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The relationship between work hours and utilization of general practitioners in four Canadian provinces.

ABSTRACT: OBJECTIVE: To assess whether long work hours act as a barrier to accessing general practitioner (GP) services. DATA SOURCES: Secondary data from the 1996/1997 National Population Health Survey (NPHS) and administrative health services utilization data from four Canadian provinces. STUDY DESIGN: This study was cross-sectional, however, employment variables and GP utilization were reflective of the 12-month period preceding the NPHS interview date. Negative binomial regression was used to model the relationship between the number of GP visits in a 1-year period and employment-related variables while adjusting for other determinants of GP utilization including education, income, and health status. DATA EXTRACTION METHODS: NPHS and administrative data were linked to create an analysis file. PRINCIPAL FINDINGS: Subjects with long, standard work hours (>45 hours/week, with most hours during the day) had significantly lower GP utilization rates compared with full-time workers. White-collar workers with long work hours visited a GP significantly less often than white-collar workers with regular hours. CONCLUSIONS: Long work hours may act as a nonfinancial barrier to accessing GP services independent of health status.

SUBMITTER: Fell DB

PROVIDER: S-EPMC1955285 | biostudies-literature | 2007 Aug

REPOSITORIES: biostudies-literature

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The relationship between work hours and utilization of general practitioners in four Canadian provinces.

Fell Deshayne B DB Kephart George G Curtis Lori J LJ Bower Kelly K Muhajarine Nazeem N Reid Robert R Roos Leslie L

Health services research 20070801 4

<h4>Objective</h4>To assess whether long work hours act as a barrier to accessing general practitioner (GP) services.<h4>Data sources</h4>Secondary data from the 1996/1997 National Population Health Survey (NPHS) and administrative health services utilization data from four Canadian provinces.<h4>Study design</h4>This study was cross-sectional, however, employment variables and GP utilization were reflective of the 12-month period preceding the NPHS interview date. Negative binomial regression w ...[more]

PMID: 17610434

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Project description: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?h 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?h weekly (median 52.5). 25% of the respondents worked more than 62.2?h 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 One thousand eighty hundred seventy-six RGPs (40.4%) responded, 640 (34.1%) had registered OOH work. Male RGPs worked on average 1.5?h more doing regular work than did females (p =?0.001) and on average 2.3?h more OOH work than females (p =?0.079). RGPs with no OOH work registered a mean of 1.0?h 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.

Project description:Occupational stressors are commonly encountered in small animal veterinary practice and have been associated with burnout. The working context of veterinarians differs by specialty, and this can potentially lead to variable exposures to risk factors for burnout. The aim of this study was to explore differences in demographic and working conditions of veterinary general practitioners (GPs) and emergency practitioners (EPs) to compare exposure to different potential stressors. An anonymous, online survey was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 participant responses were analyzed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Significant differences (P < 0.05) in the demographics and work-related exposures were found between the two groups. GPs were found to be older than EPs with a greater number of years of experience in their field (P < 0.001). Most veterinary GPs worked only day shifts (207/236, 87.7%); where EPs worked a greater variety of shift patterns, with "only day shifts" being the least common shift pattern (P < 0.001). Most GPs worked a set and predictable roster pattern (195/236, 83.6%), while most EPs did not (51/83, 61.5%). EPs worked more weekends and public holidays (P < 0.001). The EP group performed more hours of work each week but worked less overtime. The main contributing factors for overtime were scheduling factors for GPs and staffing issues for EPs. EPs were commonly not able to take meal-breaks and GPs' meal-breaks were commonly interrupted by work. EPs were more frequently exposed to patient death, euthanasia (including for financial reasons), emotionally distressed clients and delivering negative news (P < 0.001). Both groups indicated that most work environments were collegiate and supportive, and a minority reported toxic colleagues (11.8%) or management teams (26.9%). Just under one-half of respondents reported having witnessed or experienced workplace bullying. Of our respondent group, 52.0% (166/319) were not satisfied with their remuneration. Desire to leave their principal area of practice was prevalent among this survey group (192/319, 60.2%) with approximately one-third considering leaving the veterinary profession. We discuss the implications of these workplace factors, including mitigation strategies.

Project description:Increasingly, nurse practitioners (NPs) are deployed in teams along with general practitioners (GPs) to help meet the demand for out-of-hours care. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours.A descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus group discussions. Data was collected between June, 2014 and October, 2015 at an out-of-hours primary care organisation in the Netherlands. Overall, 38 health professionals (GPs, NPs, and support staff) participated in the study. The interviews were audio-taped and transcribed verbatim. Two researchers conducted an inductive content analysis, involving the identification of relevant items in a first phase and clustering into themes in a second phase.The following four themes emerged from the data: clarity of NP role and regulation, shared caseload and use of skills, communication concerning professional roles, trust and support in NP practice. Main factors influencing collaboration between GPs and NPs included a lack of knowledge regarding the NPs' scope of practice and regulations governing NP role; differences in teams in sharing caseload and using each other's skills effectively; varying support of GPs for the NP role; and limited communication between GPs and NPs regarding professional roles during the shift. Lack of collaboration was perceived to result in an increased risk of delay for patients who needed treatment from a GP, especially in teams with more NPs. Collaboration was not perceived to improve over time as teams varied across shifts.In out-of-hours primary care teams constantly change and team members are often unfamiliar with each other or other's competences. In this environment, knowledge and communication about team members' roles is continuously at stake. Especially in teams with more NPs, team members need to use each other's skills to deliver care to all patients on time.

Dataset Information

The relationship between work hours and utilization of general practitioners in four Canadian provinces.

Publications

The relationship between work hours and utilization of general practitioners in four Canadian provinces.

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