“Are You Going to be a Specialist? Or Just a GP?”

“Are you going to be a specialist? Or just a GP?”

As a medical student and junior doctor in my hospital training years, I was often asked this question by friends, senior doctors and well meaning patients.  It really grated on me, that one little word: “just”.

I always thought I’d become a GP. As a teenager, I was inspired to study medicine by my own GP who had always looked after my family with such care and compassion.  As I went through my training I dabbled with the idea of other specialties; I was fascinating by the life stories of my geriatric patients, I loved the cute-factor of paediatrics, I was hooked on the emotional highs and lows of obstetrics, I enjoyed the team atmosphere of the emergency department. But I think, deep down, that I always knew I liked ALL of medicine too much and that above all I wanted to make a meaningful difference to my patients’ lives. For me, GP was the obvious choice.

Nowadays, when I tell people that I’m a GP, they ask instead “So are you going to specialise in anything?” They don’t seem to understand that I HAVE already specialised. I’ve specialised in General Practice (and GP obstetrics) by doing an additional 4 years of training on top of my medical degree and internship. I am officially registered with the Australian Medical Board as a “Specialist General Practitioner”. This has been a conscious decision; I haven’t just become a GP by default.

So to be asked these sorts of questions always seems so unfair. It implies that “GP” and “specialist” are two diametrically opposed alternatives, and that GP is the lessor of the two. If you’re smart, ambitious, passionate and successful you become a specialist. If you can’t get into anything else or if you want the easy option you become a GP. It’s seen as a back-up option, not as a worthwhile career in itself.

GPs vs specialist

The specialist vs “just a GP” dichotomy also perpetuates the idea that GPs are not “experts” in their own right; that GPs are the amateur doctors that do the easy bits of all the other specialties and then refer on when it gets too complicated.

I’d like to dispel that myth. GPs ARE experts. We are the expert in each and every one of our patients.

We are also the experts in:

  • Preventative medicine
  • Undifferentiated illness
  • Chronic disease management
  • Complex multi-comorbidity
  • Judicious use of finite medical resources
  • Coordination of the health care team

We do these things better than anyone else. In fact, studies (see here and here) have repeatedly demonstrated that an increasing number of primary care doctors results in better health outcomes overall, a higher quality of health service and at a decreased cost. Whereas an increasing number of specialists is associated with higher costs and poorer quality of care, including higher overall mortality.  So, as a group, GPs do a far better job at improving health outcomes and for less cost compared to specialists.

So where do all these negative attitudes come from? Unfortunately some hospital doctors perpetuate these views. They refer to General Practice dismissively as “coughs, colds and sore holes” or (particularly for female GPs) “tears and smears”. I have heard some specialists loudly criticise GPs for not knowing everything that they know about their chosen field, apparently unable to appreciate the enormous breadth of knowledge they have in other areas.

Once I even heard my university professor talk to our class about a high achieving doctor that he had gone through med school with, saying “She had so much potential, she could have been a professor of medicine. It was such a waste that she chose a career in General Practice”.

Even though the overwhelming majority of health care happens in the primary health care sector, the lion’s share of university and junior doctor teaching is done in hospitals by specialists, so it’s hardly surprising that many of our hospital counterparts have such inaccurate views of General Practice.

Admittedly, not all GPs are great teachers, and a GP rotation spent sitting in a corner of a consulting room is not likely to leave a good impression on the student. The subtleties and intricacies of a GP consult are not well appreciated by watching (or snoozing) in the background. Perhaps, as teachers, we could be doing better.

Here’s the thing. Any doctor who thinks that General Practice is easy has clearly never tried it themselves.

The reality is that General Practice is an enormously rewarding, challenging and varied career and that no two days are ever the same. We have no idea what is going to walk through our door next and it could be anything from an infant with a fever, a pregnant lady with pre-eclampsia, an elderly patient with new onset AF, a young man suffering with crippling anxiety, a parent grieving the death of a child to a full-blown heart attack. And all of these medical conditions come with added layers of complexity from the patient’s personality factors, social circumstances, family situation, expectations, medical co-morbidities, values and beliefs.

