Out-of-hours workload among Norwegian general practitioners – an observational study

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Abstract

Background

Repeated studies of working hours among Norwegian regular general practitioners (RGPs) have shown that the average total number of weekly working hours has remained unchanged since 1994 and up until 2014. For both male and female RGPs, the mean total weekly working hours amounted to almost 50 h in 2014.

In recent years, Norwegian RGPs have become increasingly dissatisfied. They experience significantly increased workload without compensation in the form of more doctors or better payment. A study from the Norwegian Directorate of Health in 2018 (the RGP study) showed that Norwegian RGPs worked 55.6 h weekly (median 52.5). 25% of the respondents worked more than 62.2 h weekly.

Based on data from the RGP study we investigated Norwegian RGP’s out-of-hours (OOH) work, how the working time was distributed, and to what extent the OOH work affected the regular working hours.

Methods

In early 2018, an electronic survey was sent to all 4640 RGPs in Norway. Each RGP reported how many minutes that were spent that particular day on various tasks during seven consecutive days. Working time also included additional tasks in the municipality, other professional medical work and OOH primary health care. Differences were analysed by independent t-tests, and regression analyses.

Results

One thousand eighty hundred seventy-six RGPs (40.4%) responded, 640 (34.1%) had registered OOH work. Male RGPs worked on average 1.5 h more doing regular work than did females ( p = 0.001) and on average 2.3 h more OOH work than females ( p = 0.079). RGPs with no OOH work registered a mean of 1.0 h more clinical work than RGPs working OOH ( p = 0.043). There was a large variation in OOH working hours. A linear regression analysis showed that male RGPs and RGPs in rural areas had the heaviest OOH workload.

Conclusions

One in three Norwegian RGPs undertook OOH work during the registration week in the RGP study. OOH work was done in addition to a sizeable regular workload as an RGP. We found small gender differences. OOH work was not compensated with reduced regular RGP work.

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Most cited references 14

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Exploring physician specialist response rates to web-based surveys

Ceara Tess Cunningham, Hude Quan, Brenda R. Hemmelgarn … (2015)

Background Survey research in healthcare is an important tool to collect information about healthcare delivery, service use and overall issues relating to quality of care. Unfortunately, physicians are often a group with low survey response rates and little research has looked at response rates among physician specialists. For these reasons, the purpose of this project was to explore survey response rates among physician specialists in a large metropolitan Canadian city. Methods As part of a larger project to look at physician payment plans, an online survey about medical billing practices was distributed to 904 physicians from various medical specialties. The primary method for physicians to complete the survey was via the Internet using a well-known and established survey company (www.surveymonkey.com). Multiple methods were used to encourage survey response such as individual personalized email invitations, multiple reminders, and a draw for three gift certificate prizes were used to increase response rate. Descriptive statistics were used to assess response rates and reasons for non-response. Results Overall survey response rate was 35.0%. Response rates varied by specialty: Neurology/neurosurgery (46.6%); internal medicine (42.9%); general surgery (29.6%); pediatrics (29.2%); and psychiatry (27.1%). Non-respondents listed lack of time/survey burden as the main reason for not responding to our survey. Conclusions Our survey results provide a look into the challenges of collecting healthcare research where response rates to surveys are often low. The findings presented here should help researchers in planning future survey based studies. Findings from this study and others suggest smaller monetary incentives for each individual may be a more appropriate way to increase response rates.

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Job satisfaction among general practitioners: a systematic literature review.

