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Master Thesis

Les déterminants de la pratique du partage d’honoraires en Médecine Générale : la volonté du collectif

Abstract : Background: self-employed French General Practitioner’s usual source of income is fee-for-service on an individual basis. Professionnal associations practicing fee sharing are scarce and little known. Primary cares evolution raises questions about remuneration methods and their impacts on medical practices. As this subject has never been treated before, we aimed to explore determining factors for fee sharing among French GPs. Objectives: primary objective was to explore determining factors as described by interviewed GPs. Secondary objectives included description of motivations, advantages, disadvantages and limits of fee sharing as well as practical uses among studied sample. Method: qualitative research design using content analysis was used. Eleven French GPs currently or formerly practicing fee sharing participated in semistructured telephone interviews. Analysis was conducted through NVivo software following phenomenological analysis principles. Results: main motivation is a quest for an alternative to individual fee-for-service which is massively rejected. Other motivations seem to be of a more philosophical or activist nature, aiming for a group activity. Fee sharing draws away from competition and supports installation for a new member. Main advantage is to promote teamwork. It guarantees financial security, stimulates positive values and foster the overall GPs mission. Main disadvantage is reduction in individual freedoms and rigidity in organization which might be a source of tensions. It requires good relationship, great confidence and fairness in sharing out of tasks. A framework seems to be necessary but has also to be flexible. Participants reckon that this plan can’t be generalized to every GPs as it requires deep motivations. Scope of sharing was from limited to full with a distribution depending usually on work time. Conclusion: this research gives better knowledge of fee sharing, which could be part of a solution for fostering teamwork or drawing away from fee-for-service plans. It is a collective tool able to promote solidarity values. Self-governance allows to soften its limits.
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Master Thesis
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Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Thursday, August 23, 2018 - 12:17:55 PM
Last modification on : Friday, August 31, 2018 - 1:08:31 AM
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  • HAL Id : dumas-01860366, version 1



Maud Kieffer-Nunes. Les déterminants de la pratique du partage d’honoraires en Médecine Générale : la volonté du collectif. Médecine humaine et pathologie. 2018. ⟨dumas-01860366⟩



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