Not only do we have to be able to initially manage every single symptom and medical condition imaginable, we have to be able to do it without a full suite of investigation tools, without easy access to allied health and other specialists and all within an allocated time slot of 10-15 minutes.  What’s more we are not managing that patient just for that episode of illness (or until we can turf them to another team), rather we are caring for their overall health and well being in the short, medium and longer term.

Many of us have also chosen to pursue further training in sub-specialised areas, eg obstetrics, anaesthetics, surgery, emergency medicine, aboriginal health, dermatology, paediatrics, sexual health, addiction medicine, medical education and many more. I may be in the clinic one day, and the next be performing an emergency caesarean section, or resuscitating a newborn. Really, the depth and breadth of work that we can pursue as GPs is unrivaled – and we are incredibly lucky in this respect.

Don’t get me wrong. I have a huge appreciation for my specialist (? partialist) colleagues. In particular I am grateful for the depth of knowledge and skills that they have in their niche area that I could never hope to achieve. I know that they, too, want the best outcomes for our patients and that the system works best when we all work together.

However, I’d really like for people to stop asking “are you going to be a specialist, or just a GP?” and instead to enquire “What type of doctor are you going to be?”. It’s up to all of us to  change the conversation and give General Practice the respect and prestige it deserves, so that medical career choices can be seen to be more like this:

In no particular order

There is reason for optimism. The General Practice Student Network has over 60% of medical students as members and is doing great work to be a shining light of General Practice amidst the loud voices of hospital medicine. Also, applications to Australian General Practice Training are becoming more and more competitive. This year there were over 2000 applicants for only 1200 training places and eventually this will help to change the perception of GP as an easy back-up option if Plan A doesn’t work out.

The growing online presence of passionate GPs on social media can only help to spread the word about what we believe is the best job in the world. Check out blog posts from notjustagp.comkidocs.org and greengp.wordpress.com on what they love about General Practice. For those of us who supervise medical students, we have the perfect opportunity to share our passion with the next generation by getting them involved in not just watching, but doing. I encourage you to let them sit in the big chair, and seat yourself in the corner so you can learn something from them, too.

To my patients: I know you may never understand the intricacies of medical training, but I want you to know that out of all the career paths on offer, I chose to be your GP; to be the person that you turn to in your time of need, to see you as a whole person and not just a diseased organ, and to be the one who helps guide you to health and wellness. I hope you know that I feel truly privileged to be your doctor.

In answer to the original question, no I’m not “just” a GP. I’m a broadly-skilled, sub-specialised, expert GP, providing a damn fine health service to my patients and my community. And I absolutely love it.

169 thoughts on ““Are You Going to be a Specialist? Or Just a GP?”

  1. As I go further and further into specialty medical training, it feels as if I’m reaching into obscure academic corners. Whilst I’m happy to learn how to manage the conditions of the few people who need this care, ultimately it’s the GPs who do the real work for the true burden of Ill-health. Your patients are lucky to have you and others GPs like you Pen!

  2. Or to quote from the song “The One to See is Your GP” from GP the Musical:

    “Specialists aren’t that special after all

    Narrow, limited, not general

    The one to see is your GP

    Chorus:

    With a little science and a lot of care

    In times of trouble your GP will be there

    Nobody can fix you faster

    With a few words, pills or plaster

    The one to see is your GP”

  3. The problem with general practice is that it can be easy, if you want to work like a glorified triage clerk. Where general practice becomes challenging (and exciting and rewarding and a privilege) is when you seek to do it well. When you seek to broaden your clinical skills. When you make a difference every day. When you become part of the patient journey and not just a bystander.

