Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

122 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
7.3.3 Financial policies supported by the stakeholders
When asked to pick financing policies, the majority of the stakeholders chose to mix
fee-for-service with capitation as a complementary mechanism of funding. The policy on
incentives for the installation in a low density area had a good score but was not the
main priority of the stakeholders; this could be due to the fact that Impulseo I has been
recently started, thus is no longer a priority or, as suggested by the literature, a oneshot
lump sum does not compensate, on the longer term, for poorer working
conditions.
Thus when confronted with the need to choose a policy, capitation might have been
picked because this is still a rather new policy in the Belgian context. Indeed, capitation
funding currently applies only to 165,000 patients registered under the "maison
médicale/ wijkgezondheidscentra" scheme while the other (majority) GPs can receive
25€ per patient through the “Global Medical Record” (DMG-GMD) scheme. Authors
from the European Observatory on Health systems and policies suggest that there is
room for improving the role of capitation in the funding of GPs 222 .
Interviewed students were more reluctant to the idea of capitation. This might be
explained by the wording of the question: the students were asked to choose for
capitation instead of fee-for-service whereas the question asked to the stakeholders was
about capitation as an additional way of financing general practice. These are of course,
very different policies. Clearly, our study suggests that there is no room for removing
the fee-for-service scheme but more for a diversification of the funding mechanism. This
is also very consistent with current trends in physicians payment mechanisms 224 .
7.4 WORKING CONDITIONS
Working conditions of general practitioners are a general concept including the many
aspects of general practice influencing the job satisfaction and satisfaction in the lifestyle.
This includes two main themes: the working schedule and its influence on the work-life
balance and the working organisation such as team-work. These elements and
particularly the first one, are considered as major drivers of physician satisfaction 225 .
7.4.1 Different perceptions of the GP working conditions
The literature review and the Belgian GP leavers study stress the importance of
working conditions as key factors for retention. Leaving general practice was the result
of high demand such as work load, having to be constantly on-call, dealing with
emergencies, high responsibilities and the perceived burden of continuous medical
education. These high demands were in conflict with personal responsibilities, like family
life. The students hold, however, conflicting views about working conditions. On one
hand general practice is perceived as a difficult profession with a lot of uncertainties
(especially for the clinical decision process) and a lonely job with a high workload. On
the other hand, the GP profession is appreciated for its variety in the work, autonomy
and the privilege of working with patients in different stages of their life.
An interesting finding is that general practice students hold a more positive opinion than
other specialty students regarding how difficult general practice could be. Students
choosing a specialty career considered general practice as a more lonely profession than
the students in general practice did: this may suggest either that the expectations
regarding team-work are different between these two groups of students or that these
groups hold a different perception of the reality of GP team-work. Our study supports
both explanations. The student study shows that the expectations regarding team
working do not differ largely between GP students and specialist students. However,
GP students did have a slightly higher preference for “flexible” schedule while specialist
students valued more heavily “job security”. This could explain why students hold
different perspectives on the GP’s work: for the GP students: the costs of working
alone as a GP is slightly paid off by the positive return of its corollary, autonomy. This
trade-off may apply less to specialist student which tend to value more job security than
autonomy. The stakeholders' survey supports this hypothesis: they gave the same
weight to autonomy and team working: both values were important. This suggests that