Career after successful medical board examination in general practice--a cross-sectional survey.

QUESTION UNDER STUDY: Switzerland is facing a shortage of general practitioners (GPs). Knowledge of the factors influencing career choice is crucial for increasing the attractiveness of general practice. The aim of our study was to report the working conditions of recently certified GPs and the effect of vocational training in general practice on GP skills and knowledge, and economic skills. Furthermore, we recorded when GPs chose general practice as a career, as well as potential barriers to and facilitators of their decision. STUDY DESIGN: Cross-sectional survey with an online-based questionnaire. STUDY GROUP: 1,133 physicians certified in general practice between the years 2000 and 2010. RESULTS: The response rate was 40.6% (456); 426 (44.1% females) were included in further analysis. A total of 341 (80.0%) were currently working in general practice. Female GPs were significantly more often employed (rather than working independently), working part-time and in group practices. Fifty-two (12.2%) of the participants did not work in general practice although they had intended to earlier. The majority (54.3%) of the participants working as GPs decided to become a GP during their residency. Overall, 60.6% of all participants completed vocational training in a general practice, which significantly improved self-perceived general practice skills compared with their colleagues without such training. CONCLUSIONS: Residency is a more important time-period than medical school for career decisions to become a GP. Attractive residency programmes must be developed to engage physicians in this vulnerable phase. The workplace settings of female GPs were significantly different from those of male GPs. Vocational training in general practice had a positive effect on self-perceived GP skills.

Utilisation of information technologies in ambulatory care in Switzerland.

BACKGROUND: The importance of electronic medical records for the healthcare system is well documented. IT enables easy storage, communication and decision support and can provide important tools in the care of chronically ill patients in the form of a reminder system. METHODS: A questionnaire was developed and send out to 1200 physicians extracted from the official data base. After four weeks the non-responders received a written reminder. Data collection started in December 2007 and was completed in February 2008. RESULTS: 719 questionnaires were received back, representing a response rate of 59.9%. The data revealed a significant underuse of electronic medical records (EMRs) and IT compared to other European countries. Smaller practices, older physicians and especially primary care physicians tended to use less EMR. Only 10.2% of all physicians declared an interest in considering investment in IT in the next three years, 66.9% expressly denied wishing to do so. The most important barriers were the costs, the unclear benefit and a feared worsening of the doctor-patient-communication during consultation. CONCLUSION: IT and especially EMRs are underused in daily ambulatory care in Switzerland. To increase the use of EMRs, several approaches could be helpful. First of all, the benefit of EMRs in daily routine care have to be increased as, for example, by decision support systems, tools to avoid pharmaceutical interactions and reminder systems to enable a proactive treatment of chronically ill patients. Furthermore, adequate approaches to offer appropriate reimbursement for the financial investments have to considered such as an additional payment for electronically generated, evidence based quality indicators.

Family medicine in Switzerland: training experiences in medical school and residency.

BACKGROUND AND OBJECTIVES: A shift away from family medicine to medical specialties is noticed in many of the competition-based health care systems in Western countries. Our study's objective was to learn about career development of young physicians in German-speaking countries, with a particular focus on Switzerland. METHODS: We performed a qualitative assessment of data on physicians' training experiences in family medicine during medical school and residency. Data were obtained through a focus group interview with 12 participants, six of whom were family medicine residents, and data were analyzed by content analysis. RESULTS: The results indicate that family medicine is not well established in medical school curricula, that family physicians are often discriminated against by specialists with regard to their professional competence, that there are no structured residency programs and a lack of information about residency posts in family medicine as well as family practices to be taken over, and that the competition-based health care system does not foster a gatekeeper model and favors financially the specialists' work to the detriment of that of family physicians. CONCLUSIONS: Suggestions for improvement of the situation of family medicine include providing well-trained family physicians as educators in medical schools, early training courses in family practices in medical school for all students, well-structured residency programs, support by the Swiss Society of Family Medicine in planning to open a family practice, financial incentives for family physicians, and implementation of gatekeeper models.

Primary care in Switzerland--no longer attractive for young physicians?

BACKGROUND AND OBJECTIVES: A trend away from primary care (PC) to other specialties has been noted in Switzerland, as well as in the health-care systems of many other Western countries. The objective of the present study was to ascertain how many third-year residents graduating in 2001/02 from medical schools in German-speaking Switzerland wanted to become PC physicians (PCPs), whether this career goal was continuously followed, and how many subjects switched to or away from PC during residency. METHODS: Data reported are from the third assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2005, at the third assessment, 515 residents (53.8% females, 46.2% males) were asked what specialty qualifications and career goals they aspired to. In addition, participants' socio-demographic, personality, and career-related characteristics as well as their life goals were addressed. RESULTS: Of n = 515 (total sample) third-year residents, 81 had not yet decided on the medical field in which they wished to specialise, while 434 had made this decision. Of the latter, only 42 (9.7%) aspired to become PCPs. Twelve of the 42 future PCPs consistently mentioned PC as a career goal from graduation throughout residency. The other 30 subjects only decided on PC during the course of their residencies. A switch away from PC was also noted in the case of 19 subjects who on graduation or after the first year of residency aspired to become PCPs, but abandoned this goal after three years of residency. Future PCPs differ from those pursuing other specialties in terms of personal and career-related characteristics, as well as in their life goals, insofar as they are less career-orientated and regard having more time outside work a priority. There are few gender-based differences between female and male future PCPs. CONCLUSION: Primary care seems to hold little attraction as a career goal for young physicians. Residency experiences would seem to have more of an effect on choice of specialty than teaching experiences during medical school. The percentage of subjects qualifying in PC is far too low to fill the need for the future generation of PCPs. In addition to efforts to incorporate PC issues into medical school curricula, structured residency programs should be established to promote PC.