Experiences Of General Practitioners Research Articles

Could the patient have been seen by a nurse; a questionnaire based survey of GP and patient views in Danish general practice

BackgroundNurses in Denmark have been increasingly involved in general practice care, which may have implications for the role of the general practitioner (GP) and patients’ experience of primary care. The aim of this study was to explore possibilities of doctor-nurse substitution seen from GP and patient perspectives and patient preferences in regard to consultations with a personal GP.MethodsThe study was based on data from a Danish survey on disease patterns in general practice (KOS 2008). Background information on patients and GPs was linked with their responses to whether a nurse could have substituted the GP in consultations and patient-assessed importance of seeing a personal GP. Associations were measured with prevalence rate ratio (PR).ResultsDoctor-nurse substitution was a possibility in 14.8% of consultations according to GPs and in 11.7% according to patients. GP and patient agreed on substitution in 3.5% of consultations (Kappa = 0.164). Follow-up consultations were more often feasible for substitution than new episode according to GPs (adj. PR = 2.06 (1.62-2.62)), but not according to patients (adj. PR = 1.02 (0.64-1.33)). Follow-up consultations were related to high importance of seeing the personal GP (adj. PR = 1.18 (1.05-1.33). For both patients and GPs, consultations with patients with chronic conditions were not significantly associated with nurse substitution. Male and younger patients did more often suggest substitution than women and older patients. For GPs, increasing patient age was associated with relevance of substitution. Patients who found it 'very important’ to see their personal GP were less likely to consider nurse substitution a possibility (adj. PR = 0.57 (0.45-0.71).ConclusionsGPs and patients found nurse substitution relevant in more than one in ten consultations, although they rarely agreed on which consultations. Follow-up consultations and consultations with older patients were associated with GPs considering nurse substitution appropriate more often. For patients, male and younger patients most often found substitution relevant. High importance of seeing the personal GP may contribute to patient reluctance to nurse substitution, especially for follow-up consultations. The results indicate a need for involving patients’ perspective when altering the future roles of primary health care professionals.

The role of private general practitioners in the treatment of alcohol dependence in the Free State province

AbstractObjectives: The study was undertaken to investigate the role of private general practitioners (GPs) in the treatment of alcohol dependence in the Free State province.Design: A descriptive cross-sectional study. A questionnaire was used to describe the experiences of GPs with patients with alcohol dependence.Outcome measures: The treatment role of individual participants was defined in terms of the range of services provided and the enablers and obstacles faced in performing interventions in their local context.Setting and subjects: Seventy-seven private GPs were selected by means of a stratified randomised sampling process from areas in the immediate proximity of regional hospitals, district hospitals, or basic environments (without local hospital services), in three geographical areas defined by existing health service delivery boundaries.Results: 29.9% of participants practised medical detoxification, either in hospital or in outpatient settings. Involvement related to the local organisation of ...

GPs’ experiences with out-of-hours GP cooperatives: A survey study from the Netherlands

Background: Out-of-hours primary care has been provided by general practitioner (GP) cooperatives since the year 2000 in the Netherlands. Early studies in countries with similar organizational structures showed positive GP experiences. However, nowadays it is said that GPs experience a high workload at the cooperative and that they outsource a considerable part of their shifts.Objectives: To examine positive and negative experiences of GPs providing out-of-hours primary care, and the frequency and reasons for outsourcing shifts.Methods: A cross-sectional observational survey among 688 GPs connected to six GP cooperatives in the Netherlands, using a web-based questionnaire.Results: The response was 55% (n = 378). The main reasons for working in GP cooperatives were to retain registration as GP (79%) and remain experienced in acute care (74%). GPs considered the peak hours (81%) and the high number of patients (73%) as the most negative aspects. Most GPs chose to provide the out-of-hours shifts themselves: 85% outsourced maximally 25% of their shifts. The percentage of outsourced shifts increased with age. Main reasons for outsourcing were the desire to have more private time (76%); the high workload in daytime practice (71%); and less the workload during out-of-hours (46%).Conclusion: GPs are motivated to work in out-of-hours GP cooperatives, and they outsource few shifts. GPs consider the peak load and the large number of (non-urgent) help requests as the most negative aspects. To motivate and involve GPs for 7 × 24-h primary care, it is important to set limits on their workload.

