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64 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 The sequence of themes in the interview was designed to ‘guide’ the participants through their personal history and help them reflect upon elements that influenced their decision to stop working as a GP. Following themes were addressed: • motivation to choose medicine/general practice (to get an idea of the personal context), • expectations regarding the GP profession and experiences and feelings during training and as a trained GP, • decision making process to stop working as a GP, • current profession (because factors related to the new profession could play a role in the decision to stop working as a GP). At the end of the interview, we also explored participants’ suggestions to prevent young GPs from quitting their profession. To ensure not to miss the topics identified in the literature whilst not steering participation, the interviewer went over a topic list at the end of the interview session (see appendix 4.1. and 4.2.). They were invited to briefly comment on it, when they felt necessary. The initial interview guide was developed in Dutch and subsequently translated to French by the French-speaking interviewer. This draft version was adapted after feedback from the steering group and after one pilot interview in Flanders After piloting the French version minor corrections were made (words, omitting a question duplicating and previous question). The remaining interviews were performed following the final version (see appendix 4.1 and 4.2 for the interview in both languages). 4.3.2 Participants All presidents of the Flemish regional bodies of GPs and FAG (Forum des Associations de Généralistes) were requested to list colleagues who left their GP profession in the past 5 years. Using this method we were able to collect 30 Flemish speaking and 45 French speaking potential candidates. From this group of 75 GPs, 16 Belgian former GP’s (8 in each language) were interviewed, 3 men and 13 women, aged between 30 and 44 years. Their practice experience ranged from 1 to 14 years and they left the profession between 6 and less then 1 year. (see appendix 4.3.) The selection of these participants was based on the following criteria: • participant not (much) older then 40 (we focus on the group of GP’s in their first 10 years of practice), • has worked as a general practitioner, so excluding doctors working only part-time along some other day time job, • did not stop practicing more the approximately 5 years ago (so reasons for quitting are still clear in their mind), • allowing a mix of new careers, because factors related to the attractiveness for these could play a role in the decision process to stop work as a GP. Of the 75 potential candidates, 54 former GPs answered to these criteria and were asked to participate by telephone. Eighteen GPs could not be reached (wrong contact data, no reply). One GP was abroad and 2 GPs refused to participate because of a serious illness. Seventeen did not return the phone call and were not contacted again because the target number of 16 GPs was reached. 4.3.3 Interviews After one pilot interview the interviewers agreed on the final version and on interview strategies. Two researchers (LS, CD) conducted the interviews. We allowed the
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 65 interviewer to probe areas suggested by the respondents’ answers, picking up information and in this way exploring specific topics. This could be done by prepared questions or just by asking for more detail and depth. The selected GPs were contacted to arrange the interview. Interviews were performed at the participants’ premises and took between 45 – 90 minutes. 4.3.4 Analysis All interviews were audiotaped and transcribed verbatim. The grounded theory approach (Constant Comparison method) was used to analyze the data. Open coding is the first step in the analytic process. In the process of coding, pieces of text were identified and labeled. In a second step these open codes were grouped into concepts (axial coding). Two researchers (LS, HB) independently coded one Dutch interview following this procedure and a list of codes was developed. During the axial coding process, it appeared that codes concerning experiences during training and work as a general practitioner could be arranged following the concepts and sub-concepts in a topic matrix. Concepts and sub-concepts were added if new information was available. Separate concepts were developed for the motivation to study medicine and to choose for general medicine. Codes regarding experiences with the new profession and suggestions for the future were also aggregated in a concept list (appendix 4.4.). The French-speaking researcher (CD) also coded one interview in French and independently developed a list of codes and concepts. During a first meeting two researchers (CD, HB) compared all concepts and aligned their lists of concepts and coding. This list of concepts was used and adapted if necessary during the analysis of the 14 remaining interviews. A constant comparison of concepts lead to the final lists of concepts related to the decision of young GP to stop their practice-work. During a second meeting 2 researchers (CD, HB) discussed these concepts and came to an agreement on the most prominent findings. In a final step of the coding process, the concepts were further aggregated and structured by the 3 researchers (CD, HB, LS). A central concept ‘being overwhelmed – overpowered by the job’ was agreed upon and all other concepts were structured around this theme (see the concept frame in appendix 4.5.). 4.4 RESULTS A remarkable observation during the interviews was that many interviewees showed their emotions of anger, greave and sometimes relief. Some of them even cried. For many interviewees, the decision process was a very complex one, which greatly upset them. Some GPs are still dealing with emotional feelings and are ambiguous about their decision. Most of them have not closed the door for taking up a job in general practice in the future. MG5 « quitter mes patients, ça n’a pas été simple… faire un brin de causette dans la salle d’attente avec eux » HA1 « Ja, ik heb mij echt twee jaar moeten voortsslepen,… ik heb zo twee jaar aan een stuk eigenlijk heel veel opgekropt. En dingen die ik wilde vragen maar niet durfde vragen. Euh en uiteindelijk dan twee jaar later heb ik gezegd van: dit kan zo niet meer verder. » HA 8 « Want mijn werk, dat, ik had het idee, ik doe dat goed. Ik doe dat met toewijding. Maar ik kon niet goed tegen die druk van thuis. Want ik had zoiets van, ja, ik heb geen andere oplossing. … Maar mijn kinderen, die begonnen dan echt, ja meer uiterlijk tekenen van gemis… dan is dat echt aan mezelf gaan knagen…»…«.Ik zat echt in een tweestrijd»…
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