Abstract Body

Background Several European countries are facing a shortage of general practitioners (GPs). This shortage is in part linked to GP attrition. This study aimed to examine the career trajectories and multiple underlying decisions of general practice graduates. Methods We conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant’s career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants’ trajectories. We compared and contrasted trajectories to develop a typology of career trajectories. Results We identified 6 main types of career trajectories: ‘stable’ (graduates who had never considered leaving general practice), ‘reaffirmed (graduates who had considered leaving but opted to make substantial changes to their practice whilst remaining), ‘reactional reorientations’ (graduates who had left to escape the challenges of general practice), ‘inspired reorientations’ (graduates who had left to pursue a different job rather than to escape), ‘reorientations out of loyalty’ (graduates who had never wanted to practise as GPs and who had remained true to their original professional aspirations) and ‘mobiles’ (graduates who valued change and did not want to set-up practice). Conclusion Reasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.