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

Abstract

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 hours 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 hours weekly (median 52.5). 25% of the respondents worked more than 62.2 hours 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: 1876 RGPs (40.4%) responded, 640 (34.1%) had registered OOH work. Male RGPs worked on average 1.5 hours more doing regular work than did females (p=0.001) and on average 2.3 hours more OOH work than females (p=0.079). RGPs with no OOH work registered a mean of 1.0 hours 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.

Working hours, on-call shifts, and risk of occupational injuries among hospital physicians: A case-crossover study

“…This study adds to earlier research that has mainly used self‐reported data, 9 cross‐sectional design, 10 few medical specialties, prevalence of injuries, 15 or only needle‐stick injuries. Our analysis, using 7‐day windows to estimate the likelihood of occupational injuries, suggested that shift intensity, as indicated by the number of consecutive working days and number of on‐call shifts, increased the likelihood of occupational injury.…”

“…Previous studies of physicians’ working hours and on‐call work have utilized self‐reported data, which are prone to recall or reporting bias 9 . Further limitations include the use of cross‐sectional designs 10 and study populations that cover only a few medical specialties.…”

“…Previous studies of physicians' working hours and oncall work have utilized self-reported data, which are prone to recall or reporting bias. 9 Further limitations include the use of cross-sectional designs 10 and study populations that cover only a few medical specialties. Recently, objective and detailed daily working-hour data from employers' registries have become available for studies of health care personnel, 11 although few studies to date have investigated the association between extended working hours and safety among physicians.…”