Preventing a shortage of general practitioners in Austria

Background: In Austria, almost half of GPs will reach retirement age within the upcoming ten years. Nevertheless, the specific number of young physicians who intend to replace them is unknown and might be insufficient. Avoiding a GP shortage is therefore an indispensable challenge. Aims. Developing a comprehensive catalogue of potentially effective measures to prevent a GP shortage, assessing these measures’ understandability, effectiveness and feasibility, identifying practical considerations for implementing prioritised measures and analysing current GP shortage reform processes. Methods: Firstly, a search strategy for international policy documents and literature reviews included bibliographical databases, institutional websites, an internet search engine, and references of included publications. Three experts reviewed extracted measures. Secondly, identified measures were assessed for understandability, effectiveness and feasibility by a two-phase expert panel process. Ten relevant experts performed structured assessments through e-mail and a face-to-face workshop. Thirdly, previously prioritised measures were assessed for practical considerations concerning implementation by six relevant experts through a semi-structured questionnaire. Fourthly, 26 semi-structured interviews were performed with key experts from different stakeholders and regions and supplemented with a documentary analysis. Theories on agenda setting and research utilization informed a framework analysis. Results: Firstly, ten policy documents and 32 literature reviews informed a catalogue of 95 potentially effective measures. Secondly, seven measures were considered effective and feasible by key experts. Thirdly, several practical considerations were identified concerning implementing prioritised measures. Fourthly, the GP shortage receives public and stakeholder attention but there seems to be little agreement on its definition, severity, causes and solutions. Attention was reportedly raised by alarmed mayors and media coverage but less by advocacy efforts or policy entrepreneurship. Research studies apparently increased recognition of the problem and policy alternatives. Conclusions: This thesis offers a comprehensive catalogue of assessed measures to prevent a GP shortage. The current reform processes indicate room for improvement.