure, either. “I’m considering it. Long-term contacts with patients in your district mean that you know a lot more people well and can consider the patient more as an individual. It seems like very satisfying work.”
