What are the negatives to GPwSi development and niche GP? There are concepts and self view issues discuss and there some practical considerations.
Stories we tell ourselves
For some of us, we have told ourselves stories about what type of work we do, or what type of work makes up real general practice. Perhaps the story in our head is that we see all comers and have to be able to offer something for all problems. James Clear, in his book Atomic Habits talks about the fact that when we change, we might need to change the stories we tell ourselves “I’m the sort of person that _____________” to allow us to wear a new identity. Changing focus as we develop a special interest may mean less general work. Will you need to change the story you tell about yourself to develop a niche? Or will the two ideas sit side by side?
We know grief is not just about people dying. It can be about changes in identity. In this episode of the Just a GP podcast, Dr Ashlea Broomfield reflects on the changes in her mindset and grief to move from generalism to providing the type of focused practice that was important for her to provide.
Patient factors
Perhaps this means certain patients can no longer get in to see you or there are reduced appointment slots for routine or on the day medicine. For some doctors this will be a good thing, a reduced pressure to see all comers and a chance to focus on and really develop quality care in one area.
There can be frustrations from patients “I can’t get to see you anymore” “I don’t want to see the other doctors” To this I would suggest that we are not indispensable, the patients will do fine with another practitioner and we cannot forge on in generalism if it is untenable, poorly renumerated and leading to burnout.
Practical difficulties with GPwSI
Where will you offer this service? Will there be confusion between patients seeing you in your niche which may have different booking criteria like longer appointments, different gap payments compared to a regular booking? Is your current physical set up appropriate? Dr Ashlea Broomfield in the podcast mentioned above describes wanting a calm, reflective space quite different from the practical medical consulting room and so it was necessary for a room without telephones, corridor noise, hard linoleum floors and with warmth, quiet, stillness.
Do you need to inform your medical indemnity insurer? For example as your skin cancer treatments get more complex with flaps, facial blocks, you may move out of the standard non-procedural band of general practice indemnity insurance and need extra cover from your insurer. If your work focuses on a greater proportion of your income from one area, this may also trigger a review from your insurer. My insurer desires a yearly report on the proportion of vasectomy work compared to general practice.
Will your Continuing Professional Development needs and completion change? Will you keep your general registration and college post-nominals? The RACGP and AHPRA does have guidelines on what it regards as recency requirements.
If you are the only person in your practice who offers a specific therapy – prolotherapy, aesthetic injections, what is the plan if you go on leave? Other doctors can easily take your asthma or hypothyroid bread and butter patients but may not be able to to manager complications or follow up of your niche.
Now that you have special powers and a special referral network, you aren’t replaceble. Not as easy to find locums/backfill your role.
To be eligible for Medicare Australia Practice Incentive Programs, a practice must offer a full breadth of general practice. In February 2023, a skin cancer practice in Queensland lost its accreditation status for not offering a full breadth of practice and therefore lost access to Medicare funding for practice nurse support. If your work niches down significantly, will this be a concern for you?
These negatives are not a barrier
These items are not a barrier that should stop you pursuing GPwSI work if it nourishes your passion and re-ignites your interest in medicine. Developing your GP niche may also be protective against burnout. Do think deeply about these issues and let me know about others you have come across.
Dr Simon Wilson