General Practitioner Workforce Research Articles

General practitioner workforce sustainability to maximise effective and equitable patient care: a realist review protocol

IntroductionThere are not enough general practitioners (GPs) in the UK National Health Service. This problem is worse in areas of the country where poverty and underinvestment in health and social...

Does workforce explain the relationship between funding and patient experience? A mediation analysis of primary care data in England

ObjectivesTo determine whether general practitioner (GP) workforce contributes to the link between practice funding and patient experience. Specifically, to determine whether increased practice funding is associated with better patient experience,...

Redesigning Primary Care: The Emergence of Artificial-Intelligence-Driven Symptom Diagnostic Tools.

Modern healthcare is facing a juxtaposition of increasing patient demands owing to an aging population and a decreasing general practitioner workforce, leading to strained access to primary care. The coronavirus disease 2019 pandemic has emphasized the potential for alternative consultation methods, highlighting opportunities to minimize unnecessary care. This article discusses the role of artificial-intelligence-driven symptom checkers, particularly their efficiency, utility, and challenges in primary care. Based on a study conducted in Italian general practices, insights from both physicians and patients were gathered regarding this emergent technology, highlighting differences in perceived utility, user satisfaction, and potential challenges. While symptom checkers are seen as potential tools for addressing healthcare challenges, concerns regarding their accuracy and the potential for misdiagnosis persist. Patients generally viewed them positively, valuing their ease of use and the empowerment they provide in managing health. However, some general practitioners perceive these tools as challenges to their expertise. This article proposes that artificial-intelligence-based symptom checkers can optimize medical-history taking for the benefit of both general practitioners and patients, with potential enhancements in complex diagnostic tasks rather than routine diagnoses. It underscores the importance of carefully integrating digital innovations while preserving the essential human touch in healthcare. Symptom checkers offer promising solutions; ensuring their accuracy, reliability, and effective integration into primary care requires rigorous research, clinical guidance, and an understanding of varied user perceptions. Collaboration among technologists, clinicians, and patients is paramount for the successful evolution of digital tools in healthcare.

Job satisfaction criteria to improve general practitioner recruitment: a Delphi consensus.

The clinical general practitioner (GP) workforce is decreasing. Many studies have analysed the negative aspects of the profession but, few examine the positive aspects and job satisfaction. A European collaborative group including 8 participating countries recently conducted a qualitative study to analyse the positive factors and found 31 job satisfaction factors. To determine which of these 31 factors are important and applicable to future policies to improve family medicine attractiveness, recruitment, and retention in France. The Delphi consensus method was chosen. Two Delphi rounds were conducted in March-April 2017 and retained satisfaction factors with at least 70% of scores ≥7. The Nominal Group Technique (NGT) was used to rank these retained factors. Participants assigned 5 points to the factor they considered most important, 3 points to the second, and 1 point to the third. Factors receiving at least 5% (10 points) of the total points (198 points) were included in the final list. The expert panel included GPs and non-GPs. Twenty-nine experts began the procedure and 22 completed it. Thirty factors were retained after the 2 Delphi rounds. The NGT resulted in 8 factors: (i) Engage in family medicine to take care of the patients; (ii) Care coordination, patient advocacy; (iii) Flexibility in work; (iv) Trying to be a person-centred doctor; (v) Involvement in healthcare organization; (vi) Benefiting from a well-managed practice; (vii) Being a teacher, a trainer; (viii) Efficient professional collaboration. These 8 job satisfaction factors are important to consider and apply to future policy development.

Cross-sectional analysis of the clinical work hours of early-career general practitioners.

The clinical working hours of early-career general practitioners (GPs) are an important factor in Australian GP workforce planning. This study aimed to establish the prevalence and associations of early-career GPs working full time (nine or more sessions per week) inclinical practice. This was a cross-sectional questionnaire-based study ofalumni (from six months to two years post-Fellowship) from three regional training organisations. Multivariable logistic regression was used to establish factors associated with alumni working full time. Of 356 currently practising early-career alumni participants, 30% worked full time. Factors associated with working full time included spouse/partner employment and family structure and any examination failure. Factors associated with working less than full time included female gender, being an Australian medical graduate, provision of other medical work and having taken additional leave during training. A high proportion of early-career GPs working part time in clinical general practice has implications for workplace planning, as GPs seek workload diversity and flexibility across their career stages.

Recruitment of general practitioners in China: a scoping review of strategies and challenges.

