Möglichkeiten zur Attraktivitätssteigerung der Hausarztmedizin aus der Sicht junger Ärztinnen und Ärzte

Hintergrund: Ziel der Studie ist es zu untersuchen, welche berufliche Laufbahn junge Ärztinnen und Ärzte gegen Ende ihrer fachärztlichen Weiterbildung anstreben und welche Faktoren aus ihrer Sicht eine Tätigkeit in der ärztlichen Grundversorgung attraktiver machen könnten. Methodik: Im Rahmen einer seit 2001 laufenden Schweizer prospektiven Studie zu Determinanten der Karriereentwicklung nahmen 534 junge Ärztinnen und Ärzte im Jahr 2007 an der vierten Befragung teil. Sie machten Angaben zur angestrebten beruflichen Laufbahn, zum geplanten Praxismodell und Praxisstandort, ferner benannten sie Faktoren, die für bzw. gegen die Hausarztmedizin sprechen und welche die Attraktivität der Hausarztmedizin steigern würden. Ergebnisse: 84 Personen (42% Männer, 58% Frauen) streben eine Tätigkeit als Hausarzt/-ärztin an (60% spezialisieren sich in Allgemeinmedizin, 40% in Allgemeiner Innerer Medizin), 450 spezialisieren sich in einem anderen Fachgebiet. Von den 534 Studienteilnehmenden möchten 208 später in einer Praxis arbeiten, mehrheitlich in einer Gruppenpraxis (88%). 49% der zukünftigen Hausärzte planen eine Praxis in einer Stadt, von den Spezialisten sind es 77%. Als wesentliche Gründe gegen die Hausarztmedizin werden die unsichere Entwicklung der Hausarztmedizin und das niedrige Einkommen genannt, als positive Faktoren die Vielseitigkeit, das breite Patientenspektrum sowie die Kontinuität der Arzt-Patient-Beziehung. Um die Attraktivität der Hausarztmedizin zu steigern, müssten interdisziplinäre Gruppenpraxen gefördert und die finanziellen Rahmenbedingungen verbessert werden. Schlussfolgerung: Die Hausarztmedizin wird als interessantes Berufsfeld eingeschätzt, die gegenwärtigen Rahmenbedingungen für die Ausübung der hausärztlichen Tätigkeit wirken jedoch abschreckend

Work-life conflicts and health among Swiss physicians--in comparison with other university graduates and with the general Swiss working population

QUESTION UNDER STUDY: The present study aimed to compare the prevalence of work-life conflicts and the health status of physicians, with a representative sample of university graduates as well as with a representative sample of the general Swiss working population. Furthermore, it aimed to analyse whether work-life conflicts correlate with the health of physicians, as it does in the general working population. METHODS: The present cross-sectional study analysed data from 2007 originating from the SwissMedCareer Study (a prospective cohort study of physicians who graduated in 2001; n = 543) and the Swiss Household Panel (a representative Swiss survey on living and working conditions; university graduates of the same age range: n = 172, general working population of the same age range: n = 670). Data were analysed with Chi2 tests, correlations and logistic regressions. RESULTS: Physicians reported strong time-based as well as strain-based work-life conflicts more frequently than university graduates and the general working population. Significantly more physicians reported "moderate" to "very poor" health than the other two samples. Surprisingly, on the other side of the scale ("very good" health), physicians outnumbered the other samples too. Strong associations between work-life conflict and self-rated health as well as various health complaints were found for physicians. CONCLUSION: The high prevalence of work-life conflicts may explain the comparably high prevalence of poor self-rated health in the physicians' sample

Swiss students and young physicians want a flexible goal-oriented GP training curriculum.

