From training to practice: a longitudinal study on the retention and career entry of young general practitioners in Czechia

BACKGROUND: The location of postgraduate training is considered a key determinant for the future practice location of primary care physicians. This study evaluates the effectiveness of the GP training program in Czechia, focusing on the spatial and temporal links between the place of training and subsequent career entry. METHODS: We conducted a longitudinal analysis of contractual data from the General Health Insurance Company (GHIC). While GHIC insures approximately 60% of the Czech population, it maintains contracts with virtually all GP practices providing standard care in Czechia, ensuring near-complete coverage of the primary care provider network. We tracked 661 GP trainees who completed their training between 2009 and 2022. Career paths were analyzed using geolocation mapping at four administrative levels (from municipality to region) alongside data on age, sex, and full-time equivalent (FTE) workloads. RESULTS: Entry into independent practice is a gradual process: only 55% of doctors established a contract within the first year (44% specifically in GP), increasing to 83% after seven years (79% in GP). A significant gender gap was observed: men entered practice more rapidly and with higher FTEs, while women (representing 73% of the cohort) showed a slower, steadier increase in practice involvement. Geographic retention at the regional level (NUTS 3) reached 65% for part-time and 49% for full-time positions after seven years. Retention at the municipal level (LAU 2) was lower (40% and 28% respectively), often linked to trainees taking over established practices from their trainers. CONCLUSIONS: The study confirms the ongoing feminization of primary care and a growing preference for flexible workloads among young GPs. While the place of training significantly influences future practice location, the transition to independent practice is not immediate. These findings suggest that healthcare workforce planning should account for the specific career trajectories of female physicians and the importance of regional training capacities to ensure long-term stability in primary care.