title: Motives for early retirement of self-employed GPs in the Netherlands: a comparison of two time periods.
abstract: BACKGROUND
  The high cost of training and the relatively long period of training for physicians make it beneficial to stimulate physicians to retire later. Therefore, a better understanding of the link between the factors influencing the decision to retire and actual turnover would benefit policies designed to encourage later retirement. This study focuses on actual GP turnover and the determining factors for this in the Netherlands. The period 2003-2007 saw fewer GPs retiring from general practice than the period 1998-2002. In addition, GPs' retirement age was higher in 2003-2007. For these two periods, we analysed work perception, objective workload and reasons for leaving, and related these with the probability that GPs would leave general practice at an early age.
  
  
  METHODS
  In 2003, a first retrospective survey was sent to 520 self-employed GPs who had retired between 1998 and 2002. In 2008, the same survey was sent to 405 GPs who had retired between 2003 and 2007. The response rates were 60% and 54%, respectively. Analyses were done to compare work perception, objective workload, external factors and personal reasons for retiring.
  
  
  RESULTS
  For both male and female GPs, work perception was different in the periods under scrutiny: both groups reported greater job satisfaction and a lower degree of emotional exhaustion in the later period, although there was no notable difference in subjective workload. The objective workload was lower in the second period. Moreover, most external factors and personal reasons that may contribute to the decision to retire were reported as less important in the second period. There was a stronger decrease in the probability that female GPs leave general practice within one year than for male GPs. This underscores the gender differences and the need for disaggregated data collection.
  
  
  CONCLUSIONS
  The results of this study suggest that the decrease in the probability of GPs leaving general practice within one year and the increasing retirement age are caused by a decrease in the objective workload, a change in GPs' work perception, external factors and personal reasons. Based on the results of this study, we consider workload reduction policies are the most useful instruments to control retention and retirement.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.vangreuningen@nivel.nl
authors.forename: Malou
authors.initials: M
authors.lastname: Van Greuningen
authors.forename: Phil J M
authors.initials: PJ
authors.lastname: Heiligers
authors.forename: Lud F J
authors.initials: LF
authors.lastname: Van der Velden
mesh_terms: D000375:Aging; D016001:Confidence Intervals; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006280:Health Workforce; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D011331:Private Practice; D012179:Retirement / Q000639:trends*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016526:Workload