Dying from cancer or other chronic diseases in the Netherlands: ten-year trends derived from death certificate data.

BACKGROUND: For the further development of palliative care, it is relevant to gain insight into trends in non-acute mortality. The aim of this article is twofold: (a) to provide insight into ten-year trends in the characteristics of patients who died from cancer or other chronic diseases in the Netherlands; (b) to show how national death statistics, derived from physicians' death certificates, can be used in this type of investigations. METHODS: Secondary analysis of data from 1996 to 2006 on the "primary" or "underlying" cause of death from official death certificates filled out by physicians and additional data from 2003 to 2006 on the place of death from these certificates. RESULTS: Of the 135,000 people who died in the Netherlands in 2006, 77,000 (or 57%) died from a chronic disease. Cancer was the most frequent cause of death (40,000). Stroke accounted for 10,000 deaths, dementia for 8,000 deaths and COPD and heart failure each accounted for 6,000 deaths. Compared to 1996, the number of people who died from chronic diseases has risen by 6%.Of all non-acute deaths, almost three quarters were at least 70 years old when they died. Almost one third of the people died at home (31%), 28% in a hospital, 25% in a nursing home and 16% somewhere else. CONCLUSION: Further investments to facilitate dying at home are desirable. Death certificate data proved to be useful to describe and monitor trends in non-acute deaths. Advantages of the use of death certificate data concern the reliability of the data, the opportunities for selection on the basis of the ICD-10, and the availability and low cost price of the data.

Is networking different with doctors working part-time? Differences in social networks of part-time and full-time doctors.

BACKGROUND: Part-time working is a growing phenomenon in medicine, which is expected to influence informal networks at work differently compared to full-time working. The opportunity to meet and build up social capital at work has offered a basis for theoretical arguments. METHODS: Twenty-eight teams of medical specialists in the Netherlands, including 226 individuals participated in this study. Interviews with team representatives and individual questionnaires were used. Data were gathered on three types of networks: relationships of consulting, communication and trust. For analyses, network and multilevel applications were used. Differences between individual doctors and between teams were both analysed, taking the dependency structure of the data into account, because networks of individual doctors are not independent. Teams were divided into teams with and without doctors working part-time. RESULTS AND DISCUSSION: Contrary to expectations we found no impact of part-time working on the size of personal networks, neither at the individual nor at the team level. The same was found regarding efficient reachability. Whereas we expected part-time doctors to choose their relations as efficiently as possible, we even found the opposite in intended relationships of trust, implying that efficiency in reaching each other was higher for full-time doctors. But we found as expected that in mixed teams with part-time doctors the frequency of regular communication was less compared to full-time teams. Furthermore, as expected the strength of the intended relationships of trust of part-time and full-time doctors was equally high. CONCLUSION: From these findings we can conclude that part-time doctors are not aiming at efficiency by limiting the size of networks or by efficient reachability, because they want to contact their colleagues directly in order to prevent from communication errors. On the other hand, together with the growth of teams, we found this strategy, focussed on reaching all colleagues, was diminishing. And our data confirmed that formalisation was increasing together with the growth of teams.

Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004.

BACKGROUND: Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. METHODS: Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. RESULTS: Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. CONCLUSION: In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted.

Part-time and full-time medical specialists, are there differences in allocation of time?

BACKGROUND: An increasing number of medical specialists prefer to work part-time. This development can be found worldwide. Problems to be faced in the realization of part-time work in medicine include the division of night and weekend shifts, as well as communication between physicians and continuity of care. People tend to think that physicians working part-time are less devoted to their work, implying that full-time physicians complete a greater number of tasks. The central question in this article is whether part-time medical specialists allocate their time differently to their tasks than full-time medical specialists. METHODS: A questionnaire was sent by mail to all internists (N = 817), surgeons (N = 693) and radiologists (N = 621) working in general hospitals in the Netherlands. Questions were asked about the actual situation, such as hours worked and night and weekend shifts. The response was 53% (n = 411) for internists, 52% (n = 359) for surgeons, and 36% (n = 213) for radiologists. Due to non-response on specific questions there were 367 internists, 316 surgeons, and 71 radiologists included in the analyses. Multilevel analyses were used to analyze the data. RESULTS: Part-time medical specialists do not spend proportionally more time on direct patient care. With respect to night and weekend shifts, part-time medical specialists account for proportionally more or an equal share of these shifts. The number of hours worked per FTE is higher for part-time than for full-time medical specialists, although this difference is only significant for surgeons. CONCLUSION: In general, part-time medical specialists do their share of the job. However, we focussed on input only. Besides input, output like the numbers of services provided deserves attention as well. The trend in medicine towards more part-time work has an important consequence: more medical specialists are needed to get the work done. Therefore, a greater number of medical specialists have to be trained. Part-time work is not only a female concern; there are also (international) trends for male medical specialists that show a decline in the number of hours worked. This indicates an overall change in attitudes towards the number of hours medical specialists should work.

Why are some medical specialists working part-time, while others work full-time?

Although medical specialists primarily work full-time, part-time work is on the increase, a trend that can be found worldwide. This article seeks to answer the question why some medical specialists work part-time, while others do not although they are willing to work part-time. Two approaches are used. First, we studied reported reasons and as a second approach we used a theoretical model, based on goal-directed behavior and restrictions. A questionnaire was sent to all internists (N=817), surgeons (N=693) and radiologists (N=621) working in general hospitals in The Netherlands. Questions were asked about personal traits, characteristics of the work situation, and motives for working full-time or part-time. Frequencies were reported for the reasons given, and multilevel analysis was used to test the theoretical model. The results show that the reported reasons for working part-time and being willing to work part-time are the same: the importance of family and leisure pursuits. The second approach showed that medical specialists working part-time tend to be female, older, and have children below the age of five. Surgeons are least likely to work part-time. A willingness to work part-time is purely individual and not related to any of the explanatory variables. We conclude that working part-time is related to both professional and personal circumstances. Policy should be aimed at removing the organizational difficulties that obstruct the realization of part-time work. Alternatively, perhaps there should be a change in working hours for all medical specialists. As the majority of all full-time working medical specialists are willing to work part-time, this might indicate that most medical specialists actually prefer "normal" working hours.