Factors Associated with Dual Practice in Surgery Specialists:  Application of Multi-Level Analysis on National Registry Data

Bayat, Mahnaz; Khalilnejad, Roghaye; Amini, Ali; Harirchi, Iraj; Zalani, Gholamhossein Salehi; Mirbahaeddin, S. Elmira; Khodadost, Mahmoud; Pooyan, Ebrahim Jafari; Yaseri, Mehdi; Shokri, Azad

doi:10.18502/ijph.v48i5.1805

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…Medical specialists were more likely to participate in MJH, as reported in other studies 14 54. Similar to other studies,15 17 55 MJH was more likely to occur among doctors in urban GP 56. Nurses in management positions had a lower chance of engaging in MJH, as was also found in a study among nurses in China,57 and because they are assuming additional, complex roles58 that may limit the time for MJH.…”

Section: Discussionsupporting

confidence: 84%

Examining the extent, forms and factors influencing multiple job holding among medical doctors, professional nurses and rehabilitation therapists in two South African provinces: a cross-sectional study

Matiwane,

Blaauw,

Rispel

2023

BMJ Open

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ObjectiveMultiple job holding (MJH), or working in more than one paid job simultaneously, is a common characteristic of health labour markets. The study examined the extent (prevalence), forms and factors influencing MJH among public sector medical doctors, professional nurses and rehabilitation therapists in two South African provinces.DesignA cross-sectional, analytical study.Setting29 public sector hospitals in the Gauteng and Mpumalanga provinces of South Africa.ParticipantsFull-time public sector medical doctors, professional nurses and rehabilitation therapists.ResultsWe obtained an overall response rate of 84.3%, with 486 medical doctors, 571 professional nurses and 340 rehabilitation therapists completing the survey. The mean age was 39.9±9.7 years for medical doctors, 43.7±10.4 years for professional nurses and 32.3±8.7 years for rehabilitation therapists. In the preceding 12 months, the prevalence of MJH was 33.7% (95% CI 25.8% to 42.6%) among medical doctors, 8.6% (95% CI 6.3% to 11.7%) among professional nurses and 38.7% (95% CI 31.5% to 46.5%) among rehabilitation therapists. Medical doctors worked a median of 20 (10–40) hours per month in their additional jobs, professional nurses worked 24 (12–34) hours per month and rehabilitation therapists worked 16 (8–28) hours per month. Private practice was the most prevalent form of MJH among medical doctors and rehabilitation therapists, compared with nursing agencies for professional nurses. MJH was significantly more likely among medical specialists (OR 4.3, p<0.001), married professional nurses (OR 2.4, p=0.022) and male rehabilitation therapists (OR 2.4, p=0.005).ConclusionThe high prevalence of MJH could adversely affect the care of public sector patients. The study findings should inform the review and revision of existing MJH policies.

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Section: Discussionsupporting

confidence: 84%

Examining the extent, forms and factors influencing multiple job holding among medical doctors, professional nurses and rehabilitation therapists in two South African provinces: a cross-sectional study

Matiwane,

Blaauw,

Rispel

2023

BMJ Open

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“…Working as a faculty member involves more research and educational activities; however, it is not usually accompanied by adequate income as they have less chance for dual practice compared with non-faculty surgeons. 6 We found that nearly 90% of the respondents dedicated less than two hours a week to research among which a huge proportion had no research activities. We found that shortage of time and lack of motivation was the cause in about 70% of the responses.…”

Section: Discussionmentioning

confidence: 74%

The Research Status of Neurological Surgery Residents; A Survey of Iranian Residency Programs

