Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

4 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
INTRODUCTION
General practitioners (GPs) play an important role in the health care system. They are
usually the first medical contact with the patients. The GP is also a key interface
between outpatient and hospital care; he plays a vital role in linking clinical cares with
other community-based services; he is an important ally in care integration, particularly
for frail elderly and patients with chronic diseases. In most European countries,
socioeconomically vulnerable patients find an easier access to their GP than to specialty
medicine 1 . In other words, the GP should be in the driver’s seat 2 .
However, the driver’s car seems to be running out of gas. From a GP’s point of view,
life seems not to be that successful story international bodies and policy blueprints are
calling for. Indeed, studies from several Western countries indicate that the health care
system is facing difficulties in recruiting and retaining general practitioners in the
workforce. The percentage of UK doctors choosing general practice has declined from
one third among the 1983 graduates to one fourth in 1993 3 . Such a declining trend has
also been observed in other European countries like Switzerland where the percentage
of primary care providers has declined from 60% of all actively working doctors in 1991
to 50% in 2004 4 .
Belgium does face similar problems. In 2000, Van Baelen et al. 5 carried out a 5-years
follow-up of the cohort of GPs who graduated in 1995 (licensed or not for the Health
Insurance). From this cohort, around one out of three had left the GP profession five
years after their graduation. Another Belgian study 6 studied the activity of general
practitioners. They found that 85% of the young physicians working in the curative
sector in 1994 were still active in the curative sector 8-years later, 3.4% had shifted in
the non-curative sector, and 7.8% were working in a mix of curative and non-curative
activities.
Furthermore, Roberfroid et al 7 studied the percentage of GPs effectively working in the
curative sector in 2005. They concluded that the global number of GPs registered in the
Cadastre of Health Care Professions (2005) was 21804. Among them, only 4 out of 5
were registered as active in Belgium (i.e., alive, not retired and not dropped out and
whatever the professional field e.g., curative sector, administration, research centre). In
this GP population, 11626 GPs (63.4%) had performed 1 contact to at least 50 individual
patients during that year (thus considered as GPs practising care).
The drop-out of general practitioners from family medicine is disturbing for three
reasons. First, the WHO, since the Alma Ata declaration, has put primary care as a key
ally in achieving the Health For All Agenda 2 . This is not only a WHO statement but also
an important point of the March 2008 Belgian governmental declaration, calling for
reinforcing the role of the general practitioner. Second, there are some indications that
strong primary care reach better results in terms of health status and equity and that
primary care plays a vital role in care coordination 8 . Thus, having general practitioners
dropping-out of medicine may risk jeopardizing the continuity and quality of care.
Finally, the inactivity among GPs can considered as a loss of the social resources
invested in the teaching by both public authorities and students themselves 6 .
This situation requires an understanding of the factors influencing the attraction of
students into the general practice studies and of the recruitment and the retention of
the general practitioners in the practice. The goal of this study is to analyze and to
suggest policies to improve attraction, recruitment and retention of GPs into the
profession. The background of this study has been the analysis of the GP medical supply
in Belgium 7 and this topic is out of the scope of the present report.
This report attempts answering the following questions in order to formulate
suggestions for policies:
• What is the situation in Belgium regarding the evolution of the
inactivity of all medical doctors in the curative sector and the inactivity
of young GPs in the curative sector after their degree as medical
doctor (MD)?