Extent and nature of dual practice engagement among Iran medical specialists

Abstract

BackgroundDual practice (DP) by medical specialists is a widespread issue across health systems. This study aims to determine the level of DP engagement among Iran’s specialists.MethodsA pre-structured form was developed to collect the data about medical specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes, and eventually a combination of the first name, surname, and father’s name.ResultsA total of 48 345 records were collected for 30 273 specialists from 858 (93%) hospitals out of total 925 hospitals. Sixteen thousand eight hundred forty-nine (69% of) specialists were non-faculty members and 6317 (26% of) specialists were employed on a contract basis. Eleven thousand six hundred and thirty-eight (47.7% of) specialists were engaged in DP on total. Female specialists had 0.78 times less DP chance; faculties compared to non-faculties had 0.65 times more DP chance and full-time geographic specialists compared to non-full-time specialists had 0.15 times more DP chance. DP was more frequent in specialists with higher age and more job experience and in provinces with more population, deprivation, and higher number of specialists per facility (P < 0.05).ConclusionsThe level of DP is relatively high among Iran medical specialists, especially in geographic full-time specialists. However, they are totally banned and they receive extra payment for being full-time; restrictive regulations and financial incentives without considering other factors might not eliminate DP in specialists and it should be addressed based on conditions of each country and regions inside the country.

Dual practice and multiple job holding among Iranian general practitioners: Rate and effective factors

“…We only examined GPs, while most of the other studies examined all physicians and specialists, which naturally increased the number of physicians' dual practice in other countries. In Bayat et al study, the rate of dual practice among Iranian specialists was 47.7% . Hence, for the interpretation and comparison of the results, the target groups should be the same.…”

“…In this regard, it was found that male GPs were more inclined to work in the private sector or have dual practice in both the private and public sectors. Bayat et al indicated that female specialists in Iran were less likely to have dual practice . According to previous studies, gender was one of the most critical factors influencing physicians' economic performance, including income, working hours, and dual practice …”

“…However, some of them have identified the nature and motives of having two or more occupations, which could be known as the first practical step for designing appropriate policies and interventions to manage the phenomenon . One of the most important studies in this field in Iran was the study of Bayat et al. They had focused on the rate and the factors influencing physician dual practice .…”

“…One of the most important studies in this field in Iran was the study of Bayat et al. They had focused on the rate and the factors influencing physician dual practice . However, their study ignored the impact of the physicians' financial expectations and incentives on dual practice.…”

Setting Health Care Services Tariffs in Iran: Half a Century Quest for a Window of Opportunity

“…Analyzing interviews and documents showed significant differences between medical tariffs in public and private sectors, as well as between intra-and inter-disciplinary prices, is an important factor that led to unfavorable outcomes, that are listed below: and Six th (2016-2020) five-year Development Plan, which based on this amendment, physicians were prevented from simultaneously working in both public and private sectors (dual practice) [50,51]. In this amendment, legislators implied that the main reason for the tendency of physicians to leave the public sector or preference to work in a private sector is the financial incentive, but failed to provide practical solutions to incentivize participation in the public sector [52,53].…”