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22 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 Model of recruitment and retention of the GPs in distant area (Bilodeau and al. 2006 ). Professional identity e.g. : Medical school Personal identity e.g. : Age, gender Origin Personal identity e.g. : Age, gender Origin Expectations regarding the profession e.g. : Autonomy Governmental, regional and local policies e.g. : Incentives Rural exposure during residency or medical school Attraction Expectations regarding the local community e.g. : Cultural activities The quality of public schools (opening their owner family practice office) RECRUITMENT Working conditions e.g. : Heavy workload Satisfaction Life satisfaction e.g. : Spousal happiness Fit Work Social General Governmental, regional and local policies RETENTION Three parts are developed in the following pages. • The first one details factors influencing favorably or not the choice to become general practitioner (GP) (College, high school and undergraduate Students). • The second one presents the parameters that have an impact on the recruitment of the general practitioner in a given area. • The final chapter considers the factors influencing the longevity of a career of general practitioner (retention). 2.3.1.2 Attraction: Choice to become general practitioner (College, high school and undergraduate Students) Several characteristics related to the profession attract students who are likely or plan to be GPs, influencing specialty choice of undergraduate and graduate students, and educating future GPs. This literature mainly comes from the US (61%) and from the UK (71% of the European papers). Some Australian and New Zealand studies (5%) and a few Canadian ones (3%) complete the sources. PERSONAL IDENTITY The profile of the student, namely his personal experience as regards health (personal/family experiences with health problems) 18 , his participation in health-related curricula/activities (such as an internship in a healthcare setting, career fair or field trip) 18 , its rural or urban origins 19 and its academic strengths in required subjects (particularly mathematics and science) 18 have an impact on the attraction for the general practice. The personality of the future GP also weigh in the balance of the choice of the profession. He presents a pronounced tendency for altruism 18 , 20 , 21 , for social compassion attitudes and values 22 , 23 and a less authoritarian personality 21 than in other specialties. The future GPs are less concerned than other future specialists about the
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 23 income 23 , 24 , 25 and the prestige 23 , 26 but more concerned about the psychosocial issues of their patients 19 , 26 , 27 , 28 , 29 . Different demographic factors are linked with the attraction for general practice. The gender, the age, the race, the marital status and the socioeconomic status are items to be considered. Female students view GP more positively than male students 22 , 23 , 24 , 30 , 31 . Women have a propensity for relation-orientated, humanistic specialties, such as family medicine 20 , 21 , 25 , 32 , 33 , 34 . Older age would be a factor favorably influencing the orientation towards general practice according to some studies 20 , 21 , 23 , 26 , 34 , 35 5 . Other studies did not observe the influence of age 19 , 36 . No consensus is observed about the influence of ethnicity. One study suggests that nonwhites might be more inclined than whites to select general practice 33 . Being married and having children would positively influence the attraction for general 21 , 23 , 27 , 32 , 33 , practice according to some authors, in particular if the partner is also a GP 35 5 Several studies specify that a low socioeconomic status or low parental income or education is related to the choice of family practice 20 , 21 , 37 . PROFESSIONAL IDENTITY The respected title of GP associated with a notion of prestige is an important factor: the society considers actually the GP like a positive role model 34 , 38 , 39 , 40 , 41 , 42 , 43 , 44 . In addition, the medical school has a clear influence on the attraction for general practice. Several aspects include the school’s characteristics, the environment, the curriculum, the role models suggested and the students' perception. School characteristics and environment From a macroscopic point of view, the global academic commitment towards general practice influences the attraction of the student for that specialty 18 , in particular according to the presence of a department of family medicine 41 , 45 , 46 79 . The size of the department, just like its research activity also indicates of the importance conferred on this discipline 45 . The culture of the academic medicine impregnated or not by the mission to encourage students to become GPs also plays a role in the attraction for the profession 26 , 45 , 47 77 . The attraction of the job is therefore related to quantitative parameters as the proportion of faculty in family medicine 32 , 41 . The academic learning environment usually valued and promoted by the medical school faculty favors specialty and subspecialty careers over GP careers. Moreover, the creation of subspecialty-oriented or research-oriented academic environment has unidirectional long-term effects on career decisions of medical graduates 26 . Finally, the increasing representation and leadership by GPs on admission committees has a beneficial effect on the applicants in general medicine 34 . From a microscopic point of view, the direct environment of the student influences his choice, like the class size 45 and the proportion of matriculating students who express an interest in family medicine 32 . In the US, the attendance of a public medical school influences positively the choice to become a GP rather than a specialist: the public medical schools have indeed more reacted to the social pressure to train a higher number of primary care physicians than the private medical schools 21 , 32 , 33 . Curriculum in general practice The literature frequently points out that students have a positive attitude after completing a course in GP 21 , 26 , 41 , 45 , 48 , 49 . Optional courses in primary care as well as
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