| Reasons (multiple usually present) | Timing (context) | Doctor’s characteristics (context) | Exposure (context) |
|---|---|---|---|
| Environmental | |||
| Work experience in GP setting | Medical school or pre-vocational, reinforced over time | Open to all specialties, haven’t decided on specific specialties | Generally positive or neutral clinical experience/s in general practice placement, feeling connection or ‘clicking’ with holistic and individualised person-centred care, and/or a patient demographic, and/or a medical community, and/or rural areas, and/or exemplary generalist clinicians |
| Ruling specialties and medical interests in or out | Medical school and pre-vocational experiences | Open to all specialties, but is becoming more self-aware of own interests, skills, and capabilities over time – discovers they enjoy a broad variety of medicine and work | Experiencing a broad variety of areas of clinical medicine, to the point where they could not choose only one specific specialty to continue in. An ‘aha’ moment often came, realising how different medical areas can be included in GP specialty (with or without training), and GP career could be tailored individually to self |
| Validation and support experienced in the general practice environment | Medical school and early pre-vocational | Feels vulnerable with lack of skills or knowledge, and is within identity formation as doctor or GP | Medical experiences that were more than observation in the general practice setting with GPs and allied health, ‘feeling helpful’ in the general practice setting compared to other specialty placement experiences, and connecting with GP role models who invested in personal relationships and demonstrated in-depth generalism and continuity of care medicine, while showing that their lifestyles allowed family and other interests to be prominent |
| Hospital non-GP specialties perceived as less favourable environment to the individual | Pre-vocational | Tired, burnt out, frustrated, may have completed 10+ years of university and hospital vocational training by this stage | Some exposure to general practice setting Usually this mechanism was triggered during pre-vocational training which takes place in hospital settings Hospital administration (which was difficult to appeal to for personal leave and considerations) particularly prompted this conclusion |
| Professional | |||
| GP medical work fits their personal medical interests, after comparing GP and hospital non-GP specialties | Medical school and pre-vocational | Individual prefers to ‘know’ patients over a long period of time through interactional and holistic person-centred care; likes a broad variety of presentations and lesser patient acuity | Exploring different specialties’ skills, attributes, personalities, lifestyle, and own medical interests, preferred values and lifestyle through placements and postgraduate doctor training, including the GP specialty |
| GP work setting fits their personality, skills and norms, after comparing GP and hospital non-GP specialties | Medical school and pre-vocational | Individual wants to privilege family, personal wellbeing, and external goals, not just medical work | Observations of specialty trainees and consultants, finding out information from trainees and consultants, and personal experience working within different specialties, including the GP specialty |
| Holds a health system perspective, rather than only privileging their specialty or discipline | Registrar and fellow | The doctor feels quietly providing value to the healthcare system is important through disease prevention interventions and longitudinal episodic care, rather than easily measurable once-off acute hospital care | Experiencing GP work over more than 12 months and realising the value and impact that general practice has on individuals and at a system level |
| Medical status perceived to matter less than personal rewards derived from helping others | Medical student to fellow | The doctor values being a part of patients’ health progress and lives, enjoys helping others | Experiencing GP work in one practice for more than 12 months, having their own patient pool. Talking about medical status with people external to medical profession. |
| Registrar training takes less time and requirements than other specialties | The doctor prefers above factors over other specialties’ perceived benefits and long training programmes; wants to plan life outside medical career within 2–5 years rather than 5–10 years | Comparison of non-GP and GP specialty training requirements Speaking with non-GP and GP registrars and consultants | |
| Previous medical experience and credentials (including those gained when pursuing other training pathways) are valued and not ‘wasted’ in GP work and can be used still | Pre-vocational to fellow | The doctor previously began training in or has serious interest in other specialist medical pathways (for example, paediatrics or women’s health) but is interested in pivoting to GP because of incompatibilities in lifestyle, or personal or family goals, and similar reasons | Explanation by senior doctors that other medical experience and credentials are beneficial, welcomed, and acknowledged in GP or rural generalist settings |
| Non-professional | |||
| Work–life balance and personal sustainability is attainable in GP career | Medical school to fellow | Does not believe medical career should ‘take over’ their lives, believes in the importance of self-care and wellbeing, and is willing to take actions to perform self-care | Seeing and knowing GP role models who have built successful and sustainable careers that allow them to be excellent doctors, but also spend time with their families and achieve other goals external to medical career |
| Agreeable or tolerable projected economic and social position as GP | Registrar, fellow | No financial responsibilities (for example, mortgage, family) undertaken during pre-vocational years, willingness to change medical perspectives, considers GP pay sufficient since they have enough patients and Medicare billing competence/understanding | Comparison with GP pay and status with non-medical careers, rather than non-specialist careers Availability of locum GP and emergency department positions as second job for GP registrar period Understanding and experience in Medicare billing |