BackgroundChina is rapidly expanding its general practitioner (GP) workforce as part of recent healthcare reform, with an extra 400,000 GPs by 2030. This scoping review identifies the published strategies for GP recruitment that are being implemented and the challenges encountered.MethodsWe searched six English and three Chinese databases from 2015 to April 2022, following Arksey and O’Malley’s framework and the PRISMA ScR reporting guidelines.ResultsA total of 40 Chinese-language and 5 English-language records were included. We identified multiple policies, pathways and programmes focused on expanding GP recruitment. Twenty-two evaluations of these initiatives show varying degrees of effectiveness. Selecting general practice as a career is affected by many factors, including individual’s background, remuneration and benefits, career prospects, working environment, self-fulfilment, and current national developments and reorganisations of primary care. The challenge most frequently reported was the adequate provision of qualified GP in rural regions. The targeting of students from rural areas and provision of free education in return for an obligatory six-years’ working in their hometown upon graduation appears to be effective. Extracted records mostly studied views of trainees in a defined locality, and we identified a paucity of studies which explored the perspectives of organisations and institutions, similarly there were areas of China not contributing to the literature and there were no records taking a national perspective.ConclusionsLong-term monitoring is required to assess policy changes and to systematically evaluate the effectiveness of the interventions nationally. The monitoring of the challenges influencing GP recruitment can be used to inform the design of future initiatives.Development of a minimum agreed standardised set of outcomes used to measure and report evaluations will help assess the relative contributions and cost effectiveness of different approaches being used to boost GP numbers. We provide suggestions for improving the benefits and rewards for GPs and how to promote recruitment to the more rural or less attractive areas.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-022-01854-0.

The impact of role modelling on the future general practitioner workforce: a systematic review

ABSTRACT Role modelling has been identified as an important phenomenon in medical education. Key reports have highlighted the ability of role modelling to support medical students towards careers in family medicine although the literature of specific relevance to role modelling in speciality has not been systematically explored. This systematic review aimed to fill this evidence gap by assimilating the worldwide literature on the impact of role modelling on the future general practitioner (GP) workforce. A systematic search was conducted in Medline, Embase, Scopus, Web of Science, Cochrane, ERIC and CINAHL, and all authors were involved in the article screening process. A review protocol determined those articles selected for inclusion, which were then quality assessed, coded and thematically analysed. Forty-six articles were included which generated four broad themes: the identity of role models in general practice, role modelling and becoming a doctor, the impact of role modelling on attitudes towards the speciality, and the subsequent influence on behaviours/career choice. Our systematic review confirmed that role modelling in both primary and secondary care has a crucial impact on the future GP workforce, with the potential to shape perceptions, to attract and deter individuals from the career, and to support their development as professionals. Role modelling must be consciously employed and supported as an educational strategy to facilitate the training of future GPs.

General Practitioner Time Availability Per Inhabitant Per Year: A New Indicator to Measure Access to Primary Care.

The number of general practitioners (GPs) per inhabitant, used commonly as an indicator of primary care (PC) access, reports only imprecisely on the true availability of GPs. The aim of this study is to develop a new PC access indicator that better reflects the availability of GPs to take care of patients at the population level, the average GP time availability per inhabitant per year. We extracted the data from the Commonwealth Fund International Health Policy Survey of Primary Care Physicians conducted in 2015, including 11 Western countries and 12,049 randomly drawn GPs. We built the indicator by combining two questions about weekly workload in hours and percentage of time spent on face-to-face contact with patients. The indicator was then adjusted regarding the number of GPs, the weeks worked per year and the country's population size. On average, GPs worked 43 h a week. The average time spent on face-to-face contact with patients was 30.5 h/week (35 h including emails and telephone contact), ranging from 22 h in Sweden and 38 h in France. The mean time available of GPs for face-to-face contact was 69 min/inhabitant/year, ranging from 38 min in Sweden to 118 min in Australia. Including email and telephone contact, the mean contact time rose to 79 min/inhabitant/year, ranging from 48 min in Sweden to 127 min in Australia. The new indicator provides an accurate and sensitive estimate of a GP's true time availability at the population level. Results should be interpreted in the context of PC workforce organization, which may help guide GP workforce development.

General Practice in England: The Current Crisis, Opportunities, and Challenges.

