Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

10.08.2013 Views

2 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 3.6.4 Measures proposed by the students to make the GP profession more attractive............................ 55 3.7 DISCUSSION ................................................................................................................................................................... 56 3.7.1 General observations....................................................................................................................................... 56 3.7.2 Factors relating to specialty choice before medical school..................................................................... 57 3.8 FACTORS DURING THE CURRICULUM RELATING TO SPECIALTY CHOICE........................................ 58 3.8.2 Factors attracting students to choose the GP profession in Belgium................................................... 59 3.8.3 Suggestions for making General practice more attractive for medical students................................ 60 3.9 SUMMARY: MOTIVATIONS OF 7TH YEAR STUDENTS TO CHOOSE (OR NOT) THE GP PROFESSION................................................................................................................................................................... 61 4 CHAPTER 4: WHY YOUNG GENERAL PRACTITIONERS CHOOSE TO LEAVE THE PRACTICE: A QUALITATIVE STUDY..................................................................................... 63 4.1 INTRODUCTION.......................................................................................................................................................... 63 4.2 RESEARCH QUESTION ............................................................................................................................................... 63 4.3 METHODS........................................................................................................................................................................ 63 4.3.1 Qualitative instrument..................................................................................................................................... 63 4.3.2 Participants ......................................................................................................................................................... 64 4.3.3 Interviews ........................................................................................................................................................... 64 4.3.4 Analysis................................................................................................................................................................ 65 4.4 RESULTS ........................................................................................................................................................................... 65 4.4.1 Factors related to leaving general practice ................................................................................................. 66 4.4.2 Suggestions of participants for retention in general practice.................................................................. 71 4.5 DISCUSSION ................................................................................................................................................................... 73 4.5.1 Methodological issues ...................................................................................................................................... 73 4.5.2 Findings................................................................................................................................................................ 74 4.6 SUMMARY: MOTIVATIONS OF GENERAL PRACTIONERS WHO LEFT THE PROFESSION ................ 76 5 CHAPTER 5: POLICIES INFLUENCING THE ATTRACTION, RECRUITMENT AND RETENTION OF GENERAL PRACTITIONERS (GPS)........................................................... 77 5.1 OBJECTIVES..................................................................................................................................................................... 77 5.2 LITERATURE SEARCH METHODOLOGY.............................................................................................................. 77 5.3 SUMMARY: LITERATURE REVIEW ON POLICIES INFLUENCING ATTRACTION, RECRUITMENT AND RETENTION OF GENERAL PRACTITIONERS ..........................................................................................87 5.3.1 Attraction ........................................................................................................................................................... 87 5.3.2 Recruitment........................................................................................................................................................ 87 5.3.3 Retention ............................................................................................................................................................ 88 6 CHAPTER 6: WHAT ARE THE POLICIES TO BE IMPLEMENTED IN BELGIUM TO IMPROVE ATTRACTION, RECRUITMENT AND RETENTION OF THE GENERAL PRACTITIONERS: A STAKEHOLDERS’ ANALYSIS.............................................................. 89 6.1 INTRODUCTION.......................................................................................................................................................... 89 6.2 OBJECTIVES..................................................................................................................................................................... 90 6.3 METHOD OF THE STAKEHOLDER SURVEY........................................................................................................ 90 6.3.1 Design.................................................................................................................................................................. 90 6.3.2 Development of the questionnaire ............................................................................................................... 91 6.3.3 Identification of policy options....................................................................................................................... 91 6.3.4 Development of policy criteria...................................................................................................................... 92 6.3.5 Development of the scoring and the ranking ............................................................................................. 93 6.3.6 Open-ended comments................................................................................................................................... 94 6.4 IDENTIFICATION OF STAKEHOLDERS................................................................................................................. 94 6.4.1 Groups of stakeholders................................................................................................................................... 94 6.4.2 Gathering and validation of names................................................................................................................ 95 6.4.3 Sample size, stratification and participation rate........................................................................................ 96 6.5 DATA COLLECTION METHOD............................................................................................................................... 97 6.5.1 Face-to-face interview...................................................................................................................................... 97 6.5.2 Training of the interviewers ........................................................................................................................... 97

KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 3 6.5.3 Reaching the stakeholders .............................................................................................................................. 97 6.5.4 Unfolding of the interviews ............................................................................................................................ 97 6.6 RESULTS OF THE STAKEHOLDERS SURVEY ....................................................................................................... 98 6.6.1 Which challenges does face General Practice in Belgium? ...................................................................... 98 6.6.2 What are the most important policies for each topic? ............................................................................99 6.6.3 Summary: what are the policies more likely to be implemented according to the stakeholders? 106 6.6.4 Summary: new policies according to the stakeholders .......................................................................... 108 6.7 WHY DO THE STAKEHOLDERS PREFER SOME POLICIES? .......................................................................... 108 6.7.1 Introduction ..................................................................................................................................................... 108 6.7.2 Method .............................................................................................................................................................. 109 6.7.3 Results: influence of criteria ......................................................................................................................... 109 6.7.4 Other criteria mentioned by the stakeholders ........................................................................................ 112 6.7.5 Influence of stakeholder characteristics..................................................................................................... 112 6.8 DISCUSSION ................................................................................................................................................................. 114 6.8.1 Main Findings.................................................................................................................................................... 114 6.8.2 Health care organization policies ................................................................................................................ 116 6.9 STRENGTHS OF THE STUDY.................................................................................................................................. 117 6.10 SUGGESTED POLICY OPTIONS............................................................................................................................. 117 6.11 LIMITATIONS OF THE STAKEHOLDERS STUDY ............................................................................................. 118 6.12 SUMMARY: POLICIES TO BE IMPLEMENTED IN BELGIUM TO IMPROVE ATTRACTION, RECRUITMENT AND RETENTION OF THE GENERAL PRACTITIONERS: A STAKEHOLDERS’ ANALYSIS....................................................................................................................................................................... 118 6.12.1 Most important policies................................................................................................................................. 118 6.12.2 Discarded policies........................................................................................................................................... 119 7 ROUND-UP ................................................................................................................................ 120 7.1 ATTRACTION, RECRUITMENT AND RETENTION OF GENERAL PRACTITIONERS.......................... 120 7.2 ROLE OF UNIVERSITIES AND OF MEDICAL EDUCATION .......................................................................... 120 7.2.1 Major role of GP clerkship ........................................................................................................................... 120 7.2.2 Importance of teaching general practice.................................................................................................... 120 7.2.3 Influence of the culture of the medical faculty ......................................................................................... 120 7.2.4 Policies to foster the role of medical faculties ......................................................................................... 121 7.3 ECONOMIC INCENTIVES ........................................................................................................................................ 121 7.3.1 GP income and influence on the retention............................................................................................... 121 7.3.2 Economic incentives....................................................................................................................................... 121 7.3.3 Financial policies supported by the stakeholders .................................................................................... 122 7.4 WORKING CONDITIONS....................................................................................................................................... 122 7.4.1 Different perceptions of the GP working conditions ............................................................................. 122 7.4.2 Suggested policies to improve the working conditions in general practice....................................... 123 7.5 HEALTH SYSTEM ORGANIZATION ..................................................................................................................... 123 7.6 PUTTING ALL TOGETHER ...................................................................................................................................... 124 7.6.1 Tackling the issue over the whole life cycle: attraction, recruitment and retention....................... 124 7.6.2 Taking a reform perspective......................................................................................................................... 124 7.6.3 Getting the message through ....................................................................................................................... 125 8 REFERENCES............................................................................................................................. 126

2 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion KCE Reports 90<br />

3.6.4 Measures proposed by the stud<strong>en</strong>ts to make the GP profession more attractive............................ 55<br />

3.7 DISCUSSION ................................................................................................................................................................... 56<br />

3.7.1 G<strong>en</strong>eral observations....................................................................................................................................... 56<br />

3.7.2 Factors relating to specialty choice before medical school..................................................................... 57<br />

3.8 FACTORS DURING THE CURRICULUM RELATING TO SPECIALTY CHOICE........................................ 58<br />

3.8.2 Factors attracting stud<strong>en</strong>ts to choose the GP profession in Belgium................................................... 59<br />

3.8.3 Suggestions for making G<strong>en</strong>eral practice more attractive for medical stud<strong>en</strong>ts................................ 60<br />

