Download the report (150 p.) - KCE

16 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
1.5 DISCUSSION
1.5.1 Main findings
These results show that the absolute number of licensed GPs has been increasing but
the proportion of inactive licensed GPs in the curative sector also increased.
The first important finding is that the number of licensed GPs increased during this last
decade. Such increase might be explained by the mandatory training to become a
general practitioner that has been progressively introduced.
Secondly, the results show, between 1995 and 2005, an increasing percentage of
inactivity in the curative sector among licensed GPs for all age groups, both genders and
both linguistic communities. This also applies to the proportion of small practices. The
level of inactivity is however age-specific: it was more pronounced among the age group
between 30 and 49 years. This suggests a recruitment problem (adding postgraduates –
those with an MD degree– to the pool of practicing GPs) in general practice. This
finding is consistent with the longitudinal follow-up: the inactivity percentage among the
recently qualified GPs increased in the more recent cohorts compared with the older
ones. This was not counterbalanced by GPs coming back in the curative sector: more
GPs left the curative sector than GPs came back 9 to 11 years after their MD degree if
they had been inactive in that sector before.
Third, if we compare the inactivity proportions between the licensed GPs and the
specialists, there are slight differences regarding both the trends and the level of
inactivity. Indeed, the global inactivity for specialists also increased for both genders and
this increase was higher than for the licensed GPs. In particular, the young female and
male specialists aged 30 to 39 years were both more likely to be inactive in 2005 than
the corresponding young female and male GPs.
Finally, we found little evidence that the communities had either different inactivity level
or different growth rate of inactivity, between 1995 and 2005. However, for the 40-49
years old, the annual inactivity growth rate in the curative sector was more important
among the Dutch-speaking GPs compared to the French-speaking GPs.
1.5.2 Strengths of the study
This is the first Belgian study that describes the evolution of the inactivity among GPs
on both cross-sectional and longitudinal data by age, gender and linguistic community.
A second strength of this study is the comparison with specialists that allowed
observing that the global inactivity percentage for specialists also increased for both
genders and this increase rate was higher than for the licensed GPs, especially for men.
The third strength is the fact that two valid data sources have been analyzed showing
converging results. Furthermore, in 2002, the CIPMP compared its file with a file of one
of the 3 most important Sickness Funds of Belgium (see appendix 1.6). They found a
rather good level of concordance: when the CIPMP recorded a place of curative activity,
the sickness fund recorded a curative act in 91% of the cases. However, when the
CIPMP could not find any curative activity, the sickness funds did actually register one in
43% of the cases. This could owe to the important percentage of GPs having a very
small practice size (around 17% according to the INAMI/RIZIV analyses): these GPs
would not have a practice office and would thus not be identified by the CIPMP.
Last, the findings of this study are valid as showed by their accordance with the results
of previous works, as discussed below.
1.5.3 Comparison with previous works
The results are consistent with the studies synthesised in appendix 1.10.
According to Roberfroid et al 7 , 11 626 GPs performed at least 1 contact to at least 50
individual patients in 2005 among the 18332 active general practitioners, that is 63%