Парашкевова-Симеонова, Боряна; Parashkevova-Simeonova, Boriana

Професионална кариера на лекарите в общата медицинска практика

2014

Тракийски университет

Thesis

bul

лекари; кариера; обща медицинска практика

Introduction: Primary health care is the only level of the Healthcare System which allows the most effective usage of the limited financial resources for achieving better outcome in health preservation and improvement. Primary health care in Bulgaria is entirely based on the general practitioners work. Goal: Measurement and analysis of the professional path, legislation barriers and satisfaction of the general practitioners, as key resource ensuring stability of the primary health care. Research task: 1. Studying the components and perspectives for professional career of the general practitioners; 2. Examination of the profile of the GPs as workforce; 3. Research of the organizational aspects of physicians’ work and defining the main issues in organizational context; 4. Investigating the factors of satisfactions from the general practitioner’s job; 5. Examination of characteristic determining the ethical context of the GPs work – trust, acknowledgement and public recognition; 6. Studying the legislation barriers met in the general practice and the development of the primary health care practices. Materials and methods: The study uses for its purposes the following methods: quantitative methods with the execution of empiric sociological research among the general practitioners in Stara Zagora Region, through individual semi standardized interview – face to face, and qualitative methods – analysis of documents and monitoring. Statistical methods are being used as well. Subject of research are all general practitioners on the territory of Stara Zagora District. . The questionary contains 34 questions divided into six main areas: characteristics of the physicians; characteristics of the practice; morally-ethical dimensions of the professional career; work-life balance; professional activities. The professional satisfaction is being studied using JSS – job satisfaction scale. Results and discussion: There are 235 physicians (as of the period of the research July – December 2012) owners of outpatients’ departments for primary health care on the territory of Stara Zagora District, who are contractual counterparts of the Regional Health Insurance Fund Stara Zagora for providing primary health care (PHC). A total number of 223 out of 235 participated the study which defines 94.9% participation rate. The group of general practitioners working on the territory of Stara Zagora District is one of the biggest in the country. Their average age is 49 years. The greatest number and percentage is in the 45-54 years group. There is only 1 doctor in the age group up to 35 years. The women represent almost three fourths of the workforce in the healthcare area in the EU, and in the physician’s profession they are half of it. In our survey the women represent almost two thirds -62.8% (140). The professional characteristics of the general practitioners show that 30.6% have qualification General Medicine and 44.4% have no qualification. Based on the characteristics of their outpatients departments, GP’s are being distinguished as follows: 92% work in individual practices and only a very small number in group ones. The satisfaction model is being studied by the basic indications of stratification. Statistically sizable differences per gender, type of practice and some of the satisfaction factors have been identified. The development of healthcare in the conditions of market economy, affects traditional values in the 83 medical profession like trust and acknowledgement. The trust is key element in all interpersonal relations, but has a significant importance in the relations doctor – patient. Relatively small number physicians – 15.2% put the highest possible rate of the trust of their patients. The characteristics of primary health care in the different countries are various, but nevertheless the complexity and well developed system of primary care should possess the four basic elements: access, continuity of the health care, complexity (integrity) and coordination of the activities. Every third GP (30%) out of the studied group shares that the responsibility and provision of out hours care is amongst the most common issues in their work. Conclusions: There is a real threat of lack of physicians in the general medical practice. The opportunities for career development in the area of the general practice are critical especially for the young professionals. Urgent measures should be taken in order to make the general medicine practice more attractive and satisfactory. The multiple challenges in front of the GPs in the small villages do not reflect the aspirations and interests of the physicians for professional realization and career development. GPs are, in a big extent, skeptical in regards of the recognition for their work both by the patients and the doctors. Se well determined insufficient acknowledgment of the physicians work in the general practice is being perceived as indicator showing the perspective of the GP’s career. More than half of the general practitioners think that the medical professions is not possessing sufficient public prestige. Every third GP defines the problem with the continuous twenty four hours access, as one of the most common in their practice. The satisfaction rate as per the applied scale outlines a model in which all studied factors have contribution. Clinical freedom is being assessed as the most satisfying thing in the general medical practice. The lack of satisfaction is related predominantly to the regulations which should be followed. The contributions of the dissertation are as follows: Implemented for a first time methodological approach with opportunity of in depth analysis of the problem for career development. This approach could be applied as a model for comparison of the effectiveness of the implemented policies in following researches. The practical contributions are in the context of the goals set. They are as follows: The profile of the general practitioners as a workforce is being studied; The organizational aspects of physicians’ work are being studied and basic issues are being determined; The factors of professional satisfactions are explored; Ethical determinant features of the GPs work like trust, acknowledgement and public recognition are examined.