Generalist practicing: is it worth it?

This article was exclusively written for The European Sting by Ms. Ana Laura Dutra Queruz, a 18 years old and a second year medical student at UniCesumar, in Maringá, Paraná – Brazil. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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The foundation of a health system should always be primary health care, which meets the majority of the health needs of the population over their lives. Primary health care (PHC) includes a range of services such as prevention, treatment and palliative care, combining physical, psychological and social aspects of the community, this places PHC as the gateway to a health system. General practitioners (GP), although truly indispensable to the primary attention, are in a number decay due to the lack of incitement during medical formation to this area. In 2011, Brazil registered, according to the Federal Council of Medicine, 204,563 specialist physicians and 167,225 generalists. Recently, a crisis in GP workforce has been spread worldwide, medical students are guided to specialization careers and it has became uncommon to find students that aim to be general practicers. Why would the ones that study and appreciate medicine chose to work with only a small portion of it? Following the generalist career, the doctor is subject to face a range of different demands. This one needs as well to be able to accomplish indispensable clinical procedures for emergency care. A combination of these factors characterizes the GP’s work as much more complex and challenging, especially in countries as Brazil, where public health lacks the structure and resources to perform such obligations. We can also observe a job market favorable to the specialist, in addition to a better remuneration and social prestige. The new workforce chases for specialization careers as soon as possible, looking for acknowledgment and financial feedback, commonly associated to the specialists. A reluctance to work in primary health care is due to the hospitals and clinics excessive demand, in addition, a low scientific and professional potential image of the generalist was created within the professionals, the fake idea of dependence of the specialist tends to lead students to opt for the specialties. A recrudescence of the shortage of professionals in primary care occurring around the world is a consequence of the image of the general practitioner in society, its low valorization by the public health and the much more exhaustive work. The lack of medical investment causes the community to have even lower access to the health system, with the consequent poor guidance and precarious health. But then, how would this be solved? Community’s health depends on institutions that encourage patients to seek the general practitioner, demonstrating its importance in promoting and maintaining health. Medical schools must undertake to provide the student with the basic healthcare system, understanding and contributing to public health and basic procedures, at the beginning of the course, in a practical setting. The presence of the student in the general practitioner’s work environment places this professional as inspiration and demonstrating the importance of cherishing primary healthcare. Home visits to the local community, working in prevention of various diseases, would cultivate an interest in general medicine, without allowing our future health workforce to close their minds to previously planned specialties. Finally, the association of the figure of the specialist as a professional that holds better perception and clinical resolution, greater understanding and knowledge will be deconstructed gradually. References https://www.cremesp.org.br/siteAcao=CentroDados&acao=detalhes_capitulos&cod_capitulo=2 https://www.who.int/whr/2006/06_chap3_en.pdf McDonald, Paula, How can medical schools encourage students to choose general practice as a career?, Br J Gen Pract. 2016 Jun; link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871286/ Coulter, Angela, What do patients and the public want from primary care?, BMJ 2005;331:1199, 17 November 2005 link: https://www.bmj.com/content/331/7526/1199.full J, Judd, Building health promotion capacity in a primary health care workforce in the Northern Territory: some lessons from practice, Health Promot J Austr. 2013 Dec;24. link: https://www.ncbi.nlm.nih.gov/pubmed/24355336 About the author Ana Laura Dutra Queruz is 18 years old and a second year medical student at UniCesumar, in Maringá, Paraná – Brazil. She has a lot of interest in health and how it is affected. Besides, she really likes politics, social actions and music. She has been improving her learning and skills to disseminate her knowledgement and possibly helping the community.