A growing shortage of general practitioners (GPs), in Switzerland and around the world, has forced countries to find new ways to attract young physicians to the specialty. In 2017, Switzerland began to fund hundreds of new study places for medical students. This wave of young physicians will soon finish University and be ready for postgraduate training. We hypothesized that an attractive postgraduate training program would encourage interested young physicians to pursue a GP career. This is a cross-sectional survey of young physicians from the Swiss Young General Practitioners Association (JHaS), members of Cursus Romand de médecine de famille (CRMF), and all current medical students (5 <sup>th</sup> or 6 <sup>th</sup> years) (n = 554) in Switzerland, excluding students indicating definitely not to become GPs. We asked all if they were likely to become a GP (Likert: 1-10), and then asked them to score general features of a GP training curriculum, and likely effects of the curriculum on their career choice (Likert scale). They then rated our model curriculum (GO-GP) for attractiveness and effect (Likert Scales, open questions). Most participants thought they would become GPs (Likert: 8 of 10). Over 90% identified the same features as an important part of a curriculum ("yes" or "likely yes"): Our respondents thought the GO-GP curriculum was attractive (7.3 of 10). It was most attractive to those highly motivated to become GPs. After reviewing the curriculum, most respondents (58%) felt GO-GP would make them more likely to become a GP. Almost 80% of respondents thought an attractive postgraduate training program like GO-GP could motivate more young physicians to become GPs. Overall, medical students and young physicians found similar features attractive in the general and GO-GP curriculum, regardless of region or gender, and thought an attractive curriculum would attract more young doctors to the GP specialty. Key points An attractive postgraduate training program in general practice can attract more young physicians to become GPs. In this study cross-sectional survey including medical students (n = 242) and young physicians (n = 312) we presented general features for a curriculum and a model curriculum for general practice training, for evaluation of attractiveness to our study population. General practice training curriculum provides flexibility in choice of rotations, access to short rotations in a wide variety of medical specialties, training in specialty practices as well, mentoring and career guidance by GPs and guidance in choosing courses/certificate programs necessary for general practice. These findings help building attractive postgraduate training programs in general practice and fight GP shortage

How do physicians and their partners coordinate their careers and private lives?

QUESTIONS UNDER STUDY: Over the past few years, there has been increasing interest in the question of how couples coordinate their careers and private lives. The aim of this study was to investigate the career arrangements of physicians and their partners according to gender and parenthood status, and to compare dual-physician couples with other types of couples. METHODS: Data pertaining to 414 physicians (214 females, 51.7%; 200 males, 48.3%) from a cohort of medical school graduates participating in the SwissMedCareer Study was analysed according to socio-demographic variables, employment status and career prioritisation of the physicians and their partners. Differences in terms of gender, parenthood status and type of couple were investigated with Chi-square tests. RESULTS: The most prevalent career arrangement for a male physician with young children was that of full-time employment for the physician himself with a partner not in employment or working less than 50%-time. By contrast, the most common arrangement for a female physician with young children was that of 50-69% part-time employment with a partner working full-time. For couples without children, the most common arrangement was full-time employment for both partners. Dual-physician couples differed significantly from other types of couples in terms of how they rated career priority, with male physicians with physician partners more likely than male physicians with partners holding another academic degree or with non-academic partners to regard both careers as equally important (p ≤0.001). Female physicians with physician partners were more likely to consider their partners' careers as of prime importance than those with academic or non-academic partners (p ≤0.001). CONCLUSION: The priority given by couples to the man's career reflects traditional gender-role attitudes in male and female physicians. Starting a family slows down the career progress of female physicians but not of male physicians. Providing more childcare facilities in hospitals and flexible working hours to meet the needs of physician parents with young children could encourage a higher work participation of physician-mothers and might constitute an effective strategy for combating the shortage of physicians in Switzerland

The new generation of family physicians - career motivation, life goals and work-life balance

QUESTIONS UNDER STUDY: The present study aimed to investigate the differences between future family physicians, and physicians aspiring to other medical specialities, in terms of sociodemographic factors and variables concerning personality factors, career motivation, career success, importance of life goals and work-life balance; further, the stability in career choice of family physicians from medical school through to residency was evaluated. METHODS: Data reported are from four assessments of the Swiss physicians' longitudinal career development study, begun in 2001 (T1). At T4, in 2007, 543 residents (76% of the initial sample at T1) completed a questionnaire concerning their personal and professional goals. The difference between family physicians and specialists was studied by multivariate analyses of covariance adjusted for gender. RESULTS: Of the study sample, 84 (17%) decided on family medicine, 66% of them as early as medical school or at the beginning of residency. Compared to specialists, more family physicians are married and more have children. Their intrinsic and extrinsic career motivation is lower, their extraprofessional concerns are greater and they rate their objective and subjective career success lower. The favoured models of work-family and work-life balance respectively are part-time oriented. CONCLUSION: Future family physicians, both females and males, are less career-oriented. The results suggest that the waning reputation of family medicine and the uncertain development of this medical discipline in the Swiss healthcare system attract less career-oriented applicants. A well-balanced integration of professional and private life is an essential goal for the new generation of doctors; this applies even more to female doctors and family physicians. Considering this trend, the question arises whether the current number of medical school graduates is sufficient to ensure the population's healthcare provision in the future