The views of mothers and GPs about postpartum care in Australian general practice.

BackgroundThe postpartum period is a time of increased morbidity for mothers and infants under 12 months, yet is an under-researched area of primary care. Despite a relatively clear framework for involving general practitioners (GPs) in antenatal care, the structure of maternity service provision in some Australian jurisdictions has resulted in highly variable roles of general practice in routine postpartum care. This study aimed to investigate the views and experiences of mothers and GPs about postpartum care in general practice.MethodsThis was a qualitative study of mothers and GPs in rural, regional and metropolitan areas of Queensland, Australia. Semi-structured interviews were conducted with 88 mothers and six general practitioners between September 2010 and February 2012. Interviews were recorded and transcribed verbatim. Data were analysed thematically and compared across groups.ResultsThree main themes emerged: The relationship between the mother and GP; practice management; and GP visits. This paper focuses on the theme GP visits and its subthemes: recommendations for GP visits; scope of practice; and content of a routine visit. Recommendations about GP visits given to mothers varied by birthing sector, obstetric provider and model of maternity care resulting in confusion amongst mothers about the timing and role of GPs in routine postpartum care. Similarly, GPs voiced concerns about a lack of consistent guidelines for their involvement in routine postpartum care. Although ideally placed to provide primary care to mothers and their infants in the postpartum period, the lack of consistent guidelines for the role of GPs is of concern to both the GPs and early parenting women.ConclusionGeneral practice is an important source of postpartum care for mothers and provides a basis for ongoing support for the family. More consistent guidelines and better coordination with other care providers would benefit both mothers and GPs.

An investigation of factors that influence general practitioners' referral of computed tomography scans in patients with headache

In assessing patients with headaches, general practitioners (GPs) play an important role in determining which patients require computed tomography (CT) scans. The purpose of this study was to identify factors that influence GPs' decisions to refer CT scans for patients with headaches. A self-administered survey was presented to GPs in Western Australia. One hundred and twenty-eight vignettes describing patients who may have required CT referral for headache were constructed encompassing six clinical variables. Nine vignettes, selected at random, were presented to each respondent. Respondents were asked if they would refer the patient for diagnostic imaging tests, if so, which imaging modalities would they request, how urgently and the perceived benefits of the requested imaging modality. Multinomial logistic regression was used for the multivariate analysis. We received 105 completed questionnaires (21%). GPs were more likely to refer patients with headaches for diagnostic imaging and CT scans in the following clinical scenarios: patients with a history of colorectal cancer and epilepsy; and patients feeling unwell for the past 6 weeks and headache being exacerbated with valsalva manoeuvrers. Private health insurance and other respondent demographics such as GPs experience and site of care increased imaging referral. GP's referral decisions of diagnostic imaging and CT examinations for patients with headaches are dependent on clinical scenarios and the likelihood of a significant pathology. Further research is required to identify the significant clinical findings with regard to the CT referrals and ensure that CT scans are not requested in patients who are unlikely to benefit.

G178 What Do GPs and Bereaved Parents Think About Paediatric Oncologists and Palliative Care?

AimThe aim of the study was to examine the experiences of bereaved parents and general practitioners (GPs) following the death of a child with cancer within the family home. This...

Enabling factors for antibiotic prescribing for upper respiratory tract infections: Perspectives of Lithuanian and Russian general practitioners

Introduction. General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians. This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries.Method. Five focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed.Results. Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical company activities.Conclusions. Comprehensive efforts to reduce the burden of non-clinically grounded antibiotic prescription should go beyond addressing factors at the physician–patient level and take into account important factors in the enabling environment as well.

Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed‐methods study

To report the expectations and experiences of general practitioners and practice nurses regarding the U-CARE programme, to gain a better understanding of the barriers and facilitators in providing proactive, structured care to frail older people and to determine whether implementation is feasible. Care for older patients with complex care needs in primary care is fragmented, reactive and time consuming. A structured, proactive care programme was developed to improve physical functioning and quality of life in frail older patients. An explanatory mixed-methods study nested in a cluster-randomized trial. The barriers to and needs for the provision of structured, proactive care, and expectations regarding the U-CARE programme were assessed with pre-questionnaires sent to all participating general practitioners (n=32) and practice nurses (n=21) in October 2010. Postquestionnaires measured experiences with the programme after 5months. Twelve months later, focus group meetings were conducted. Practice nurses and general practitioners reported that it was difficult to provide proactive and structured care to older patients with multi-morbidity, different cultural backgrounds and low socioeconomic status. Barriers were a lack of time and financial compensation. Most general practitioners and practice nurses indicated that the programme added value for the coordination of care and allowed them to provide structured care. This explanatory mixed-methods study showed that general practitioners and practice nurses perceived the U-CARE programme as feasible in general practice. A transition was made from reactive, ad hoc care towards a proactive and preventive care approach.

General Practitioners’ coronary risk estimates, decisions to start lipid-lowering treatment, gender and length of clinical experience: their interactions in primary prevention

We investigated whether the risk estimates of General Practitioners (GPs) and their treatment decisions mutually influence each other and whether factors not related to the patient's risk, such as the gender and length in clinical practice, interact. The quantitative assessment of the absolute risk of developing coronary heart disease (CHD) and the decision to start treatment with lipid-lowering drugs are crucial tasks in the primary prevention of CHD. Nine clinical vignettes, four rated high-risk and five rated low-risk according to the Framingham equation, were mailed to three groups of 90 randomly selected GPs in Stockholm. One group (R) was asked to estimate the risk of CHD within 10 years on a visual analogue scale. A second group (R1D) was asked to estimate the risk and to specify whether they would recommend a pharmacological lipid-lowering treatment. A third group (D) only to indicate whether they would recommend treatment. Response rate ranged from 42.2% to 45.6%. The median risk estimates were higher in the R group than in the R1D group (difference not statistically significant). R1D group showed higher proportions of correct decisions to start treatment compared with the R group (86.2% versus 77.5%, P50.19). More correct decisions were made by female doctors (OR 1.77, 95% CI 1.19-2.61, P50.004) and by less experienced doctors (OR 0.97, 95% CI 0.95-0.99, P50.016). The task of making CHD risk estimates and the task of making decisions whether to start lipid-lowering treatment do not seem to influence each other. The gender of physicians and the length of clinical experience seem to affect treatment decisions. Female GPs and less experienced GPs are more likely to make correct decisions. However, the relatively low response rate to the questionnaires may limit the generalizability of these results.

Clinical audit for the tibial tuberosity advancement procedure

To quantitatively assess the learning curve for the tibial tuberosity advancement (TTA) procedure performed by a single surgeon using the cumulative summation (CUSUM) technique and to determine if surgeon performance remained under control (i.e. within specified quality boundaries) after the learning curve had been climbed. Retrospective study. Dogs (n = 122) with cranial cruciate ligament deficient stifles (n = 167). Records of all dogs that had a TTA procedure performed by the same surgeon were reviewed. Cases were included if the following information was available: weight, breed, date of surgery, presence of partial or full cruciate rupture, meniscal pathology, occurrence and description of postoperative complications and treatment with a minimum of 12 months follow-up. Patients were excluded if they had a concurrent illness. Major complications were defined as those requiring revision surgery. The CUSUM technique was used to determine the time taken for the surgeon to reach a pre-defined level of competency and to monitor ongoing performance. Major complications occurred in 15 out of 167 procedures (9%) within 12 months of TTA surgery. The complication rate decreased as surgical experience was gained with the technique, however the learning curve continued until the 22nd procedure. Thereafter, despite the target complication rate being re-set at a lower level, the surgeon's performance remained acceptable, i.e. within the revised quality boundary. The CUSUM technique was used for clinical audit, to determine the learning curve for the TTA procedure for a single surgeon, and to monitor ongoing performance. An experienced general practitioner had a learning curve of 22 procedures and complication rates were within the published ranges.

