GP training the least-worst: survey

On the day GP training returned to the colleges, the Medical Board delivered some encouraging news, at least compared with other specialities.

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The latest annual national survey of Australia’s doctors in training reveals “small but worrying signs” of pressure on medical training, with bullying, harassment and racism seeing an alarming increase.

However, RACGP trainees who responded to the 2022 Medical Training Survey, which is conducted by the Medical Board, reported more favourable experiences throughout the survey when compared to the overall response.

Some of the more notable findings include that:

• 76% of RACGP trainees said their college supported flexible training arrangements compared to 61% of survey respondents overall
• 55% of RACGP trainees said they received support when needed compared to 45% nationally
• 81% of RACGP trainees said their college supported good work/life balance compared to 65% overall (and 75% compared to 61% overall said they actually had a good work/life balance)
• 85% of RACGP trainees said they had a positive workplace culture compared to 77% overall.

While the 2022 results are broadly consistent with previous years, with some small but statistically significant variations in year-on-year results, Medical Board chair Dr Anne Tonkin said the culture of medical training “needed attention”.

“It is totally unacceptable that 55% of Aboriginal and Torres Strait Islander trainees experienced and/or witnessed bullying, harassment, discrimination and racism,” Dr Tonkin said. “It is inexcusable that 34% of all trainees did. The 1% variation from last year in the overall rate reported is not statistically significant and sets a baseline for a problem that demands action.”

The source of this bullying, harassment, discrimination and racism also changed in 2022, with an increase in patients and/or patients’ family/carers identified as the source of the incident (up from 38% in 2021 to 45% in 2022).

Just as alarming was the reluctance of trainees to report these incidences. Of those who had experienced bullying, harassment, discrimination and/or racism, 70% did not report it. Of these trainees, 55% were concerned about the repercussions, and 51% said nothing would be done if they did make a report.

When it came to general practice, 15% of RACGP trainee respondents said they had experienced bullying, harassment discrimination and/or racism compared to 22% nationally, while 18% said they had witnessed it compared with the 30% overall response.

But GP trainees saw a much greater proportion of incidents due to the actions of patients or their families and carers. Of those who said they had experienced it, 47% of RACGP trainees said it was from a patient (compared to 40% overall), while 53% who witnessed behaviour said it was from patient (compared to 44% nationally).

However, RACGP trainees who experienced it were much more likely to have reported it (42% compared to 30%), and much more likely to have followed it up (57% compared to 47%).

The number of trainees who rated their workload as heavy or very heavy has increased by 7% to 53% since the start of the pandemic in 2020.

In the case of GP trainees, 8% said they had to work overtime always or most of the time compared with 16% of trainees overall, while 15% of GP trainees had to work unpaid overtime versus 22% overall.

However, getting paid for unrostered overtime was a different story, with fewer than half of GP trainees getting paid (47%) compared with 61% overall who got paid.

RACGP national training director Dr James Brown was upbeat about the survey – at least so far as it applied to those in training for general practice.

“RACGP trainee responses against most parameters were favourable in comparison to the overall national response which is a credit to the regional training organisations who had previously managed training,” he said, adding that that the college intended to build on the RTOs’ success.

“That excessive workload, bullying, harassment and racism is prevalent, particularly in the hospital setting, is deeply concerning. It is incumbent on the RACGP and the other medical colleges to urgently address this.

“The spaces where doctors train and work need to be culturally safe, and clearly much more work needs to be done here. Registrar support and well-being is a primary focus of the RACGP training model and we are prioritising cultural safety as a key feature of the program.

“My message to GPs in training who are battling under the workload is know that the RACGP is fighting for you. I have no doubt that with the right support and increased general practice experiences for medical students and junior residents, we will see many more doctors choosing general practice training and finding general practice a fulfilling career.”

While around 18,500 trainees in total responded to the survey, only about 2500 were GP trainees.

However, AMA president Professor Steve Robson said the survey had highlighted the impact of a health system in crisis, with ongoing systemic problems of racism and bullying.

“Once again, we are presented with evidence of a workforce under immense pressure with an increasing number of doctors in training thinking about a future outside medicine,” Professor Robson said. 

“The fact that 20% of those who responded to the survey are considering a career outside of medicine should be a wake-up call for governments across the country, particularly as these are doctors in training who have spent years investing in their education and training.”