Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

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56 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 The table also illustrates the effect sizes of the student opinions on how to make the GP profession more attractive. 3.6.4.1 Financial incentives The strongest effect (0.382) concerns the item with respect to income. Students who study family medicine/general practice are more likely than the other students to state that the income gap between specialists and GPs should not be so large. The students wanting to specialize are not as enthusiastic as the future-GPs about the idea of a financial incentive for the practice support, but they also think it would make the GP profession more attractive. The same can be said about organizing continuity during the night and the weekend. 3.6.4.2 GP influence in policy decisions GP-students are more in favor for ‘a greater influence of GPs in the policy decisions when their patients are taken to hospital’ (effect size = 0.220). Apparently studentspecialists do not want the interference of the GP when a patient is admitted to hospital, even though they are also in favor of the obligatory registration of a patient with a GP. 3.6.4.3 Gatekeeping The final statistically significant effect can be found in the proposition to make general practice more attractive by obliging people to go and see a GP before consulting a specialist. Although all students think that this measure will have a positive influence on the interest of the GP-profession, the GP-students value this measure more positively. 3.6.4.4 Results of the binary logistic regression Controlling for gender and differences between student population of Dutch and French speaking parts of Belgium (table 7, appendix 3.8), four statistically significant relationships can be noticed y . They relate to the income, duty obligation, patient list and fee-for-service system: 3.7 DISCUSSION 3.7.1 General observations • the chance that a student chooses general practice is great when this student is in favor of the idea that a GP should earn as much as a specialist (odds ratio 3.462 [95% CI (1,741-6,885)]) • the chance of a choice for GP is also great when the student thinks that continuity during the night and weekend should be organized via doctors on call (odds ratio 3.563 [95% CI (1,079-11,763)]) • the chance of a choice for GP is great when the student is in favor of a patient-list system with the GP (odds ratio 2.204 [95% CI (1,197- 4,059)]). • On the other hand the chance to study GP is smaller when the student is in favor of the so-called capitation system instead of the fee-forservice payment (odds ratio 0.479 [95% CI (0,278-0,824)]). Again being a female student reinforces these relationships. This study offers a snapshot of the opinions and attitudes of the seventh year medical students in Belgium in relation to their future work. As shown by the statistics on GP y Before putting the statements in a binary logistic regression the answers were dichotomised e..g. completely disagree, disagree and disagree a bit became ‘disagree’ and agree a bit, agree and completely disagree became ‘agree’.
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 57 workforce in the chapter above about one third of the population of the future workforce choose for general practice. One limitation of this study is that it analyses the group of students in the seventh year: trends over time that may be new and not applicable to the present sample, were not studied. We did not include GPs in training although this group would have been interested in relation to our research questions. Within the time frame only a limited number of people could be interviewed and adding the GP’s in training would have made our interview group to heterogeneous. Although only 1 out of 7 students answered to the call to participate in the interviewstudy, a diverse sample of 7 th year medical students was obtained and saturation of information was reached. The use of quantitative and qualitative methodologies helped to triangulate the data. The quantitative findings underpin the qualitative findings, strengthening the validity of the results. Sometimes, the quantitative study gave more insight in the importance of different aspects (scores), because of the great sample size of the quantitative study (transversal study of all 7 th year medical students, overall response rate of 62,9%) Students opting for general practice and for another specialty hold different opinions for many domains addressed in this study. Furthermore we analyzed whether the differences where effects of differences between the student population of official Dutch or French speaking Belgian universities or due to a gender effect. Differences between the two language sub populations were hardly discovered, except for the motivation to choose medical education. The gender effect was more prominent. 3.7.2 Factors relating to specialty choice before medical school Students went back in their personal histories and reported on a period of some seven to eight years before. Roughly one third of the students who reported that they began their medical education with a specific specialization in mind (153 out of 483) made the choice for general practice when starting their studies (41 out of 153). The qualitative study shows that students hold vague and general ideas about the practice of medicine before they entered medical school. For instance the surgeon saves lives and the GP holds a central position in the health system, mostly working on his own. 3.7.2.1 Study medicine: helping people, prestige and intellectual challenge Both populations of students reported the prestige of studying medicine. Both the qualitative and quantitative studies indicate that dealing with people and intellectual challenge, the fundamentals of medicine, highly motivated all students. In addition, caring for people, general interest and the correspondence with their own characteristics contributed to the choice of studying medicine. There are considerable differences between both populations of students. The item ‘helping people’ for instance, seems to have been more decisive for GP students. Being a French-speaking male student weakens this positive relationship. ‘Intellectual challenge’ seems more influential for non-GP students, but this has only limited importance (12% and 5% of both groups mentioned it as reason to choose medicine). This is in line with literature findings describing a more pronounced tendency for altruism and social compassion attitudes and values in GPs 18 , 20 , 21 , 22 . As in large scale Australian study, the quantitative analysis (bivariate and multivariate) shows that prestige and a variety of job opportunities are significantly more important for non-GP students. 26 . 3.7.2.2 Keep the doctor in the family A parent, often physician, frequently influenced the student to choose for medicine. Strikingly, about one out of four final year students in Belgium have one parent being a medical doctor. One third to half of the medical students have a doctor or dentist in
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Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

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