[Early suspension of private practice: the current trends for general practitioners in three counties in western France]. / Cessations anticipées d'activité des médecins généralistes libéraux dans les trois départements de l'ouest de la France. Quelle réalité?

The purpose of this study is to conduct a census of general practitioners in order to better understand their early withdrawal from primary care practice and to assess the impact of such withdrawal on current medical demography. The study covers the withdrawals from January 2000 to December 2005 in three western French counties. Data were collected through the district councils of the practitioners'guild, followed by a questionnaire filled in by 75 doctors. The participation rate was 60%. The study reveals that only 29% of these withdrawals are due to retirement. More than one in two doctors left to pursue another paid employment, and more than 25% chose to relocate their practice in a different area of the county. Two thirds of them were practicing in rural or semi-rural locations. Less than half, 47%, were replaced by a successor. General practitioners surveyed did not stop all professional medical care provision and service activities. Their careers are complex, and they are mobile professionals. The main reasons for suspending their activities in a given location were essentially related to the difficulties they had in dealing with their work loads and in maintaining a healthy work-life balance. They have noted that they will leave a range of possibilities open, either looking for private practice or not, exploring the possibility of primary care or not; the basis of their decision is whether a new position will correspond to their desire of mobility and meet their needs for more free.

[Exploring the prospects for general practitioners over 55 years old from three counties of western France]. / Perspectives d'activité pour les médecins généralistes de plus de 55 ans dans l'ouest de la France.

OBJECTIVE: Medical demography and the practice of medicine will be influenced by the personal plans of GPs and their decisions to stop practicing in the coming years. This study aims to understand the events that could potentially worsen the medical demography in terms of shortages of GPs for primary care in the short term. METHOD: 455 GPs (all aged over 55 years) practicing in three districts of western France were selected to participate in this prospective study. 258 valid and complete questionnaires (56%) were received. With the use of a special programme, SPSS version 1.5, an overall comprehensive analysis and one by geographical sub-regional groups were performed. RESULTS: When queried about their plans or wishes for their practice between the present time and their age of 65, of the responding physicians, 27% wanted to continue working under the same conditions, 10% were undecided, and 63% wanted to stop or adjust their professional activity before age 65. The main reasons and factors motivating these plans were their current time constraints, the workload related to administrative tasks and the continuity of care; moreover, GPs noted the demands and expectations of patients, professional burnout and difficulties in obtaining a healthy work-life balance as factors contributing to these plans. DISCUSSION: Physicians who wanted to stop practicing (30%) were the least satisfied with their work and seem to have anticipated this plan of action given that they reduced their number of hours in the office and on-call. Those who wish to adapt their work time (33%) are for the most part satisfied even if they work more, but 70% want to reduce their work hours. CONCLUSION: The impact of these projects is a potentially heavy one, especially since two of the counties concerned have a low medical density and high rate of practicing physicians. Government measures currently proposed do not seem to respond to the evolution of private practice expected by GPs over 55 years.