Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

26 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
Mentoring relationships with a rural GP have great effects on the recruitment of the GP
25 , 57 , 75 , 80 , 81 , 94 , 99 , 101 , 102
. On the other hand, the perception that rural physicians are
not reimbursed as well as were their urban counterparts does not encourage the GP to
start in rural area 25 , 77 .
Finally, the mean level of debt 88 predicts urban practice rather than rural practice.
EXPECTATIONS REGARDING THE PROFESSION
Many characteristics related to the profession dissuade the GPs to practice in rural
areas: the level of professional commitment (long work hours, frequent calls) 74 , the
feeling of professional isolation 64 , 74 , the concern about staying up to date 74 and the
higher level of responsibility than urban doctors 77 .
On the other hand, some features of the profession have a positive influence on the
74 ,
recruitment of the GPs in rural area: intellectual aspects (wide variety of procedures)
79 , 92 74 , 92
and professional autonomy .
Some expectations of GPs concerning the social, financial and professional supports of
the local community can be mentioned. The presence of a social support network, 74 of
a specialist support 92 , the opportunity to follow continuing education 78 , the availability
of capital for practice development 78 are significant criteria in favor of a recruitment in
rural areas.
GOVERNMENTAL, REGIONAL AND LOCAL POLICIES
The financial issues greatly influence the recruitment of the GPs in rural area. Loan
repayment programs attracts the GP in a rural practice 57 , 103 . In addition, some data
suggest that a higher debt load upon leaving training is inversely related to the likelihood
of practicing in a rural area 67 .
An other very important aspect is the rural exposure early during residency or medical
18 , 32 , 38 , 57 , 67 , 75
school that would have a beneficial effect on the recruitment in this area
, 76 , 77 , 79 , 81 , 86 , 90 , 91 , 98 , 100 , 101 , 102 , 104 , 105 , 106 , 107 , 108 , 109
the longer the exposure, the
stronger positive impact 90 .
Various items related to the experience of the GP have also an effect on the
recruitment in rural areas. Examples from foreign programs are the participation to the
“Physician Shortage Area Program (PSAP)” 88 , 94 and to the National Health Services
Corps 85 , 89 , 94 .
EXPECTATIONS REGARDING THE LOCAL COMMUNITY
The future local environment has an effect on the decision. A friendly community
supports the recruitment 110 whereas a high rate of poverty among rural residents
rather dissuades it 78 .
Moreover, the access to cheaper housing and quality housing in rural area are positive
factors 92 .
The spouse influences the recruitment of the GP in rural areas by a stronger tendency
to choose for a rural area if the spouse adheres to it. Positive factors are a rural
exposure during the childhood 74 , 82 , the compatibility with the partner’s career
aspiration 78 , 79 and the satisfying quality of rural life 74 , 79 . The proximity of the family
and an environment favorable to its development are also important 18 , 77 , 92 , 103 , 110 .
Finally the availability of social infrastructures (leisure, education, culture) also supports
the recruitment of GPs in a rural zone 77 , 78 , 79 , 95 .
2.3.1.4 Recruitment: indifferent area
Different parameters influence the decision to begin with a GP practice, independently
of its geographic situation. Half of the scarce literature available for this part comes
from US data and the other half is Europeans studies (mostly from the UK).