General practitioners views and experiences in managing depression in patients with chronic obstructive pulmonary disease

Up to 40% of patients with chronic obstructive pulmonary disease (COPD) suffer from comorbid depression. However, there is little data available on the perceptions and experiences of general practitioners (GPs) on the management of depression in patients with COPD. The study investigated GPs’ views about recognizing and treating depression in patients with COPD. A postal survey of 3957 GPs in England about their views on recognizing and treating depression in patients with COPD was conducted. Participants were drawn from the General Medical Services statistics database maintained by the Department of Health. A total of 3957 GPs were mailed. Of these, 857 (22%) complete responses were received. Seventy two percent of the GPs reported screening for depression regularly in patients with COPD. Over 95% of the GPs’ views were that depression interferes with the self-management of COPD and 584 (67%) thought that it exacerbates the symptoms of COPD. However, over two-fifths of GPs were concerned that convincing COPD patients with comorbid depression to receive appropriate treatment was a challenge. Barriers for treatment of comorbid depression in patients with COPD include lack of adequate provision of psychological services and long waiting times for psychological treatment. It is encouraging that most GPs were vigilant and proactively screening for depression. However, there is limited immediate access and provision to psychological therapies to refer COPD patients for treatment in the primary care setting. Further study is required.

Where have all the GPs gone--where will they go? Study of Finnish GPs.

BackgroundIn this paper a specialist in general practice is referred to as a general practitioner (GP). In Finland only half of all GPs work as a health centre physician. The present aim was to establish what the working places of specializing and specialized physicians in general practice are, and where they assume they will work in the future.MethodsThe study population comprised 5,357 physicians licensed in Finland during the years 1977–1996. Altogether 2,956 questionnaires were returned, a response rate of 55.2%. Those either specializing (GP trainees, n=133) or already having specialized (GPs, n=426) in general practice were included in the study. Respondents were asked what kind of physician’s work they would most preferably do. They were further asked what work they assumed they would be doing in the year 2020.ResultsAltogether 72% were working in public primary health centres and 14% in the private sector. Of GPs 53% and of GP trainees 70% would most preferably work in health centres. Of GPs 14% would most preferably work as private practitioners and 9% as occupational health physicians. Sixteen per cent assumed they would be working as private practitioners and 35% assumed they would be retired in the year 2020. Of GP trainees 57% assumed they would be working as health centre physicians in 2020.ConclusionsAccording to the present findings many experienced GPs will leave their work as a health centre physician. Moreover, several GP trainees do not consider health centre physician’s work as a long-term career option. These trends may in the future reflect a recruiting problem in many primary health centres.

Establishing a general practitioner led minor injury service: mixed methods evaluation at 10 months with an emphasis on use of radiology by GPs in the out-of-hours setting

A mixed methods study was conducted to evaluate a recently established general practitioner (GP) led minor injury (MI) service; it included a patient feedback study, a qualitative enquiry into the experience of the MI GPs, and analysis of use of radiology. Forty-nine (81.6 %) patients surveyed were seen in 30 min or less. Forty-five (75 %) felt that the quality of the service was excellent/very good. Twenty-seven (45 %) responders felt that the X-ray service was expensive; 49 (81.6 %) patients said that they would be happy to use the service again. 271 X-rays were taken (137, 50.55 % upper limb, 95, 35.06 % lower limb, 18, 6.64 % CXR). One hundred and ninety-four (73.48 %) patients were self-financing. There was an 86.72 % (235/271) concordance between GP/radiologist findings. Issues elaborated by MI GPs at the focus group included secondary care/hospital interaction, patients' experience, professional fulfilment, competence concerns, finances, and interest in educational resources; they were unanimous in maintaining the service at 10 months. This study demonstrates a positive experience by patients, and conservative evaluation of X-rays by GPs.