Karriereförderliche und karrierehinderliche Erfahrungen in der Weiterbildungszeit junger Ärztinnen und Ärzte Ergebnisse einer Schweizer Longitudinalstudie

BACKGROUND AND OBJECTIVES: Postgraduate education after medical school plays an important role in the career development of young doctors. This study investigated what supporting and obstructing factors help or hinder the of young doctors during their specialty training. METHODS: As part of a broader prospective study on determinants of career development of young doctors which had started in 2001, 529 participants were investigated in 2009 regarding the most important career-relevant factors experienced during their specialty training. Content analysis was used to assign the answers given to open questions to inductively defined categories RESULTS: The 1301 answers given about career-supporting factors and the 1047 answers given about career-hindering factors were assigned to 9 and 12 categories respectively. These categories were divided into internal and external career-relevant factors. Important factors relative to career enhancement were career support by superiors and high achievement motivation, followed by good professional qualifications and beneficial working conditions. The answers given in these four categories accounted for two thirds of all mentioned career supporting factors. Regarding career barriers, the four categories with the highest number of answers were lack of career support, unfavourable work-place conditions, extraprofessional concerns and labour market conditions. Significant gender differences were only be found regarding career-hindering factors: Female doctors mentioned more often mentioned concerns and gender-related barriers, while male doctors more often reported labour market conditions and unfavourable personality traits for influencing career advancement. CONCLUSIONS: Career promotion should be provided in a continuous, structured and institutionalized way to make better use of the potential of well trained doctors. The new generation of doctors should not only advocate better professional conditions but also be aware of barriers within themselves that have an impact on their career development

Family physicians in Switzerland: transition from residency to family practice

Family physician tutors should actively approach trainees in medical school and residency, pointing out the advantages of family medicine in terms of continuity of patient contact and the wide range of illnesses and patients, as well as the prospect of a work-life balance tailored to personal needs. Unlike other countries, Switzerland started its structured residency-training programs only recently

Angst und Depression bei jungen Ärztinnen und Ärzten - Ergebnisse einer Schweizer Longitudinalstudie

