Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

88 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
5.3.3 Retention
Practice location is also strongly influenced by the preferences of GP spouse, especially
when a choice has to be made between urban and rural area. Spouse pay attention for
themselves and their family to aspects such as job opportunity, community links,
community environment, housing, services, schools, and leisure.
The main policies used to attract GPs in rural area are economic incentives to support
starting general practice (grants, subsidies, loans) :
• Funding medical schools for expansion or maintenance of health
professions education and training (e.g. US Title VII funding) is
moderately effective. As far as we are informed, cost-effectiveness of
such programs was not evaluated.
• Subsidies (grants) for starting family practice are used to sustain rural
healthcare workforce (Australia, Canada), but it is not sure if they are
effective or cost-effective. Young French GPs judged such initiatives
irrelevant.
• Financial support to medical students (grants, loans) in exchange for a
period of service in underserved areas (US federal National Health
Service Corps and similar state programs) is moderately effective, at
least in the short-term. Surprisingly, it was found that loan repayment
in exchange of obligated service was an effective retention policy. Cost
effectiveness was not evaluated.
Another recruitment strategy is to use "recruiters". For example, the Robert Wood
Foundation's Southern Rural Access Program (SRAP) consists in the use of granted
recruiters to assist rural communities in assessing healthcare needs and recruiting
primary care providers.
Other initiatives exist to give young graduates an administrative support for
locating/opening their own family practice.
Three factors arise from the review of literature for the retention of GPs, both in rural
or undifferentiated areas.
The difficult working conditions (e.g. workload, flexibility of working schedules) and
work-family balance (e.g., to save time for personal and family life and leisure) influence
the decision to quit the profession, in particular in rural areas but policies in this field
have still to be implemented and evaluated.
Low income is a second factor. In the literature, general practitioners working in rural
areas felt being less favored than their urban counterparts. But, economic retention
incentives, such as increasing fee rates for physicians practicing in rural regions
(Canada), and specific allowances and deprivation payments (UK) does not seem to be
effective in the long-term. GPs may feel inadequately compensated for higher workload
and poorer working conditions or environment.
Another, but broader, economic incentive is community development that could play a
role in retention of the GPs. Some GPs suffer from a lack of professional support (e.g.,
specialty support, educational opportunities, and support from local hospitals or
community health staff) or a lack of community support for private life (e.g. availability
of leisure and cultural activities, quality of school for the children, spouse’s well-being).
Many other programs and policies have been developed but their effectiveness has not
been tested yet. Salaried practice, continuing medical education, locum relief, and
professional development putting "inactive" GPs back into practice, delaying retirement,
and community integration are among those programs. Implementation and
effectiveness are also challenging. Providing immigrant visa to International Medical
Graduates (IMGs) in exchange of a variable period of obligated service is effective, at
least in the short-term, but this however raises issues of discrimination against IMGs
and ethical issues.