Sources and implications of dissatisfaction among new GPs in the inner-city

Object;ives. We aimed to examine the factors that were most stressful for n ew principals in inner-city general practice. In addition, given the concer ns about retention of new principals, to ascertain whether high perceived s tress translated into regret that they had joined their practice and factor s that: might protect from regret. Methods. A questionnaire survey, within an inner-city Health Authority. The subjects were 101 GPs appointed as principals between 1992 and 1995. Results. Eighty-three out of 101 GPs replied. The greatest sources of stres s were, in order, patient expectations, fear of complaint, out-cc-hours str ess and fear of violence. Although these stresses were scored highly, 61% e xpressed no regret at having joined their practice with just 4% reporting c onsiderable regret. Stress within the partnership and stress arising from p atient expectations accounted for 23% of the variation in regret. Holders o f the MRCGP were significantly protected against regret; there was no evide nce that other factors such as medical positions outside the practice, memb ership of a young principals support group, fundholding status or training practices offered significant protection against regret. Conclusion. Despite reported difficulties in recruiting new young principal s to the inner-city-and despite their reported high levels of stress-few ha ve regrets about their decision to join their practice. FOP those who did r egret joining their practice, the three principal associations were partner ship stress, patient expectations and not possessing the MRCGP. Each of the se factors may be amenable to intervention by policies geared to improve GP retention.