Facilitators and barriers affecting general practitioners’ choice to work in primary care units in Austria

Abstract

Background General practitioner (GP) workforce shortages are a global threat to primary health care systems. In Austria, nearly 75 % of qualified GPs are not working as contracted GPs within the social health insurance system. This study aims to explore the facilitators and barriers for non-contracted GPs to work in a primary care unit (PCU). Methods We conducted twelve semi-structured, problem-focused interviews among purposively sampled non-contracted GPs. To extract categories of facilitators and barriers for working in a PCU, transcribed interviews were inductively coded using qualitative content analysis. These subcategories were then grouped into categories of thematic criteria and mapped on the macro-, meso-, micro-, and individual levels. Results We identified 36 factors, including 18 facilitators and 18 barriers. Most facilitators were located on the micro-level, while most barriers were located on the macro-level. Teamwork, which allows focus on professional medical work, shared responsibilities, flexibility in working time and work-life balance, mainly make PCUs attractive as workplaces and correspond with individual demands. By contrast, the absence of a clear vision for reform and insufficient implementation produce general ignorance and resistance. The conditions of contracts with social health insurance providers, including the remuneration system, requirements for PCUs and high workload with little time for individual patient care, are seen as inflexible and discouraging. Combined with insufficient vocational training and the low perceived status of GPs and PHC generally, GPs voiced concerns about being an entrepreneur and businessperson. Conclusions Targeted and proactive measures are necessary to attract non-contracted GPs to leave their current individual work-life arrangement and consider working in a PCU, especially considering the higher perceived risks. Multi-faceted efforts are needed to approach factors on all levels. Addressing system barriers should include a reform strategy with a clearly stated mission, defined PHC role, and tangible stakeholder commitment, as well as a modernized remuneration system and supportive measures to equip GPs with essential competences and skills. Proactive communication and exchange could promote the already existing attractive working conditions in PCUs and attract non-contracted GPs into the public sector.