Khosravi

Mehri

Jabbaripour

et al. 2021

Int Clin Neurosci J

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Background: Research activities promote the appreciation for evidence-based medicine (EBM), quality patient care and clinical competence of resident physicians. We decided to investigate the research background of Iranian neurological surgery residents and their attitude toward research through a survey. Methods: This cross-sectional study was done on Iranian neurological surgery resident physicians between February and April 2020. We provided an online survey, including 13 questions, using Google form and then sent the link to survey via WhatsApp application. Following the first post, two more reminders were sent to the groups after 2 and 4 weeks. Results: Responses were received from 89 respondents from which about 88% used to spend two hours or less per week for research. Almost equal numbers of resident physicians chose academic position (n=43) or private practice (n=39) as their future job. Only seven respondents stated immigration for assumed future job position. Clinical research (47%) was the most frequent type of research done by participants and clinical research education (43.2%) during medical school was the most common way of obtaining research experience. Agreement with doing research during residency program (45.6%) was more than disagreement (22.4%) and neutral attitude (32%). Conclusion: There is a low tendency among Iranian neurological surgery residents for conducting research projects during their programs. Lack of a proper research curriculum, heavy clinical duties and consequent shortage of time as well as insufficient encouraging points, are the main reasons. Designing a research plan for residency programs may successfully increase the research involvement rate.

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“…Extent. Five studies reported the rates of dual practice for general practitioners and medical specialists [5,11,12,15,21]. These rates were reported to be 18.65% for general practitioners working in both public or private sectors, 26.17% for general practitioners working in two or more job places (either public or private) [11], 57% for surgeons working in the public sector, 70% for non-full-time specialists in multiple job holdings, 58% for non-faculty member specialists in multiple job holdings, 69% for urinary tract and genital and neurosurgery [21], 63.1% for surgical specialists in other service locations [12], 47.7% for specialists in various medical specialties [15], and 42.3% for public medical specialists in the private sector [5].…”

Section: Main Themesmentioning

confidence: 99%

Current knowledge of physicians’ dual practice in Iran: A scoping review and defining the research agenda for achieving universal health coverage

et al. 2022

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Background Physicians’ dual practice (simultaneous practice in both public and private sectors) may be challenging for achieving universal health coverage. The purpose of this review is to identify the types of available evidence in physicians’ dual practice in Iran and define the research agenda for achieving universal health coverage (UHC). Methods We conducted a scoping review of the literature using Arksey and O’Malley’s approach. We searched Embase, PubMed, the Cochrane Library, Scopus, Web of Science core collection, as well as internal databases including the National Magazine Database (Magiran) and the Scientific Information Database (SID) until August 3, 2020. Studies published in Persian or English and investigating physicians’ dual practice in the health system of Iran were included. Each step of the study was performed by two of the present researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) recommendations were used to conduct this study and report the findings. Results Fourteen studies were included in the current review. The findings were categorized and synthesized into five themes including the forms of dual practice, the extent of dual practice, the motivators and factors affecting dual practice, the policy options, and the consequences of dual practice. There were limited evidence on the nature, types, and prevalence of this phenomenon for different provinces and medical specialties and on health policy options in Iran. There seems to be a methodological gap (a gap in the type of study and its method) in the subject area. Most studies have only used quantitative or qualitative study methods and based on the self-report of research samples in most of the included studies. Conclusions More research is required at national level on the nature, types, and prevalence of this phenomenon, focusing on clarifying the root causes of this phenomenon and on the effects of dual practice on the indicators of accessibility to health services, especially for vulnerable populations, the quality of care provided, and equity, and on complex policy research on health policy options in Iran. The research questions proposed in the present study can help to bridge the knowledge gap in this area. Additional studies should address issues related to the quality of data collection in physicians’ dual practice.

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Factors Associated with Dual Practice in Surgery Specialists: Application of Multi-Level Analysis on National Registry Data

Cited by 3 publications

References 24 publications

Examining the extent, forms and factors influencing multiple job holding among medical doctors, professional nurses and rehabilitation therapists in two South African provinces: a cross-sectional study

Examining the extent, forms and factors influencing multiple job holding among medical doctors, professional nurses and rehabilitation therapists in two South African provinces: a cross-sectional study

The Research Status of Neurological Surgery Residents; A Survey of Iranian Residency Programs

Current knowledge of physicians’ dual practice in Iran: A scoping review and defining the research agenda for achieving universal health coverage

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