Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 29
The challenge of maintaining high-quality care 34 , of keeping up with a continuously
expanding list of recommended therapeutic and preventive treatments 122 and the
amount of responsibility play a negative role for the retention 121 . The lack of flexibility
in working arrangements 72 , the dissatisfaction (for example in the UK, following the
NHS reforms) 61 , 118 , 122 , the heavy workload 65 , 72 , 118 , 124 118 , 121
, the long hours of work
are also related to the problem of the GP retention.
A lot of stressing agents have also an effect on the intention to leave (e.g., night visits,
fear of assault during visits, finding a locum) 121 . Additional factors are linked to the
patients with their increasing demands and expectation 65 , 72 .
On the other hand, the studies identified some facilitating factors related to the
profession. An overall satisfaction 80 , 120 , 121 , the development of the personal abilities 121 ,
the variety in the job 121 , the recognition for good work 121 , 125 , the positive relationships
with the patients 125 are favorable for the GP retention.
The local community features are influential. The positive relationships with the local
communities 120 and the professional community support that allow adequate time off
80 72
, training and career development support the retention of the GP. On the other
hand, working in deprived areas with lower payments discourages the retention 123 .
As a matter of fact, the financial parameters influence the retention of the GP, as noted
in the chapters about attraction and recruitment. Many studies present the low incomes
72 , 118 , 120 122
and the rising practice costs as negative factors. It should be noted that the
GPs with higher incomes were less likely to reduce their working time 122 . A study
found that the income is not related to the decision of retirement 122 .
LIFE SATISFACTION
The family is important for the retention: if the GP profession creates an imbalance in
the family life, the GP will have a higher intention to leave his/her job 121 . A study further
specifies that part-time GPs with an important marital or parental role have less
intention to leave their job than full-time GPs 126 .
2.4 SUMMARY: LITERATURE REVIEW ON FACTORS
INFLUENCING ATTRACTION, RECRUITMENT AND
RETENTION
This chapter considers all factors that play a role in the attraction of the future general
practitioners and in their decision to start and go on with their practice. Many papers
study the situation in North America and in Australia, in particular the factors that
influence the work in remote rural areas. Some conclusions might not be applicable to
Belgium. Nevertheless, the identification of all factors potentially interacting with the
attraction, recruitment and retention in the GP profession are worth being analyzed in
the context of this project.
This literature review emphasizes the role of extrinsic factors. The most important or
influential extrinsic factors that have an effect on the attraction, recruitment and
retention were identified as the following ones:
• The major role of the medical school (student’s exposure, role model,
curriculum…);
• The difficult working conditions (heavy workload, the stressful and the
non controllable lifestyle, inflexibility of hours, required commitment
and on call availability…);
• The level of income;
• The positive aspects of relationships within the patient.
These findings also underline the complexity of the factors interacting in the decisions
and the necessity to tackle the problem using a multidimensional approach.