To own or not to own--how can we best educate general practice registrars about practice ownership?

Background:
Despite low uptake of practice ownership by recent trainees, research has shown that registrars are interested in learning about practice ownership. We aimed to determine how registrars would prefer to learn these skills during general practice training.
Discussion
Registrars are keen to learn more about practice ownership. Establishing a mentor relationship with an experienced doctor-owner is essential for this education to succeed.

Results:
Registrars are interested in learning more about practice ownership in the later stages of training. They need more than just information – they are requesting opportunities to learn from current doctor-owners. Mentorship from doctor-owners was seen to be valuable and could be facilitated through a number of avenues.
Over the past decade in the Australian Capital Territory and southeast New South Wales, only a small number of general practice registrars have gone on to own, or part own, a practice in our region. Anecdotally, the situation is similar in other regions of Australia. In 2011, approximately 12% of GPs worked in a corporate general practice, compared to 8% in 2008.2 Although Australian commentary has been limited,3 there has been an international discussion regarding the benefits and disadvantages of corporatised healthcare since the late 1990s.4 The inevitable conflict between the therapeutic relationship and the financial profitability of a corporate structure has been noted.5 Should there be the complete disappearance of the doctor-owned model, we believe this would be to the detriment of general practice. However, this doesn’t look likely in the Australian context in the near future.

Due to the low uptake of practice ownership by recent trainees, it has been assumed that registrars are not interested in the opportunity of owning a practice. However, a recent survey of 63 general practice registrars in the Canberra region6 found that 27% were interested in future practice ownership, with another 38% undecided. Only 21% were definitely not interested in owning a practice. Over half (54%) of respondents said they would like to learn more about how to run a practice during their general practice training. There was strong interest in learning via mentoring and face-to-face teaching.6 This current research further explores acceptable modes of education delivery for registrars interested in future practice ownership.

The aim of this research was to explore and develop models for delivering education on practice ownership to general practice registrars and recent general practice fellows.

Methods:
This research was undertaken using a qualitative grounded theory approach with focus groups and in-depth interviews involving registrars and recent fellows (completed training within 5 years).

Current registrars and fellows (graduating 2011–12) (total 86) from the CoastCityCountry General Practice Training Group were invited via email to participate in either a focus group or an interview (but not both). Interest in practice ownership was not a prerequisite for attendance at a focus group.

Two focus groups were undertaken: the first involving three senior registrars and one recent fellow in April, and the second with four junior registrars and two senior registrars in May 2012. In both groups there was an approximately equal mix of participants who were interested in practice ownership and those that were not. From June to July 2012, a further nine semi-structured interviews were conducted, seven were face-to-face and two were via telephone due to distance. Interviewees were recruited from an email invitation to registrars and fellows who had not attended the focus groups, including those who had expressed interest in attending the focus groups but were unable to make the specific time. Recruitment for interviews ceased when no new themes were emerging in the data. All participants were asked to complete an anonymous questionnaire with demographic information.

Focus groups were chosen to provide an opportunity for new ideas on education delivery and mentoring to be discussed and developed in more detail. Within the focus groups, the facilitator proposed questions for informal discussion among participants and discussion of ideas between participants was encouraged. Groups were also shown two statements about practice ownership education and were asked to comment on these. Finally, the groups were shown different cartoon pictures and asked to comment on which represented mentorship to them and why.

A thematic analysis was conducted on the focus group transcripts with the assistance of software program NVivo9. Reliability of the themes emerging from the data was ensured by consensus during regular meetings of the research team, as well as discussions between the two facilitators that were present at the focus groups. Themes that were identified as being only partially explored formed the basis for in-depth interviews. The interviews were conducted using a semi-structured interview style that provided the opportunity to explore personal experiences with interest in and knowledge of practice ownership. Both the focus groups and interviews were audiotaped and then transcribed. NVivo9 was used to collate the de-identified data and the data was then analysed for themes using the constant comparative method of grounded theory.

Results:
Our complete sample included 10 female registrars, four male registrars, two female fellows and three male fellows. Not every participant chose to answer the demographic information. Eleven were aged 25–35 years, and six were aged 36–50 years. None were over the age of 50 years. Fifteen had completed their basic medical training in Australia, and 14 were either on or had completed, the general, general practice training pathway. Five intended to work rurally, eight intended to work in metropolitan or outer metropolitan areas, and five were undecided about the place they intended to work.