Enriching Careers in General Practice A career structure for general practice

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Abstract
Training for general practitioners usually provides little experience in research, business management, or dealing with chronic disease. It is these areas that could provide scope for further training after becoming a general practitioner principal and provided career goals. Formally recognised research practices, perhaps with one partner coordinating research but all participating, and district research facilitators could increase both the quality and the quantity of research in general practice. Recognising the different skills of doctors in the partnership and referring patients to the most appropriate partner will improve care for patients as well as provide career development. Further training could be aimed at filling gaps in the practice's pool of skills. Good management skills are becoming more important as practice teams get bigger and fundholding spreads. Some doctors may wish to become full time or part time managers and the idea of accredited courses for management has been raised. Vocational training for general practice in Britain is considerably shorter than the training for a hospital specialty. It uses progressive educational methods and the mentor relationship with a trainer but offers few opportunities for research,1 limited training in the business side of general practice, and little experience of the management of chronic diseases.2 In 1968 the Royal Commission on Medical Education advocated a five year vocational training,3 and the Royal College of General Practitioners has recommended two years in general practice.4 This goal is now approached by Denmark,5 but in the Netherlands training takes two years, although it is due to increase to three later this year.6 The number of general practitioners with higher degrees is lamentably low: only 50 out of 3041 MDs were awarded to general practitioners between 1973 and 1988.7 Increasing the length of training to give time for research will not …