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KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 121
7.2.4 Policies to foster the role of medical faculties
Belgium is not alone in facing these recruitment difficulties and policies implemented by
other countries are worth considering. The literature review highlighted successful
policies including structural changes such as improving the position of the general
practice in the faculty of medicine in the universities, changing the admission processes
to target more students with general potential practitioner and redesigning
undergraduate medical education (e.g. GP-oriented clinical medicine courses, exposure
to general practice and role models). ).
Conversely, the literature review showed that the development of academic
departments of general practice as well as increasing physician supply are not efficient
ways for improving GPs’ attraction and recruitment
What do the stakeholders think about the implementation of these policies in Belgium?
Most of the Belgian stakeholders view a change of culture within the universities as
important to improve the recruitment of GPs. Two policies in particular were
supported: to have more GP-oriented clinical medical courses and to make clerkships in
general practice compulsory for all medical students. The policy suggesting a better
selection of students according to social skills was not supported by the stakeholders,
although it is a landmark and an effective strategy abroad (the Jefferson Physician
Shortage Area Program -PSAP) 88 , 94 . Difficulties in assessing those skills as well as their
further development during the studies are the main reasons that were evoked to put
this policy aside. Despite the recent media hullabaloo about the numerus clausus,
according to the stakeholders’ survey, removing the numerus clausus is clearly a
discarded policy.
7.3 ECONOMIC INCENTIVES
7.3.1 GP income and influence on the retention
The literature review suggested that GPs have lower income than specialists. In the US,
between 1994 and 2004, the median income for GPs increased much less than for
specialists 223 . In this study, the influence of income differences on the attraction and
retention of GPs is mixed. On one hand the study on GPs leavers suggested that
income was a minor issue in the decision to leave medicine. But, on the other hand,
both the students’ study and the stakeholders’ study suggest that income is an issue.
Mostly all Belgian stakeholders recognized that the remuneration of working time was
lower in general practice than in other specialties. This was also clearly stated by
students choosing either general practice or another specialty: both groups agreed that
financial conditions were not that good in general practice. Thus it is likely that the
perception of income difference plays a negative role in attraction or recruitment of
students although it does not influence that much the retention in general practice. This
is consistent with the literature review showing that poor income deters students from
choosing GP.
7.3.2 Economic incentives
Two economic incentives are used abroad: the grants to students starting medical
education and subsidies for starting to work as a general practitioner. The first kind of
economic incentive might not be relevant for Belgium (except maybe for student of
underprivileged background) where most of the teaching is publicly funded. The
literature review of policies suggests that economic incentives for physicians practicing
in rural regions (similar to Impulseo Icc) do not seem to be effective in the long-term
because GPs may feel inadequately compensated for the poorer working conditions.
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Impulseo I may be considered as a financial help allowing GPs to start a family practice. The program
provides 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".