Could innovative job design improve GP recruitment?

Recruitment into GP partner posts continues to be a real challenge. Despite the fact that the family doctor’s role, in the purely clinical sense, is little changed and surely still appealing to a significant proportion of medical graduates, young GPs are not choosing to apply for partnership positions. Why is this?

Increasing pressure of work, both clinical and administrative, seems to be a major factor, as does funding and the falling profits earned by partners. The risk-reward ratio appears to have shifted so far that committing to partnership status no longer appeals to a generation of doctors who expect to move several times during the course of their career.

Is there anything that existing partners could do to address the problem?

With partners under enormous pressure in their practices, it would not be surprising if the focus is frequently on finding someone to share the “heat and burden of the day”, rather than on configuring the job for maximum appeal. New colleagues may be required to take on more of the less popular aspects of the job, such as urgent work or home visits, at least for an initial period. Existing partners may feel this is reasonable, given that they own the business and are carrying a heavy administrative responsibility.

However, if partnerships are to continue to underpin general practice in the future, the existing partners will need to accommodate, inspire and encourage new GPs to join them. How can they ensure that their practices are attractive and enticing for younger colleagues? How will they balance their needs with those of incoming partners? 

The expectations of young professionals are very different from their predecessors. Millennials have a different approach to work than their baby boomer forebears. Millennials prefer a different balance of family and work lives, and some accommodation for family commitments is expected. Many will seek diverse or portfolio careers early on, so that later in their career they will have development opportunities outside of, or alongside, core general practice. 

If advertised partnerships are primarily designed to meet the needs of the practice, and they do not offer flexibility in response to applicant preference, then they are likely to deter many potential colleagues. We know that flexibility is important because it is a key reason why locum careers remain popular.

Similar issues may apply to salaried doctor roles, which are also difficult to fill. Many salaried doctors feel their jobs incorporate the elements that partners do not wish to do, and they feel marginalised and unable to pursue their own passions and interests. If the salaried role was made more attractive, and the status raised, then recruitment should improve and the pressure on partners and practices will ease as a consequence. 

As practice leaders, the responsibility for structuring GP jobs, salaried and partner, lies with existing partners. Would a more imaginative and flexible approach that allows individuals to find greater levels of career fulfillment yield benefits? Two or even three portfolio doctors, instead of one whole timer, might be a more complex arrangement for practices to manage, but it would add resilience and stability if those appointed stay longer as a result of their own needs being met? 

This approach, which is essentially the application of flexible, or ‘agile’ recruitment and employment practices, is much talked about in the management literature. The GP Career Plus pilot takes this approach for GPs coming towards retirement, but the development of specific guidance aimed at GPs setting out in their careers would surely be worthwhile too?

Breaking the cycle is crucial because vacant posts heap more pressure onto existing doctors and practices, and this, in turn, deters candidates from applying. Undoubtedly some of the factors, such as overall funding levels, are determined nationally and are difficult to influence at practice level, but there is no reason why practices cannot offer jobs that incorporate ‘flexibility, control, and a better work-life balance’.

Indeed, young and aspiring GPs could contribute greatly to the debate, if asked, and provide guidance to help practices design jobs that are attractive by ensuring they match the needs, preferences, and aspirations of the millennial applicants they are targeting.

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