A study of antibiotic prescribing: the experience of Lithuanian and Russian GPs

Abstract Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients’ faith in antibiotics as medication for upper respiratory tract infections; patient potential to influence a GP’s decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing for upper respiratory tract infections. Conclusions. Understanding the nature of physician-patient interaction is critical to the effective pursuit of clinically grounded antibiotic use as this study undertaken in Lithuania and the Russian Federation has shown. Both physicians and patients must be targeted to ensure correct antibiotic use. Further, GPs should be supported in enhancing their communication skills about antibiotic use with their patients and encouraged to implement a shared decision-making model in their practices.

Remuneration and organization in general practice: Do GPs prefer private practice or salaried positions?

Objective. In Norway the default payment option for general practice is a patient list system based on private practice, but other options exist. This study aimed to explore whether general practitioners (GPs) prefer private practice or salaried positions. Design. Cross-sectional online survey (QuestBack). Setting. General practice in Norway. Intervention. Participants were asked whether their current practice was based on (1) private practice in which the GP holds office space, equipment, and employs the staff, (2) private practice in which the GPs hire office space, equipment, or staff from the municipality, (3) salary with bonus arrangements, or (4) salary without bonus arrangement. Furthermore, they were asked which of these options they would prefer if they could choose. Subjects. GPs in Norway (n = 3270). Main outcome measures. Proportion of GPs who preferred private practice. Results. Responses were obtained from 1304 GPs (40%). Among these, 75% were currently in private practice, 18% in private practice with some services provided by the municipality, 4% had a fixed salary plus a proportion of service fees, whereas 3% had salary only. Corresponding figures for the preferred option were 52%, 26%, 16%, and 6%, respectively. In multivariate logistic regression analysis, size of municipality, specialty attainment, and number of patients listed were associated with preference for private practice. Conclusion. The majority of Norwegian GPs had and preferred private practice, but a significant minority would prefer a salaried position. The current private practice based system in Norway seems best suited to the preferences of experienced GPs in urban communities.

General practitioner registrars’ experiences of multisource feedback: a qualitative study

To explore the experiences of general practitioner (GP) specialty training registrars, thereby generating more understanding of the ways in which multisource feedback impacts upon their self-perceptions and professional behaviour, and provide information that might guide its use in the revalidation process of practising GPs. Complete transcripts of semi-structured, audio-taped qualitative interviews were analysed using the constant comparative method, to describe the experiences of multisource feedback for individual registrars. Five GP registrars participated. The first theme to emerge was the importance of the educational supervisor in encouraging the registrar through the emotional response, then facilitating interpretation of feedback and personal development. The second was the differing attitudes to learning and development, which may be in conflict with threats to self-image. The current RCGP format for obtaining multisource feedback for GP registrars may not always be achieving its purpose of challenging self-perceptions and motivating improved performance. An enhanced qualitative approach, through personal interviews rather than anonymous questionnaires, may provide a more accurate picture. This would address the concerns of some registrars by reducing their logistical burden and may facilitate more constructive feedback. The educational supervisor has an important role in promoting personal development, once this feedback is shared. The challenge for teaching organisations is to create a climate of comfort for learning, yet encourage learning beyond a 'comfort zone'.

The Attitudes and Practices of General Practitioners about the Use of Chaperones in Melbourne, Australia.