  4. A lot of the GP bashing that I was exposed to happened in a tertiary ED. They would lament, “oh another rubbish GP referral” While it was true there were some terrible transfer letters from a small number of GPs, the ED docs soon realised that the vast majority of GPs held back 99% of the cases that might have ended up in the department! Great post once again Pen

  5. spare a thought for those of us who have gone into public health specialty training….we’re apparently not even ‘real’ doctors anymore

  6. While I appreciate the general theme of your article, I think lumping all specialist together and saying they are not as good at managing “undifferentiated cases” or “judicious use of finite resource” is applying the same bias to others. There are a vast quantity of different types of specialist, many I would argue are ‘generalist’. I would consider working in an outer regional ED, as I do, a generalist profession with similar issue. The reality is, patients continue to present to Emergency departments for primary health care. On top of that I see patients of all ages and ethnicities. I also have to deal with a raft of patients who are referred on after quite random blood tests or for completely non-urgent scans or my absolute favorite, after being promised admission by their GP. While I have an amazing respect for the awesome GP’s whose patient I do not see, as they are managed as appropriate in the community, you cannot deny there is an increasing number who do use their own clinics as a triage service and my ED as ongoing care. I find it hard to be too sympathetic when my full time GP colleagues are taking home double or more what I earn and cry that they have ‘no time’ to sort things out. Health care in Australia would be improved if we spent less time arguing about who was best at what and more about how we can make our services cohesive!

    • So you earn $55k a year then? I think that is a bit disingenuous. Yes there are ‘ordinary’ GPs as there are ‘ordinary’ specialists. I have seen a female patient with PV loss – I would describe as gushing, call me in a panic because the ‘promised’ admission didn’t happen (she was discharged within 4 hours of attendance), but luckily the ambos agreed to take her to another hospital.

    • Hi EDDr,

      Thanks for your comment. I’m sorry to hear that you’ve got a few GPs who are using your service inappropriately. As Benedict X and Gerry pointed out I think there unfortunately a very few GPs who do give us all a bad name with poor quality referrals but most of the good work being done is less obvious to our hospital colleagues. There are always going to be good and bad people in every discipline. I’m certainly not trying to argue that all GPs are awesome, but I do think we need to be given more credit for our skills than we often are.

      I definitely agree that there’s a large overlap of expertise across the medical spectrum and that our friends in ED do face a lot of the same challenges as GPs in terms of undifferentiated patients, time and resource pressures.

      “Health care in Australia would be improved if we spent less time arguing about who was best at what and more about how we can make our services cohesive!” <<— Yes, I agree! Lets's celebrate and respect each others unique skills and work together for the best for our patients.

      Penny.

    • Yes you have a point in stating that there are many substandard GP referrals to ED (by the way do you follow this up with those GPs? – they may be unaware that they are doing this). On the other hand I can also relate numerous examples of patients that I have sent in, as an experienced (ex-procedural, ex-rural)GP whom I knew had to be admitted only to have them sent home again & again. Often these patients rotate between me and the ED numerous times, despite many phone calls and letters, until they finally get admitted when I start threatening to go to the Minister or the Press. One such case got admitted, to ICU, but handed my extremely detailed referral letter back to me after discharge several weeks later – still in the sealed envelope. This is but one of many such examples that I can recount – as I am sure you can. On the grand scale I do however believe that Penny’s comments are overwhelmingly correct. I think the problem does not however lie in the ED – it is the VMOs in the wards especially in tertiary hospitals who are still stuck in the 1970s mindset of “just a GP”

  7. Except Centrelink and other government departments are refusing to accept DSP or similar applications with the GP diagnosing such things as major depressive disorder, schizophrenia, lupus, MS, Stroke, atrial fibrillation and I am sure there is a comprehensive list somewhere.

    This, unfortunately, is part of the dumbing down of general practice. Expect more. Sorry for the downer.

  8. When I’m feeling a little tetchy I have been known to remark that specialising is what you do if you can’t cope in general practice.

  9. I love you so much right now……
    The “just a GP” line has been the cause of many a snark from myself. Despite what they may think, a nephrologist or a spinal surgeon isn’t capable of doing what we do, any more that we are capable of doing what they do.

  10. I have great respect for good GPs (and good doctors) but unfortunately the reality is that for a long time, GP was the default option for people who couldn’t be bothered or were unable to get into other specialties or pass the exams. And back in the day, people didn’t need to specialise to be a GP. You kind of just finished internship/housemanship and you were it, if one was so inclined.

