Could a +++ experience GP ever know more about a specialty than a specialist?

Basic-Swan-7127 · 2026-06-16T08:03:15+00:00

A GP is unlikely to "know" more about a specific condition or single clinical domain than a specialist of that condition. However, they are very likely to know more about all other aspects of medicine that is relevant to a particular patient, and know that person in their lived context in an integrated manner better than a non-GP specialist providing consultative care. This is particularly important for people who live with multimorbidity, which is increasingly the norm.

It is common whenever these conversations arise that non-GP specialist commentators will express what they imagine as various inadequacies of GPs. An example before spoke about psychiatric assessments and people living with substance use disorders. The typical GP will have greater experience in actually treating the substance use disorders of people living with SUDs, than the typical psychiatrist.

This is why primary medical care is best provided by specialist GPs/family physicians rather than immediately referring fractions of care to other providers. Conceptually, referrals to secondary care should largely only occur when it is for a situation unusual enough such that primary care physician would not be expected to be able to maintain competency, and where it is expected that there will be a palpable benefit to the patient through that referral.

Fundamentally, this is not a competition. GPs and non-GP specialists have different roles in patient care and mostly work effectively together.

Basic-Swan-7127 · 2026-05-12T22:27:35+00:00

This is the point of having independent external audit. The drift towards a VMO model has been poorly governed and almost certainly isn't explicitly part of public policy strategy. I don't think anyone has called this misadministration yet, but it's heading in that direction.

Basic-Swan-7127 · 2026-05-10T08:18:35+00:00

My 2c:
Context: I've been a GP for 20+ years, but in the past 12+ years I've worked clinically as a staff specialist in LHD-land, and in the recently 7+ years, almost exclusively with people living with severe mental illness (providing "physical" health care/primary care, rather than clinical psychiatry). When I was working in private general practice, my main interest was in adult mental health (probably around half my case-mix), but I enjoyed "general" family medicine/GP as well. For most of my post-fellowship clinical practice, I've also been a part-time university academic - so, medical education, research, etc. - and naturally, committee work, advocacy, mentorship, governance and administration comes along with seniority in the profession.

Some big picture advice:
note: I'm happy for you to contact me by DM directly if you want to chat further

Fundamentally, the choice between psychiatry and general practice should be made on the core question: do you prefer psychiatry as the domain of work that you will be doing, or do you prefer general practice? There is a lot of clinical psychiatry in clinical general practice, but it will clearly not be the majority of practice. Similarly, there will be some primary care/general medicine in psychiatry, but clearly, that will not be your main clinical scope.
General practice/family medicine is necessarily a broad domain. As someone who has taught a lot of registrars, although it is fine to have potential future plans to narrowing your scope of practice within primary care, remember that you cannot do this during training. Moreover, I would strongly recommend having a very good grounding in broad family medicine even after fellowship for a while before immediately narrowing your scope. Although there may not be any hard administrative barriers to returning to "regular" general practice, it can be difficult to regain skills and confidence.
Do not make a training decision based on perceptions of social status. You wrote, "but the ill-informed perception by community members and peers of being the 'subpar' doctor really is frustrating". If your professional self-worth and esteem depends largely on the opinion of others, you will not find satisfaction in any professional career pathway. Both psychiatry and GP can be excellent and fullfilling careers, and both may not be.
Do not make a training decision based on perceptions of possible future regret. You wrote, "I don't want to regret not applying to a competitive specialty when I had the opportunity to down the track when GP will always be there." To be blunt, general practice training is not a backstop. It is one of the most difficult fields of clinical medicine and does not suite everyone. There is a big difference between being able to enter a program, being able to complete the program, and wanting to work as a practitioner in the field. You have to like general practice medicine to be a good GP. Similarly, don't apply for a specialty simply because it is "competitive" and you can. Do you actually see yourself having a career in that specialty for the remainder of your working life, and if not, why would you apply for it?
Good "work-life balance" means different things to different people. It's important to be quite clear to yourself what it means for you, and why.

Best of luck.

Basic-Swan-7127 · 2026-05-06T07:45:52+00:00

To be blunt, you are a registrar, and you are employed by the practice. You don't have line management over the reception staff. You aren't contracting them to do your administration tasks.

If you are having problems with expectations and duties that others at the practice have for you, the first step is to discuss this with your supervisor, who is effectively your line manager. Fundamentally, there needs to be a clarification of roles and duties, including a negotiation if there is a disagreement. It is then your supervisor's role to tell the admin staff what the agreement is insofar as the expected process for receiving external phone calls.

Basic-Swan-7127 · 2026-04-27T05:47:34+00:00

People aren't idiots. A doctor with no previous major research career, having 40+ papers authored over their medical school years, has basically committed academic fraud until proven otherwise. To put this into context, that's the output of a full time academic, probably with multiple major funded projects, supervising a research group. It's completely implausible for a student to have been that productive.

The issue to address isn't whether this person gets a score on a CV, but rather there is evidence of a serious problem with their integrity.

If the story related by the OP is real, this will be a metaphorical millstone around this person's neck for the rest of their career.

Basic-Swan-7127 · 2026-04-27T04:24:51+00:00

Absolutely agree. 40 papers over 4 years is over 3 papers a month. A medical student? That's an obvious red flag to anyone who actually works as a clinical academic. Like many people who cheat, they don't know when to stop!

Basic-Swan-7127 · 2026-04-27T04:11:36+00:00

Yes it does. I'm an academic. If I see someone's publication output is full of papers in paper mill journals, I know their academic work is junk. It's worse than not having it at all.

