INTRODUCTION: General practitioners (GPs) play a key role in the delivery of health care in Switzerland. Assessing GPs’ workload over time is essential to meet the population’s health service demand and for future health care planning.
METHODS: The study involved four questionnaire-based cross-sectional studies among a representative sample of Swiss GPs on a five-yearly basis since 2005. Data on GPs’ self-estimated workload and practice administration (face-to-face consultations, house calls, nursing home visits and clinical administrative work) were analysed in hours per week (h/week) or full-time equivalents (FTE; 100% = 55 h/week).
RESULTS: The mean age of GPs (n = 2,037) in 2020 was 54.9 years, significantly higher than in 2005 (51.4 years, p <0.001, n = 1,780). The proportion of female GPs increased gradually from 16.5% in 2005 to 36.2% in 2020 (p <0.001). The GPs’ workload significantly decreased over the last 15 years from 50.2 h/week to 43.4 h/week or from 90.9% FTE in 2005 to 78.9% FTE in 2020 (p <0.001). The decreased average workload across years was less pronounced in women (–4.4% FTE) than in men (–9.0% FTE, p = 0.015). Across all survey years, women worked on average 12.7 h/week or 23.2% FTE less than men (p <0.001). The time spent with patients gradually decreased, whereas the amount of time spent on clinical administrative work remained stable since 2005 (9 h/week). In 2020, GPs were working more frequently in group practices compared to 2005 (45.0% vs. 12.4%, p <0.001).
CONCLUSION: This study demonstrates a decrease in GPs’ overall workload from 2005 to 2020, indicating that the “new” generation of GPs prefers to work part-time. This decrease is at the expense of direct face-to-face encounters with patients. Over the last 15 years, a clear trend exists towards more women in the Swiss general practice, persisting over-ageing of GPs, replacement of single-handed practices by group practices, and increasing burden of administrative tasks, a risk factor for burnout and reduced job satisfaction. To maintain an efficient healthcare system in the future, substantial efforts are crucial to provide a positive and motivating insight into general practice to pre- and postgraduate students and improve the operational working conditions of GPs.
Zusammenfassung. Über das Ausmass von nicht evidenzbasierten Protonenpumpeninhibitoren(PPI)-Verschreibungen im hausärztlichen Setting in der Schweiz ist wenig bekannt. Eine Empfehlung zur Langzeittherapie wurde im Jahr 2014 in die «Top-5-Liste» von «smarter medicine» für die ambulante Innere Medizin aufgenommen. Die Beobachtungsstudie erfasste in einer Praxis mit sechs Hausärzten retrospektiv über drei Monate den Anteil von Patientinnen und Patienten ohne evidenzbasierte Indikation für eine PPI-Einnahme. Von 2225 analysierten Patientinnen und Patienten nahmen 11,1 % (n = 248) einen PPI ein. Der prozentuale Anteil ohne klare evidenzbasierte Indikation betrug 46,8 %. Annähernd jeder zweite wies keine klare evidenzbasierte Indikation für eine PPI-Einnahme auf. Die erhobenen Resultate könnten einen Anreiz für Hausärztinnen und Hausärzte sein, bei der Verschreibung eines PPI eine gerechtfertigte Indikation zu überdenken, dies auch im Sinne von «smarter medicine».
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