Wer strebt am Ende des Medizinstudiums eine Hausärztekarriere an? Umfrage unter Schweizer Studierenden.

How Many Advanced Medical Students Aim for a Career as a GP? Survey among Swiss Students Abstract. According to an earlier prognosis for 2025, Switzerland will lack 5000 general practitioners (GP), since only 10-20 % of medical students wanted to choose this profession at the time of the survey. The aim of our investigation among advanced medical students was to record their career intentions anew. Beside the probability of becoming a GP, we looked at the time point of this decision and at factors around family medicine (doctor-patient relation, career possibilities, etc.) influencing this decision. The results showed that measures to promote family medicine have been successful: 60 % of interrogated students are possible GPs (20 % decided, 40 % interested), 15 % are undecided, 25 % have decided not to become a GP. The favorable factors to become a GP were: autonomy, doctor-patient relationship, possibility of part-time work, work content. Less favorable were: income, reputation, political situation. These are the points where action is required to promote careers in family medicine with attractive training and practice conditions.

Swiss students and young physicians want a flexible goal-oriented GP training curriculum.

BACKGROUND: A growing shortage of general practitioners (GPs), in Switzerland and around the world, has forced countries to find new ways to attract young physicians to the specialty. In 2017, Switzerland began to fund hundreds of new study places for medical students. This wave of young physicians will soon finish University and be ready for postgraduate training. We hypothesized that an attractive postgraduate training program would encourage interested young physicians to pursue a GP career. METHODS: This is a cross-sectional survey of young physicians from the Swiss Young General Practitioners Association (JHaS), members of Cursus Romand de médecine de famille (CRMF), and all current medical students (5th or 6th years) (n = 554) in Switzerland, excluding students indicating definitely not to become GPs. We asked all if they were likely to become a GP (Likert: 1-10), and then asked them to score general features of a GP training curriculum, and likely effects of the curriculum on their career choice (Likert scale). They then rated our model curriculum (GO-GP) for attractiveness and effect (Likert Scales, open questions). RESULTS: Most participants thought they would become GPs (Likert: 8 of 10). Over 90% identified the same features as an important part of a curriculum ("yes" or "likely yes"): Our respondents thought the GO-GP curriculum was attractive (7.3 of 10). It was most attractive to those highly motivated to become GPs. After reviewing the curriculum, most respondents (58%) felt GO-GP would make them more likely to become a GP. Almost 80% of respondents thought an attractive postgraduate training program like GO-GP could motivate more young physicians to become GPs. CONCLUSIONS: Overall, medical students and young physicians found similar features attractive in the general and GO-GP curriculum, regardless of region or gender, and thought an attractive curriculum would attract more young doctors to the GP specialty. Key points An attractive postgraduate training program in general practice can attract more young physicians to become GPs. In this study cross-sectional survey including medical students (n = 242) and young physicians (n = 312) we presented general features for a curriculum and a model curriculum for general practice training, for evaluation of attractiveness to our study population. General practice training curriculum provides flexibility in choice of rotations, access to short rotations in a wide variety of medical specialties, training in specialty practices as well, mentoring and career guidance by GPs and guidance in choosing courses/certificate programs necessary for general practice. These findings help building attractive postgraduate training programs in general practice and fight GP shortage.

From practice employee to (co-)owner: young GPs predict their future careers: a cross-sectional survey.

BACKGROUND: In Switzerland, the mean age of GPs in 1993 was 46. In 2015, it had increased to 55, and GPs over 65 made up 15% of the workforce of the about 6000 GPs. As older, self-employed GPs retire, young doctors will be needed to fill their positions and eventually take over their practices. We set out to determine what kind of employment young GPs wanted, if they thought their preference would change over time, and the working conditions and factors most important in their choice of practice. METHODS: We administered a cross-sectional online survey to members of the Swiss Young General Practitioners Association (n = 443). Our survey relied on closed questions, ratings of attractiveness of fictional job ads, and an open question to capture participants' characteristics, and their preferred type of practice and working conditions. RESULTS: We received 270 (61%) replies. Most were women (71%) and wanted to work in the suburbs or countryside in small GP-owned group practices, with up to five colleagues. Most intended to work part-time: mean desired workload was 78% for men and 66% for women. Positive working climate was a major factor in choosing a GP practice. Most participants projected a career arc from employment to ownership or co-ownership of a practice within five years; only 7-9% preferred to remain employees. CONCLUSIONS: Young and future GPs in Switzerland want to work part-time in small, GP-owned group practices. Practices should offer them employment opportunities with a path to (co-)ownership.

