Some concerns or worries about GPwSI is that this is a drain on general practice – that consultation time is lost for true generalist work. On face yes, of course. If I am working on my GP niche, that is less time for generalist consulting. However as discussed before I feel that developing work that really excites you provides the energy to keep you at work that you may have looked to change. True generalism is very hard. There is no control on what is going to walk in the door, being spread over a generalist field inevitably means you cannot be competent in all things and these reasons may lead to us feeling overwhelmed or unfulfilled in GP work. We are already missing two of the factors that Self determination theory suggests we need to thrive
In published articles about GPwSI, there are concerns about GPs missing from the generalist workforce pool, about the financial viability of GPwSI schemes (mostly UK related) and concerns about standards and training . There are positive takes on GPwSI like this article from the AJGP– that we are not a drain on resources, consulting time or efficient specialist care
For myself, having an area that I feel confident in and allows me to offer a defined work flow for one particular patient problem (vasectomy) has led to me feeling more tolerant of some of the other stressors of GP work. I still enjoy the variety of true GP work and most of my consulting hours is spent this way. Having that 20% of work in an area where I can create autonomy and competence has been useful to me.
Working in my niche does reduce hours spent in general consultation however this is still patient care time and in an area that patients value. Patients demonstrate their appreciation with words, reviews and being willing to pay for the service, more than my general consulting patients do. In the complex pressure cooker of medicine post-pandemic this trumps any negatives workforce planners may rail against. There are many things the healthcare system could do to improve the sustainability of generalism, unfortunately few are being looked at.
Dr Simon Wilson. Also shared on Linkedin