Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
Br J Gen Pract. 2011 Jul;61(588):e411-8. doi: 10.3399/bjgp11X583191.
Despite being a key player in the healthcare system, training and practising general practice has become less attractive in many countries and is in need of reform.
To identify political priorities for improving GPs' attraction to the profession and their retention within it.
Stakeholder face-to-face survey in Belgium, 2008.
A total of 102 key stakeholders were recruited from policymakers, professional groups, academia, GP leaders, and the media. All interviewees were asked to score 23 policies on four criteria: effectiveness in attracting and retaining GPs, cost to society, acceptance by other health professionals, and accessibility of care. An overall performance score was computed (from -3 to +3) for each type of policy - training, financing, work-life balance, practice organisation, and governance - and for innovative versus conservative policies.
Practice organisation policies and training policies received the highest scores (mean score ≥ 1.11). Financing policies, governance, and work-life balance policies scored poorly (mean score ≤ 0.65) because they had negative effects, particularly in relation to cost, acceptance, and accessibility of care. Stakeholders were keen on moving GPs towards team work, improving their role as care coordinator, and helping them to offload administrative tasks (score ≥ 1.4). They also favoured moves to increase the early and integrated exposure of all medical students to general practice. Overall, conservative policies were better scored than innovative ones (beta = -0.16, 95% confidence interval = -0.28 to -0.03).
The reforming of general practice is made difficult by the small-step approach, as well as the importance of decision criteria related to cost, acceptance, and access.
尽管全科医生在医疗体系中扮演着重要角色，但在许多国家，培训和从事全科医学的吸引力有所下降，因此需要进行改革。
确定提高全科医生职业吸引力和留住他们的政治优先事项。
2008 年在比利时进行利益相关者面对面调查。
从政策制定者、专业团体、学术界、全科医生领导人和媒体中招募了总共 102 名关键利益相关者。所有受访者都被要求根据四项标准对 23 项政策进行评分：吸引和留住全科医生的有效性、对社会的成本、其他卫生专业人员的接受程度以及医疗保健的可及性。为每种类型的政策（培训、融资、工作生活平衡、实践组织和治理）以及创新与保守政策计算了总体绩效评分（从-3 到+3）。
实践组织政策和培训政策得分最高（平均得分≥1.11）。融资政策、治理和工作生活平衡政策得分较低（平均得分≤0.65），因为它们有负面影响，特别是在成本、接受程度和医疗保健的可及性方面。利益相关者热衷于促使全科医生转向团队合作，提高他们作为护理协调员的角色，并帮助他们减轻行政任务（得分≥1.4）。他们还赞成增加所有医学生早期和综合接触全科医学的机会。总体而言，保守政策的得分高于创新政策（β=-0.16，95%置信区间=-0.28 至-0.03）。
由于小步骤方法以及与成本、接受程度和可及性相关的决策标准的重要性，全科医学的改革变得困难。
