Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

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100 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 between the various specialties, targeted lectures, some lectures given by GPs for a better matching with the GP profession. The fear of some respondents is however that the courses would be too much GP orientated and not all courses can integrate a general practice approach. The most discarded policy is the development of a Clinical Academic activity for general practice. This policy got a mean rank of 3.51 and a mean score of 4.33). The reasons for rejecting this policy is that family practice cannot be performed in a hospital, far from the patient’s home. It would be better to develop the training practice with GPs who are trained to coach students. The next figure (figure 2) shows that a teaching policy involving more GP approach in the master courses as well as a policy making compulsory a clerkship in the GP’s Master was considered as more efficient in at least 3 criteria out of 4 than the other two policies (a better selection of students or the development of academic GP activity). Indeed, they performed better in attracting medical students; they had a better costbenefit performance and were more likely to be accepted by other health professionals. A better selection of students was also well performing on accessibility of care, maybe because a selection of future GPs would be more favorable to patients. However, this policy was under-performing on the other 3 criteria. Developing an academic GP practice is clearly not a good strategy; indeed, it is under performing on the four criteria. Figure 2: Criteria of teaching and training policies: radar by policy In the open-ended questions, some respondents take this opportunity to insist on policies that were mentioned previously and they develop three main themes i.e., the quality of the lectures, the importance of a multidisciplinary approach and more knowledge of the profession. The lectures are mentioned in different ways. Suggestions about their content included e.g., a much earlier contact with patients through first line courses, a more practical
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 101 approach of psychology and communication, new lectures about forensic medicine, patient’s rights, the structure of the health system, developing the clinical feeling as well as the critical thinking. Suggestions regarding the duration of the lectures i.e., shorter and more targeted, were also made. The second theme in the open-ended comments is the multidisciplinary approach that seems important for all stakeholders with various suggestions of studying together during the first years of studies in order to develop a sense of health community. Finally, the knowledge of the profession is the third theme mentioned: lectures about administrative work, difficulties and how to react, participation to meetings of professionals are proposed. 6.6.2.2 Financing policies The literature review showed that financing policies have an important place in attracting the young professionals in the practice. In this study, the competition was very tied regarding financing policies. Most policies had a rank between 2.34 and 2.71 (table 17). However, one policy recorded a higher preference: the capitation in addition to other fee-for-service got a mean rank of 1.90. This policy has, however, a mean score of 4.97 and comes next to “incentives for the installation in an underserved geographical area” which got a mean score of 5.14. This difference can be explained by the fact that capitation is rather new in the Belgian context despite having a smaller score than the Impulseo related policy (incentives for the installation in an underserved geographical area). Table 17: Preferred financing policies: mean ranks and scores (n=102) Financing policies Mean rank Mean score 1. Capitation in addition to other fee-for-service 1.90 4.97 2. Increase the consultation fees 2.34 4.08 3. Incentives for the installation in an underserved geographical area 2.47 5.14 4. Target or quality of care payment in addition to other fee-for-service 2.66 4.73 5. Combining wage-earning and fee for service 2.71 4.33 The qualitative comments show that capitation seems interesting to get the patient’s loyalty and to improve the GP’s central role in the health care system. However; the fixed price should not be paid by the patient but directly by the Sickness funds directly. This measure should be enlarged to the on-call duties too. In addition, fear of control is mentioned. Other measures are suggested: a fixed price for the duty and a decrease of the price of the drugs. The policy that got the highest mean rank (2.71) and was thus the most discarded was the combination of wage earning and fee for service (mean score of 4.33). The term “wage-earning” was shocking for most interviewees: this idea is against their conception of an independent profession paid through fee-for-service. Moreover, they did not understand how this could be implemented in practice. Finally, for a few of them it is far too expensive for the society. Others think it is a current tendency because it will offer economic comfort to the GP and allow him to better practice medicine. However, the patients should not pay the out-of-pocket expense too much though they should not believe the care is totally free. Diversifying the payment is a good solution for most of the respondents, combining a fixed price for practicing, a fixed price per patient (global medical record for example) and some additional payments for special acts. Some interviewees suggested other forms of remuneration linked to continuous training, to computing and to be on duty. Choosing financing policies was more complicated as shown by the less contracted scores and ranking of these policies compared to the learning policies. Figure 3 helps to explain these results. Capitation in addition to other fee-for-service and the increase of the consultation fees were both good for improving the attraction-retention of GPs and
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Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

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