Executive summary
General practice is the most accessed sector of the healthcare system and the health of general practice is essential to the health of all Australians.
Each year, almost nine in 10 Australians visit a GP. In 2022 more than 179 million health services were provided by GPs, and on average, patients received 7.9 episodes of care from their GP throughout the year.
The General Practice: Health of the Nation report provides annual insights into the state of general practice in Australia. By summarising data from the Health of the Nation survey, and point-in-time data and trends from government and stakeholder publications, the report examines current and emerging health issues, patient access to care, workforce profile, job satisfaction and the business of general practice.
Each year, RACGP members select a topic of interest. The seventh annual General Practice: Health of the Nation report’s topic of interest is the ‘attraction and retention of the general practice workforce’. This year the report highlights several concerning themes relating to the general practice workforce.
Many factors influence the decision to become a GP. Aspirations for regular hours and quality of life, along with the ability to balance family and career, the diversity and breadth of work and the ability to build relationships with patients over time are all dominant contributing factors to decision making.
For pre-Fellowship and New Fellows, the decision to become a GP is made in the postgraduate years or as an early or mid-career change. Mid- and late-career GPs were more likely to report making the decision to become a GP at university, than pre-Fellowship or New Fellows. This apparent shift towards later stage decision making may impact the focus of future campaigns promoting general practice. Later career decision making may serve to refocus future promotional campaigns to early and mid-career medical practitioners who are seeking a specialisation that provides them the opportunity to balance family and career, and where anticipated regular hours and quality of life are dominant influencing factors.
Since 2021, the likelihood of GPs recommending general practice as a career has been trending downward. In 2023, less than half of practising GPs indicated they would recommend their profession to their junior colleagues. We continue to see a decline in the number of medical students reporting general practice as their preferred specialty, along with fewer active doctors in RACGP training programs. The challenges of attracting medical students and junior doctors into the profession continue.
Across practice settings and locations, we see significant differences in the likelihood that GPs will recommend the profession. GPs working in Aboriginal Medical Services or Aboriginal Community Controlled Health Organisations (62%) are significantly more likely to recommend general practice as a career than those working in group practice (non-corporate) (39%).
Similarly, GPs working in remote (51%) and very remote settings (52%) are more likely to state they would recommend general practice as a career when compared to those working in major cities (36%) and inner-regional areas (38%).
The differences in the likelihood to recommend the profession across practice settings is evidence of the disparate professional experiences of GPs in Australia and serves to highlight the inadequacies of the current primary healthcare system.
The cost of care is increasing. In addition, the proportion of GPs who bulk bill most of their patients decreased significantly in the last year. This is reflective of anecdotal reports from GPs about the increasing cost of providing healthcare services in general practice and further compounds patient access issues.
The downward trend in GP job satisfaction has continued this year. GPs report that their overall job satisfaction has decreased from 70% in 2022 to 66% in 2023. Simultaneously, there has been an increase in those GPs who report that they are ‘very dissatisfied’ with their overall job satisfaction.
Maintaining a healthy work–life balance is important for GP wellbeing and directly impacts workforce retention rates. GP work–life balance has declined annually since 2019, and the proportion of GPs who have experienced feelings of burnout remains high, with over seven in 10 (71%) reporting such an experience in 2023. Heavy workloads and demands on GP time are eroding optimism about the profession, despite some of the pressures of the COVID-19 pandemic receding. Alarmingly, among practising GPs, 64% are considering reducing the time they spend practising or are considering stopping practise altogether.
Regulatory and compliance burden and burnout are the dominant issues leading to GPs considering a reduction to the amount of time they spend practising, or to cease practising as a GP entirely. The new Continuing Professional Development (CPD) requirements were also reported as a significant contributor to the desire to both reduce time practising or cease practising entirely.
There has been a notable drop in GPs satisfaction with remuneration, with 48% of GPs reporting dissatisfaction with their remuneration this year. The consequences of this are now evident, with increased costs to patients and challenges meeting workforce targets.
As the discontent and frustration with the profession has grown, the acceleration in the number of GPs who expect to retire within the next five years continues. Almost three in 10 GPs (29%) intend to retire in the next five years, resulting in a net premature loss of 24% of all practising GPs.
Increased concerns with systemic issues in the Australian healthcare system are also evident this year. Patient health issues and access to care have become increasingly compounded by ongoing dysfunction in the health system. Specifically, workload and GP stress, health system fragmentation and patient financial issues have all increased significantly since 2022.
The seventh annual General Practice: Health of the Nation report paints a sobering picture of a workforce under considerable strain and facing significant attraction and retention challenges across all career stages. The 2023–24 Federal Budget commitments go some way to improving access to primary healthcare and reducing out-of-pocket costs for patients. The Government has listened and responded to the RACGP’s calls to better support GPs, practice teams and their patients, but without continued and sustained policy reform, the steady erosion of optimism across the profession will continue.
For more information, read the full report.