Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
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KCE Reports 90 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion 77<br />
5 CHAPTER 5: POLICIES INFLUENCING THE<br />
ATTRACTION, RECRUITMENT AND<br />
RETENTION OF GENERAL PRACTITIONERS<br />
(GPS)<br />
5.1 OBJECTIVES<br />
Chapter 4 showed some of the reasons why GPs leave the practice, in particular the<br />
high demanding characteristics of the profession and the perception of lack of job<br />
control. The former GPs formulated the suggestions to prev<strong>en</strong>t GPs from leaving the<br />
profession: supportive measures as for example group practices, deputizing services; a<br />
specific support for GPs who experi<strong>en</strong>ce difficulties and finally suggestions to improve<br />
the medical training of future g<strong>en</strong>eral practitioners in the faculties.<br />
This chapter reviews the international literature in order to highlight policies able to<br />
improve GPs attraction, ret<strong>en</strong>tion and recruitm<strong>en</strong>t: what can be learned about the<br />
effectiv<strong>en</strong>ess or impact of policies implem<strong>en</strong>ted to improve attraction, recruitm<strong>en</strong>t and<br />
ret<strong>en</strong>tion?<br />
5.2 LITERATURE SEARCH METHODOLOGY aa<br />
The literature search focused on publications and reports on existing policies and on<br />
the evaluation of effectiv<strong>en</strong>ess on these policies (offering opportunities for evid<strong>en</strong>cebased<br />
outcomes). The researchers separated political debates (such as the October<br />
2007 strike of Fr<strong>en</strong>ch resid<strong>en</strong>ts), policy analysis and discussions, policy implications of<br />
research not related to policy evaluation, comm<strong>en</strong>taries, editorials and opinions<br />
(offering opportunities for intellectual and ideological appeal).<br />
For theoretical considerations (cf. Bilodeau et al 2006 16 ), three categories of policy<br />
studies are pres<strong>en</strong>ted (attraction-recruitm<strong>en</strong>t-ret<strong>en</strong>tion). As in the study of factors<br />
affecting GPs attraction, recruitm<strong>en</strong>t and ret<strong>en</strong>tion (cf. chapter 2), a substantial body of<br />
the policy literature concerns issues in rural practice. Consequ<strong>en</strong>tly, excluding rural<br />
practice-related papers from the literature review would have resulted in a very small<br />
number of sources. Keeping rural literature may also be justified by the<br />
following reasons. Firstly, some policies, e.g. medical education programs designed to<br />
attract and recruit rural practitioners, also address more of less explicitly issues of<br />
primary care physicians attraction and recruitm<strong>en</strong>t. They may therefore be inspiring<br />
sources. Secondly, the issues of GPs attraction-recruitm<strong>en</strong>t-ret<strong>en</strong>tion are not only<br />
matters of global GP-to-population ratio, but can be examined under the hypothesis of a<br />
heterog<strong>en</strong>eous d<strong>en</strong>sity of GPs, i.e. a problem of balance of GPs distribution betwe<strong>en</strong><br />
areas in industrialized countries such as Australia, Canada, and USA. Finally, a shortage<br />
of GPs cannot be excluded in the forthcoming years in specific Belgian areas.<br />
5.2.1.1 Attraction: the role of Universities<br />
US MEDICAL SCHOOLS PROGRAMS<br />
The USA provides some literature about the role of universities in modulating the<br />
supply of GPs. During the 70s and 80s, the abs<strong>en</strong>ce of regulation of the GP market led<br />
to the notion that training more medical stud<strong>en</strong>ts would expand the number of primary<br />
care physicians (PCPs, which include GPs, internists, pediatricians and obstetricians).<br />
This resulted in an oversupply of specialists and a shortage of PCPs in the early 1990s<br />
that, together with the movem<strong>en</strong>t towards managed care, compelled policymakers to<br />
revisit the issue of physician supply.<br />
aa The literature search methodology has already be<strong>en</strong> ext<strong>en</strong>sively explained in chapter 3.