    Of course, things have changed since then and GP is a legitimate and cost effective specialty by and large. However, there are a large number of GPs who really do try and maximise the the amount the taxpayer pays them and spends 6 minutes per patient and just sends everyone off to ED or specialist outpatients, and I believe this is the frustration expressed by EDDr. While he may get ~$200,000 per year doing shift work, there are lots of country GPs easily earning $400,000 and up for very short consults. Of course, they don’t have a monopoly on double dipping, since many hospital specialists do as well with being paid a public salary while doing mainly private work, but ED isn’t one of them.

    • Them’s figting words mate. The GP system you describe has not been around for two decades and nearly all GPs, incl IMGs, now hold a formal postgraduate qualification or two. The complexity of GP work, done properly, is also much more difficult than in years gone by as we are now the de facto General Physicians and we manage complex conditions at a level not done previously.

      The comments regarding “large number of GPs” who rort the system sounds more like political propaganda than fact – happy to be proven wrong.

      I would also very seriously question your statement regarding country GPs earning $ 400K or more while doing 6min consults. A country GP deals with matters that cannot just be flicked down the road to a specialist – often the closest partialist is 2-3h drive away. On top of that many of them are on call for their local hospital and emergency services and work very long hours – and I doubt very much that the majority of country GPs earn the type of money that you describe.

      I am also keen to understand what you describe as “double dipping” in the context of a Country GP – I have worked in several different states over the years and have experienced most of the variations of remuneration that hospitals offer – the GP does not usually get a salary – they get a standby fee if on call and they claim fee for service when seeing pts as outpatients or inpatients – last time I did that the standby fee was just under $ 100 a day although admittedly this was several years ago. It barely made up for multiple phone calls every night, meetings, paperwork, etc.

      • Yep, the country GP is not a public servant so doesn’t have all these perks. For his* $400k that is a 24/7/52 job, no academic leave, long service leave taken out of the $400k. If he and his family want a holiday, beside planning 12 months ahead, it is going to cost him $8000 a week plus no holiday pay.

        * well not that many women are prepared to work such hours, or at least doesn’t have a house husband prepared to support them.

  11. Great post penny!!! I find it amazing that after 6 years of medical school, 3 years post graduate training and then 3 years GP training (so what that? 12 years!) my friends and even family ask “what are you going to specialise in”? With the full knowledge I am working as a GP! Is that not enough?? 12 years of training? For the public though I think the belief is once graduated from a medial school, everyone is a GP!
    I found it unbelievable though when my mum told me she was speaking to a 5th year medical student who was excited as she was going to be a “GP” next year after graduation. My mum politely explained that it is a post graduate training course and you are not automatically a GP. This girl had no clue!!! Oh dear
    I am lucky to have many colleagues and friends and patients who respect general practice and understand the service it provides. Hopefully others with catch on!

  12. Thanks for a great read!
    As a med student in my younger years when asked what area I was interested in, my immediate reply was “Anything but a GP! How boring; coughs and back pain all day!” My how the wheel turns.
    It wasn’t until clinical years when I was placed with 3 fantastic GPs over a couple of years that I saw how rich & rewarding GP could be. The day we diagnosed a new Parkinson’s was eye-opening: as GPs we are the sieve for the multitude of benign presentations, and I for one love being the first person in line to try and put the puzzle pieces together.
    These days I try to spread the passion to the next generation – and yes, there are still “coughs and back pain” days that are difficult to find inspiring!

  13. Reblogged this on the beauty of scrutiny and commented:
    A blog post scrutinising the myth of General Practice- the specialty is high varied and requires a lot of skill.
    If you have had a bad experience with a GP, please don’t think that all are like that (and I encourage you to find a new one if your current GP is not attending to your medical needs!)

