Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

82 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
Australia: General Practice Rural Incentives Program
In Australia, elements of the General Practice Rural Incentives Program (GPRIP, started
1992) include relocation incentive grants, training grants, and remote area grants
(Humphreys et al 1998 104 , McDonald et al 2002 154 ). GPRIP has not been evaluated
thoroughly to date. Holub and Williams 167 noted however in 1996 that there was an
increase in GPs practicing in rural areas.
Canada
In Canada, all provinces offer medical education grants and subsidies for starting family
practice to sustain rural healthcare workforce 168 . A prominent example is the Alberta
Rural Physician Action Plan (RPAP), an independent not-for-profit company established
in 1991 by the Government of Alberta and providing a provincially-focused
comprehensive, integrated and sustained program for the education, recruitment and
retention of physicians in rural practice ("education pipeline" strategy) 76 , 169 . Figures are
impressive : in rural Alberta, physician-to-population ratio increased from 1:1021 to
1:956 between 1995 and 2001 170 .
Belgium: Impulseo programs
The Belgian Impulseo I and II programs (2006) may be considered as a financial help
allowed to GPs starting a family practice. The programs provide a loan (maximum
15000 EUR) to young GPs starting their family practice. A subsidy (20000 EUR) can be
allowed to GPs opening a family practice in "urban positive action zones" or "shortage
areas", defined as:
• an area with less than 90 GPs for 100.000 population, or
• an area with a population density less than 125/km² and less than 120
GPs for 100.000 population.
The Impulseo program also allows for additional assistance:
• a 30000 EUR loan for self-employed GPs,
• a free administrative assistance during the first 18 months following the
start of family practice.
This strategy launched in 2006 has not yet been evaluated.
UK: effect of salary on recruitment
The effect of salaried contract on recruitment has been tested in UK. A pilot study was
conducted by Williams et al. 2001 171 on 46 "personal medical services" sites
concentrated in deprived areas, with salaried contracts (contrarily to the status of
independent contractor of a GP principal). The hypothesis is that a salary contract
counteracts the disincentives to GP recruitment linked with caring for poor families in
deprived communities, high workload, out-of-hours work, and management
responsibilities. Two hundred ninety one applications were received and the median
time to recruitment was 6 weeks. The study shows that salaried contracts offer positive
incentives to recruitment: a fixed salary (about £ 44000 for a full-time), flexibility of
working hours, reduced management and out-of-hours duties. The fact that most
applicants were GPs with a previous experience as registrar (resident) (26%) or locum
(31%) suggests that newly qualified GPs prefer to delay entry into principal posts, as
seen, in France, in the study by Levasseur et al. (2006) 147 (see below).
France
• Such initiatives as NHSC and other incentives are pragmatic attempts
to address recruitment issues, but it is difficult to assess their
relevance in the absence of information on career concerns of young
medical graduates. An interesting qualitative study on recruitment,
performed in Brittany (Région Bretagne) by Levasseur et al (2006) 147 ,
provides insight into difficulties faced by 27 interns and newly
graduated physicians, having recently or intending to open their own