Christopher Harrison
Joan Henderson
Helena Britt
The Australian medical workforce is growing as we seek to meet the clinical demand of an ageing population.1 It is expected that younger general practitioners will gradually replace older retiring GPs. Using BEACH data (April 2009 to March 2012) we compared 439 GPs aged less than 40 years (younger GPs) and 697 GPs aged 60+ years (older GPs) to determine whether there were differences between the two groups – particularly in terms of prescribing (Table 1).
Younger GPs were more likely to be female, hold FRACGP, be an Australian graduate and work in a group practice. Older GPs were more likely to manage patients who: were male, were aged 45+ years, held a Commonwealth healthcare card (HCC) or Veterans’ Affairs card; were from a non-English speaking background (NESB); were visited at home or at a residential aged care facility; had been previously to the practice. There was no difference in the number of problems managed at encounters, however, younger GPs managed more new problems while older GPs managed more chronic problems.
Table 1. BEACH GPs: April 2009 to March 2012
| Characteristic | GPs aged <40 years (95% CI) | GPs aged 60+ years (95% CI) |
|---|
| GP | Proportion |
|---|
| Female |
58.1% (53.5–62.7) |
18.7% (15.8–21.5) |
| FRACGP |
83.1% (79.5–86.6) |
22.7% (19.5–25.8) |
| Australian graduate |
76.3% (72.3–80.3) |
62.9% (59.3–66.5) |
| Solo practitioner |
2.1% (0.7–3.4) |
22.2% (19.1–25.3) |
| Patient | Proportion |
|---|
| Female |
62.5% (61.3–63.8) |
54.4% (53.5–55.3) |
| 45+ years |
44.0% (42.5–45.5) |
63.8% (62.4–65.2) |
| HCC |
35.2% (33.4–37.0) |
50.7% (49.1–52.3) |
| Veterans’ Affairs card |
1.9% (1.7–2.1) |
3.2% (2.9–3.5) |
| NESB |
5.5% (4.2–6.7) |
10.5% (8.9–12.2) |
| New to practice |
9.9% (8.8–10.9) |
7.6% (6.9–8.3) |
| Aged care facility |
2.4% (1.8–3.1) |
0.8% (0.5–1.1) |
| Home or institutional visit |
1.5% (1.0–1.9) |
0.4% (0.3–0.6) |
| Management | Rate per 100 encounters |
|---|
Problems managed
- new problems
- chronic problems
|
154.5 (151.8–157.1)
64.8 (62.9–66.7)
41.8 (39.8–43.7) |
153.0 (150.4–155.7)
53.5 (52.0–55.0)
61.7 (59.4–64.1) |
Medications
- prescribed
- advised OTC
- GP supplied
|
98.6 (96.2–101.0)
71.9 (69.7–74.2)
13.2 (12.2–14.1)
13.5 (12.3–14.7) |
112.4 (108.9–115.8)
94.5 (91.2–97.8)
8.0 (7.0–9.0)
9.9 (8.7–11.0) |
| Other treatments
|
66.4 (62.7–70.0)
43.8 (40.7–47.0)
22.5 (21.3–23.7) |
48.0 (45.5–50.4)
29.2 (27.2–31.2)
18.7 (17.6–19.9) |
Referrals
- allied health
- specialist
- pathology
- imaging
|
16.2 (15.4–16.9)
5.5 (5.1–5.9)
9.5 (9.0–9.9)
56.6 (54.0–59.1)
10.6 (10.1–11.1) |
12.6 (12.0–13.2)
3.2 (3.0–3.5)
8.0 (7.6–8.4)
38.2 (36.3–40.1)
9.3 (8.9–9.8) |
Older GPs recorded more medications overall, particularly those prescribed, while younger GPs recorded more supplied and advised for over-the-counter purchase medications. Older GPs recorded opioids at a higher rate, but the systemic antibiotic rate did not differ. Younger GPs provided more non-pharmacological treatments, such as clinical and procedural treatments and referrals, and ordered more imaging and pathology tests.
There are clear differences between the two groups of GPs, especially in their prescribing. While some of these differences may be explained by a higher proportion of young GPs being female,2 or older GPs seeing more older patients with more chronic problems, other behaviours may be unique to the older cohort and may not be replaced by the younger GPs. Further research measuring the impact of these differences on future general practice is required.
Competing interests: None.
Provenance and peer review: Commissioned; not peer reviewed.
Acknowledgements
The authors thank the GP participants in BEACH and all members of the BEACH team. Funding contributors to BEACH for April 2009–March 2012: Australian Government Departments of Health and Ageing and Veterans’ Affairs; Abbott Australasia Pty Ltd; AstraZeneca Pty Ltd (Aust); Bayer Australia Ltd; CSL Biotherapies Pty Ltd; GlaxoSmithKline Australia Pty Ltd; Janssen-Cilag Pty Ltd; Merck, Sharp & Dohme (Aust) Pty Ltd; Novartis Pharmaceuticals Australia Pty Ltd; Pfizer Australia; Sanofi-Aventis Australia Pty Ltd; Wyeth Australia Pty Ltd.
References
- Harrison C, Britt H. General practice – workforce gaps now and in 2020. Aust Fam Physician 2011;40:12–5.
- Harrison CM, Britt HC, Charles J. Sex of the GP – 20 years on. Med J Aust 2011;195:192–6.
Correspondence afp@racgp.org.au
Opening or saving files
Files on the website can be opened or downloaded and saved to your computer or device.
To open click on the link, your computer or device will try and open the file using compatible software.
To save the file right click or option-click the link and choose "Save As...". Follow the prompts to chose a location.
Types of file
PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). These files will have "PDF" in brackets along with the filesize of the download. To open a PDF file you will need compatible software such as Adobe Reader. If you do not have it you can download Adobe Reader free of charge.
DOC Some documents on this site are in Microsoft Word format. These will have "DOC" in brackets along with the filesize of the download. To view these documents you will need software that can read Microsoft Word format. If you don't have anything you can download the MS Word Viewer free of charge.
MP3 Most web browsers will play the MP3 audio within the browser