[The life cycle of general practitioners' professional motivations: the case of prevention]

[Motivations of general practitioners (GPs) working in healthcare centres. Interview-based study]

OBJECTIVE

Healthcare centres (CDS) are mono- or multidisciplinary ambulatory healthcare services staffed by salaried personnel, designed to facilitate access to affordable healthcare. New healthcare centres have been created over recent years in order to attract general practitioners (GP). In order for healthcare centres to constitute a solution to physician shortages, the motivations of doctors working in these centres must be defined in order to determine whether it is possible to extend this process. This study tried to determine the reasons why physicians choose this type of practice and their motivations.

METHODS

A qualitative study based on semi-structured interviews was conducted with GPs working in health centres in the Brittany and Pays de la Loire regions. Thematic analysis was used to study the data obtained.

RESULTS

Twelve GPs were interviewed. The main incentives were salary and benefits, and good working conditions. Often informal professional exchanges were considered to be particularly important. Other motivations were also revealed during the interviews: physicians emphasized the service provided to the population, the accessibility of healthcare centres, and their feeling of being able to provide good quality of care.

CONCLUSION

The motivations of GPs working in healthcare centres can be classified as external and internal. In order to extend the healthcare centre model and recruit and retain physicians, administrators, in addition to providing good working conditions, should also develop public health actions, and improve their communication to raise awareness about these centres.

Disengagement of general practitioners in cervical cancer screening

In the absence of organized cervical cancer screening (CCS) programs, gynecologists remain principal actors in obtaining a Pap smear, followed by general practitioners (GPs). In France, with the growing scarcity of gynecologists and social inequalities in access to opportunistic screening, GPs are valuable resources for women's gynecologic follow-up. We aimed to investigate the characteristics of GPs who do not perform CCS, analyzing the effect of GPs' sex and their evolution over time. On the basis of data from three cross-sectional surveys conducted among representative samples of French GPs in 1998, 2002, and 2009 (n=5199), we constructed univariate and multivariate logistic mixed models (level 2: county, level 1: GP) with random intercept stratified on GPs' sex to investigate the characteristics of the GPs associated with no practice of CCS ever. Almost one-third of all GPs did not perform CCS ever and it increased with time. Male GPs were always more likely not to perform it (odds ratio=0.50, 95% confidence interval=0.42-0.59). The percentage of GPs not performing CCS increased more markedly among male than among female GPs, and increased more among the youngest age group. Increasingly fewer GPs engage in CCS when the growing scarcity of medical gynecologists calls for more participation. Female GPs remain significantly more active in CCS than male GPs. The participation in CCS is determined differently according to the practitioner's sex.

Intrinsic and extrinsic motivations in primary care: an explanatory study among French general practitioners

BACKGROUND

Like many other OECD nations, France has implemented a pay-for-performance (P4P) model in primary care. However, the benefits have been debated, particularly regarding the possibly undesirable effects of extrinsic motivation (EM) on intrinsic motivation (IM).

OBJECTIVE

To examine the relationship between French GPs' IM and EM based on an intrinsic motivation composite score (IMCS) developed for this purpose. If a negative relationship is found, P4P schemes could have side effects on GPs' IM that is a key determinant of quality of care.

METHOD

From data on 423 GPs practicing in a region of France, IM indicators are selected using a multiple correspondence analysis and aggregated from a multilevel model.

RESULTS

Several doctors' characteristics have significant impacts on IMCS variability, especially group practice and salaried practice. Qualitative EM variables are negatively correlated with the IMCS: GPs who report not being satisfied with their income or feeling "often" constrained by patients' requests in terms of consultations length and office appointments obtain a lower mean IMCS than other GPs.

CONCLUSION

Our results provide a cautionary message to regulators who should take into account the potential side effects of increasing EM through policies such as P4P.