Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 75
availability of services in time and the number of GPs in the practice is small, patients
can call for attention at practically any time. This lack of job control was also linked with
the family balance. In general, the lack of flexibility in working arrangements, long hours
and difficulties in finding a locum are factors linked with job control described in the
literature 65 , 72 , 118 , 121 , 124 .
Job control linked with an unequal partnership with colleagues and disagreements on
practice policies is also a new finding in our study. This is an important finding because
the existing evidence links positive relationships with and support from the professional
community with retention 72 , 80 . Furthermore partnership arrangements could be a
mediating factor between external workload pressures and individual general
practitioners’ experience of work 140 .
FEW STATEMENTS ABOUT FINANCIAL ISSUES
In contrast to the international literature 72 , 118 , 120 , 121 , 122 financial issues are not a main
raison to stop working as a GP. However, in relation to a high workload and availability
it adds weight to the balance.
NEED FOR SWITCHING TO ANOTHER CAREER
Some GPs showed that at the time of stopping they were in need of a next step in their
career track and they had solid and positive grounds for choosing. As holds for society
in general, highly trained professionals may feel the need to change after a period of
time of working and build up a flexible, modular career. This finding corresponds to the
literature: opportunities for braking career whilst being guaranteed later return and job
rotations could prevent GPs form leaving 146 . However, in Belgium GPs tend to stay in
their initial practice: financial constraints (for example ownership of premises) prevent
them from changing between practices or jobs.
4.5.2.2 Policy options proposed by the interviewees for increasing the GP retention
Based on the suggestions of the participants, three domains for action can be identified:
the general health services level, general practice organizations and medical training.
GENERAL HEALTH SERVICES LEVEL
First, working conditions (including financial remuneration and patients’ attitudes)
should be tackled at the general national health services level. Supportive measures
(promoting group practices, deputizing services, providing practice support, resolving
the problem of too much availability) seem to be important. For instance, deputizing
services start at 5 pm and local authorities provide means for building premises for
group practices.
Working conditions (workload, flexibility of working schedules, job enrichment) are also
found to be relevant in the literature but policies in this field have still to be
implemented and evaluated. Intra-personal factors possibly interact with structural ones
and different sub-groups of practitioners with different needs regarding working
conditions exist.
From our data it seems that financial issues are not of foremost importance, indicating
that these measures alone may not be effective to attract and retain GPs. So, like in
other countries 147 Economic retention incentives seem not to be effective in the long
run.
SUPPORT OF GENERAL PRACTICE ORGANIZATIONS
General practitioner organizations have a task in providing appropriate support for GPs
experiencing difficulties and in this way prevent them from burn out. They may play a
role in sensitizing patients regarding their demands and attitudes.