Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
KCE Reports 90 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion 85<br />
loans of graduates and practitioners in exchange for service) and direct financial<br />
inc<strong>en</strong>tives (funds for resid<strong>en</strong>ts and practitioners in exchange for service).<br />
In Quebec (Canada), a well-known economic inc<strong>en</strong>tive is the increase of fee rates (fee<br />
tariff) by 15% for physicians practicing in rural regions, and a decrease by 30% for those<br />
who practice in university regions 168 . This inc<strong>en</strong>tive is also operating in most other<br />
Canadian provinces, with variable adjustm<strong>en</strong>ts. In UK, specific allowances and<br />
deprivation paym<strong>en</strong>ts (increase in capitation rates) also exist for GP practicing in<br />
underserved, either urban or rural "designated" areas, i.e. where there is a ratio of GPto-population<br />
lower than 1:3000. This a comp<strong>en</strong>sation for higher workload and poorer<br />
working conditions, rather than a ret<strong>en</strong>tion inc<strong>en</strong>tive.<br />
PREPAREDNESS<br />
As shown above, preparedness by medical education would be se<strong>en</strong> as a ret<strong>en</strong>tion,<br />
rather than a recruitm<strong>en</strong>t policy 109 .<br />
LOCUM RELIEF<br />
A common factor associated with rural practice is the lack of access to locum relief<br />
programs. In Australia, Locum Relief Programs were developed to address the problems<br />
of significantly higher workloads and fewer holidays for rural GPs compared to their<br />
metropolitan counterparts. G<strong>en</strong>erally, research into locum relief programs measure GP<br />
attitudes towards the service provided, instead of trying to show a effect on<br />
recruitm<strong>en</strong>t or ret<strong>en</strong>tion. In Australia, the inadequate access to locum relief has be<strong>en</strong><br />
addressed since the mid 1990s, with the introduction of a national Rural Locum Relief<br />
Program 154 . The program was established to provide locum coverage and give greater<br />
support for junior practitioners who would not otherwise work in rural areas. In<br />
Canada, locum relief programs also exist in most provinces 168 . The problem is that<br />
locum relief supposes an adequately staffed workforce. Implem<strong>en</strong>tation and<br />
effectiv<strong>en</strong>ess are chall<strong>en</strong>ging. For example, locum looks appealing from the viewpoint of<br />
GPs who b<strong>en</strong>efit from a temporary relief. However, things may not be all rosy from the<br />
viewpoint of GPs providing locum services. Which GP would accept to build a career<br />
on something very far from ideal, and would relinquish a stable <strong>en</strong>vironm<strong>en</strong>t, continuity<br />
of care and close physician-pati<strong>en</strong>t relationships? In our opinion, providing locum<br />
services is not appealing in the long-term for highly qualified professionals and cannot be<br />
satisfying for those who did not choose it.<br />
CONTINUING MEDICAL EDUCATION (CME)<br />
One of the key strategies to retain GPs in rural areas is to increase on-going medical<br />
training accessible to rural GPs 182 . Continuing medical education (CME) addresses the<br />
professional needs of GPs by providing postgraduate studies to develop clinical skills,<br />
and socialization issues. Although CME does not appear to significantly impact on<br />
recruitm<strong>en</strong>t, the positive evaluations by rural GPs suggest that CME does influ<strong>en</strong>ce<br />
ret<strong>en</strong>tion, but there is no evid<strong>en</strong>ce to support these claims 154 .<br />
INCREASING GPS JOB SATISFACTION (OR NOT DISSATISFYING GPS)<br />
In organizational psychology, job satisfaction is an immediate anteced<strong>en</strong>t of personnel<br />
turnover int<strong>en</strong>tion and behavior 183 and therefore a predictor of ret<strong>en</strong>tion. The<br />
difficulties with literature on job satisfaction is to deal with factors common to every<br />
workers (e.g. stress), which do not add much to knowledge for the pres<strong>en</strong>t project, or<br />
with highly context-dep<strong>en</strong>d<strong>en</strong>t determinants of job satisfaction, which are not<br />
transferable to other settings and contexts. Part of literature on job satisfaction is<br />
devoted to empirical testing of theoretical models, which does not usefully contribute<br />
to the pres<strong>en</strong>t literature review (e.g. the methodologically nice study by Landon et al. 122<br />
). Finally, most studies on job satisfaction are surveys, in which doctors are asked why<br />
they are satisfied or not or why they stay or leave g<strong>en</strong>eral practice. This approach may<br />
lead to "self-serving bias" in attribution theory, i.e. people only partly understand the<br />
reasons behind their behavior.