Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
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120 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion KCE Reports 90<br />
7 ROUND-UP<br />
This research was carried out by 7 Belgian Universities during the 2007-2008 period. It<br />
aimed at measuring, explaining and proposing policies to improve g<strong>en</strong>eral practitioners<br />
attraction, ret<strong>en</strong>tion and recruitm<strong>en</strong>t into clinical practice. This chapter summarizes and<br />
articulates the main findings, putting them in relation with the literature and op<strong>en</strong>ing<br />
av<strong>en</strong>ues for policymaking.<br />
7.1 ATTRACTION, RECRUITMENT AND RETENTION OF<br />
GENERAL PRACTITIONERS<br />
The research among stud<strong>en</strong>ts has shown that, after 7 years of medical undergraduate<br />
training, one medical stud<strong>en</strong>t out of three chooses for a career in g<strong>en</strong>eral practice/family<br />
medicine. Although this rate is low compared to the Belgian g<strong>en</strong>eral<br />
practitioners/specialists quota distribution (43% for g<strong>en</strong>eral practitioners -57% for<br />
specialists), this is consist<strong>en</strong>t with the international literature review: many countries<br />
face this problem. Furthermore, once graduated, many GPs do not <strong>en</strong>ter g<strong>en</strong>eral<br />
practice and many leave it after a few years of practice. The pres<strong>en</strong>t study shows that, in<br />
the last decade, the perc<strong>en</strong>tage of GPs being inactive in the curative medical sector has<br />
increased annually, particularly among the youngest age group. This increase was<br />
observed in both linguistic communities and g<strong>en</strong>ders. More precisely, among the cohort<br />
of graduates of 2005, one out of 10 did not have any curative practice and 1 out of 6<br />
had a small clinical activity.<br />
The research highlighted many reasons for these low attraction, recruitm<strong>en</strong>t and<br />
ret<strong>en</strong>tion of GPs in Belgium. Theses reasons have to do with the role of university, the<br />
economic inc<strong>en</strong>tives, the working conditions, and the organisation of health care in<br />
Belgium. For each of these topics, we summarize and discuss the findings of the<br />
research and the policies id<strong>en</strong>tified through the stakeholders analysis. In a last section,<br />
we articulate these differ<strong>en</strong>t topics into 3 main strategies.<br />
7.2 ROLE OF UNIVERSITIES AND OF MEDICAL EDUCATION<br />
7.2.1 Major role of GP clerkship<br />
The findings show that most stud<strong>en</strong>ts start their medical training with vague ideas about<br />
their specialty choice and what working as a g<strong>en</strong>eral practitioner <strong>en</strong>tails in practice.<br />
Clerkship plays an ess<strong>en</strong>tial role in the stud<strong>en</strong>ts’ choice because this is the very first<br />
experi<strong>en</strong>ce with real life medicine and it is the most important trigger of the specialty<br />
choice. Unfortunately, according to the stud<strong>en</strong>ts' study, poor timing, short duration and<br />
relative over-repres<strong>en</strong>tation of other specialties downgrade the positive effect clerkship<br />
in g<strong>en</strong>eral practice could have to increase the attraction for g<strong>en</strong>eral practice.<br />
7.2.2 Importance of teaching g<strong>en</strong>eral practice<br />
Second, the choice of specialty is also related to the cont<strong>en</strong>t of the lecturing of g<strong>en</strong>eral<br />
practice as such. The qualitative and quantitative stud<strong>en</strong>ts’ research clearly shows that<br />
curr<strong>en</strong>t teaching of medicine in g<strong>en</strong>eral is not favorable to g<strong>en</strong>eral practice. Stud<strong>en</strong>ts are<br />
mostly taught by medical specialists who have a t<strong>en</strong>d<strong>en</strong>cy to display an unfavorable<br />
image of the daily work of g<strong>en</strong>eral practitioners in their practice. The teaching by<br />
g<strong>en</strong>eral practice professors seems not to be able to reverse this situation.<br />
7.2.3 Influ<strong>en</strong>ce of the culture of the medical faculty<br />
Finally, the culture of the faculty of medicine disfavors the choice of g<strong>en</strong>eral practice by<br />
the stud<strong>en</strong>ts: indeed, the recruitm<strong>en</strong>t of g<strong>en</strong>eral practitioners in the 7th year is<br />
sometimes considered as a second choice for those not having succeeded in the race<br />
for a career in a medical specialty. This should not overlook the fact that many stud<strong>en</strong>ts<br />
do choose g<strong>en</strong>eral practice as a first-choice.