  14. Reblogged this on caitiespace and commented:
    Amen to this.

    A post expressing what a lot of us who elect to become GPs truly feel about our profession. No medical profession is a fallback. They all require passion and hard work, otherwise there would be no point getting out of bed in the morning.
    I am choosing to be a General Practicioner because I want to work in the rural environment that I grew up in, and there is really no other medical specialty that you can do in these environments. That’s on top of the fact that I love all facets of medicine, and can’t really see myself giving up any of them.

    I hope you enjoy the blog as much as I did.

  15. I’m a final year medical student planning to become a GP – despite having had doctors tell me I’m “too smart” to be “just” a GP, and what about X, Y or Z. I’ve been fortunate enough to have exceptional GP supervisors during my medical school placements, and I’m sure I’ll find the career path really rewarding: I love the variety and having the opportunity to be the one to put the puzzle pieces together and make a diagnosis. Thanks for this insightful piece!

  16. My husband has just been accepted into to Adelaide to Outback GP program for next year and he has fielded this question a few times over the last little while! Very well explained. Reposted on my blog – hope you don’t mind!

    • Congratulations to him! AOGP is a great training provider. A few of my awesome GP registrar and blogging mates are there: ruralflyingdoc.com and greengp.wordpress.com. My cousin has also joined AOGP this year too. Best wishes!

  17. I know my patients and families personally, admit to Hospital, do the antenatals, do the house visits, vasectomies,palliative care, treat the fractures ,depression,and emergencies, and present the prizes at the local high school! General practice is easier now than in the past – we have risk management procedures in the practice, I can look up nearly everything on the net, and enjoy the company and opinions of my practice colleagues freely. Great career choice, but choose your medical circumstances wisely and take regular breaks…

  18. Great post Penny, showing your usual deft diplomacy skills and meticulous research! Personally as a GP of 15 years I am seeing less of the “just a GP” in the last few years. Perhaps it is a reflection of reduced contact with the teaching hospitals and my patients knowing where I am at in my career. I do however feel there has been an increasing respect for GP as a career now that there is a compulsory training program and standards are lifting.

  19. I think, an appropriate simile would be: “Do you prefer to work in Triage or not?” As an end-user of the medical system, I see GPs as a frontline service.. I have to rely on them to spot a serious disease and direct me to the right specialist, which I think is not an easier task than specialist occupations further down the tree.

    Perhaps the skills required of a GP would be more appreciated, when we finally get to the point of combining systems biology in the research world with the various branches of pathology…

    • Thanks for your comment. With all due respect I feel you may be underestimating the breadth of work we undertake as GPs. The vast majority of patients we not only diagnose but also manage ourselves. Although it is an important skill to be able to refer appropriately, only a very small proportion of our patients will actually ever need referral.

  20. Will forward this to my son who started as a brand new medical student yesterday. I couldn’t care less whether he becomes a GP or a specialist as long as he makes the right choice for himself but we all work hard in our own fields and what we really need is respect and understanding for each other’s roles.

  21. Great piece, Id be lost without my GP here in Ireland. She not only is a doctor, but an ear, she is filled with empathy, she takes time to care. Best wishes.

  22. I love this. I’m in my fifth year of medical school now, with just over a year to go, and although there are many rotations I love, nothing really gets close to family medicine. I don’t know about other countries, but in South Africa, GPs are technically licensed to administer short-duration anaesthesia, to deliver babies, to remove tonsils and appendixes, and so on and so forth. So for now, I don’t think I WANT to focus on just one thing. General Practice is incredible.

  23. I totally agree with you. My Dad is a GP and I love it when I run into his patients sometime and they tell me “he’s our family doctor”. It’s like he actually becomes a member of their families. They love him, share problems with him, so GPs are so much more than just doctors, they are healers. Specialists deal with a particular organ or system, GPs have to take care of all and they do it well.

  24. How interesting to hear that GPs experience the same kind of attitude that I, as a student midwife, have sometimes had from people saying “you’re too smart to be just a midwife, why don’t you become a doctor?”. As a service user, I’ve only had one experience of needing to see a partialist – for speech therapy – but have had many issues resolved by helpful and well-informed GPs. You have to know something about everything, that’s hardly easy!

