Remuneration and organization in general practice: Do GPs prefer private practice or salaried positions?

Halvorsen, Peder Andreas; Steinert, Svein; Aaraas, Ivar J.

doi:10.3109/02813432.2012.711191

Cited by 12 publications

(14 citation statements)

References 16 publications

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“…Subsequently, they were asked to select three activities from the list – in order of priority - on which they would like to spend more time and three activities on which they would like to spend less time. Additionally, they were asked about preferences for practice organisation and remuneration (reported elsewhere) [17]. During the data collection period these questions raised some discussion and criticism in an internet forum for Norwegian GPs, including doubts about whether the study was independent of governmental reform interests (although it was independent).…”

Section: Methodsmentioning

confidence: 99%

What professional activities do general practitioners find most meaningful? Cross sectional survey of Norwegian general practitioners

et al. 2013

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BackgroundHealth reforms in many countries affect the scope and nature of primary care. General Practitioners (GPs) are expected to spend more time developing public health, preventive health care, coordination of care and teamwork. We aimed to explore which professional activities GPs consider to be meaningful and how they would like to prioritise tasks.MethodsIn a cross sectional online survey 3,270 GPs were invited to consider twenty different activities in general practice. They were asked to rate each of them on a Likert scale anchored from 1 (not meaningful) to 5 (very meaningful). They then selected three activities from the item list on which they would like to spend more time and three activities on which they would like to spend less time. We used multinomial logistic regression to explore associations between the GPs’ preferences for time spent on preventive health care activities and age, gender and practice characteristics.ResultsApproximately 40% (n=1,308) responded. The most meaningful activities were handling common symptoms and complaints (94% scored 4 or 5), chronic somatic diseases (93%), terminal care (80%), chronic psychiatric diseases (77%), risk conditions (76%) and on call emergency services (70%). In terms of priority the same items prevailed except that GPs would like to spend less time on emergency services. Items with low priority were health certificates, practice administration, meetings with local health authorities, medically unexplained symptoms, addiction medicine, follow up of people certified unfit for work, psychosocial problems, preventive health clinics for children and school health services. In multivariate regression models physician and practice characteristics explained no more than 10% of the variability in the GPs’ preferences for time spent on preventive health care services.ConclusionsThe GPs found diagnosis and treatment of diseases most meaningful. Their priorities were partly at odds with those of the health authorities and policy makers.

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Section: Methodsmentioning

confidence: 99%

What professional activities do general practitioners find most meaningful? Cross sectional survey of Norwegian general practitioners

et al. 2013

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“…Capitation payments amount to about 30% of GPs' incomes, while the other two sources provide the remaining 70%. In addition, salaried contracts (with or without bonuses) are offered to GPs in some rural municipalities (Halvorsen et al ., 2012). The mean income of GPs appears to be at least as high as the mean income of hospital doctors (Abelsen and Olsen, ).…”

Section: Introductionmentioning

confidence: 99%

Modelling Nonlinearities and Reference Dependence in General Practitioners' Income Preferences

et al. 2015

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This paper tests for the existence of nonlinearity and reference dependence in income preferences for general practitioners. Confirming the theory of reference dependent utility within the context of a discrete choice experiment, we find that losses loom larger than gains in income for Norwegian general practitioners, i.e. they value losses from their current income level around three times higher than the equivalent gains. Our results are validated by comparison with equivalent contingent valuation values for marginal willingness to pay and marginal willingness to accept compensation for changes in job characteristics. Physicians' income preferences determine the effectiveness of 'pay for performance' and other incentive schemes. Our results may explain the relative ineffectiveness of financial incentive schemes that rely on increasing physicians' incomes. Copyright © 2015 John Wiley & Sons, Ltd.

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“…3 http://legeforeningen.no/Emner/Andre-emner/Legestatistikk/ . Note: Right and left column is copied from [ 20 ] a gross taxable income after deducting operating costs and national insurance costs (pension, sick pay etc.) b Mean income is constructed from the mid-points of the selected income range for each GP.…”

Section: Resultsmentioning

confidence: 99%

“…The surveys were planned and executed independently of each other, but some of the questions from 2009 were included in 2012 to enable identification of changes in GPs’ preferences for contract. Results from the 2009 survey have been published previously; see [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

General practitioners’ altered preferences for private practice vs. salaried positions: a consequence of proposed policy regulations?

Holte

Abelsen

Halvorsen

et al. 2015

BMC Health Serv Res

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BackgroundGeneral practitioners (GPs) in most high-income countries have a history of being independent private providers with much autonomy. While GPs remain private providers, their autonomous position appears to be challenged by increased policy regulations. This paper examines the extent to which GPs’ preferences for private practice vs. salaried contracts changed in a period where a new health care reform, involving proposed increased regulations of the GPs, was introduced.MethodsWe use data collected from Norwegian GPs through structured online questionnaires in December 2009 and May 2012.ResultsWe find that the proportion of GPs who prefer private practice (i.e. the default contract for GPs in Norway) decreases from 52% to 36% in the period from 2009 to 2012. While 67% of the GPs who worked in private practice preferred this type of contract in 2009, the proportion had dropped by 20 percentage points in 2012. Salaried contracts are preferred by GPs who are young, work in a small municipality, have more patients listed than they prefer, work more hours per week than they prefer, have relatively low income or few patients listed.ConclusionWe find that GPs’ preferences for private practice vs. salaried positions have changed substantially in the last few years, with a significant shift towards salaried contracts. With the proportions of GPs remaining fairly similar across private practice and salaried positions, there is an increasing discrepancy between GPs’ current contract and their preferred one.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0777-4) contains supplementary material, which is available to authorized users.

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Remuneration and organization in general practice: Do GPs prefer private practice or salaried positions?

Abstract: The majority of Norwegian GPs had and preferred private practice, but a significant minority would prefer a salaried position. The current private practice based system in Norway seems best suited to the preferences of experienced GPs in urban communities.

Cited by 12 publications

References 16 publications

What professional activities do general practitioners find most meaningful? Cross sectional survey of Norwegian general practitioners

What professional activities do general practitioners find most meaningful? Cross sectional survey of Norwegian general practitioners

Modelling Nonlinearities and Reference Dependence in General Practitioners' Income Preferences

General practitioners’ altered preferences for private practice vs. salaried positions: a consequence of proposed policy regulations?

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