General practice or family medicine has historically been lauded as the "jewel in the crown" of the English National Health Service (NHS) (M. Marshall, 2015). General practice, at the heart of primary care, has continued to contribute to the high ranking of the NHS in international comparisons (M. S. Razai & A. Majeed, 2021) and evidence from several decades of research has shown that general practice in the UK has improved the nation's health (Royal College of General Practitioners, 2013). Furthermore, it has provided equitable, cost-effective, and accessible care for all with the flexibility to adapt rapidly to a changing society and political climates, such as during the COVID-19 pandemic when there was rapid implementation of remote consultation models (Royal College of General Practitioners, 2013). However, this much-admired public sector service has recently come under unprecedented political and media spotlight instigated by the pressures of the current pandemic on the NHS (M. S. Razai & A. Majeed, 2021). This coupled with collapsing morale among general practitioners (GPs), a shrinking GP workforce, inexorable demands, increasing workload, and decreasing real-terms per capita funding have caused many to sound alarm on a general practice in "crisis" (C. Gerada, 2021). In this article, we describe the evolving nature of general practice and the current crisis, as well as potential solutions and opportunities going forward.

Factors associated with Australian female doctors’ long term, as opposed to short term, rural Family Medicine work

In light of current debate around securing and distributing the General Practitioner (GP) workforce in Australia, we analysed rural health workforce data to identify characteristics associated with long-term tenure for rural female GPs, an importantly lacking part of the rural workforce in Australia. In this cohort study, 555 currently practicing rural female GPs with long, versus short, rural work histories were surveyed annually. Their data were compared. In logistic regression, as expected the factors associated with 7+ years (long-term) versus <7 years (short-term) rural work were: being older (odds ratio [OR] 6.18, 95% confidence interval [CI] 1.16, 13.0, P < 0.001); being an Australian resident (OR 4.64, 95% CI 2.17, 9.91, P < 0.001); having a practice teaching commitment (OR 3.55, 95% CI 1.67, 7.55, P = 0.001); having multiple children (OR 2.19, 95% CI 1.23, 3.88, P = 0.008); rural health club experience as a medical student (OR 5.23, 95% CI 1.11, 23.86, P = 0.033); and, marginally, being rurally experienced as an undergraduate through the Rural Clinical School programme (OR 8.89, 95% CI 0.921, 85.75, P = 0.059) and having a rural background spouse (OR 1.20, 95% CI 0.94, 4.21, P = 0.070). The factors involved in long-term rural work for female GPs include a longitudinal set from medical school into postgraduate practice life, some based on Australian government policy initiatives and others on lifestyle choices. These factors should be considered in providing a clinically mature female GP workforce to rural populations.

How do Australian general practitioners spend their time? A cross-sectional analysis of Medicine in Australia: Balancing Employment and Life (MABEL) data examining ‘non-billable workload’

While Australian general practitioners (GPs) gain most of their income from direct patient interactions, they alsospend time attending to professional or practice responsibilities. The aim of this study was to determine the time Australian GPs spend on work away from direct patient care ('non-billable work'), and practice and practitioner factors associated with non-billable work. This study was a cross-sectional analysis of GPs practising >7.5 hours/week in the 2016 Medicine in Australia: Balancing Employment and Life (MABEL) dataset. The amount of time that GPs spend on non‑billable work was examined, and ordinal logistic regression was used to determine an association between the amount of this work and practice and practitioner factors. The sample of 2907 GPs spent 5.1hours (95% confidence interval: 4.88, 5.27), or14.2% of their time, on non-billable activities. Non-billable work was associated with female gender, college fellowship, location of medical degree, and rural practice. The amount of non-billable work is likely to increase with population ageing and increasing feminisation of the GP workforce. The lack of reimbursement for much of this work challenges economic viability and GP job satisfaction.

Arbeitszufriedenheit und Stresserleben der jungen Hausärztinnen und Hausärzte – Subanalyse aus der Workforce-Studie Schweizer Hausärzteschaft 2020

This questionnaire-based cross-sectional analysis with 2037 Swiss general practitioners (GPs) focused on young GPs (≤40 years) and investigated which preconditions would allow them high satisfaction and low stress levels in their work. Young GPs (n = 206) are more often female (57 %, p <0.001), 46 % are employed, have a lower workload (38.2 vs. 44.0 hours per week, p <0.001) and plan significantly more often consultations of 30 minutes (p = 0.006) than older colleagues. Under 40-year-old GPs were more satisfied with their work situation (p = 0.046), but had a higher stress level (p = 0.01) compared to GPs >40 years of age. Administrative tasks tend to increase stress levels (p = 0.054). Knowing the problems of the young GP workforce is essential to securing the next generation of physicians.

