Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
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18 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion KCE Reports 90<br />
n See app<strong>en</strong>dix 1.4<br />
rec<strong>en</strong>t study (Meeus, 2007 14 ) showed that this group is rather limited (see app<strong>en</strong>dix<br />
1.7).<br />
The second risk of misclassification comes from the definition of “inactive in the<br />
curative sector”: those having “zero curative acts” during the year. This criterion falls<br />
short to be a fully active MD in the curative sector (the official minimum to be certified<br />
is about 1250 contacts a year). This is why we paid att<strong>en</strong>tion to small practices that<br />
decrease over time, at least for the lic<strong>en</strong>sed GPs older than 30 years old. Pooling<br />
together the “inactivity” with the small practice groups would have thus increased the<br />
overall inactivity rate and slightly smoothed the tr<strong>en</strong>d in the inactivity rate.<br />
Thirdly, the situation codes n of the activity of the MDs registered in the INAMI/RIZIV<br />
database are based on spontaneous and their personal and non-compulsory declaration.<br />
This information may thus not always be updated or accurate, influ<strong>en</strong>cing the total<br />
number of MDs who are really “active” (or inactive). Rec<strong>en</strong>t data from the<br />
INAMI/RIZIV show that the situation codes are 98% correct wh<strong>en</strong> the GP is inactive;<br />
but for those called “active”, only 71% do really practice care 15 .<br />
Fourth, we excluded from the d<strong>en</strong>ominator the situation codes corresponding to<br />
inactivity. Consequ<strong>en</strong>tly, our inactivity perc<strong>en</strong>tages are restricted to those who are still<br />
pot<strong>en</strong>tially available. We could have included the GPs being abroad or temporarily<br />
inactive in our d<strong>en</strong>ominator, but if we had chos<strong>en</strong> to include those extra losses; the<br />
perc<strong>en</strong>tages of inactivity would have be<strong>en</strong> higher. However this group has a rather small<br />
size and our perc<strong>en</strong>tages would have not be<strong>en</strong> too much affected. Furthermore, we did<br />
not take into account those who never registered at the INAMI/RIZIV whereas such a<br />
decision also contributes to poor recruitm<strong>en</strong>t for the curative practice.<br />
Fifth, the CIPMP database registers curative activities by comparing various files and<br />
information. Some information may be missing: it is possible that some GPs are active in<br />
the curative sector but are not being registered as such. However, comparisons with<br />
sickness funds and RIZIV/INAMI databases have shown a good concordance betwe<strong>en</strong><br />
the information of the CIPMP and these databases (see details in app<strong>en</strong>dix 1.6).<br />
Sixth, the year of MD degree used in the inactivity analyses is approximate, since it is<br />
based on the theoretical year of MD degree (which is reliable) and not on the exact<br />
(observed) time of MD degree. For those who were still allowed to follow a part-time<br />
training, the estimated date of the degree is thus too early in the life cycle, and the<br />
inactivity rate might thus be overestimated.<br />
Finally, the scope of this study was limited to the factors and policies that influ<strong>en</strong>ce the<br />
attraction, recruitm<strong>en</strong>t and ret<strong>en</strong>tion in the profession. This study did not consider<br />
other topics that should have be<strong>en</strong> also interesting for analyzing in detail the<br />
demography of the GP population. As stated in introduction, the background of this<br />
study was the analysis of the medical supply in Belgium 7 and this topic was not anymore<br />
considered in this report. There is also a lack of information on the GP population who<br />
is inactive and is not anymore available: only the pot<strong>en</strong>tial workforce has be<strong>en</strong> the<br />
target population of the analyses. One also has to take into account the increase of<br />
foreigners in medical specialization and practice, a consequ<strong>en</strong>ce of the rec<strong>en</strong>t op<strong>en</strong>ness<br />
of the EU internal market. This situation g<strong>en</strong>erates questions concerning medical<br />
workforce supply planning. Indeed, in 2006, 106 foreign MDs began a practice,<br />
contributing for 12.1% of the medical workforce inflow, comp<strong>en</strong>sating to some ext<strong>en</strong>t<br />
the observed losses of Belgian GPs working in the curative sector 7 .