A cry for help from exhausted and overloaded GPS
Singing along with the crowd in full roar watching Parquet Courts play in Auckland last Friday night was a joy, even if I was feeling a bit buggered.
What is a middle-aged GP doing in the Powerstation wearing an N95 listening to a New York rock band?
As my very understanding wife says, personality maintenance in my job is so important.
You fight burnout by finding experiences that lift you out of being misanthropic and curmudgeonly, or you end up not liking people and being grumpy.
If I were to write a book on being a general practitioner, I would call it Running on Empathy.
It is a fantastic job to look after families from the cradle to the grave. By and large, most patients are a pleasure to serve, and often show their appreciation.
By the time I retire, I will be a veteran of almost a quarter of a million consultations. Over half my colleagues intend to retire in the next five to 10 years, and anecdotally, discussions with other practitioners indicate they would gladly retire now if circumstances would allow.
They are exhausted. They soldier on with the increasing demands of patient numbers, complexity of disease, rising standards and extra compliance requirements. Covid-19 is now surging, creating pressure for consultations on already-groaning lists.
There is an increasing amount of aggression and rudeness from clients. Managing this, including some vexatious complaints, takes away valuable consultation time. We now need to support upset staff who are often abused when advising patients that appointments are not available that day.
Over my career, I have often felt overloaded, and have experienced stressors like being punched in the face by a client, being stalked, and my staff and I receiving death threats.
A patient wrote to me repetitively for months saying he would sue me because I had medically stopped him driving. It is fair to say that general practice is a calling, requires dedication and resilience, and is not for the fainthearted.
Burnout happens when there is a mismatch in these areas of work: community, control, reward, workload, fairness, and values.
Burnout isn’t depression — it encompasses significant exhaustion, cynicism and a marked diminishment in sense of personal achievement.
Rest is essential, often unavailable in the modern primary care environment. Recovery involves rekindling a passion for life, and resolution of the conditions that created the overload including the resolution of non-supportive organisational issues.
One of those conditions is the chronic underfunding of primary care. In my view, this has happened as the GP workforce in New Zealand is made up of caring, cooperative people who generally wish to help others, rather than lobby for funding.
This makes it easy for governments to limit primary care resource in favour of secondary care indicators like hip replacements and cataract waiting list times.
GPS are stymied by the present funding structures.
Capitation payments are a privilege, but come with stringent limitations on co-payments as well as requirements for the provision of 24-hour care.
Funding is based on our work patterns from at least two decades ago. GPS continue to work in 15-minute allotments as complexity of disease and their treatments burgeon, leaving them little energy for political engagement at the end of a consulting week.
There are good initiatives like Health Care Homes that can improve efficiency, but if not supported by adequate resources, then we may just race faster to the bottom.
“Negotiations” for capitation increases occur each year, due to the clause in the Primary Health Organisation services agreement for the value of patient funding to be maintained. There is also a formula for “reasonable fee increases”, which are calculated by Health New Zealand (previously DHBS) and the Ministry of Health.
If agreement on capitation cannot be reached, the ministry unilaterally determines an increase. This should involve giving reasonable notice and consultation with primary care.
This year the ministry dictated a 3 per cent increase in capitation without consultation or notice. Gen Pro, an organisation for GP practice owners, estimated that costs had increased 12 per cent over the past year.
This was not counting impending pay parity settlement for nurses’ wages. Frankly, this is unsustainable for primary care. General practices are struggling.
In a time of short supply and high inflation, medical staff become expensive. No wonder it is hard to get into a GP and A and E becomes overloaded.
I predict a serious shortage of experienced GPS within a decade.
This will cause significant blowouts in secondary care costs. I am also forecasting some very disgruntled younger colleagues burdened with increasing demand and diminishing resources.
I fear for the future of general practice while it is funded by such an outdated system.
Maybe I am getting grumpy, but I think we all deserve better than that.