Collaboration with general practitioners: preferences of medical specialists--a qualitative study.
BACKGROUND
Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs?


METHODS
We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories.


RESULTS
'Teaching GPs' and 'regulating patient flow' (referrals) appeared to dominate when the motivational factors were considered. In addition, specialists want to develop relationships with the GPs on a more personal level. Most specialists believe that there is not much they can learn from GPs. 'Lack of time', 'no financial compensation', and 'no support from colleagues' were considered to be the main concerns to establishing collaborative care practices. Additionally, projects were often experienced as too complex and time consuming whereas guidelines were experienced as too restrictive.


CONCLUSIONS
Specialists are particularly interested in collaborating because the GP is the gatekeeper for access to secondary health care resources. Specialists feel that they are able to teach the GPs something, but they do not feel that they have anything to learn from the GPs. With respect to professional expertise, therefore, specialists do not consider GPs as equals. Once personal relationships with the GPs have been established, an informal network with incidental professional contact seems to be sufficient to satisfy the collaborative needs of the specialist. The concerns seem to outweigh any positive motivational forces to developing new models of collaborative practice.
Berendsen
Annette J
AJ
Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. a.j.berendsen@med.umcg.nl
Benneker
Wim H G M
WH
Schuling
Jan
J
Rijkers-Koorn
Nienke
N
Slaets
Joris P J
JP
Meyboom-de Jong
Betty
B
D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D020793:Gatekeeping; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D008875:Middle Aged; D017146:Models, Organizational; D009042:Motivation; D009426:Netherlands; D010348:Patient Care Team; D010549:Personal Satisfaction; D036301:Qualitative Research; D012017:Referral and Consultation; D013038:Specialization