Schwill Simon, Magez Julia, Jäger Cornelia, von Meißner Wolfgang Cg, Szecsenyi Joachim, Flum Elisabeth
Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2016 Dec;118-119:73-79. doi: 10.1016/j.zefq.2016.10.003. Epub 2016 Nov 3.
In 2011, the national German Medical Association (Bundesärztekammer) published guidelines for a slim-lined training program in general practice (Quereinstieg) for qualified medical specialists in other fields (e. g., surgeons, internists or anesthesiologists). This step is part of a strategy to prevent further shortages of general practitioners in Germany. In the state of Baden-Wuerttemberg, qualified medical specialists are allowed to complete their general practice training in approximately two years instead of five. The aim of this study was to understand the reasons of specialists for changing to a career in general practice.
The postgraduate training program VerbundweiterbildungBaden-Württemberg had 597 trainees at the time of the study in December 2015. Previously qualified specialists in another medical discipline were identified and invited to participate in this study. Qualitative data was gathered using semi-structured interviews with content analysis of the interviews performed by three independent members of the research team.
In total, 36 out of 597 trainees were identified as previously qualified specialists in another medical discipline. All 36 were invited to take part and 15 agreed to participate in this study. Overall, 15 interviews were performed, with a mean time of 24.19minutes. Participants with a median age of 40 years (33-59 years) - mainly anesthesiologists (n=7), surgeons (n=3) and internists (n=3) - presented with an average of 6.5 years of professional experience in their specialty. First, the participants' motivation to switch career arose from the wish to intensify the quality of patient contacts with a holistic approach including family and social background and from the infinite variety of general practice. Another reason given for a career change was self-employment opportunities. Finally, feelings of frustration over poor working conditions in hospitals resulted in a job search elsewhere in medicine, taking account of the challenges of ageing and family life. A major finding was that without the slim-lined program, the majority of participants would not have changed their career.
The slim-lined training program in general practice attracts experienced medical doctors. Specialists decide to change career because of the particular ways of working in general practice and with the intention to improve their daily work as a physician, either to improve individual working conditions and/or to improve their individual curative work profile. In addition, specialists are attracted by the concept of self-employment in general practice. Therefore, appreciation of the specific ways of working in general practice as well as management skills are most important during the reduced 2-year training. Further studies should investigate if facilitating a career switch to general practice is a good way to improve the shortage of general practitioners.
2011年，德国国家医学协会（联邦医师协会）发布了针对其他领域（如外科医生、内科医生或麻醉师）合格医学专家的全科医学精简培训计划（跨专业入职培训）指南。这一举措是德国防止全科医生进一步短缺战略的一部分。在巴登-符腾堡州，合格的医学专家可以在大约两年而非五年内完成全科医学培训。本研究的目的是了解专家转向全科医学职业的原因。
在2015年12月研究时，巴登-符腾堡州联合继续教育培训项目有597名学员。确定了此前在另一医学学科合格的专家并邀请他们参与本研究。通过半结构化访谈收集定性数据，并由研究团队的三名独立成员对访谈进行内容分析。
在597名学员中，共有36人被确定为此前在另一医学学科合格的专家。邀请了所有36人参与，15人同意参加本研究。总共进行了15次访谈，平均时长为24.19分钟。参与者的年龄中位数为40岁（33 - 59岁），主要是麻醉师（n = 7）、外科医生（n = 3）和内科医生（n = 3），他们在各自专业领域的平均工作经验为6.5年。首先，参与者转行的动机源于希望通过包括家庭和社会背景的整体方法加强与患者接触的质量，以及源于全科医学的无限多样性。给出的另一个转行原因是自主创业机会。最后，考虑到老龄化和家庭生活的挑战，对医院恶劣工作条件的挫败感导致在医学领域其他地方寻找工作。一个主要发现是，如果没有精简计划，大多数参与者不会改变职业。
全科医学精简培训计划吸引了经验丰富的医生。专家决定转行是因为全科医学独特的工作方式，并且有意改善他们作为医生的日常工作，要么改善个人工作条件，要么改善个人治疗工作概况。此外，专家被全科医学中的自主创业概念所吸引。因此，在为期两年的精简培训期间，重视全科医学的特定工作方式以及管理技能最为重要。进一步的研究应调查促进转向全科医学职业是否是改善全科医生短缺的好方法。
