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

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.

Workload in Norwegian general practice 2018 - an observational study.

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.

Paperless migrants and Norwegian general practitioners. / Papirløse migranter og norske allmennleger.

BACKGROUND: In Norway, the rights of paperless migrants are restricted. We wished to investigate the extent to which Norwegian general practitioners give treatment to this group and their grounds for doing so, as well as to identify the health problems that were presented. MATERIAL AND METHOD: In 2010, an online questionnaire was distributed to 3 994 general practitioners who were members of the Norwegian Medical Association. RESULTS: Altogether 1 027 GPs responded. Of these, 237 (23 %) reported to have treated paperless migrants. Mental problems, pregnancy-related issues and respiratory ailments were the most frequently reported reasons for contact. Of the 237 GPs who reported to have treated paperless migrants, altogether 166 (70 %) stated that they would continue to receive these patients. INTERPRETATION: The fact that most of the GPs who had treated paperless migrants would continue to receive this patient group and thus provide health services beyond this group's entitlements, we regard as a wish to comply with the Code of Ethics for Norwegian doctors.

[How to improve continuing education and quality improvement in general practice?]. / Hvordan bedre kvalitet og videre- og etterutdanning i allmennpraksis?

BACKGROUND: Research has shown that many activities routinely used for continuing education and quality improvement in general practice, such as written information and lectures, have little or no effect on practice. MATERIAL AND METHODS: The Norwegian Institute of Public Health initiated a consensus-building process on how to improve continuing education and quality improvement in Norwegian general practice. RESULTS AND INTERPRETATION: The work of the consensus panel led to a report in which nine initiatives were proposed: development of a national plan, strengthening of the support available for group-based learning, academic outreach visits, practice based activities, personal learning plans, a national centre for quality improvement in general practice, improved use of referral and discharge information, multidisciplinary collaboration, and patient involvement.