Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 83
family practice after a short (2-4 years) period of postgraduate locum.
The authors describe the decisions and trajectory of individual medical
graduates, their professional and private aspirations (especially their
vision that job is but one element of life, and their wish to save time
for personal and family life and leisure). The authors also notice that
young graduates do not appreciate the working conditions of family
medicine, but they do not have any clear «vision" of what is family
practice, neither for themselves, nor for the role of family practice
within the health system.
Levasseur et al 2006 147 also report that the decision to start family practice is
individualistic. Moreover, the profession is not structured as a political force.
Use of recruiters
Another recruitment strategy is to use "recruiters". For example, the Robert Wood
Foundation's Southern Rural Access Program (SRAP) consists in the use of granted
recruiters to assist rural communities in assessing healthcare needs and recruiting
primary care providers. Recruiters were shown to be able to find primary care
providers to fill vacancies, at a cost of $ 50000 for 5 years to secure one provider 78 .
OTHER INITIATIVES
Faculty support
An original UK project labeled "GP Assistant/Research Associate scheme" 111 , tested the
hypothesis of a beneficial effect of career development on inner city recruitment (and
retention) of young GPs. The project consisted in associating young general
practitioners to research and teaching projects of the Department of General Practice
and Primary Care at the Guy's, King's and St Thomas School of Medicine in London
(UK). A qualitative study of 34 stakeholders and 14 GP Assistants showed enthusiastic
support for this project, which allows professional development, managing multiple
roles, and developing new knowledge. Empowered GP Assistants felt competent and
able to initiate changes in Primary Care Groups/Trusts where they practice.
Immigration
In the USA, a system of waivers for J-1 visa holders ("exchange visitors", i.e.
postgraduate medical students in this case) is applied to foreign-trained physicians: in
exchange of 1 to 3 years obligated service in rural or underserved areas, medical
immigrants and their families may obtain a visa to stay in the country 73 . Data from
University of Kentucky show that immigrant physicians are not transient and tend to
practice in the regions where they were originally placed 73 . Similar systems are applied
in Australia and Canada. Research indicates that International Medical Graduates (IMGs)
make an essential contribution to rural areas in the United States and Canada. This is
highlighted by the prediction that without IMGs, 1 of every 5 "adequately served" US
non-metropolitan counties would become underserved 172 . Brotherton et al 2005 152
show that trends suggest that the US primary care medical workforce of the future will
include more IMGs (about 25% of the total).
The use of IMGs raise ethical issues : 1 discrimination against foreign physicians and 2
deepening physician shortage in countries of origin 173 . The image of a “medical
carousel”, in which doctors seem to be continually moving to countries with a
perceived higher standard of living, is used to describe physician behavior. Pakistani
doctors move to the UK, UK doctors move to Canada, and Canadians move to the
USA.
Migration between developed countries is not negligible 140 .
GP substitution by other health professionals
In the USA, managed care makes acceptable the use of nurse practitioners or physician
assistants to replace (missing) GPs, while it seems this is not the case in Canada 174 and
Europe, for reasons of poor cost-effectiveness and competition on a fee-for-service
market.