And it’s likely to get worse.
The Royal NZ College of General Practitioners, representing approximately 5,700 GPs throughout New Zealand recently released their latest report on their profession. Formally, it’s called the 2020 General Practice Workforce Survey.
The Survey, reporting valid responses from 3,117 GPs, contains some grim findings.
First, consider the frame of mind of the GPs you and I encounter as our first ‘port of call’ when illness strikes. The GPs were asked to rank themselves on a scale of 0 to 10 regarding how ‘burnt out’ they felt, with 10 representing ‘extremely burnt out. Fully 31% placed themselves in the highest 7-10 range.
I hope your GP is not one of those! In fact, Hawke’s Bay GPs didn’t rate themselves quite that badly. Only 27% put themselves in the 7-10 range.
The ‘burnt out’ factor is the one that might most immediately affect the quality of day-to-day care you receive as a patient.
But there’s another finding that will have huge impact on the primary care system we depend on.
Fully 31% of NZ GPs plan to retire within the next five years; another 18% within the next ten years … together, half of all GPs. That deserves a WOW! Again, the situation is only slightly as bad in Hawke’s Bay, where 27% say they will retire in five years.
As health consumers, there wouldn’t seem to be much you and I can do about this looming ‘macro’ workforce crisis, other than plead that the Government will do something about it. A third medical school? More aggressive overseas recruiting? The Survey reports that 63% of practicing GPs received their initial medical degree in NZ, and 37% overseas (not quite half of these from the UK).
The Survey reports a variety of other intriguing insights into the ‘innards’ of the GP world, some of which are reflected in the infographic below – 58% are women (who are younger, paid appreciably less, but also work fewer hours, 7 hours less per week than their male counterparts); the median age of all GPs is 52 years; and the median personal pre-tax income is $140,000.
The Survey also provides some ‘before and after’ information on practice change driven by the Covid pandemic. Most striking is the increased use of video consultations – only 11% were reported using (in past surveys) pre-Covid, jumping to 54% now.
I wonder how sympathetic the public will be to the work time commitment of our GPs. GPs are considered full employed if they work 36 hours per week – however, only 45% of respondents work to that level. The average for males is 38.5 hours and for females 31.5 hours. The Survey suggests that female GPs, who are younger, reserve more time for child-rearing responsibilities.
All respondents agree that a ‘less stressful working environment’ is the top incentive that would induce them to work more, but second for women is ‘children growing older’ (four times the number of men who said this … talk about gender role stereotypes!), while second for men is ‘higher remuneration’.
Bottom line: If you ever get to see your GP in person again, take him or her an apple … or a stiff whiskey!
You can download the entire Survey here.
Why are the GPs overworked? Have the numbers of them decreased? Has the population increased? Are there more people with higher health needs, eg ageing population? Is there unmet need through not being able to enrol with a doctor let alone change doctors? My experience with telehealth is that you have a 3 to 5 min phone consult instead of 10 to 15 mins face to face – still costs the same though. But are doctors dealing with far too many patients now – say 6 to 8 an hour instead of 4?
This survey left more questions than answers.
As a dr who worked for 10 years in general practisr can answer that some of that.
Numbers decreased relative to population-Yes. Population increased- Yes. More people with higher health needs -yes. Also point out with increasing technological advancements the complexity of managing illness has vastly increased. Does Bop has high proportion of elderly over 65 -yes. Telehealth – cant comment dont use it. I think its inevitable consequence of trying to manage patient load. Has funding increased relative to load. No. Is the hospital devolving large amounts of work it use to do to primary care without funding to match – yes. Do patients except 5 complex problems to be dealt with in a 15 minute consult- yes frequently. Is this possible to deal with without running behind – no. Are reception and nurses often taking increasing abuse from patients over things they have no control of – yes thats really bad. I could go on.
Yes the population has increased, and importantly has aged and become much more complex. Take for example that on average a 20-40 year old will see a GP about 2 times a year, but the 65+ patients see a GP on average 5-7 times a year.
As there are more advances and better treatments people live longer, but the complexity increases which adds to the pressure.
There are other issues such as the gradual increase in paperwork, even simple notes. For example the average note in a patients file 20-30 years ago would be 2-3 sentences per appointment, but my notes would be around 15 lines usually.
There are more lab tests to order, then check the results after we have finished work.
Patients expect more, they want to hear back about all their results (which isn’t bad, it just takes extra time to do after we have technically finished work).
There is the constant fear of missing something, that at the time is innocent sounding, but later with hindsight ends up being serious, leading to complaints, medical council, HDC or media involvement.
General practice is a great job that I enjoy, but it is a constantly stressful job, where we must be vigilant every moment of the day.
The FTE and hours worked is misdleading. As a GP I am considered to be working 0.8 FTE and 32 hours a week as I am only salaried at my primary clinic 4 days a week. Each of these days usually include 2 hours of unpaid overtime for paper work, not too infrequently until 8 or 9pm, and even going in on days off to catch up on paper work. Then there are unpaid out of hours meetings with the PHO etc. All our additional training / constant learning / conferences (so we can provide quality safe medical care) are also during our evenings or days off and not included in our working hours. Then in our region there is a requirement to work at the local A+M clinic in weekends / evenings about 12 hours a month (not included in the workforce survey).
So the official hours and reality are rather different.
For these reasons I proactively chose to only work 4 days as around 45 hours a week is enough, if I was working 5 days (plus weekends) I would burn out.
I’m a GP who has been practicing for 32 years. The statements of the GPs above are accurate in the fact the pressures on GPs have increased dramatically over the three decades I have been involved. The one point that the study does not show is that one hour of consulting generates approximately one hour of paper work. This is confirmed in numerous investigations, including one by Procare, a large Auckland PHO.So if your GP is like me and consults for 39 hours a week, a 70 hour + week, every week is commonplace. A full time GP in essence is one that sees patients for 20-25 hours a week. Despite the shortage of GPs, those who are left are desperately trying to service Kiwis. Year on year I have watched my income fall and workload increase – the Government has made it an unattractive choice for Medical School graduates. Unfortunately it is normal kiwis who are going to suffer for this poor short term cost cutting and inept planning.