Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
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KCE Reports 90 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion 87<br />
5.3 SUMMARY: LITERATURE REVIEW ON POLICIES<br />
INFLUENCING ATTRACTION, RECRUITMENT AND<br />
RETENTION OF GENERAL PRACTITIONERS<br />
5.3.1 Attraction<br />
This section pres<strong>en</strong>ts a summary of the literature review, with an emphasis on what can<br />
be inferred about effectiv<strong>en</strong>ess of policies and programs on attraction, recruitm<strong>en</strong>t or<br />
ret<strong>en</strong>tion of GPs.<br />
Medical schools play outstanding roles in the attraction of GPs. Academic culture,<br />
importance of g<strong>en</strong>eral practice in the medical faculty, curriculum, exposure to g<strong>en</strong>eral<br />
practice and role models influ<strong>en</strong>ce the choice to start a career in g<strong>en</strong>eral practice.<br />
Many policies, designed by governm<strong>en</strong>ts, or private initiatives and programs developed<br />
by medical schools are coher<strong>en</strong>t with this observation. These policies may include<br />
structural changes (e.g. elevating GP faculty into major leadership roles, increasing the<br />
number of GP faculty, instituting new administrative structures to coordinate GP<br />
activities, changing the admissions process to target more stud<strong>en</strong>ts with (rural) GP<br />
pot<strong>en</strong>tial and relationships-driv<strong>en</strong> personality, redesigning undergraduate medical<br />
education (e.g. GP-ori<strong>en</strong>ted clinical medicine courses, exposure to g<strong>en</strong>eral practice and<br />
role models) and financial assistance (loans, grants).<br />
Most of these initiatives were successful, although success is variable, in producing long<br />
lasting above average proportions of GPs and other primary care physicians (PCPs), and<br />
in fostering graduates <strong>en</strong>tering rural practice, e.g. the G<strong>en</strong>eralist Physician Initiative<br />
program (GPI). Nevertheless, it is not sure whether the developm<strong>en</strong>t of Academic<br />
Departm<strong>en</strong>ts of G<strong>en</strong>eral Medicine (as in the GPI program) can be solely responsible for<br />
an increase in GPs "production".<br />
The best-described and most effective policies designed to "produce" future GPs and<br />
reduce geographical disparities are global ("pipeline") policies to attract stud<strong>en</strong>ts with<br />
rural background or with strong interest in family medicine, and training them within<br />
appropriate medical curriculum (e.g. the Jefferson Physician Shortage Area Program<br />
(PSAP)). Nevertheless, it was shown that specific policies inspired by such programs, but<br />
merely targeting applicants with rural or underserved area background, or exposing<br />
stud<strong>en</strong>ts early to primary care practice are not necessarily effective.<br />
Other positive factors for attraction are psychosocial factors (relationships with pati<strong>en</strong>ts<br />
and professionals, variety of tasks g<strong>en</strong>erating intellectual chall<strong>en</strong>ge...) and factors related<br />
to professional id<strong>en</strong>tity (autonomy) and lifestyle (flexibility of work).<br />
Conversely, factors deterring stud<strong>en</strong>ts from a GP career are poor working conditions<br />
and the perception of a lack of prestige and salary compared to the specialists.<br />
5.3.2 Recruitm<strong>en</strong>t<br />
Literature about recruitm<strong>en</strong>t is almost <strong>en</strong>tirely dedicated to distributional issues, i.e. the<br />
geographical inequities existing in the availability of GPs, especially betwe<strong>en</strong> rural and<br />
urban areas.<br />
Rural origin is one of the most frequ<strong>en</strong>tly studied factors for the recruitm<strong>en</strong>t in rural<br />
area. Consequ<strong>en</strong>tly, some high school and college undergraduate schools developed<br />
premedical recruitm<strong>en</strong>t activities targeting future GPs with rural background.<br />
In addition, the role of the medical school is again, underlined, mainly preparedness and<br />
role models proposed to the stud<strong>en</strong>ts. Programs who prepare (=preparedness for rural<br />
practice) to be rural physicians, particularly for small-town living, l<strong>en</strong>gth<strong>en</strong> the stay in<br />
the rural practices. Resid<strong>en</strong>cy rotations in rural areas are the best educational<br />
experi<strong>en</strong>ces both to prepare physicians for rural practice and to l<strong>en</strong>gth<strong>en</strong> the time they<br />
stay there. Preparedness would therefore be se<strong>en</strong> as a ret<strong>en</strong>tion rather than a<br />
recruitm<strong>en</strong>t policy.