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KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 77
5 CHAPTER 5: POLICIES INFLUENCING THE
ATTRACTION, RECRUITMENT AND
RETENTION OF GENERAL PRACTITIONERS
(GPS)
5.1 OBJECTIVES
Chapter 4 showed some of the reasons why GPs leave the practice, in particular the
high demanding characteristics of the profession and the perception of lack of job
control. The former GPs formulated the suggestions to prevent GPs from leaving the
profession: supportive measures as for example group practices, deputizing services; a
specific support for GPs who experience difficulties and finally suggestions to improve
the medical training of future general practitioners in the faculties.
This chapter reviews the international literature in order to highlight policies able to
improve GPs attraction, retention and recruitment: what can be learned about the
effectiveness or impact of policies implemented to improve attraction, recruitment and
retention?
5.2 LITERATURE SEARCH METHODOLOGY aa
The literature search focused on publications and reports on existing policies and on
the evaluation of effectiveness on these policies (offering opportunities for evidencebased
outcomes). The researchers separated political debates (such as the October
2007 strike of French residents), policy analysis and discussions, policy implications of
research not related to policy evaluation, commentaries, editorials and opinions
(offering opportunities for intellectual and ideological appeal).
For theoretical considerations (cf. Bilodeau et al 2006 16 ), three categories of policy
studies are presented (attraction-recruitment-retention). As in the study of factors
affecting GPs attraction, recruitment and retention (cf. chapter 2), a substantial body of
the policy literature concerns issues in rural practice. Consequently, excluding rural
practice-related papers from the literature review would have resulted in a very small
number of sources. Keeping rural literature may also be justified by the
following reasons. Firstly, some policies, e.g. medical education programs designed to
attract and recruit rural practitioners, also address more of less explicitly issues of
primary care physicians attraction and recruitment. They may therefore be inspiring
sources. Secondly, the issues of GPs attraction-recruitment-retention are not only
matters of global GP-to-population ratio, but can be examined under the hypothesis of a
heterogeneous density of GPs, i.e. a problem of balance of GPs distribution between
areas in industrialized countries such as Australia, Canada, and USA. Finally, a shortage
of GPs cannot be excluded in the forthcoming years in specific Belgian areas.
5.2.1.1 Attraction: the role of Universities
US MEDICAL SCHOOLS PROGRAMS
The USA provides some literature about the role of universities in modulating the
supply of GPs. During the 70s and 80s, the absence of regulation of the GP market led
to the notion that training more medical students would expand the number of primary
care physicians (PCPs, which include GPs, internists, pediatricians and obstetricians).
This resulted in an oversupply of specialists and a shortage of PCPs in the early 1990s
that, together with the movement towards managed care, compelled policymakers to
revisit the issue of physician supply.
aa The literature search methodology has already been extensively explained in chapter 3.