Klaas H. Groenier, Jaap W Groothoff, J Bleecker … (2005)

In recent years, the incidence of being overworked and burnt out has increased among general practitioners (GPs). One of the factors that influences the development of burnout is the job satisfaction that physicians experience. Therefore, we conducted a literature review to answer the question: what factors influence the job satisfaction experienced by GPs? We used two methods to retrieve citations. We searched four literature databases for citations from 1990 until July 2006, and we checked the reference lists of relevant articles. The inclusion criteria were: GPs had to be the subjects of the study, the study had to describe empirical research, the study had to focus on job satisfaction, and the number of subjects had to be greater than 30. We found 24 relevant citations. Factors increasing job satisfaction which were mentioned more than twice were: diversity of work, relations and contact with colleagues, and being involved in teaching medical students. Factors decreasing job satisfaction were: low income, too many working hours, administrative burdens, heavy workload, lack of time, and lack of recognition. Aspects of job satisfaction concerning the content of the profession seem to increase job satisfaction, and aspects concerning employment conditions seem to decrease job satisfaction.

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Workload in Norwegian general practice 2018 – an observational study

Tone Morken, Ingrid Rebnord, Kjell Maartmann-Moe … (2019)

Background Rising workload in general practice has been a recent cause for concern in several countries; this is also the case in Norway. Long working hours and heavy workload seem to affect recruitment and retention of regular general practitioners (RGPs). We investigated Norwegian RGPs’ workload in terms of time used on patient-related office work, administrative work, municipality tasks and other professional activities in relation to RGPs, and gender, age, employment status and size of municipality. Methods In early 2018, an electronic survey was sent to all 4716 RGPs in Norway. In addition to demographic background, the RGP reported minutes per day used on various tasks in the RGP practice prospectively during 1 week. Working time also included additional tasks in the municipality, other professional work and on out-of-hours primary health care. Differences were analysed by chi square test, independent t-tests, and one-way ANOVA. Results Among 1876 RGPs (39.8%), the mean total working hours per week was 55.6, while the mean for regular number of working hours was 49.0 h weekly. Men worked 1.5 h more than women (49.7 vs. 48.2 h, p = 0.010). Self-employed RGPs work more than salaried RGPs (49.3 vs. 42.5 h, p < 0.001), and RGPs age 55–64 years worked more than RGPs at age 30–39 (51.1 vs. 47.3 h, p < 0.001). 54.1% of the regular working hours was used on face-to-face patient work. Conclusions Norwegian RGPs have long working hours compared to recommended regular working hours in Norway, with small gender differences. Only half of the working time is used on face-to-face consultations. There seems to be a trend of increasing workload among Norwegian GPs, at the cost of direct patient contact. Further research should address identifying factors that can reduce long working hours. Electronic supplementary material The online version of this article (10.1186/s12913-019-4283-y) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Ingrid Keilegavlen Rebnord:

ORCID: http://orcid.org/0000-0002-1975-7404

inre@norceresearch.no

Tone Morken: tomo@norceresearch.no

Kjell Maartmann-Moe: kmaartma@online.no

Steinar Hunskaar: steinar.hunskar@uib.no

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 14 October 2020

Publication date PMC-release: 14 October 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 944

Affiliations

[1 ]National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Aarstadveien 17, NO-5009 Bergen, Norway

[2 ]GRID grid.461584.a, ISNI 0000 0001 0093 1110, The Norwegian Directorate of Health, ; Oslo, Norway

[3 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Global Public Health and Primary Care, , University of Bergen, ; Bergen, Norway

Author information

Ingrid Keilegavlen Rebnord http://orcid.org/0000-0002-1975-7404

Article

Publisher ID: 5773

DOI: 10.1186/s12913-020-05773-7

PMC ID: 7557051

PubMed ID: 33054822

SO-VID: 078d7bf2-7e7b-4c0c-887b-78ab138dd312

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 18 December 2019

Date accepted : 29 September 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003506, Helse- og Omsorgsdepartementet;

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: general practice,family medicine,out-of-hours medical care,primary care,workload,survey,observational study

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: general practice, family medicine, out-of-hours medical care, primary care, workload, survey, observational study

Out-of-hours workload among Norwegian general practitioners – an observational study

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Chinese Journal of General Practice

Most cited references 14

Exploring physician specialist response rates to web-based surveys

Job satisfaction among general practitioners: a systematic literature review.

Workload in Norwegian general practice 2018 – an observational study

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