Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias 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)?
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 5 • What does the international literature tell us about the factors and policies influencing GPs’ attraction, recruitment and retention? • What are the motivations of 7th year medical students to choose or not the GP profession and why do young general practitioners choose to leave the practice? • What are the policies, in the Belgian context, most likely to improve the attraction, retention and recruitment of general practitioners into the profession? To answer to those research questions, this report is structured with six chapters. The first one analyzes the current situation in Belgium by describing the evolution of the proportion of inactive GPs in the Belgian curative sector. Two databases have been analysed. First, the INAMI/RIZIV database enabled to perform a time-series study and to observe the evolution of the inactivity level of the Medical Doctors (MDs) in the curative sector under the AMI a for specific years between 1995 and 2005. Secondly, the CIPMP (Centre d'Information des Professions Médicales et Paramédicales) database was used for a cohort analysis to study the inactivity of young GPs in the curative sector after their MD degree. The second chapter provides the international literature background of the report. It summarizes the factors influencing GPs’ attraction, recruitment and retention from the national and international literature. This chapter provides a conceptual overview and definition of the concepts used in this report. It reviewed 165 papers published since 1997, mainly found in Medline and ISI web, as well as in other important databases. The third chapter addresses the problems of attraction and recruitment of the students into general practice. This chapter analyzes their motivations and the process of specialty choice. It includes two data collections. The first part presents the results of 24 semi-structured qualitative interviews with students in 7 th year of medical training. The second part undertakes a survey by questionnaire delivered to 768 students from all the Belgian Universities providing a postgraduate medical training. The fourth chapter addresses the problems of retention. Through qualitative semistructured interviews with 16 Belgian former GP’s, it undertakes to understand why young general practitioners choose to leave the practice. Suggestions that these GPs propose at the health system level to improve the retention in the profession have also been studied. The fifth and sixth chapters move to policies to improve GPs attraction, recruitment and retention. The fifth chapter reviews the international literature for policies able to increase attraction, recruitment and retention of general practitioners. The last chapter presents a stakeholders’ analysis in order to test the policies that could be implemented in Belgium to improve the GPs’ career. This study interviewed, thanks to a multi-criteria quantitative face-to-face questionnaire, 102 important Belgian stakeholders: policymakers, unions’ representatives, universities’ stakeholders, media and GPs themselves. An analysis of the GP medical supply is out of the scope of this report: this topic has been extensively analysed in a recent KCE report 7 . a Assurance Maladie Invalidité/Ziekte en invaliditeitsverzekering (Health Insurance)
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KCE Reports 90 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion 5<br />
• What does the international literature tell us about the factors and<br />
policies influ<strong>en</strong>cing GPs’ attraction, recruitm<strong>en</strong>t and ret<strong>en</strong>tion?<br />
• What are the motivations of 7th year medical stud<strong>en</strong>ts to choose or<br />
not the GP profession and why do young g<strong>en</strong>eral practitioners choose<br />
to leave the practice?<br />
• What are the policies, in the Belgian context, most likely to improve<br />
the attraction, ret<strong>en</strong>tion and recruitm<strong>en</strong>t of g<strong>en</strong>eral practitioners into<br />
the profession?<br />
To answer to those research questions, this report is structured with six chapters. The<br />
first one analyzes the curr<strong>en</strong>t situation in Belgium by describing the evolution of the<br />
proportion of inactive GPs in the Belgian curative sector. Two databases have be<strong>en</strong><br />
analysed. First, the INAMI/RIZIV database <strong>en</strong>abled to perform a time-series study and to<br />
observe the evolution of the inactivity level of the Medical Doctors (MDs) in the<br />
curative sector under the AMI a for specific years betwe<strong>en</strong> 1995 and 2005. Secondly, the<br />
CIPMP (C<strong>en</strong>tre d'Information des Professions Médicales et Paramédicales) database was<br />
used for a cohort analysis to study the inactivity of young GPs in the curative sector<br />
after their MD degree.<br />
The second chapter provides the international literature background of the report. It<br />
summarizes the factors influ<strong>en</strong>cing GPs’ attraction, recruitm<strong>en</strong>t and ret<strong>en</strong>tion from the<br />
national and international literature. This chapter provides a conceptual overview and<br />
definition of the concepts used in this report. It reviewed 165 papers published since<br />
1997, mainly found in Medline and ISI web, as well as in other important databases.<br />
The third chapter addresses the problems of attraction and recruitm<strong>en</strong>t of the stud<strong>en</strong>ts<br />
into g<strong>en</strong>eral practice. This chapter analyzes their motivations and the process of<br />
specialty choice. It includes two data collections. The first part pres<strong>en</strong>ts the results of<br />
24 semi-structured qualitative interviews with stud<strong>en</strong>ts in 7 th year of medical training.<br />
The second part undertakes a survey by questionnaire delivered to 768 stud<strong>en</strong>ts from<br />
all the Belgian Universities providing a postgraduate medical training.<br />
The fourth chapter addresses the problems of ret<strong>en</strong>tion. Through qualitative semistructured<br />
interviews with 16 Belgian former GP’s, it undertakes to understand why<br />
young g<strong>en</strong>eral practitioners choose to leave the practice. Suggestions that these GPs<br />
propose at the health system level to improve the ret<strong>en</strong>tion in the profession have also<br />
be<strong>en</strong> studied.<br />
The fifth and sixth chapters move to policies to improve GPs attraction, recruitm<strong>en</strong>t<br />
and ret<strong>en</strong>tion. The fifth chapter reviews the international literature for policies able to<br />
increase attraction, recruitm<strong>en</strong>t and ret<strong>en</strong>tion of g<strong>en</strong>eral practitioners. The last chapter<br />
pres<strong>en</strong>ts a stakeholders’ analysis in order to test the policies that could be implem<strong>en</strong>ted<br />
in Belgium to improve the GPs’ career. This study interviewed, thanks to a multi-criteria<br />
quantitative face-to-face questionnaire, 102 important Belgian stakeholders: policymakers,<br />
unions’ repres<strong>en</strong>tatives, universities’ stakeholders, media and GPs themselves.<br />
An analysis of the GP medical supply is out of the scope of this report: this topic has<br />
be<strong>en</strong> ext<strong>en</strong>sively analysed in a rec<strong>en</strong>t KCE report 7 .<br />
a Assurance Maladie Invalidité/Ziekte <strong>en</strong> invaliditeitsverzekering (Health Insurance)
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