Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

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20 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 2 CHAPTER 2: LITERATURE REVIEW ON FACTORS INFLUENCING ATTRACTION, RECRUITMENT AND RETENTION OF GENERAL PRACTITIONERS 2.1 OBJECTIVES The previous chapter showed that GPs were increasingly more likely to drop out from medicine after their graduation. The systematic literature review of this chapter aims to analyze the factors that influence attraction, recruitment and retention of GPs in the profession in Western countries. 2.2 LITERATURE SEARCH METHODOLOGY Cf. details in appendix 2 2.2.1 Strategy of research: • Large scope of inclusion criteria ensuring a broad exploratory phase, • Search equation to obtaining a high sensitivity. The literature search was limited to the publications published since 1997 2.2.2 Data sources The existing literature was first searched in Pubmed: http://www.ncbi.nlm.nih.gov/sites/entrez and ISI web of Science: http://portal.isiknowledge.com/portal.cgi?DestApp=WOS&Func=Frame The other websites/data bases consulted are in appendix 2.1 2.2.3 Phase 1: Research questions The literature review focuses on factors and policies (see chapter 5 for the policies) influencing GPs attraction-recruitment-retention in industrialized countries. The objective is to identify the effective policies to improve attraction, recruitment and retention in order to formulate a range of possible solutions to be proposed to the stakeholders of chapter 7. A large body of literature comes from North America, Australia and New Zealand. The problems of recruitment and retention are in particular crucial and well studied in the rural areas of those regions. The theoretical considerations were based on the recent work of Bilodeau et al (2006) 16 published by the GRIS (Groupe de Recherche Interdisciplinaire en Santé, Montréal). They analyzed the factors influencing the recruitment and retention that are defined as follows: • Attraction: attracting students who are likely or plan to be GPs, influencing specialty choice of undergraduate and graduate students, and educating future GPs, • Recruitment: adding postgraduates –those with an MD degree– to the pool of practicing GPs (through internship, residency and, secondarily, choice of practice location), • Retention: maintaining GPs in they current practice.
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 21 Furthermore, they developed a theoretical model that displays the relationships between the main categories of factors that influence the attraction, recruitment and retention of GPs in remote areas. 2.2.4 Phase 2: Identification, selection and quality appraisal of the literature The appendices 2.2 and 2.3 summarize the terms used, the search strategy and the selection procedure of the papers. The tree in appendix 2.4 details the number of articles found and selected, as well as the resons for inclusion/exclusion. The researchers selected the papers using a specific appraisal tool (see appendix 2.5). The results of the quality appraisal are summarized in the tables of the appendix 2.6. 2.3 RESULTS OF THE LITERATURE REVIEW: ATTRACTION, RECRUITMENT AND RETENTION IN THE GP PROFESSION 2.3.1 Factors affecting GPs attraction-recruitment-retention The attraction of future general practitioners, their recruitment in the profession and the longevity of their career are three poles subject to a variety of influencing factors. The object of this chapter is to analyze their description in the literature. 2.3.1.1 Theories about GPs attraction-recruitment-retention This chapter introduces two theoretical models that present in a structured way the factors influencing the attraction, recruitment and retention of the general practitioners in the profession. Bland-Meurer and al. (1995) 17 are the authors of another model which focused on a presentation of the factors influencing the attraction of the future general practitioners for the profession. This model is in fact integrated in the attraction part of the model of Bilodeau and al. that will be further detailed. Bilodeau et al elaborated a theoretical model (2006) based on existing knowledge that considers different factors related to the 3 poles of the problem, namely attraction to the profession, recruitment and the retention of this choice of career (see illustration below). They considered all factors concerned in the process of decision of a place of practice and their interrelationship. The authors consider that the attraction, the recruitment and the retention of the practice in rural area refer to three distinct dynamics with specific factors. This model has limitations that will be discussed in the chapter about policies. It is quite artificial as the same factors interfere with the three stages. Moreover, some personal factors also influence the decisions. The authors define the concept of attraction as a positive attitude with regard to the practice of medicine in rural area, without necessarily any further installation of their practice in this area. This research opted for another definition of attraction: “attracting students who are likely or plan to be GPs, influencing specialty choice of undergraduate and graduate students, and educating future GPs”, not only limited to the rural area. The concepts of recruitment and retention used in this research are otherwise in adequacy with the definitions of Bilodeau et al. • recruitment = adding postgraduates –those with an MD degree– to the pool of practicing GPs (through internship, residency and, secondarily, choice of practice location) • retention = maintaining GPs in their current practice The model of Bilodeau et al provides an adequate framework to organize the results of this literature review in a logical and judiciously articulated way.
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Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

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