GENERAL PRACTITIONERS' PREFERENCES FOR CLINICAL WORK IN THE PHYSICIAN'S OFFICE VERSUS PUBLIC HEALTH TASKS

Wednesday, October 23, 2013
Key Ballroom Foyer (Hilton Baltimore)
Poster Board # P4-11
Health Services, and Policy Research (HSP)

Peder A. Halvorsen, MD, PhD1, Ivar J. Aaraas, MD, PhD1, Jan Abel Olsen, MA, MSc, PhD1, Olaf Gjerløw Aasland, MD, MHA2 and Ivar Sønbø Kristiansen, MD, PhD, MPH3, (1)University of Tromsø, Tromsø, Norway, (2)The Norwegian Medical Association, Oslo, Norway, (3)University of Oslo, Oslo, Norway
   Purpose: According to current legislation Norwegian general practitioners (GPs) may be required to work one day a week with public health tasks such as school health services, maternal and child health care, or care for patients in nursing homes and prisons.  As part of a forthcoming health care reform it was proposed that GPs should spend two days a week in public health. Changing the remuneration scheme from private capitation and fee-for-service practice to salaried positions was also considered.  We aimed to explore determinants of GPs’ preferences for time spent in public health.

   Methods: In a cross sectional web-based survey 3,270 GPs were asked to state their preference for “practice A” (4 days in the GPs office, 1 day in public health, 1,000 patient enlisted,  private practice ) versus “practice B” (3 days in the office, 2 days in public health, 750 patients enlisted, salaried position).  The GPs were randomly allocated to different versions of the choice task where income level relative to their current job was manipulated.  Subsequently they were presented with 4 type B practices that differed with respect to number of patients enlisted, corresponding income and working hours per week and asked which practice they found most attractive.  

   Results: Approximately 40% (n=1,308) responded.  When forced to choose between type A and type B practices, 76% - 78% preferred type A practice when offered better income relative to type B practices.  Even when offered relatively higher income in type B practices, 43 – 58% still preferred type A practice.  In logistic regression analysis additional predictors of preference for type B practice were short patient lists and a general preference for salaried positions.  Among the 4 type B practices, 38% preferred a practice with 1,000 patients listed, 37.5 working hours a week and a salary of 750,000 NOK (129,000 USD) or a less busy practice, whereas the others chose more busy practices.  In logistic regression analysis older GPs, females, those with short patient lists and those with preference for salaried positions were more likely to prefer the less busy practices.    

   Conclusion: GPs seem to have strong preferences for time spent in their offices, private practice, or both.  Offering salaried positions and less busy practices might increase preferences for time spent in public health.