Training and retention in rural and remote Australia: Examining the association between GP vocational training placements and subsequent practice location in Western Australia

This paper aims to provide insights on the association between exposure to rural general practice vocational training placements and subsequent rural practice location in Western Australia. We further explore the possibility that the observed associations might depend on an individual's rural upbringing and or an individual's exposure to general practice during medical school. To this end, a cross-sectional analysis of practice location of 353 general practitioners who completed their vocational training through WA General Practice Education and Training between 2010 and 2017 was conducted. The empirical analysis uses a fully recursive conditional mixed process estimator to jointly estimate the probabilities that a general practitioner (GP) completes their vocational training placement at a rural location and subsequently practices at a rural location. The results show that GPs who chose rural locations for their first and last vocational training placements are more likely to practice at a rural location compared to their counterparts choosing metropolitan locations. Also, the probability of subsequent rural practice is further strengthened by having a rural background and having exposure to general practice during medical school even after controlling for potential confounders. The results also indicate that GPs stay in rural locations for reasons linked to their career, family and lifestyles. This evidence underscores the importance of vocational training organisations in WA and reinforces the need for ongoing rural opportunities in training to ameliorate location-based disparities in the distribution of the GP workforce in Western Australia.

Examining non-medical prescribing trends in New Zealand: 2016\u20132020

BackgroundPopulation growth and general practitioner workforce constraints are creating increasing demand for health services in New Zealand (NZ) and internationally. Non-medical prescribing (NMP) is one strategy that has been introduced to help manage this. Little is known about the NMP practice trends in NZ. The aim of this study was to provide a current overview of the scale, scope, and trends of NMP practice in NZ.MethodsAll claims for community dispensed medicines prescribed by a non-medical prescriber were extracted from the NZ Pharmaceutical Collection for the period 2016–2020. Patient demographics were retrieved from the Primary Health Organisation enrolment collection. These national databases contain prescription information for all subsidised community pharmacy medicines dispensed and healthcare enrolment data for 96% of New Zealanders.ResultsThe proportion of prescriptions written by all NMP providers and patients receiving NMP prescriptions increased each year from 1.8% (2016) to 3.6% (2019) and 8.4% (2016) to 14.4% (2019) respectively. From 2016 to 2019, the proportion of NMP patients who had at least one NMP prescription increased from 26% to 39% for nurse prescribers, from 1% to 9% for pharmacist prescribers, from 2% to 3% for dietitian prescribers, and decreased from 47% to 22% for dentists, and from 20% to 12% for midwives. The most commonly prescribed medicines were antibiotics (amoxicillin, amoxicillin with clavulanic acid, and metronidazole), and analgesics (paracetamol, and codeine phosphate). While some NMP providers were prescribing for patients with greater health needs, all NMP providers could be better utilised to reach more of these patients.ConclusionsThis study highlights that although the NMP service has been implemented in NZ, it has yet to become mainstream healthcare practice. This work provides a baseline to evaluate the NMP service moving forward and enable policy development. Improved implementation and integration of primary care NMP services can ensure continued access to prescribing services and medicines for our communities.

Characteristics of patients who access zero, one or multiple general practices and reasons for their choices: a study in regional Australia

BackgroundMost people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none.MethodsA cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey.ResultsMost people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97–0.99), residence in the regional centre aOR 2.90(2.22–3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22–2.21) and no out of pocket costs aOR 1.36(1.04–1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p < 0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p = 0.006) than single practice attendees.ConclusionsThose attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.

Bullying in the New Zealand general practitioner workforce.

INTRODUCTION In recent years, there has been growing acknowledgment of problematic unprofessional behaviours such as bullying in the health workforce. AIM The purpose of this research is to investigate how bullying manifests in general practice, responses to bullying and the impact of this behaviour. METHODS Qualitative research using semi-structured interviews or focus groups was conducted. Twenty-four doctors working in the scope of general practice in New Zealand participated: 21 by interview and three by focus group. Participants had been accused of bullying or subject to bullying. RESULTS Results are reported in three categories: people who have experienced being bullied, people accused of bullying, and the cycle of bullying. Participants experienced a range of negative behaviours and had varied responses to bullying, yet the impact of the behaviour was the same. There was considerable overlap in experiences of participants experiencing and accused of bullying, and these categories were not static. DISCUSSION Bullying has a substantial negative impact on the general practice workforce. Responses to bullying often fail to consider the complexities of the behaviour and are premised on simple notions of bully and victim, failing to consider the wider work environment.

