De komende tien tot vijftien jaar vertrekt meer dan de helft van de huisartsopleiders. Jonge huisartsopleiders moeten die lacune opvullen. Vooral in de regio Amsterdam is daarvoor nauwelijks voldoende capaciteit.
Elk jaar komen er meer eerstejaars studenten geneeskunde. De minister van VWS besloot de instroom in de huisartsenopleiding in 2009 te verhogen tot 598 huisartsen-in-opleiding. De Stichting Beroepsopleiding Huisartsen (SBOH), financier van de huisartsen- en verpleeghuisartsen-in-opleiding, moet zorgen dat daarvoor voldoende opleiders en praktijkplekken zijn. De komende tien tot vijftien jaar vertrekt echter meer dan de helft van de huisartsopleiders vanwege pensionering. Er moeten dus nieuwe opleiders komen en er moet vooral ook gekeken worden waar. Het NIVEL bracht met subsidie van SBOH in kaart in welke regio’s er hoeveel huisartsenopleiders gaan stoppen, en hoeveel jonge niet-opleiders daar praktijk voeren. Zij zijn immers de potentiele vervangers. In Midden-Nederland zit het wel goed. Maar in Amsterdam, met twee universiteiten, is het probleem nijpender. Daar moet vrijwel iedere jonge huisarts opleider worden en dan zijn het er nog maar net genoeg.
Deeltijd
Een groot aantal huisartsen werkt in deeltijd en vindt het daardoor lastig om opleider te zijn, wat het potentieel aan opleiders verkleint. Daarbij voorziet ook een aantal huisartsen in de begeleiding van snuffelstages en coschappen. Zij vinden dat leuk om te doen, maar deze huisartsen kunnen daardoor niet ook nog een assistent opleiden tot huisarts. Hoeveel huisartsen investeren in snuffelstages en coschappen is niet goed geregistreerd en moeilijk in harde cijfers om te zetten. Maar het kost huisartsen veel tijd. De onderzoekers vroegen opleiders en jonge niet-opleiders ook wat er te verbeteren valt en te wensen is voor het opleiderschap. Daaruit kwam naar voren dat huisartsen graag zelf inbreng willen in het selecteren van assistenten huisartsgeneeskunde die in de praktijk komen werken en dat zij een realistische vergoeding willen krijgen. Die gewenste realistische vergoeding is overigens niet veel hoger dan de huidige vergoeding.
Background: Health Services Research is policy related and results have an impact on practices. Implementation of research output into practices is performed with a variety of strategies. Type of policy intentions and research output create a specific context for implementation. The main question here is: what combinations of background factors and implementation strategies lead to successful implementations in health care? Methods: Sources for this study are evaluations of 72 completed implementation projects in health care settings (60% of all projects were evaluated as successful). Qualitative analyses focused on clustering background factors: social environment of professionals and users, types of interventions, organizational structure and culture. Quantitative analyses were based on systematic gathered information with registration formula. First, characteristics are registered, like goals, strategy choice, organizational change, perception of change, support of management. Second, successful implementation as independent variable was included. For each implementation goal success was measured (1 = goal is not reached; 5 = goal is fully reached). A second measure of success was: integration of implemented products in organization or procedures (1 = no/ low integration; 5 = highly integrated). Results: Qualitative analyses resulted in clustering five types of implementation. Nationwide organization oriented change (e.g. implementing quality systems), nationwide user oriented prevention and care, (e.g. web-based prevention of alcohol abuse), implementation of profession oriented guidelines, effect- and validation studies (testing instruments), information and education for care users (e.g. support for parent– child relations). Preliminary results from quantitative analysis show that 80% of pre-set goals are achieved. But the success factor of integration is for only 20% of all projects mentioned. Conclusions: Success in implementation projects is reached highly if we define success as reaching pre-set goals, but implementation is not very successful if success is defined as integration. The question is: when is implementation completed and are all projects we define as implementation really implementing products?
Abstract Background Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. Methods Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. Results Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. Conclusion In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted.
Background: Workforce planning for general practitioners needs to be informed by data on retirement intentions of GPs and factors that influence them. Several studies have investigated the association of explanatory factors with intentions to leave practice and actual leaving (e.g. in the UK, USA, Belgium). This study focuses on the actual leaving of GPs and factors that may influence this, in the Netherlands. At the start of the 21st century, measures were taken to reduce high workload among GPs by e.g. organizing out-of-hours primary care. Therefore we analyze reasons to leave and their influence on the retirement age before and after the measures took place. Methods: A first retrospective survey was sent in 2003 to 520 selfemployed GPs, who retired between 1998 and 2002. The same survey was sent in 2008 to 405 GPs who retired between 2003 and 2007. The response rates were respectively 60 and 54%. Analyses were performed with retirement age as outcome variable and work perception, external factors and personal reasons as independent factors to compare the periods. Results: Retirement age was higher in 2003–2007 (M: 56; F: 51) than in 1998–2002 (M: 52; F: 50), especially for male GPs. Female GPs retired at an earlier age than males in both periods. Significant differences were found between both surveys on reasons for leaving. Almost all reasons mentioned had less influence in 2003–2007 than in 1998–2002, by male, female or all GPs. Demands from government and health insurers (female), societal developments (all), demands from patients (female), health (female) and emotional exhaustion (male) were less important in 2003–2007 than in 1998–2002. However, external control (male) was a more important reason to leave in the second period. Job satisfaction was reported (all) higher in 2003–2007. In 998–2002, external control was positively and career change negatively related with retirement age. In 2003– 2007, career change was negatively related to retirement age and being female contributed significantly to a lower retirement age. Conclusions: The results suggest that the measures taken by the government may have improved job satisfaction among GPs, may have caused a higher retirement age and less (negative) explanatory factors influencing actual turnover in 2003–2007.
