GPs today have higher stress and lower morale than in 1982

GPs are ageing and their morale has declined steeply, but they are also working more collaboratively and making more use of IT than ever before, a study by Trinity’s College’s department of public health shows.

The study points to worrying levels of low morale and high stress among GPs. These problems are increasing over time; last year, 34 per cent of GPs said their morale was good or very good, compared to 62 per cent in 2005. Conversely, the proportion reporting low morale tripled during this period.

As for stress levels, these have increased substantially over the period. GPs reporting low or very low levels of stress fell from 42 per cent to 11 per cent. The proportion with high or very high stress increased fourfold.

“This probably reflects the morale of the nation over recent years, which is reflected in daily contact with patients,” says Prof Tom O’Dowd of Trinity. “GPs are not immune from personal, professional and patient stress, especially in hardened economic times.”

The report, Structure of General Practice in Ireland 1982-2015, is a unique piece of research, spanning 33 years of general practice in Ireland. Data has been collected in 1982, 1992, 2005 and 2015, so valid comparisons can be drawn. A response rate of 72 per cent last year means firm conclusions can also be arrived at in relation to the development of services.

It shows that while IT has made its entrance into doctors’ surgeries, it isn’t used that often to communicate with patients. Ninety-four per cent of GPs, and 100 per cent of those under 40, say they use electronic medical records. The vast majority of doctors are using computers to prescribe drugs, record clinical notes and access lab results, but only 26 per cent are ordering lab tests in this way.

Ageing profession

Yet 37 per cent say they never communicate with patients by email, and 34 per cent rarely do. Just 8 per cent email patients often.

GPs are an ageing profession, as this study shows, but there is some good news for anyone worried about a future shortage of doctors. Some 46 per cent of them say they want to continue working after age 65, up from 16 per cent a decade ago. Men were more likely to want to work on into older age than women.

Male GPs still outnumber their female counterparts, but only just. The proportion of women GPs has grown from 12 per cent in 1982 to 42 per cent last year. Women predominate among younger doctors, so it is only a matter of years, according to O’Dowd, before they are in the overall majority.

Women GPs are twice as likely to be single (7 per cent against 3 per cent) but are less likely to be working full-time (72 per cent against 91 per cent for men). Among under-40s, two-thirds of women GPs are working full-time against 100 per cent of men.

The training of GPs has changed greatly over the decades. As before, the vast majority graduate from one of the five Irish medical schools, but, increasingly, GPs have also completed postgraduate training programmes. They are also more likely to have completed this training in Ireland; the proportion of GPs who completed their training in the UK has fallen from 62 per cent to 24 per cent since 1992.

One of the fundamental changes over the period was the creation in 1998 of the first GP co-operative, which has revolutionised out-of-hours services. By 2015, 93 per cent of doctors said they were in a co-operative.

Treatment services

Sadly, GPs say their access to diagnostic and treatment services for patients is declining. For example, the proportion of doctors reporting timely access to ultrasounds fell from 59 per cent in 2005 to 27 per cent last year.

The provision of GPs services in rural area has provoked much comment over the past year, and demands for the retention of rural GPs drove one of their number, Dr Michael Harty in Co Clare, into the Dáil in February's election.

Yet the survey throws up a few surprising nuggets on the issue. The proportion of GPs in rural areas has remained stable over the past decade, at 21 per cent. That’s down 10 percentage points on 1982. Whatever shift there has been in the composition of the workforce has been into “mixed” areas rather than the cities.

The traditional image of the doctor’s surgery being a converted room to the side of the main house is certainly no longer true, if it ever was. The overwhelming majority of GPs work out of purpose-built or adapted premises, and only 3 per cent operate a surgery at their place of residence. One in 10 GPs work from one of the much-vaunted primary care centres.

Ninety per cent of premises are privately owned, rented or leased. “The tradition of the GP working from a converted garage or from their own home is now virtually gone,” the study notes.

Another traditional image, that of the single-handed doctor, is in terminal decline. The number of GPs working alone has tumbled from 62 per cent to 18 per cent over the past three decades. GPs are also more likely to be working in larger practices, shared with a growing number of colleagues.

For the first time in these surveys, corporate provision of GP services features, with 3 per cent of doctors saying they work subject to an external commercial management arrangement.

The study shows practices are better equipped, employ more nurses and operate more chronic disease clinics than before.