title: Experience as a doctor in the developing world: does it benefit the clinical and organisational performance in general practice?
abstract: BACKGROUND
  Many physicians have medical experience in developing countries early in their career, but its association with their medical performance later is not known. To explore possible associations we compared primary care physicians (GPs) with and without professional experience in a developing country in performance both clinical and organisational.
  
  
  METHODS
  A retrospective survey using two databases to analyse clinical and organisational performance respectively. Analysis was done at the GP level and practice level.517 GPs received a questionnaire regarding relevant working experience in a developing country. Indicators for clinical performance were: prescription, referral, external diagnostic procedures and minor procedures. We used the district health insurance data base covering 570.000 patients. Explorative secondary analysis of practice visits of 1004 GPs in 566 practices in the Netherlands from 1999 till 2001. We used a validated practice visit method (VIP; 385 indicators in 51 dimensions of practice management) to compare having experience in a developing country or not.
  
  
  RESULTS
  Almost 8% of the GPs had experience in a developing country of at least two years.These GPs referred 9,5% less than their colleagues and did more surgical procedures. However, in the multivariate analysis 'experience in a developing country' was not significantly associated with clinical performance or with other GP- and practice characteristics. 16% of the practices a GP or GPs with at least two years experience in a developing country. They worked more often in group and rural practices with less patients per fte GP and more often part-time. These practices are more hygienic, collaborate more with the hospital and score better on organisation of the practice. These practices score less on service and availability, spend less time on patients in the consultation and the quality of recording in the EMD is lower.
  
  
  CONCLUSIONS
  We found interesting differences in clinical and organisational performance between GPs with and without medical experience in developing countries and between their practices. It is not possible to attribute these differences to this experience, because the choice for medical experience in a tropical country probably reflects individual differences in professional motivation and personality. Experience in a developing country may be just as valuable for later performance in general practice as experience at home.
authors.affiliation: IQhealthcare, Center for Quality of Care Research, University Medical Center Nijmegen (UMCN), 6500 HB Nijmegen, The Netherlands. p.hombergh@chello.nl
authors.forename: Pieter
authors.initials: P
authors.lastname: van den Hombergh
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: Frank A M
authors.initials: FA
authors.lastname: van Balen
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D009426:Netherlands; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000458:organization & administration / Q000706:statistics & numerical data; D011216:Practice Management, Medical / Q000458:organization & administration* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000592:standards; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014330:Tropical Medicine / Q000706:statistics & numerical data; D016526:Workload / Q000523:psychology / Q000706:statistics & numerical data