Abstract
General practitioners are at the forefront of the primary health care system. A national healthcare system with primary health care at its core leads to more positive health outcomes and is less expensive than a health system which has a secondary care focus. Maintaining a general practice workforce is thus critical to the health of a nation’s population however, research literature illustrates a decline in the number of medical graduates entering general practice in New Zealand and internationally. In this study I used a qualitative approach that examined medical students’ views about general practice and being a general practitioner. This is in response to the predominantly quantitative perspective that has been used to study the general practice workforce shortage.
I conducted 40 qualitative interviews with medical students upon entry into medical school (second year medical students) and also students in their final year of study (trainee interns or ‘TIs’). Second year medical students were interviewed at the Dunedin School of Medicine, University of Otago in New Zealand. Trainee interns were interviewed at the three clinical schools of medicine belonging to the University of Otago, Dunedin, Christchurch, and Wellington. Trainee interns from The School of Medicine, University of Auckland were also included. Social constructionism, a poststructuralist view of language along with Foucault’s concepts of discourse (including principles of rarefaction), technologies and conditions of power, technologies of self, and power/knowledge formed the theoretical framework for the study.
Four main themes of discourses about general practice were identified. These were the discipline of general practice, being a general practitioner, the value of general practice, and the representation of medicine in television programmes and literature. Furthermore, from the synthesis of the identified themes with the theoretical framework I detail three critical areas which influence the construction of general practice and being a general practitioner. These are the dominance of biomedicine, the mechanisms that exclude general practice from being regarded as a specialty and the mechanisms exercised that are involved in perpetuating general practice as being poorly valued. The thesis concludes by examining the implications of the findings for the medical workforce and for medical education. This includes the institutions of the medical school, teaching hospital and the Royal New Zealand College of General Practitioners; the undergraduate curriculum and individual teachers involved in all aspects of undergraduate medical education.