  25. Here in the states we need more GPs. Unless I’m very lucky, I can’t get in to see my doctor or anyone else in the office the same day I call, because there are not enough practitioners there. The ones that are there are overworked. So glad you have found your niche and congratulations for being Freshly Pressed.

  26. I think it’s ridiculous that it cost my husband and I such a tremendous amount for him to visit a urologist who ran over an hour late and charged through the roof for a procedure which he would perform tens of times each day.
    I compare that experience with visiting my wise GP. My wonderful doctor has no idea what the next patient will present with: cold? sprained ankle? substance abuse? early onset dementia? Whereas the specialist has a pretty good understanding of what will face him when a patient walks through the door.
    And yet, in monetary and socio-status terms, one is valued more highly than the other ..

  27. I have great respect for doctors of any specialty that do their job well, and I am sure there are many excellent GP’s. My experience, however, has not been of the quality described here: our (x) family GP misdiagnosed my 14 year old son’s headaches 3 times in three months; only to have a chiropractor realize the probability of a brain tumor based solely on his description of his headaches. He was referred to an amazing neurosurgeon and had an appointment within two days. We were told he would have been dead within two weeks had he not received treatment for the cancer when he did.
    A different GP, who was very caring and compassionate, prescribed an anti-depressant for me when I discussed my ongoing depression with him. Six months later I was in a state of extreme mania, followed by rapid-cycling. I lost my job and almost my family. My neurologist (treating me for essential tremors) referred me to a psychiatrist. I was diagnosed bipolar 1. My psychiatrist told me that the prescribed antidepressant was contra-indicated for bipolar and was the cause of my manic episode. It took almost a year to find the right combination of medications to stabilize me.
    These are just two examples I can share of being misdiagnosed by a GP, only to have a doctor of an unrelated specialty recognize the true disease/disorder, and subsequent referral to the correct specialist. My son has had brain cancer three more times and deals with physical and neurological problems related to the cancer and its treatment. He was a four time cancer survivor by the age of eighteen, now in remission for four years. Would this have happened if his GP recognized it wasn’t allergies or migraines sooner? As for my mental health, I am predominately stable but continue to have breakthrough episodes not controlled by medication. I have not been able to return to work.
    Hopefully these two doctors are the exception to the rule. Good doctors of ANY specialty must be able to look below the surface and ask questions beyond the obvious.

    • Thanks for the comment, Diane.
      Yes, one of the immense challenges of general practice is picking the small number of serious problems from the large volume of benign common causes. As GPs we see lots of kids with headaches, and lots of people of all ages with depression and picking the patient who doesn’t quite fit the normal pattern can be very difficult. Sadly we are all human and do make mistakes from time to time. I think your experience demonstrates the importance of a second opinion if you don’t feel that you’re being listened to or if you’ve got that feeling in your gut that things just aren’t quite right. I wish you and your family well.

  28. There is no such thing as being just a GP.
    ( smile) It is an honorable profession and we are all called to do different things. Follow what makes you happy and the rest will follow you.

  29. Your’e right of course, the specialist, particularly the sub-specialist knows more and more about less and less. As a radiologist with some 35 years sub specialisation in paediatrics, recently returning to general radiology I know full well what is lost in specialisation. It has been mygreat privilege to teach radiology to GPs, particularly rural GPs and I am in awe of the range of knowledge they have, and their competence. Go for it Penny, don’t let widespread ignorance allow you to feel put down. Tony

  30. Great article Penny!
    Way, way, way back – 29 August 2003: I wrote a letter to the editor Oz Doc “A GP by any other name” exactly about this issue: circumstances were 3 GP proceduralists ( Obs, gas , paed) in theatre at 0200, we overheard the RN say ‘ just the GPs calling us in again”!
    Times they are a changing and I hear this less: GP world is constantly changing and challenging: there is an increased appreciation of our specific skills: there are ‘lazy’ colleagues out there who investigate and refer far far too much ( cos it’s easier and you make more money) which irritates me hugely!
    We have to keep our Fellowships to an extraordinary high standard: we will need to accept some form of peer review from time to time ( another strange phenomenon about GP land is that once VRd or Fellowed, you can practice completely on your own for the next 30 years , unless you have students or registrars)
    Generalism is the buzz word at present.
    Our skills need to reflect our own communities’ needs.

