At the 2003 RACGP Convention Forum, general practitioners initially explored the current state of the profession before identify- ing potential strategies to solve its most pressing concerns. Problems identified can be grouped under three broad domains: • personal issues – workload, lifestyle, remu- neration, career satisfaction • professional issues – standards, education, accreditation, collegiality, practice manage- ment, and • global/political issues – image and status of general practice in the health care system and litigation. All were seen as causing an immediate threat to the retention and recruitment of general practitioners. Would implementation of each solution in isolation lead to the desired outcome? Past experience would suggest not; not because any one of the solutions is wrong, but rather because a solution seen in isolation is likely to have unintended consequences. This article proposes a different strategy to understanding and approaching the problems facing general practice in Australia. System approaches acknowledge the complexity and highlight the interdependence of the many vari- ables defining a problem. Thus, there is no one correct solution to a systems problem, rather system approaches emphasise the importance of identifying the potential interactions one solution may have in a complex environment. An introduction to systems Systems approaches have been used since the 1960s in most sciences and industry, but only recently have they entered the medical domain. 1–6 A system is defined as an organised assembly of components that share a special relationship with each other – in this case retention of GPs (note: system variables are highlighted in italics). The interactions of the components of a system give it a unique behaviour, with each component contributing to as well as being affected by it. In particular no component has an independent effect on the system. Within a system, groups of com- ponents may form subsystems with their own unique properties. Boundaries separate the system from an external environment, however, the system will receive inputs from its external environment as well as providing output to it. 7 ‘Complex’ – from the Latin word complexus – means ‘entwined’ or ‘twisted together’, and the Oxford Dictionary adds that something is complex if it is ‘made of (usually several) closely connected parts’. 8 The more parts and the more connections that are entwined within a system, the more complex it will be and the more difficult to analyse. Despite these difficulties, system approaches provide important contextual knowledge about the full array of interactions and inferences of the phenomena under study – in this case what contributes to the retention of GPs. Some of the tools used in describing a system are system maps and influence dia- grams which describe the broad outline of a system and its interactions. For each part of the system, variables are identified and those influencing each other are linked generating multiple cause diagrams (Figure 1). Multiple cause diagrams are powerful tools. They visualise the interconnections between Reprinted from Australian Family Physician Vol. 33, No. 12, December 2004 1033 Discussion • PROFESSIONAL PRACTICE Joachim Sturmberg, MBBS, DipObstRACOG, MFM, PhD, FRACGP, is Associate Professor of General Practice, Monash University, Melbourne, Victoria, and Conjoint Associate Professor of General Practice, Newcastle University, New South Wales. Approaching the future of general practice How systems thinking might help General practice in Australia is facing an uncertain future leaving many general practitioners to wonder if it is still worthwhile to stay in practice. At the 2003 Royal Australian College of General Practitioners (RACGP) Convention Forum, GPs identified retention of the workforce to be of primary importance to their profession. This article argues that understanding and finding solutions to the complexities inherent in the workforce issue requires a systems approach; simple linear approaches to ‘fixing’ a particular aspect are dangerous and invariably will lead to unforseen – usually detrimental – consequences.