STOCHASTIC SIMULATION TO PROJECT SUPPLY OF THE KAZAKHSTAN GENERAL PRACTICE WORKFORCE TO 2030

Our aim was to explore the effect of the uncertainty of some parameters on total General Practitioner (GP) supply in Kazakhstan to 2030. System dynamics simulation was used to develop model for General Practitioner workforce forecasting. Sensitivity analysis (Monte Carlo method) was performed to account for changes in the number of GP as each and set of model parameters is varied. Three key input parameters were explored: retirement rate, attrition rate, recruitment rate. For each parameter relative sensitivity was calculated. Created model is the least sensitive to the parameter of the retirement rate, but is very sensitive to attrition rate. Staff turnover is one of the main problems of primary health care. The attrition rate parameter has great potential for controlling the flow of labor. The level of recruitment (other than new GPs) is another factor that has a significant impact on forecasting GPs. The sensitivity to this parameter is comparable to the sensitivity to the rate of depletion. We believe that measures taken to reduce dropouts will simultaneously increase recruitment. We also evaluated the effect of all three parameters simultaneously. If the most likely scenario is realized, then the proposal of a General Practitioner will almost completely cover the needs with a small deficit of 68 to 305 doctors. If the high limit or low limit scenarios in the labor market are implemented, Healthcare Ministry will face serious problems.

System dynamics modeling for general practitioner workforce forecasting in Kazakhstan.

Primary health care has been proven to be a highly effective and efficient way to address the main causes and risks of poor health and well-being today, as well as handling the emerging challenges that will threaten health and well-being tomorrow. In our study we used the System Dynamics approach to develop a model for the population and General Practitioner workforce to include multiple inputs and their relationships in the equations for each stock and flow. We built the model in the Any Logic software to cover the flow of medical workers, demographic data of the population and the prevalence of the disease over time. Three scenarios were examined for forecasting primary health care personnel resources. The base year for forecasting was 2018, and the modeling was carried out until 2030. All of three scenarios indicate that with the current number of graduated General Practitioners, the shortage of primary care physicians will be exacerbated. In general, the shortage can reach more than 2,000 on a population of 18.3 million (2018). The projected shortage of doctors in the primary health care system requires special attention to human resource planning. Only one third of medical graduates in Kazakhstan go to work in the primary health care system. The government needs to develop measures to stimulate and support young medical doctors to become general practitioners.

Turnover among Australian general practitioners: a longitudinal gender analysis

BackgroundLittle is known about gender differences in general practitioner (GP) turnover. It is important to understand potential divergence given both the feminization of the Australian GP workforce and projected shortages of GPs.ObjectiveThere is increasing evidence that national health outcomes are related to the extent to which health care systems incorporate high quality primary care. Quality primary care is, in turn reliant on a stable general practice (GP) workforce. With the increasing feminization of medical schools, we sought to identify correlates of turnover in the GP workforce, separately for women and men, focusing particularly on part-time employment and child-rearing, and distinguishing effects related to either planned or unplanned turnover.MethodsAnnual responses from cohorts of at least 1900 women GPs and 2000 men GPs are used for up to eight waves of the Medicine in Australia—Balancing Employment and Life (MABEL) longitudinal survey of doctors. Descriptive and bivariate correlations are provided. Random effects ordered logit is applied to dependent variables for turnover intentions measuring intent to “leave direct care” or “leave medicine”. A behavioral measure of turnover is used in random effects logit regressions, with the exclusion or inclusion of the confounding intentions variables revealing correlates of unplanned or planned turnover.ResultsPart-time employment is associated with turnover intentions among both women (84% or 94% increase in the odds ratios or ORs) and particularly men (414% or 672%), and with actual turnover for women (150% or 49%) and for men (160% or 107%). Women GPs engage in more unplanned turnover than men: they are 85% more likely to engage in turnover after controlling for intentions. Unplanned turnover is concentrated among women below 40 years of age and with young children, even though both groups report below average turnover intentions.ConclusionAlthough further studies are needed to identify specific factors associated with GP turnover among women, the analysis highlights the need to focus on women GPs who are either young or have young children. Given the substantial personal and social investment required to produce GPs, it is wasteful to lose so many young women early in their careers.

Growing the pool of rural general practitioners.

The critical importance of primary health care in maintaining a healthy population is well established internationally. Nevertheless, general practitioner care is not always easily accessible for some patients in Australia, particularly in rural regions. This is partly due to an insufficient number of medical graduates entering and being retained in the rural general practitioner workforce. Key elements of international and national programs designed to address this shortfall are discussed and include the use of entry requirements that preferentially select for applicants from a rural residence background, and immersion of medical students for a large share, or entire duration, of their training in rural communities. In addition, other factors that can influence decisions to enter and stay in rural practice are discussed.