Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
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124 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion KCE Reports 90<br />
delegation of some tasks (mainly administrative tasks). Their opinion about the GP role<br />
relative to other health actors, such as the second line and the multidisciplinary<br />
coordination (mainly for frail elderly and chronic pati<strong>en</strong>ts) was, however, less clear-cut.<br />
The stakeholders as well as both groups of stud<strong>en</strong>ts supported the idea to discourage<br />
the excessive use of the 2nd line (known as soft gate keeping) and they supported an<br />
increased role in the managem<strong>en</strong>t of the multidisciplinary team. Such <strong>en</strong>hanced role<br />
would pave the way for more delegation of clinical tasks, which also seems to be<br />
supported. However, the stakeholders fell short of recognizing that this would require a<br />
new health professional role such as the advanced-nurse practitioner.<br />
Two radical policies such as scrapping the numerus clausus (resulting in higher influx of<br />
doctors in g<strong>en</strong>eral) and the creation of regional resource ag<strong>en</strong>cies improving local<br />
working conditions for GPs (inspired by the Alberta Rural Physician Action Plan) were<br />
clearly discarded by the stakeholders.<br />
7.6 PUTTING ALL TOGETHER<br />
Improving the GP career will not work just by adding up policies. A pinch of capitation,<br />
with a “soupçon” of early GP teaching and a bit of group practice will not necessarily<br />
make the good meal GPs and Belgian pati<strong>en</strong>ts are waiting for. The coher<strong>en</strong>ce betwe<strong>en</strong><br />
policies is as much important as their individual excell<strong>en</strong>ce. How to get this coher<strong>en</strong>ce?<br />
7.6.1 Tackling the issue over the whole life cycle: attraction, recruitm<strong>en</strong>t and<br />
ret<strong>en</strong>tion.<br />
Attraction, recruitm<strong>en</strong>t and ret<strong>en</strong>tion strategies are all important. As stated in the<br />
literature review, attraction and recruitm<strong>en</strong>t strategies are important because low<br />
recruitm<strong>en</strong>t is g<strong>en</strong>erally the reason why shortages arise. Ret<strong>en</strong>tion strategies are also<br />
important because a strong ret<strong>en</strong>tion can offset poor recruitm<strong>en</strong>t. Attraction occurs all<br />
over the 7 years medical curriculum: that should lead to teaching strategies focusing on<br />
the whole master and not only at the <strong>en</strong>d of the curriculum. Strategies should focus on<br />
a better integration of GP and other specialties’ teaching. As suggested by Geyman 153 , a<br />
"pipeline education continuum" strategy may be more relevant: starting with high<br />
school, and progressing into medical school until after graduation. This has two<br />
important consequ<strong>en</strong>ces.<br />
First, because attraction and recruitm<strong>en</strong>t strategies are community-level policies<br />
whereas ret<strong>en</strong>tion strategies are much more linked to federal responsibilities, it could<br />
be necessary to improve the coher<strong>en</strong>ce betwe<strong>en</strong> the Community-level and the federal<br />
decisions to avoid a lack of coordination betwe<strong>en</strong> the policies. A gap is already visible in<br />
manpower planning: betwe<strong>en</strong> 2004 and 2006, 230 GP training posts remained unfilled<br />
and were replaced by specialist posts. The issue of GP clerkship is another domain in<br />
which such coordination could be useful.<br />
Second, strategies should focus on the whole curriculum. Strategies leading to an<br />
increased division of GP training from specialist training should probably be avoided,<br />
and, instead, better integration of these teaching should be searched. As suggested by<br />
Geyman 153 , a "pipeline education continuum" strategy may be more relevant: starting<br />
with high school, and progressing into medical school until after graduation.<br />
7.6.2 Taking a reform perspective<br />
This study has shown that it will be impossible to resolve the issues GPs are facing<br />
without taking a broader perspective on the health care system. The differ<strong>en</strong>t policies<br />
reviewed and chos<strong>en</strong> must be thus integrated. Team-working and the improved role of<br />
the GP in the health system are two instrum<strong>en</strong>ts allowing for care coordination. Many<br />
types of GP networks and collaborations are powerful instrum<strong>en</strong>ts to <strong>en</strong>hance the role<br />
of the GP. For example, <strong>en</strong>couraging the GPs to work in group will allow them to get a<br />
bigger say in a multidisciplinary team, to get funding for supporting staff; but that would<br />
require the delegation of some tasks in order to focus on their core-business. The<br />
redefinition of the GPs’ role within and outside the primary care line is the key reform