More than ‘just’ a GP

Some medical roles are often not regarded as those of a ‘real doctor’

Dr Sarah Fitzgibbon

The hashtag #JustaGP did the rounds a few years ago, in response to the experiences of family medicine doctors who found that their chosen specialty was often diminished in public discourse. We are probably all familiar with the enquiry, soon after qualifying with our MB BCh, as to whether we intended to specialise “or just be a GP”. Research has shown that junior doctors are exposed to significant negative discourse around general practice as a specialty during their hospital-based training. The blaming of GPs for emergency department crowding is almost as inevitable as brand-new Health Ministers blaming consultants for the failings of the entire HSE (brand-new Health Ministers don’t tend to blame GPs for anything; they just forget we exist).

An article in BMJ Careers in 2022, entitled ‘Which specialty makes the happiest doctors?’, proffers the notion that the quality-of-life of a GP remains unparalleled among all doctors, backing this up with incontrovertible evidence (n=1): “You may in fact remember that one GP you knew during your medical training who was always away on a fun holiday.” The article goes on to say: “If the profession of a GP is not in line with your ambitions, there is still a diverse pool of hospital specialties to choose from.” The implication being that general practice is an ambition-free zone.

There are some rungs on the ladder even lower than general practice, however.

There are the part-time doctors. The ones who will not/cannot commit to the 50/90 hour weeks. There are some days they don’t even go to work at all. Who are these people and what have they done with all of their expensive training? How dare they? There is talk about work-life balance, the notion that working in paid employment for 20 hours per week will allow all the time in the world to go conquer the waves on a surfboard you have ‘macramé-ed’ out of recycled Kefir bottles, before returning to a happy screen-free family who have prepared you a lovely spelt and tofu dinner. Oh life, it is so wonderful when you balance it carefully with that pesky work.

It demonstrates many of the barriers which result in doctors ‘choosing’ to stop working in Ireland

What is really happening for most people, however, is that they have two or three jobs, but only one results in a salary landing in the bank account. The financial value of stay-at-home parents has been recently estimated at €57,000. We know from CSO data that the person who is most likely to stay at home to carry out this vital work is the woman in a heterosexual partnership. We also know that women are more likely than men to work in paid employment part-time. We can very cleverly add these two bits of information together and work out that women will be leaving their paid work to rush home as fast as their little kitten heels can carry them, to get cracking on that unpaid work.

So less-than-full-time employment cannot really be seen as a means to achieving the perfect work-life balance, but rather as a process by which the 168 hours of the week are divided into paid-and-not-paid minutes of labour. 

And yet there remains the frowny faces on the august chaps at the top tables, who cannot figure out why the hell these women won’t just work full-time and solve the eternal manpower crisis. Easy peasy.

There are other medical roles which are generally not seen as being a ‘real doctor’. Those who ‘choose’ to leave clinical medicine and work only in non-patient-facing roles are pretty near the bottom of the pile (except the Chief Clinical Officer – that’s allowed). Those who ‘choose’ to leave general practice and work only specialised fields such as aesthetic medicine or women’s health (this is when being a specialist suddenly loses its cachet). And those who ‘choose’ to leave medicine altogether and opt for the non-paid job as a single career, or branch out into something else entirely, like art or music or hot-air ballooning.

The Irish Medical Council Supplementary Report for 2023 documents the doctors who left the medical register in that year. It demonstrates many of the barriers which result in doctors ‘choosing’ to stop working in Ireland. The statistics relate to non-EU graduates, economic migrants, people who provide care for their families, and those who find the current working environment in Ireland simply too inflexible for their needs. They are striving to achieve some kind of balance between the opposing demands in their lives, while still keeping everyone happy.

Perhaps we need to change the hashtag to #JustaHuman.