title: [Changing to a career in general practice - a qualitative study reveals motives of specialists].
abstract: BACKGROUND
  In 2011, the national German Medical Association (Bundesärztekammer) published guidelines for a slim-lined training program in general practice (Quereinstieg) for qualified medical specialists in other fields (e. g., surgeons, internists or anesthesiologists). This step is part of a strategy to prevent further shortages of general practitioners in Germany. In the state of Baden-Wuerttemberg, qualified medical specialists are allowed to complete their general practice training in approximately two years instead of five. The aim of this study was to understand the reasons of specialists for changing to a career in general practice.
  
  
  METHODS
  The postgraduate training program VerbundweiterbildungplusBaden-Württemberg had 597 trainees at the time of the study in December 2015. Previously qualified specialists in another medical discipline were identified and invited to participate in this study. Qualitative data was gathered using semi-structured interviews with content analysis of the interviews performed by three independent members of the research team.
  
  
  RESULTS
  In total, 36 out of 597 trainees were identified as previously qualified specialists in another medical discipline. All 36 were invited to take part and 15 agreed to participate in this study. Overall, 15 interviews were performed, with a mean time of 24.19minutes. Participants with a median age of 40 years (33-59 years) - mainly anesthesiologists (n=7), surgeons (n=3) and internists (n=3) - presented with an average of 6.5 years of professional experience in their specialty. First, the participants' motivation to switch career arose from the wish to intensify the quality of patient contacts with a holistic approach including family and social background and from the infinite variety of general practice. Another reason given for a career change was self-employment opportunities. Finally, feelings of frustration over poor working conditions in hospitals resulted in a job search elsewhere in medicine, taking account of the challenges of ageing and family life. A major finding was that without the slim-lined program, the majority of participants would not have changed their career.
  
  
  CONCLUSIONS
  The slim-lined training program in general practice attracts experienced medical doctors. Specialists decide to change career because of the particular ways of working in general practice and with the intention to improve their daily work as a physician, either to improve individual working conditions and/or to improve their individual curative work profile. In addition, specialists are attracted by the concept of self-employment in general practice. Therefore, appreciation of the specific ways of working in general practice as well as management skills are most important during the reduced 2-year training. Further studies should investigate if facilitating a career switch to general practice is a good way to improve the shortage of general practitioners.
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland. Electronic address: simon.schwill@med.uni-heidelberg.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Schwill
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
authors.forename: Julia
authors.initials: J
authors.lastname: Magez
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Jäger
authors.affiliation: Hausärzte am Spritzenhaus - regiopraxis KVBW Baiersbronn, Baiersbronn, Deutschland.
authors.forename: Wolfgang Cg
authors.initials: WC
authors.lastname: von Meißner
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Flum
mesh_terms: D000328:Adult; D002321:Career Choice; D002322:Career Mobility; D005194:Family Practice; D058006:General Practice; D005858:Germany; D006801:Humans; D013038:Specialization
keywords: Allgemeinmedizin; Quereinstieg Allgemeinmedizin; Weiterbildung; change to career in general practice; general practice; postgraduate medical training