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A guide to working in general practice

Shane McKeoghChoosing a specialty can be hard. Dr Shane McKeogh (MB BCh BAO MRCPI MICGP DCH) sheds some light on what it’s like to work in general practice

I’m a male GP in my late 30s and I work as a principal GP in a medium-sized GP surgery in Rathfarnham, Dublin 14. I work with two other doctors, two nurses and three administrators. This is a medium sized GP surgery. The surgery is computerised, meaning all patient records are recorded in practice management software, referrals are done through the software, and incoming paper correspondence is scanned into the system.

An average day starts at 8.30am and I see 25-30 patients per day at 15 minute intervals, typically in two blocks (or “sessions” as GPs often call them), starting at 8.30am and 1.30pm. In between these blocks of patientfacing time is where a significant amount of time is spent doing paperwork. This typically comprises following up on paperwork from the last session (referrals to hospital OPDs, allied health professionals, etc), reporting on incoming blood results, reading and acting on incoming post, preparing repeat prescriptions for patients, as well as doing any house calls which may be necessary. I typically have a sandwich sitting at my desk doing paperwork.

What particular skills do you need?

General practice is a very rewarding career choice, but it’s not for everyone. Some questions you could ask yourself to see whether this might be the career for you are:

Q1. Do you like people?

You will meet the same people and members of the extended family again and again over years. This is an incredibly privileged position to be in, and whole families will put their trust in you as “their doctor” for the majority of their medical needs. They will come to you in times of medical need, either minor or major, and will follow your advice about their health. This allows you to build up a very important relationship with a patient and interpret illness not just from a physical point of view, but in the context of their psychological and social situation.

Q2. Can you deal with uncertainty?

This is not as simple as it sounds. GPs are often the first point of call for a patient when they are unwell. A significant amount of the time, a symptom may be a manifestation of a trivial illness which will resolve spontaneously. However, it may also represent a more serious underlying problem. The patient is looking to you to make a decision about how to proceed. History and examination are the first line of any doctor’s assessment, but the timescale to get investigation results as a GP is much slower than our hospital colleagues. Blood tests and radiology investigations can take a week or more to return. Decision-making about when to investigate and when to use time as a tool to observe is a nuanced art that GPs develop over time.

Decision-making about when to investigate and when to use time as a tool to observe is a nuanced art that GPs develop over time

Q3. Do you enjoy working independently?

Although most practices are now group practices and have a team of doctors, nurses and admins, much of the working day is spent in a room face-to-face with patients as opposed to part of a hospital team on rounds in OPD. This can be a lonely experience for some, or rewarding for others as you are more reliant on your own abilities.

Q4. Do you enjoy being a business person as well as a doctor?

In time, many GPs become principals in their surgery. This is not just the lead clinician but also the employer and “boss” of their team. This is both rewarding and stressful. You are responsible for payroll, paying suppliers, staff issues and conflicts among staff members. You are where the buck stops. Many find this a positive in their career but others find this a negative experience – many GPs will say that it is this element of practice that causes them the most headaches!

Q5. Would you value the ability to develop a career portfolio?

A very attractive part of general practice is that you control your own working life. This means that you can choose to work out of hours if you wish, but it is not necessarily an inherent part of the job as most GPs are part of large co-operatives now which reduces their out of hours commitment to a minimum. It is quite possible to work part-time as a GP and part-time in another role, for example teaching, getting involved in leadership positions within the profession and, of course, spending time with one’s family.
It is quite possible to work part-time as a GP and part-time in another role, for example teaching
Speaking personally, I’m delighted I chose medicine as a career and general practice as a specialty. If I got to go back and do it over again, I wouldn’t change a thing! The best of luck to you all no matter what career path you choose!

Pathway to general practice

  • There are 14 general practice training programmes in Ireland, distributed country-wide.
  • GP training is a four-year programme, with two years spent in relevant clinical attachments and two years spent as registrars in a GP practice. Training programmes also operate day release programmes.
  • When a trainee successfully completes their training they are issued with a Certificate of Satisfactory Completion of Training. This certificate, along with passing the four modules of the MICGP exam, allows a trainee to become a fully-qualified GP.
  • The Irish College of General Practitioners (ICGP) is the body responsible for overseeing the professional development of GPs and is also the organisation through which applications to become a GP trainee are made. For more information see www.icgp.ie
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