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18 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
recent study (Meeus, 2007 14 ) showed that this group is rather limited (see appendix
1.7).
The second risk of misclassification comes from the definition of “inactive in the
curative sector”: those having “zero curative acts” during the year. This criterion falls
short to be a fully active MD in the curative sector (the official minimum to be certified
is about 1250 contacts a year). This is why we paid attention to small practices that
decrease over time, at least for the licensed GPs older than 30 years old. Pooling
together the “inactivity” with the small practice groups would have thus increased the
overall inactivity rate and slightly smoothed the trend in the inactivity rate.
Thirdly, the situation codes n of the activity of the MDs registered in the INAMI/RIZIV
database are based on spontaneous and their personal and non-compulsory declaration.
This information may thus not always be updated or accurate, influencing the total
number of MDs who are really “active” (or inactive). Recent data from the
INAMI/RIZIV show that the situation codes are 98% correct when the GP is inactive;
but for those called “active”, only 71% do really practice care 15 .
Fourth, we excluded from the denominator the situation codes corresponding to
inactivity. Consequently, our inactivity percentages are restricted to those who are still
potentially available. We could have included the GPs being abroad or temporarily
inactive in our denominator, but if we had chosen to include those extra losses; the
percentages of inactivity would have been higher. However this group has a rather small
size and our percentages would have not been too much affected. Furthermore, we did
not take into account those who never registered at the INAMI/RIZIV whereas such a
decision also contributes to poor recruitment for the curative practice.
Fifth, the CIPMP database registers curative activities by comparing various files and
information. Some information may be missing: it is possible that some GPs are active in
the curative sector but are not being registered as such. However, comparisons with
sickness funds and RIZIV/INAMI databases have shown a good concordance between
the information of the CIPMP and these databases (see details in appendix 1.6).
Sixth, the year of MD degree used in the inactivity analyses is approximate, since it is
based on the theoretical year of MD degree (which is reliable) and not on the exact
(observed) time of MD degree. For those who were still allowed to follow a part-time
training, the estimated date of the degree is thus too early in the life cycle, and the
inactivity rate might thus be overestimated.
Finally, the scope of this study was limited to the factors and policies that influence the
attraction, recruitment and retention in the profession. This study did not consider
other topics that should have been also interesting for analyzing in detail the
demography of the GP population. As stated in introduction, the background of this
study was the analysis of the medical supply in Belgium 7 and this topic was not anymore
considered in this report. There is also a lack of information on the GP population who
is inactive and is not anymore available: only the potential workforce has been the
target population of the analyses. One also has to take into account the increase of
foreigners in medical specialization and practice, a consequence of the recent openness
of the EU internal market. This situation generates questions concerning medical
workforce supply planning. Indeed, in 2006, 106 foreign MDs began a practice,
contributing for 12.1% of the medical workforce inflow, compensating to some extent
the observed losses of Belgian GPs working in the curative sector 7 .
n See appendix 1.4