    Again long ago I suggested a change in branding to ‘Primary Care Physician’: my practice has used this name since in any correspondence
    E.g.
    Dr X FRACGP FACRRM
    Primary Care Physician

    Happy to discuss !

  31. I wish more doctors were like you! I’m a nursing student, and I would actually love to one day work alongside a GP with your attitude. It really is a shame that more people don’t appreciate just what general practice and primary care really means. Thanks for sharing! 🙂

  32. Wow, that was a great article, as a student looking to (hopefully) study medicine in two years, i have been looking into what medicine can give me, most of the experince and talks ive had gave me that “just a GP” impression which, to be honest, put me off GP a lot ( also the factor of tht my GP is a grumpy old man who looks like he studied medicine with hippocrates). but now i hope to potentially look for a future career maybe as a GP, it sounds like the better speciality of them all!

    .d

  33. Very good to hear that. I am about to start my career oath after my internship and I’m considering the GP path as a potential option. Besides I like psychiatry and it is my dream path, I think that being a GP is a great responsibility for the community. You do an amazing job and we need more people to think the way you do. Tanks for sharing it with is and good luck with your work and career.

  34. Pingback: Links Roundup | Iron Dove

  35. My husband is “just” a family physician, yet his incredible and vast knowledge amazes me. He can recall thousands of patients, their issues, their medicines, the details of all medicines, their family members, and on and on I could go, and he does this when they call at 2 am, or during dinner, or when the hospitalist calls to go over details with him for his patients. He has the big picture not only of the individual, but for that person’s grandmother, and child, and aunt Suzie. He loves to not only address acute and chronic, complex issues but also treat the whole person, being sensitive to mental health issues and making recommendations as appropriate there too. He networks with local specialists, serves on the hospital’s board of trustees and leads several committees within his company. All this with a full caseload, 12 hour days. In the U.S., his compensation is probably a third of the specialists’ compensation, and quite possibly less per hour than our local auto repair tech, so “just” a family doc has less respect in every way than what it deserves. Thank you for this lovely description of your chosen profession, and more power to you, all GP’s and FP’s.

  36. I so appreciate your passion and commitment! As an ‘end-user’, (to borrow a phrase from another commenter), I’ve long and mindfully appreciated GP’s – and, I must say, their locums! Nearly all my and family critical issues have been resolved promptly by our GP – from delivering and tracking wellness of babies, to pneumonia, to infected spider bites. Some of these potentially quite serious. Issues best referred to specialists have been assessed, with referrals promptly arranged. These experiences have been in Canada. Since I’ve moved to the States, I’ve been puzzled at talk of shortage of GP’s, but have chalked that up to the US situation. We need you – we need many of you! Thank you.

  37. “But I think, deep down, that I always knew I liked ALL of medicine too much…” It goes with me too ^^ Until now I still have no idea what area in other specialist I really interested, because being a GP is way too interesting!

  38. I teach in the General Studies department at an engineering school. I’m a humanities and social science generalist myself (Ph.D. in English, undergrad in political science, and teching writing, speech, literature, political science, and film studies), so I feel some personal identification with your blog post.

    But the humanities and social sciences have always been somewhat interdisciplinary. What I find interesting is that engineering appears to be becoming more interdisciplinary, too. For example, a biomedical engineer making a device for the heart should have a solid grasp of fluid mechanics, electrical circuits, and computer programming—all of which are subjects of three different engineering specialties

    It seems possible that in fields like medicine and engineering the 21st century will belong not to specialists but to the generalists who can move fluidly among fields and see the larger patterns and connections.

  39. Even as a med student, I get this a lot. When I talk to people, a lot of them ask what kind of doctor I want to be. When I say GP, they tend to give me the “Oh,-so-you-do-not-want-to-be-a-real-doctor”-look. Seriously, -only- a GP?

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