A national census of Irish general practice training programme graduates 1990-1996

We followed the career pathways of all graduates of Irish general practice training schemes between 1990 and 1996 inclusive, with specific reference to their current positions, ten year aspirations, perceived barriers to their ideal career and attitudes to out of hours work. A postal survey using a structured questionnaire was performed. Addresses were identified for 253 of the 266 graduates (95%). A total of two hundred and nine responses were received (84% of those with an identifiable address). 173 (83%) have remained in general practice; 90% in Ireland and 60% in the same health board of their training programme. The preferred career option for 79% was to be a general practice principal; this differed significantly between males (89%) and females (74%) (p=0.016). Being a single-handed general practitioner was the preferred option for 2%; 43% considered this unacceptable. A half would prefer to work in a country town; one third considered a rural location as unacceptable. 'Out of hours' commitment and availability of local posts were the most commonly perceived barriers to career progress (53% and 45% respectively). 26% were not prepared to do any out of hours work; this differed significantly between males (10%) and females (30%) (p<.001). 17% have permanently left a career in general practice. Female general practitioners were not significantly more likely than male general practitioners to have left (19% vs. 14%, p=0.3). The most common reason given for leaving general practice was other career interest (78%). The significant increase in female general practice graduates over the past twenty years is highlighted. The vast majority of these female graduates wished to be a principal in a group practice and were prepared to undertake out of hours work. There is also a mismatch between career aspirations and the present structure of general practice in Ireland. The urgent need for changes in health system organisation to ensure that these intentions can be fulfilled is emphasised.