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<strong>KCE</strong> Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 83<br />
family practice after a short (2-4 years) period of postgraduate locum.<br />
The authors describe <strong>the</strong> decisions and trajectory of individual medical<br />
graduates, <strong>the</strong>ir professional and private aspirations (especially <strong>the</strong>ir<br />
vision that job is but one element of life, and <strong>the</strong>ir wish to save time<br />
for personal and family life and leisure). The authors also notice that<br />
young graduates do not appreciate <strong>the</strong> working conditions of family<br />
medicine, but <strong>the</strong>y do not have any clear «vision" of what is family<br />
practice, nei<strong>the</strong>r for <strong>the</strong>mselves, nor for <strong>the</strong> role of family practice<br />
within <strong>the</strong> health system.<br />
Levasseur et al 2006 147 also <strong>report</strong> that <strong>the</strong> decision to start family practice is<br />
individualistic. Moreover, <strong>the</strong> profession is not structured as a political force.<br />
Use of recruiters<br />
Ano<strong>the</strong>r recruitment strategy is to use "recruiters". For example, <strong>the</strong> Robert Wood<br />
Foundation's Sou<strong>the</strong>rn Rural Access Program (SRAP) consists in <strong>the</strong> use of granted<br />
recruiters to assist rural communities in assessing healthcare needs and recruiting<br />
primary care providers. Recruiters were shown to be able to find primary care<br />
providers to fill vacancies, at a cost of $ 50000 for 5 years to secure one provider 78 .<br />
OTHER INITIATIVES<br />
Faculty support<br />
An original UK project labeled "GP Assistant/Research Associate scheme" 111 , tested <strong>the</strong><br />
hypo<strong>the</strong>sis of a beneficial effect of career development on inner city recruitment (and<br />
retention) of young GPs. The project consisted in associating young general<br />
practitioners to research and teaching projects of <strong>the</strong> Department of General Practice<br />
and Primary Care at <strong>the</strong> Guy's, King's and St Thomas School of Medicine in London<br />
(UK). A qualitative study of 34 stakeholders and 14 GP Assistants showed enthusiastic<br />
support for this project, which allows professional development, managing multiple<br />
roles, and developing new knowledge. Empowered GP Assistants felt competent and<br />
able to initiate changes in Primary Care Groups/Trusts where <strong>the</strong>y practice.<br />
Immigration<br />
In <strong>the</strong> USA, a system of waivers for J-1 visa holders ("exchange visitors", i.e.<br />
postgraduate medical students in this case) is applied to foreign-trained physicians: in<br />
exchange of 1 to 3 years obligated service in rural or underserved areas, medical<br />
immigrants and <strong>the</strong>ir families may obtain a visa to stay in <strong>the</strong> country 73 . Data from<br />
University of Kentucky show that immigrant physicians are not transient and tend to<br />
practice in <strong>the</strong> regions where <strong>the</strong>y were originally placed 73 . Similar systems are applied<br />
in Australia and Canada. Research indicates that International Medical Graduates (IMGs)<br />
make an essential contribution to rural areas in <strong>the</strong> United States and Canada. This is<br />
highlighted by <strong>the</strong> prediction that without IMGs, 1 of every 5 "adequately served" US<br />
non-metropolitan counties would become underserved 172 . Bro<strong>the</strong>rton et al 2005 152<br />
show that trends suggest that <strong>the</strong> US primary care medical workforce of <strong>the</strong> future will<br />
include more IMGs (about 25% of <strong>the</strong> total).<br />
The use of IMGs raise ethical issues : 1 discrimination against foreign physicians and 2<br />
deepening physician shortage in countries of origin 173 . The image of a “medical<br />
carousel”, in which doctors seem to be continually moving to countries with a<br />
perceived higher standard of living, is used to describe physician behavior. Pakistani<br />
doctors move to <strong>the</strong> UK, UK doctors move to Canada, and Canadians move to <strong>the</strong><br />
USA.<br />
Migration between developed countries is not negligible 140 .<br />
GP substitution by o<strong>the</strong>r health professionals<br />
In <strong>the</strong> USA, managed care makes acceptable <strong>the</strong> use of nurse practitioners or physician<br />
assistants to replace (missing) GPs, while it seems this is not <strong>the</strong> case in Canada 174 and<br />
Europe, for reasons of poor cost-effectiveness and competition on a fee-for-service<br />
market.