OP-167 : private or salaried practice: how do general practitioners make their choice? A qualitative research study in France

Shérazade Kinouani, Gary Boukhors, Baptiste Luaces, Bernard Plédran, Bernard Gay Department of general practice, University of Bordeaux, Bordeaux, France
Background & AIM: in France, the primary health care system is largely based on the private practice of general practitioners. The number of general practitioners who had exclusively a private activity has decreased of 4.4% these last seven years, while the number of salaried general practitioners has increased. These trends could continue, at least until 2020, in spite of measures taken by French government or local communities to encourage young practitioners to choose private activity. The aim of this study was to explore the reasons determining choice between private or salaried practice among young general practitioners in Gironde (France). METHOD: a qualitative study was conducted by semi-structured interviews with a purposive sampling of young general practitioners in Gironde between june 2013 and april 2014, until reaching saturation. Data were analyzed according to Grounded theory, after triple coding. RESULTS: Through the 16 interviews led, multiple occupational factors were found, the first being professional interest. Their choice was not much influenced by the installation location (rural or urban). The occupational factors had to be consistent with their private (family or social) life. Young practitioners were attracted by health Centres. They hoped a less intensive work rhythm, which would lead to a better quality of care, an easier access to team work or the possibility of advantages of the public area in general practice. They thought current incentives were not efficient enough, inaccurate and weakly known. CONCLUSION: The problem of French medical demography could be resolved with incentives who take into account at a time the needs of population and the wishes of young doctors. A political effort must be made in order to give to the French universities enough resources to train and encourage the future general practitioners to the private practice. Keywords: general practice, private practice, qualitative research