The Portfolio GP – Dr Jason Christopher

It’s week three of our portfolio GP series and we chat to Dr Jason Christopher, one of GPDQ’s first GPs to the platform and an early adopter of the portfolio mindset.

What does ‘portfolio GP’ mean to you?

It’s not a word I use myself. I am portfolio by definition but it’s not something I promote myself as. I understand it describes a doctor who has declined full time NHS work and chosen to pursue other things.

How do you divide your time?

For the last couple of years, I have been working four to five sessions a week in the NHS. I have done 8-12 hours a week for GPDQ, a few hours a week GP study and general admin (courses, learning etc.). In the last 6 months, I have been working another 4-6 hours a week helping my brother set up a business delivering products to prevent mosquito-borne disease globally. Over the last 10-15 years it’s varied quite a lot and I always make time for fun hobbies and exercise.

What made you go down the portfolio route?

My vision for quite a long time was to practice public health in Africa. I had a bit of a philanthropic, “do my bit to tackle global inequality” kind of mission, that’s why I went down a public health route and all my jobs were oriented towards that. I did a year and a half in Uganda, I did a public health Masters, and I did quite a bit of research in child health in Africa. So in a way, I was never fully committed to NHS GP partnership and it was never really on the path for me. Partly also because if I looked around me, a lot of full-time GPs were burning out or some of them had turned into a kind of a soldier. They manage to get through the workload, but I don’t look at them and think I want to be like you. Some are impressive at surviving against the odds, but it doesn’t mean that I want to take on that same role.

Does a portfolio career support a good work-life balance?

I think I have got a great work-life balance and I feel in control of my workload. It’s manageable and I take four to five sessions a week of NHS, which is absolutely plenty. I enjoy the different perspectives my other interests and hobbies bring me. I had a mini burnout a few years ago and in hindsight, it did me good, because it meant that I was struggling really hard to maintain something I wasn’t enjoying. Shortly after, I started working with GPDQ and I discovered a newer more refreshing balance of work.

Do you think having a diverse portfolio makes you a better doctor?

And how does it affect the patient care you deliver? It helps me thrive in work as a GP, rather than merely survive. In my experience, and when I meet other GPs, there are different gears we can operate in. But it comes down to “surviving” medical practice and “thriving” in medical practice.

“Surviving” is doing a “means to an end” kind of medicine. You are getting through a session without running too late, doing what needs to be done, meeting your targets, getting through the workload without making terrible mistakes, and breathing a sigh of relief at the end. I think we often take this mode of practice because we only have ten minutes with each patient. We are pushed to quickly pigeon hole them into a mental pathway (eg. Lower back pain, depression). This leads to a certain tunnel vision because you need to get to a conclusion as soon as possible, so you can get to your next patient. There isn’t a lot of time for reflection. That’s the general survival mode of GP. We all have to be able to operate at that sort of level, but for me, if it’s just that, then the job isn’t satisfying.

Then, there is the “thriving” type of practice, where the means is the end. You do things for their own sake because you enjoy it and you have time to do it properly. A little bit more listening and a little bit more inquiring. You have a broader awareness of information coming from the patient, you’re more likely to pick up the hidden agenda, and you have more time to reflect at the end of the week. I think if I just do four to five sessions a week, I can spend more time in the “thriving” gear rather than “survivor” mode. And I can enjoy my work.

Do you think the health sector supports portfolio careers?

To be honest there is probably more assistance out there than I realise. I haven’t gone looking for it particularly. But I think increasingly more so, because it is apparent that more and more doctors want a breadth of roles, so I would expect that support has to be developed.

Do you see portfolio careers as the future for general practice?

I think slowly it is becoming clear that there does need to be a paradigm shift in how the NHS works. This sort of all-or-nothing, as in continue until you become a real soldier or till you burn out, is very dissatisfactory. If this is the choice, then more and more doctors will leave the NHS entirely. I think it’s important to cultivate this middle road, where people like me, can continue to support the NHS, but do it at a level that you find satisfactory. These other roles that you can have, can help you practice NHS work with a different perspective, which can be helpful.

What message or advice would you give other doctors about the portfolio route?

I would encourage doctors to try several different roles and get out there. Let your heart be your guide and continue to reinvent yourself. Don’t let the title “doctor” typecast you. I think the less you typecast yourself as a “doctor” and the less you typecast your patients, you will start to treat them as human beings and not as stereotypes. With a doctor, it comes with such a history of “because you’re a doctor, so you’re this, this and this”, we take up what we expect ourselves to be. It’s often unhelpful to have these fixed ideas of what we do. I think people benefit from experimenting different roles and actually discovering what they enjoy more.

If you could send a message to the NHS about portfolio GPs, what would it be?

I would say it would increase the workforce. Younger doctors in particular have a slightly different set of values from the generation behind us. I think we tend to be more self-determining than our forbearers. I think if the NHS provides a means for all this to happen, then it would be less likely that we would jump ship and become yoga teachers.

I think most GPs would give up NHS completely though are reluctant to do that. There is an attraction to the basic values of the NHS. They would like to be able to stay working in the NHS as part-time. I think the NHS does need to change. It needs to be made more feasible, less stressful, practice “thriving” medicine rather than “surviving” medicine. If they can shape it like that, then more of us will stay.