The outcome of the primary vascular access and its translation into prevalent access use rates in chronic haemodialysis patients.

BACKGROUND: The American Fistula First Breakthrough Initiative currently aims for a 66% arterio-venous fistula (AVF) rate, while in the UK, best practice tariffs target AVF and arterio-venous graft (AVG) rates of 85%. The present study aims to assess whether these goals can be achieved. METHODS: We conducted a retrospective cohort study on patients who initiated haemodialysis from 1995 to 2006. Outcomes were the final failure-free survival of the first permanent access and the type of second access created. Prevalent use rates for the access types were calculated on the 1st January of each year for the second half of the study period. RESULTS: Two hundred and eleven out of 246 patients (86%) received an AVF, 16 (6%) an AVG and 19 (8%) a permanent catheter (PC) as the first permanent access. Eighty-six (35%) patients had final failure of the primary access. One- and 3-year final failure-free survival rates were 73 and 65% for AVF compared with 40 and 20% for AVG and 62 and 0% for PC, respectively. In patients with primary AVF, female sex {hazard ratio (HR) 2.20 [confidence interval (CI) 1.29-3.73]} and vascular disease [HR 2.24 (CI 1.26-3.97)] were associated with a poorer outcome. A similar trend was observed for autoimmune disease [HR 2.14 (CI 0.99-4.65)]. As second accesses AVF, AVG and PC were created in 47% (n = 40), 38% (n = 33) and 15% (n = 13). The median prevalent use rate was 80.5% for AVF, 14% for AVG and 5.5% for PC. CONCLUSIONS: The vascular access targets set by initiatives from the USA and UK are feasible in unselected haemodialysis patients. High primary AVF rates, the superior survival rates of AVFs even in patient groups at higher risk of access failure and the high rate of creation of secondary AVFs contributed to these promising results.

Morbidity and mortality on chronic haemodialysis: a 10-year Swiss single centre analysis.

BACKGROUND: Patient survival on chronic haemodialysis varies considerably among different countries and healthcare systems. To date, the survival of Swiss dialysis patients has not been analysed separately. METHODS: We consecutively enrolled 266 patients entering the chronic haemodialysis program of the University Hospital Basel between 01.01.1995 and 30.06.2006 into a cohort study. Patient survival on chronic haemodialysis was the primary endpoint. Pre-specified sub-group analyses were performed for female and diabetic patients. RESULTS: Patient age ranged from 15 to 90 years. Seventy-two percent suffered either from coronary artery, peripheral artery or cerebrovascular disease and 34% from diabetes. Sixty-nine (26%) patients underwent kidney transplantation. Transplanted patients were significantly younger (p <0.01) and less likely to suffer from diabetes (p <0.01) and atherosclerotic diseases (coronary, peripheral, cerebrovascular p for all ≤0.01). Median survival was 4.25 years (95%CI 3.66-5.50), with one, three and five year survival rates reaching 88%, 68% and 46%. Survival rates were equal in men and women (p = 0.34), among diabetic and non-diabetic patients (p = 0.41) and among men and women stratified for the presence of diabetes (p = 0.13). Overall, 34% (91/266) patients died during the observational period. Thirty three percent of all deaths were caused by cardiac events, followed by malignant diseases (8%) and infections (7%). In 9% (23/266) dialysis was withdrawn and withdrawal of dialysis contributed to death in 25% (23/91). CONCLUSION: Survival on chronic haemodialysis treatment in Switzerland compares favourably to international reference values. Dialysis withdrawal and the frequency of kidney transplantation impact long term patient outcome and should be adjusted for when comparing mortality analysis.