Regional shortages of general practitioners threaten healthcare

Edition 30 August, by Lorre Luther

After Wilko Siderius moved from Beekbergen to Leeuwarden early in 2018, he attempted to find a local family physician close to his new home. Although suffering from life-threatening colon cancer, Siderius was unable to find a general practitioner willing to oversee his care. Every doctor he contacted in the Frisian capital turned him away, citing already unreasonably high patient loads. Unable to refer him to a general practitioner in Leeuwarden accepting new patients, several physicians advised Siderius to contact his insurance company, CZ, for assistance. CZ was not able to help. Siderius had officially come face to face with the reality of Friesland’s regional general practitioner shortage. Left with no other option, he was forced to continue receiving care from his old family doctor in Beekbergen, more than 150 kilometers away.

According to Sharon Dijksma, a member of Parliament fort he PvdA, similar situations occur with disappointing frequency in both Groningen and Friesland. The province of Zeeland and city of Tilburg are also facing similar difficulties. The issue, according to Bruno Bruins, Minister of Healthcare and Sport, is likely to get worse over the next five to ten years, due to the impending retirement of large numbers of general practitioners in these areas. According to statistics published by the Dutch Instituut voor Onderzoek van de Gezondheidszorg (Institute for Research on Healthcare), more than 46 percent of currently practicing general practitioners in Zeeland are over 55. Insurance company De Friesland estimates that over 40 percent of Leeuwarden’s family doctors will retire by 2023.

The shortfall is intensified by the reluctance of young general practitioners to live and work in areas already facing deficits in the number of family physicians. According to Bruins, the Netherlands produces enough family doctors to meet its current requirements, but there are simply not enough in areas with the most need. Economic forces often contribute to the shortage of family practitioners in heavily rural provinces like Groningen and Friesland. In East Groningen, one of the hardest hit parts of the country, most patients receive care from doctors operating solo practices in rural locations, according to Etty ter Steeg, regional manager of insurance company Menzis. Practices in these areas are often far from economically dynamic urban hubs. Limited employment opportunities for the frequently highly educated partners of young general practitioners increase the difficulty of attracting physicians to the region.

The growing feminization of the profession also contributes to the pattern. According to Bert van der Hoek, director of De Friesland, older retiring male physicians typically work 50 hours a week. Young female physicians often prefer more flexible, part-time schedules, and more women enter the profession every year. As a result, two new doctors are often required to replace one retiring family physician in areas where attracting new doctors is already an uphill struggle. According to Dijksma, the administrative red tape involved in running a practice also makes it difficult to convince young practitioners to take over existing offices. Throughout the Netherlands, increasing numbers of family doctors are choosing to work in large practice groups or under the supervision of another physician to minimize the time spent dealing with paperwork.

Dijkstra has called for efforts “to ensure areas suffering shortages remain attractive so there’ll be enough healthcare practitioners.” She’s been pushing to have the national government take on the problem. Bruin has already ordered research into the causes of the shortfalls. Efforts to remedy shortages are already underway at the provincial level, where health insurers, support organizations and practicing family physicians have started working together to create and implement solutions. The insurance company Menzis, Elann, an organization that provides support to general practitioners, and local physicians are together developing ways to address the shortage in Groningen. Menzis helps new physicians interested in working in the province purchase established practices by providing financial support. Elann offers to take care of almost all financial and administrative duties for physicians willing to relocate to the province. It even provides help negotiating contracts with insurance companies. A buddy project encourages experienced family physicians to hire and help young doctors become more comfortable with the administrative and financial sides of the business. “We’re working to get the general practitioner shortage under control as quickly as possible. We refuse to wait until a practice is empty and are always happy to speak with general practitioners who are willing to take over a difficult-toreplace practice,” says Ter Steeg.