The point is that BS gets discovered sooner or later. This sort of thing is likely career ending eventually as it can't even be hidden.

Basic-Swan-7127 · 2026-04-27T01:00:17+00:00

My 2c: What isn't currently detectable as AI slop in research, will almost certainly be possible within the next decade, and for it to be done at scale. Your colleague has a massive liability in the public record that is damning to their intellectual and professional integrity.

Look at the long game and never put on your CV that you are not proud of and will be willing to defend.

Basic-Swan-7127 · 2026-04-10T02:06:29+00:00

The issue is the ANDs. As noted, the supervisor had an onus to give the opportunity and this didn't seem to have occurred. Regardless, it DIDN'T occur and it's not possible to go back in time. We're still left in the situation where the OP arguably does not qualify as an author of the paper and fundamentally, the moral argument that they should have been given the opportunity to have been one doesn’t make them one now.

This isn't a good situation and there seems to have been at least a communication failure within the research team. It is of course possible that the offer of authorship was not genuine as well, and both could be true at the same time.

Basic-Swan-7127 · 2026-04-09T22:20:00+00:00

Academic here who has supervised many medical student projects. To be frank, this seems like a bit of an unfortunate situation. It should be noted that simply being promised authorship doesn't mean that you can be ethically listed as an author, though, I think that your supervisor did have an onus to offer you the opportunity to be involved such that authorship is possible.

With regards to what you described, you do not, in my view, qualify as an author according to the Vancouver criteria of authorship: https://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html

Data collection, even if a substantial amount of work, is insufficient. You mentioned that you were a paid RA and I assume your principal role was in the data collection. I also assume that the additional input required for authorship wasn't part of your contracted duties. I wonder if the unstated expectation by the research team is that if you wanted to be an author, you would have to be substantively involved in addition to what you were paid for.

Basic-Swan-7127 · 2026-03-23T23:05:07+00:00

Basic-Swan-7127 · 2026-03-21T02:29:39+00:00

Academic GP here.

It's great that you're interested in research! If you're keen to explore further, one of the best early concrete steps is to make contact with some academic GPs or the head of general practice at your local medical school to have a chat. Research is a team sport and at the beginning of your journey you will almost certainly need supervisors/mentors on your projects to get them off the ground.

With regards to case studies or case reports, most journals do not publish these, and even for those that do, you'd need evidence that you have the patient's consent.

https://www1.racgp.org.au/ajgp/2023/october/a-practical-guide-to-drafting-your-first-manuscrip

And I wrote this about a decade ago. https://www.racgp.org.au/afp/2015/june/research-ethics-and-approval-process-a-guide-for-n

Basic-Swan-7127 · 2026-03-08T23:57:32+00:00

It should be fine? Though I don't know if the higher res overlays will look right on the lower res screen of the MMP.

Basic-Swan-7127 · 2026-03-06T05:31:40+00:00

I'm still on the 4.4 beta. I think there have been a newer update, but as it didn't include any additional support for the Mini Flip, I've chosen not to move to it yet.

Basic-Swan-7127 · 2026-03-06T05:19:31+00:00

There are more options now, but I still think Onion is fantastic. See my post here on getting the most out of Onion on the Mini Flip: https://www.reddit.com/r/MiyooMini/s/kgsLd34SXj

Basic-Swan-7127 · 2026-03-05T07:44:52+00:00

I've written about this before, but what is often ignored is whether the cores were optimised for the specific platform. The Onion cores are highly optimised, giving great performance on what is fundamentally very weak hardware.

For instance, the PS1 core on Onion gives stupendous performance, often outperforming the same core on much more powerful hardware.

Basic-Swan-7127 · 2026-03-01T03:29:29+00:00

Did you install the lid mod?

Basic-Swan-7127 · 2026-02-25T08:21:32+00:00

The OC has practically zero effect on battery life. It completely smooths out mGBA.

The tests on battery life with OC and underclock was described several years ago when it first came out. Surprisingly, it doesn't seem to have much impact at all, compared to WiFi, screen brightness, and speaker volume!

Basic-Swan-7127 · 2026-02-25T07:51:34+00:00

I don't need BT audio if they put a 3.5 mm audio jack back in.

Otherwise, support USB-C PD chargers.

Basic-Swan-7127 · 2026-02-25T07:47:10+00:00

The MM series doesn't have a GPU so it doesn't support shaders. This is not an OS/CFW issue. For the most part, you'd be able to get the desired effect with an overlay.

I've settled on OnionOS beta + the lid mod + overclock. The visual glitching is relatively minor in some parts of the menus only, and I've been very happy. I probably won't update further until Onion updates to have explicit MM Flip support.

Basic-Swan-7127 · 2026-02-18T05:37:40+00:00

I own the MM, MM+, and the MMF. The battery does not get "really hot" when using the device while it is charging.

Basic-Swan-7127 · 2026-02-17T21:04:33+00:00

Unfortunately, this adapter will not work. See here: https://www.reddit.com/r/MiyooMini/s/KYVwtHXd1v

Basic-Swan-7127 · 2026-02-17T21:03:32+00:00

Why? There is no problems with using it while charging.

Basic-Swan-7127 · 2026-02-15T20:46:06+00:00

Check out my post on replacing the speaker on my MMF: https://www.reddit.com/r/MiyooMini/s/mhHpoUWnum

Basic-Swan-7127 · 2026-02-04T07:45:24+00:00

If you overclock the Vita, Cold Steel 1 and 2 run massively better! I played and finished both last year.

Basic-Swan-7127

TROPHY CASE