This study focuses on identifying and evaluating factors that positively influenced residents in their decision-making process in becoming general practitioners. It also challenges the assumption of an underlying chronic shortage of general practitioners in rural areas of canton Bern in Switzerland.
Firstly, these results indicate that a vocational training program in a general practice increases the likelihood of a career in general practice. In the case of our study, 81% of the trainees had become GPs or were on track . In addition to a training program in a GP setting, mentorship also plays a significant role for success. Mentorship during traineeship is enriching and effective on a professional as well as personal level, and in the field of general medicine no exception. Other studies have also indicated that mentors can make a significant contribution to the professional development of their medical trainees .
Besides the possibility of part-time work (49.7%) our study also shows most residents were female (67,9%) and trained in a dual or group practice (94.6%). The positive dynamics of a group practice with flexible work hours are important factors, allowing young doctors to take on family and professional responsibilities. Group practices lead to reduced work-load, better resource-sharing and a better cooperation with GPs in a practice. Other studies are also in line with these points and show that women consider time-related aspects and a patient orientated medical profession as important reasons for choosing general medicine . But it is not only women but also men who welcome a work-life balance. In particular, a younger generation of male medical doctors highly favor predictable work hours and personal fulfilment in comparison to their predecessors .
Accessible and efficient health care for people living in rural areas remains an issue of ongoing concern. The canton of Bern is a geopolitical area reflecting diverse urban and rural communities speaking one or both of the four major languages (German and French). Contrary to popular belief, our study shows that GPs have been seeking employment in rural areas of the canton of Bern. There is an urban-rural disparity in physician density, however the numbers of general practitioners starting a practice in a rural region in the canton of Bern has accordingly grown to meet the demands of a smaller rural population, with smaller population growth. Swiss cities und urban communities have grown markedly over the past decade. Accordingly, a higher proportion of general practitioners have started a practice in urban communities to meet the demands of an increased population growth.
Strengths and Limitations
This study allowed an evaluation of a state-funded program up to 10 years after implementation. It was a strength that participation rate was very high (92%) lowering the risk of selection bias.
We used a novel method to document the geographical distribution of new GPs with the zip code and population-based allocation. The results also provide insight on the availability of general practitioners in rural communities by documenting distribution of GPs with zip codes allocation.
However, this study has limitations. The outcome was assessed in an anonymous survey and we were therefore unable to link baseline data with outcome data. However, we chose anonymity to reduce the risk of social desirability bias .
Secondly, this study examined only residents who took part in the traineeship with a general practitioner working in the canton of Bern. Nevertheless our study results go in line with other studies in this field .
Implication for research and practice
Implementing vocational training for residents with a mentor GP in a practice is not only efficient in recruiting GPs but also provides a balanced distribution of GPs also to rural areas of canton Bern. Mentors who attend a training course can provide better support. By formalizing the process, mentoring can be more effective so that training residents becomes standardized . Although traineeships for residents with GPs have been implemented in other cantons of Switzerland, a thorough evaluation has not yet taken place. Implementing standardized traineeships in other cantons and providing traineeships in rural areas of Switzerland is also necessary and proved effective in recruiting young GPs. A federal run and funded traineeship as well as mentoring courses for GPs could be the next step in providing better coordination and availability for traineeships to all Swiss medical residents.