Comparison of French training and non-training general practices: a cross-sectional study.
BACKGROUND
As the medicine practiced in hospital settings has become more specialized, training in primary care is becoming increasingly essential for medical students, especially for future general practitioners (GPs). Only a few limited studies have investigated the representativeness of medical practices delivering this training. The aim of this study was to assess the representativeness of French GP trainers in terms of socio-demographics, patients and activities.


METHODS
We conducted a cross-sectional study covering all private GPs practicing in the Rhône-Alpes region of France in 2011. This population consisted of 4992 GPs, including 623 trainers and 4369 non-trainers, managing 8,198,684 individual patients. Data from 2011 to 2012 were provided by the Regional Health Care Insurance (RHCI). We compared GP trainers with non-trainers using the Pearson chi-square test for qualitative variables and the Student t-test for quantitative variables


RESULTS
GP trainers do not differ from non-trainers for gender, but they tend to be younger, more frequently in mid-career, and more likely to practice in a rural area. Their patients are broadly representative of patients attending general practice for age (with the exception of a higher consultation rate for infants), but patients with medical fee exemption status relating to low income are underrepresented. GP trainers have a heavier workload in terms of office visits and on-call duties. They prescribe a higher proportion of generic drugs, perform more electrocardiograms and cervical smears, and fewer plaster casts. GP trainers show better performance in diabetes follow-up, and to a lesser extent for seasonal flu vaccination and mammograms.


CONCLUSIONS
GPs and patients of training practices are globally representative, which is particularly critical in countries such as France, where the length of specialty training in a general practice setting is still limited to a few months. In addition, GP trainers tend to have better clinical performance, which conforms to their teaching modelling role and may encourage other GPs to become trainers.
Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France. laurent.letrilliart@univ-lyon1.fr.|Universite de Lyon, Equipe d'Accueil HESPER 7425, Lyon, France. laurent.letrilliart@univ-lyon1.fr.
Laurent
L
Letrilliart
Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France.
Pauline
P
Rigault-Fossier
Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France.
Benoit
B
Fossier
Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France.
Nadir
N
Kellou
Département de médicine générale, Universite de Grenoble, Grenoble, France.
Françoise
F
Paumier
Département de médicine générale, Universite de Saint-Etienne, Saint-Etienne, France.
Christophe
C
Bois
Hospices Civils de Lyon, Pôle IMER, Lyon, France.
Stéphanie
S
Polazzi
Universite de Lyon, Equipe d'Accueil HESPER 7425, Lyon, France.|Hospices Civils de Lyon, Pôle IMER, Lyon, France.
Anne-Marie
AM
Schott
Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France.|Universite de Lyon 1, Equipe d'Accueil Sciences et Société, Historicité, Education et Pratique (S2HEP) 4148, Lyon, France.
Yves
Y
Zerbib
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D058006:General Practice / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012959:Socioeconomic Factors; D016526:Workload; D055815:Young Adult
French; General practice; Performance; Representativeness; Training practices