3.9 SUMMARY: MOTIVATIONS OF 7TH YEAR STUDENTS TO CHOOSE (OR NOT) THE GP<br />

PROFESSION................................................................................................................................................................... 61<br />

4 CHAPTER 4: WHY YOUNG GENERAL PRACTITIONERS CHOOSE TO LEAVE THE<br />

PRACTICE: A QUALITATIVE STUDY..................................................................................... 63<br />

4.1 INTRODUCTION.......................................................................................................................................................... 63<br />

4.2 RESEARCH QUESTION ............................................................................................................................................... 63<br />

4.3 METHODS........................................................................................................................................................................ 63<br />

4.3.1 Qualitative instrum<strong>en</strong>t..................................................................................................................................... 63<br />

4.3.2 Participants ......................................................................................................................................................... 64<br />

4.3.3 Interviews ........................................................................................................................................................... 64<br />

4.3.4 Analysis................................................................................................................................................................ 65<br />

4.4 RESULTS ........................................................................................................................................................................... 65<br />

4.4.1 Factors related to leaving g<strong>en</strong>eral practice ................................................................................................. 66<br />

4.4.2 Suggestions of participants for ret<strong>en</strong>tion in g<strong>en</strong>eral practice.................................................................. 71<br />

4.5 DISCUSSION ................................................................................................................................................................... 73<br />

4.5.1 Methodological issues ...................................................................................................................................... 73<br />

4.5.2 Findings................................................................................................................................................................ 74<br />

4.6 SUMMARY: MOTIVATIONS OF GENERAL PRACTIONERS WHO LEFT THE PROFESSION ................ 76<br />

5 CHAPTER 5: POLICIES INFLUENCING THE ATTRACTION, RECRUITMENT AND<br />

RETENTION OF GENERAL PRACTITIONERS (GPS)........................................................... 77<br />

5.1 OBJECTIVES..................................................................................................................................................................... 77<br />

5.2 LITERATURE SEARCH METHODOLOGY.............................................................................................................. 77<br />

5.3 SUMMARY: LITERATURE REVIEW ON POLICIES INFLUENCING ATTRACTION, RECRUITMENT<br />

AND RETENTION OF GENERAL PRACTITIONERS ..........................................................................................87<br />

5.3.1 Attraction ........................................................................................................................................................... 87<br />

5.3.2 Recruitm<strong>en</strong>t........................................................................................................................................................ 87<br />

5.3.3 Ret<strong>en</strong>tion ............................................................................................................................................................ 88<br />

6 CHAPTER 6: WHAT ARE THE POLICIES TO BE IMPLEMENTED IN BELGIUM TO<br />

IMPROVE ATTRACTION, RECRUITMENT AND RETENTION OF THE GENERAL<br />

PRACTITIONERS: A STAKEHOLDERS’ ANALYSIS.............................................................. 89<br />

6.1 INTRODUCTION.......................................................................................................................................................... 89<br />

6.2 OBJECTIVES..................................................................................................................................................................... 90<br />

6.3 METHOD OF THE STAKEHOLDER SURVEY........................................................................................................ 90<br />

6.3.1 Design.................................................................................................................................................................. 90<br />

6.3.2 Developm<strong>en</strong>t of the questionnaire ............................................................................................................... 91<br />

6.3.3 Id<strong>en</strong>tification of policy options....................................................................................................................... 91<br />

6.3.4 Developm<strong>en</strong>t of policy criteria...................................................................................................................... 92<br />

6.3.5 Developm<strong>en</strong>t of the scoring and the ranking ............................................................................................. 93<br />

6.3.6 Op<strong>en</strong>-<strong>en</strong>ded comm<strong>en</strong>ts................................................................................................................................... 94<br />

6.4 IDENTIFICATION OF STAKEHOLDERS................................................................................................................. 94<br />

6.4.1 Groups of stakeholders................................................................................................................................... 94<br />

6.4.2 Gathering and validation of names................................................................................................................ 95<br />

6.4.3 Sample size, stratification and participation rate........................................................................................ 96<br />

6.5 DATA COLLECTION METHOD............................................................................................................................... 97<br />

6.5.1 Face-to-face interview...................................................................................................................................... 97<br />

6.5.2 Training of the interviewers ........................................................................................................................... 97

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