Gestion des soins non programmés en médecine générale dans le secteur du Sud Gironde.

INTRODUCTION: Unscheduled care (UC) is a current issue, particularly in the context of COVID-19 outbreak. UC is at the center of health policies, mainly in terms of the negative impact they have on hospital emergency services. This occurs in a context of imbalance between increasing health needs and changing healthcare offer. AIM: The aim of this study was to describe the organization of general practitioners in UC management in South-West France. METHOD: Our research was based on the combination of a cross-sectional descriptive study by self-questionnaire, and a collection of qualitative data via semi-structured interviews. RESULTS: 79% of practitioners delegated their hotline to a "medical secretary"; 67% had a specific organization to manage UC, especially by means of dedicated slots; 88% proposed a structured management of UC. The secretary appeared to be a necessary link for managing UC requests, mainly through the role of sorting, regulating and scheduling UC appointments. Group work was highlighted as a means to distribute the response to UC requests more fairly, to carry out unscheduled home visits and to prevent healthcare refusal. Nevertheless, this group management seemed difficult to implement outside of medical centers, especially at the level of health territory. CONCLUSION: the majority of GPs had implemented structured and shared management of UC, but they needed help and support to organize themselves across a territory, for example within the framework of "territorial health professional communities".

Private or salaried practice: how do young general practitioners make their career choice? A qualitative study.

BACKGROUND: Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners. METHODS: A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently. RESULTS: Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice. CONCLUSIONS: National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.