Fragestellung: Es wird untersucht, wie sich Symptome von Angst und Depression bei jungen Ärztinnen und Ärzten in der Weiterbildungszeit entwickeln, welche Verläufe diese Symptome zeigen und durch welche Persönlichkeitsmerkmale Verlaufstypen von beeinträchtigter Affektivität vorhergesagt werden können. Ebenfalls wird untersucht, in welchen Arbeitsplatz und Karriere bezogenen Merkmalen sowie der Work-Life Balance sich diese Verlaufstypen von einander unterscheiden. Methode: Im Rahmen einer prospektiv angelegten Studie wurde im Zeitraum von 2001 bis 2007 bei 390 jungen Ärzten verschiedener Fachrichtungen (54.9% Frauen, 45.1% Männer) untersucht, wie hoch der Anteil an Personen mit erhöhten Angst- und Depressionswerten (HADS-D) zu Beginn des zweiten, vierten und sechsten Weiterbildungsjahres ist. Ausserdem wurden mittels TwoStep Cluster Analysis Verlaufstypen von Angst und Depression identifiziert. Durch eine logistische Regressionsanalyse wurde die Prädiktion der Zugehörigkeit zu den Verlaufstypen ermittelt und in einem weiteren Schritt mittels t-Test bestimmt, durch welche Merkmale sich diese von einander unterscheiden. Ergebnisse: Hinweise für relevante Angstsymptome zeigten sich in der Berufseinstiegsphase bei 30% der Befragten, in den folgenden Jahren der Weiterbildung bei 20%; für relevante Depressionssymptome lagen die Werte bei 15% bzw. 10%. Die Clusteranalyse ergab bezüglich Affektivität zwei Verlaufstypen. Typ A (n = 135, 34.6%) mit anhaltend erhöhten Angst- und Depressionswerten während des Untersuchungszeitraums und Typ B (n = 255, 65.4%) mit unauffälligen Werten im gleichen Zeitraum. Merkmale der Persönlichkeit wie Kohärenzgefühl, Self-esteem, berufliche Selbstwirksamkeitserwartung und Overcommitment haben einen signifikanten Einfluss auf die Zugehörigkeit zum jeweiligen Verlaufstyp. Auch bezüglich den Angaben zu Arbeitszeit, Mentoring-Erfahrung, Zufriedenheit mit der beruflichen Laufbahn und Work-Life Balance unterscheiden sich Personen des Typs A von denen des Typs B. Diskussion: Für die Fähigkeit von jungen Ärztinnen und Ärzten Arbeitsbelastungen zu bewältigen spielen Persönlichkeitsmerkmale eine wichtige Rolle. Personen mit erhöhter Vulnerabilität für Angst und Depression sollten während der Weiterbildungszeit gezielt und kontinuierlich mentoriert werden. OBJECTIVES: The study investigates the development of anxiety and depression during residents' postgraduate training as well as the symptom patterns and the prediction of these patterns of impaired affectivity by personality factors. It furthermore regards the differences between these patterns in workplace- and career-related factors as well as in worklife balance. METHODS: In a prospective cohort study (2001-2007), 390 junior physicians of various specialties (54.9% females, 45.1% males) were investigated with respect to the percentage of participants with elevated anxiety and depression scores at the beginning of the second, fourth, and sixth year of residency, respectively. Symptom patterns were evaluated by two-step cluster analysis. The prediction of the assignment to the symptom patterns was investigated by logistic regression analysis. The differences in further factors between the two patterns was analyzed by t-tests. RESULTS: In the second year of residency, relevant anxiety symptoms were found in 30% of the physicians, and in the fourth and sixth year in 20%; relevant depression symptoms were found in 15% and 10%, respectively. The cluster analysis revealed two symptom patterns: Type A (n = 135, 34.6%) with continuously elevated anxiety and depression symptoms; and type B (n = 255, 65.4%) with continuously low values. Personality factors such as the sense of coherence, self-esteem, occupational self-efficacy expectation, and overcommitment significantly predicted the assignment to the symptom patterns. Also in terms of workload, mentoring experience, career satisfaction, and worklife balance, persons of type A differ from those of type B. CONCLUSION: Personality factors play an important role in physicians' ability to cope with job demands. Persons with an elevated vulnerability for anxiety and depression should be continuously supported and counselled by a mentor during residency

Facharztwahl von jungen Ärztinnen und Ärzten - der Einfluss von Geschlecht, Persönlichkeit, Karrieremotivation und Lebenszielen

Background: In the last decade the prevalence of mental and psychosomatic disorders has increased in children, adolescents as well as in adults. As a consequence more doctors are needed who supply qualified treatment to these mentally or psychosomatically ill patients. However, in some European countries the number of residents aspiring to a specialty qualification in psychiatry is steadily decreasing.The aim of this study was to investigate trends among medical school graduates to specialise in psychiatry and whether psychiatry residents differ from residents choosing other specialties in certain characteristics. Methods: In a prospective study design a cohort of Swiss medical school graduates was followed up, beginning in 2001. Six months before graduation (T1), in their second (T2) and fourth years (T3) of residency 438 physicians assessed their aspired-to specialty and career goals; in addition, personality traits, career-related factors, workplace experience and life goals were addressed.Twenty-five (5.7%) participants opted for psychiatry, 413 (94.3%) for other specialties. Results: Psychiatry residents show a high stability in their specialty choice. At the end of medical school about half of the graduates have made their decision, 40% decide during the first years of postgraduate training, about 10% change the initially aspired-to specialty.There are only few differences between psychiatry residents and residents of other specialties in regard to sociodemographic characteristics, personality traits, workplace experiences and aspired-to life goals. As expected, psychiatry residents more often aim at practising in a private practice. They also assess extraprofessional concerns such as family obligations and leisure activities as more important as residents of other specialties. Conclusion: The results of our study indicate that the need for qualified doctors in psychiatry, especially in psychiatric inpatient facilities, will no longer be met in the future. The outpatient treatment of mentally and psychosomatically ill patients will not be adequately covered because of the small number of future psychiatrists and family physicians. Above all, the restrictions for psychotherapeutic treatment, established in 2007, will contribute to even less graduates choosing psychiatry as specialty qualification