Young general practitioners want to leave the traditional model of a lone doctor working long hours behind. But will their wish to work in a group practice instead stem Switzerland’s GP shortage?
Raphael Tièche, 36, did not intend to become a family doctor, put off in part by his GP father’s long hours. He worked instead in emergency medicine at Bern University Hospital.
“But then my Dad had a problem, nobody was found to work in his family practice. So the decision was either he closes it down or I was going to take it over,” Tièche told swissinfo.ch from his Grenchen office.external link
They turned the surgery into a group practice, working with one other doctor and training up young GPs. Nobody works full-time. “There is a doctor in the practice every working day and Saturday morning, so you have the service for your patients and the spare time for yourself that you need,” explained Tièche, who works 80%. His father works 50-60%.
Father and son are the practice stakeholders, but new doctors have the option of joining in after a period of employment.
From employee to owner
This is what Corinne Sydlerexternal link, 33, did. She works 70% in a five-doctor practice in Interlaken in the Bernese Oberland.
“I wouldn’t have had enough confidence at the outset to start as an owner. You feel so overwhelmed with the medical problems and you have hundreds of patients to get to know. I worked as an employee but I knew I would have the chance to buy shares in the practice and that’s what happened after a year,” she said.
It’s a good model, she said. Many of her GPs friends do not want to commit to ownership straightaway.
Marius Bachofnerexternal link, 36, from Oberkirch in canton Lucerne, and his GP business partner, aged 38, are also aiming to build a group practice up from its current three part-time GPs. “Few young GPs want to go into single practice these days. Group practices are the future,” he said.
Both he and Sydler appreciate being able to consult with colleagues. “I have dermatology as my speciality and my colleague ear, nose and throat, so I can always call him for a quick look at a patient if needed. We can really learn from each other,” Bachofner said.
The doctors’ experiences tally very much with the findings of a survey of young GPs’ career wishes among members of the Swiss Young General Practitioners Associationexternal link, which was recently published in some Swiss and international journalsexternal link.
It was carried out in response to concerns over the current shortage in GPsexternal link, which currently stands at 2,000. The average age of a GP is now 55, with 15% of Switzerland’s around 6,000 GPs being over 65, according to a 2015 reportexternal link. With more practices coming available - but not always being taken up - the survey wanted to find out under what conditions young doctors were requesting.
“We had foreseen that the majority of young GPs would like to work part time in smaller or larger group practices. This has been a clear trend,” said Sven Streitexternal link, from the Institute of Primary Health Care at the University of Bern, who was involved in the study.
“However it was surprising then that also a majority of people are foreseeing their career as a co- owner or owner of a group practice. An earlier, much smaller study from 2011 found that quite a large proportion of people wanted to be employed rather than practice owners”.
This had caused much discussion at the time, with accusations in the media and among older GPs that young GPs were too scared to venture out on their own. In addition, the increasing “feminisation” of the medical profession, with its tendency towards more part-time work, was blamed by some for the GP shortage.
The new survey dug deeper into the GP’s career wishes and found that they did want to take the plunge, but after up to five years of employment first.
Plugging the gap?
But is this group-practice model, with its better work-life balance, going to help plug the GP gap, expected to rise to 4,000 over the next decade? No, says Streit, himself a GP.
"Especially because both men and women want to work part-time, and we are talking part-time based on a 50 hours week, not the 70-90 hours week that we know the older GPs have been working in one-person practices. This means you will need two new GPs to replace an older one,” he said.
So what can be done? The study recommended that older GPs already start to build up small group practices. “This can be challenging when you have been working for 20 years on your own, so why should you invest money to build up a group practice, but actually we think it’s the way to go to attract young GPs,” Streit said.
In terms of the profession, current measures to attract more young doctors into family medicine will take time to be effective, says Streit. Important is practical experience in a GP surgery during medical training. This takes place as a matter of course in the Netherlands and the United Kingdom, for example.
Sydler says a key issue is image. “You have to show how good this job is, that you can live a wonderful life with lots of advantages and that you can earn enough money as a GP, even if it is - until now - not the same as a specialist.”
Bachofner says in a typical day he might see someone with a lung problem, help organise housing for a patient in need, see someone who wants to give up smoking and another with diabetes.
“I also do some surgery, and a little bit of dermatology. The variety makes it exciting. Also having our own practice means we are independent and can do whatever we want and think is right. And that’s great.”
Swiss medical association: reaction
Christoph Bosshard, vice president and head of data, demography and quality, said that the study’s findings were in line with the association’external links own statistics: that part-time work is on the rise more in outpatient practices than in hospitals, especially among women.
“The statement about practice ownership seems central to me,” he added in email comments. “Doctor-owned types of practices are preferable for both patients and doctors, because no investor interests need to be served or other dependencies arise.”
On March 29, the association published its latest statistics, showing 5,921 Internal General Medicine doctors (GPs) in practices in 2016. It found more over 65s among generalists in practice (including children’s doctors) than in 2008.