Introduction. To consider the use of medical chaperones during certain clinical examinations is important whether one practises as a specialist, nurse, medical student, or generalist. Chaperones have been used by doctors conducting intimate examinations for many years but their true extent remains largely unknown. Until recently, there was no national guidance in Australia. Aim. To explore the attitudes and practices of general practitioners (GP) regarding their use of chaperones in urban Melbourne, Australia. Method. Qualitative two focus groups involving seventeen GPs from two locations. Discussions were audio-taped, transcribed verbatim and analysed. Results. Common themes and subthemes emerged which were grouped into three main areas: (a) practitioner-related, (b) patient-related and (c) practice related. Discussion. This is the first study from an Australian primary care perspective to gauge the attitudes and experiences of GPs on their use of chaperones. It will provide vital information to inform the next step of extending this research to a national GP audience. From an international perspective, this study provides an excellent template for other primary care clinicians to conduct research in this important field of doctor-patient relationship.

Review: General Practitioners at the Deep End: The Experience and Views of General Practitioners Working in the Most Severely Deprived Areas of Scotland

GENERAL PRACTITIONERS AT THE DEEP END: THE EXPERIENCE AND VIEWS OF GENERAL PRACTITIONERS WORKING IN THE MOST SEVERELY DEPRIVED AREAS OF SCOTLAND GRAHAM WATT Occas Pap R Coll Gen Pract 2012 May; (89): i–viii, 1–40 GPs at the Deep End, conceived of by academic and community GPs as a method of addressing the 40-year challenge of the inverse care law, acknowledged that the way forward for doctors practising in the most deprived and challenging social situations should come from the doctors themselves. The Deep End framework respected the GPs in those communities by putting them front and centre with academics and health service personnel acting as consultants to the process. The resulting Occasional Paper is an authentic and inspiring work that serves as a foundation for organising all of general practice, not just practices in communities which are most at risk. While each of the short chapters of the report merit reading and discussing, a few ideas stood out for me. We need to be continually reminded that general practice, at its heart, is about relationships built over time that require commitment and openness on the part of both doctor and patient. That long journey is …

Challenges in the Management of Pediatric Central Venous Access Devices in the Community

Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care (“home care”) teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.

Does an activity based remuneration system attract young doctors to general practice?

BackgroundThe use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collaborations with the medical association, it is likely to correspond - at least to some degree - with the preferences of current GPs (men in majority). The objective of this paper was to study which preferences that young doctors (women in majority), who are the potential entrants to general practice have for activity based vs. salary based payment systems.MethodsIn November-December 2010 all last year medical students and all interns in Norway (n = 1.562) were invited to participate in an online survey. The respondents were asked their opinion on systems of remuneration for GPs; inclination to work as a GP; risk attitude; income preferences; work pace tolerance. The data was analysed using one-way ANOVA and multinomial logistic regression analysis.ResultsA total of 831 (53%) responded. Nearly half the sample (47%) did not consider the remuneration system to be important for their inclination to work as GP; 36% considered the current system to make general practice more attractive, while 17% considered it to make general practice less attractive. Those who are attracted by the existing system were men and those who think high income is important, while those who are deterred by the system are risk averse and less happy with a high work pace. On the question of preferred remuneration system, half the sample preferred a mix of salary and activity based remuneration (the median respondent would prefer a 50/50 mix). Only 20% preferred a fully activity based system like the existing one. A salary system was preferred by women, and those less concerned with high income, while a fully activity based system was preferred by men, and those happy with a high work pace.ConclusionsGiven a concern about low recruitment to general practice in Norway, and the fact that an increasing share of medical students is women, we were interested in the extent to which the current Norwegian remuneration system correspond with the preferences of potential GPs. This study suggests that an existing remuneration mechanism has a selection effect on who would like to become a GP. Those most attracted are income motivated men. Those deterred are risk averse, and less happy with a high work pace. More research is needed on the extent to which experienced GPs differ along the questions we asked potential GPs, as well as studying the relative importance of other attributes than payment schemes.