Approaches towards averting a potential structural shortage of general practitioners: results of a quantitative survey on attitudes, experiences, and ideas from general practitioners in the Federal Republic of Germany.

Abstract

Background: Securing primary care poses a complex set of challenges for policymakers in national healthcare. The risk of a shortage in general practitioners raises the question as to which approach would make an effective contribution towards averting an impending healthcare shortage. There has been a lack of studies shedding light on how general practitioners pview various approaches towards securing long-term primary care, and which measures they support from their own professional experience. The aim of the study was to ascertain the opinions, attitudes, and experiences of general practitioners in securing primary care across the country. We ran a survey to ask GPs about strategies that they saw as promising or particularly pressing, how they viewed the current situation regarding the shortage of general practitioners, and what they saw as causes for any decline they had already seen in primary care.

Methods: Our survey conducted online addressed a total of 5,164 general practitioners interviewed between August 2023 and April 2024 (40% response rate). Apart from descriptive analysis, we used Student's t-test for independent samples to determine significant differences between two groups. We also performed a factor analysis (Varimax rotation).

Results: Our respondents displayed a somewhat negative view of primary care development in Germany. Many general practitioners expressed concerns as to whether primary care would remain secure in the long term. Despite partial progress, respondents saw a great need for countermeasures in the coming years. Nearly half of the respondents at 44% saw a noticeable decrease in general practices in their local area. Physicians in small towns and rural communities were more than twice as likely to experience the healthcare shortage due to a decline in general practitioners compared to their colleagues in medium-sized and large cities (42% versus 19%, p<0.001). More than half at 55% reported declining attractiveness in primary care for young physicians, which they attributed to three problem areas: 1) Position of primary care within the healthcare system, 2) Requirements for foundational and continuing medical education, 3) Working conditions. Respondents especially advocated the following approaches toward securing primary care: Establishing a primary care system (88%), more intense promotion of interest in primary care with points of contact in foundational and continuing medical education, especially in accompanying longitudinal programmes (78%), reinforcing multi-professional outpatient care centres (62%), restructuring curricula (54%) and enrolment criteria for medical study courses (51%), and reforming general medical training (55%).

Conclusions: General practitioners have their own proposals and preferences to add to the existing assessments and expert opinions. General practitioners should be involved more consistently than before in planning, implementing, and evaluating measures towards stabilising primary care. Various modes of participation and collaboration exist to this end.