A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey

Abstract

BackgroundMany western countries are facing an existing or imminent shortage of primary care physicians especially in rural areas. In Germany, working in rural areas is often thought to be associated with more working hours, a higher number of patients and a lower income than working in urban areas. These perceptions might be key reasons for the shortage. The aim of this analysis was to explore if working time, number of treated patients per week or proportion of privately insured patients vary between rural and urban areas in Germany using two different definitions of rurality within a sample of primary care physicians including general practitioners, general internists and paediatricians.MethodsThis is a secondary analysis of pre-collected data raised by a questionnaire that was sent to a representative random sample of 1500 primary care physicians chosen by data of the National Association of Statutory Health Insurance Physicians from all federal states in Germany. We employed two different methods of defining rurality; firstly, level of rurality as rated by physicians themselves (urban area, small town, rural area); secondly, rurality defined according to the Organisation for Economic Co-operation and Development.ResultsThis analysis was based upon questionnaire data from 715 physicians. Primary care physicians in single-handed practices in rural areas worked on average four hours more per week than their urban counterparts (p < 0.05). Physicians' gender, the number of patients treated per week and the type of practice (single/group handed) were significantly related to the number of working hours. Neither the proportion of privately insured patients nor the number of patients seen per week differed significantly between rural and urban areas when applying the self-rated classification of rurality.ConclusionOverall this analysis identified few differences between urban and rural primary care physician working conditions. To counter future misdistribution of primary care, students should receive practical experience in rural areas to get more practical knowledge on working conditions.

Impact of a tailored program on the implementation of evidence-based recommendations for multimorbid patients with polypharmacy in primary care practices—results of a cluster-randomized controlled trial

“…The majority of GPs (82%, n  = 18) was male and on average 55 years old. These age and gender patterns deviate slightly from a larger, representative survey among German GPs, where a higher percentage of female physicians (35%) was found [51]. There were differences between the intervention and control group concerning the structure of the practice and the sex of the GPs.…”

Technical support and delegation to practice staff – status quo and (possible) future perspectives for primary health care in Germany

“…Nearly ninety percent of German primary care physicians see patients with multiple chronic diseases frequently [3]. On the other side, Germany like other western countries is confronted with a shortage in primary care physicians, especially in rural areas [4]. …”

Zwischen Ökonomisierung und Work-Life-Balance – Perspektiven zur Abwanderung von deutschem Gesundheitspersonal nach Österreich

“…Eine kürzlich durchgeführte Befragung in Wiener Krankenanstalten [ 14 ] ergab eine durchschnittliche Arbeitsbelastung von 52 Stunden für FachzärztInnen, 55 Stunden für OberärztInnen, und bis zu 60 Stunden für ÄrztInnen in Ausbildung für Allgemeinmedizin. In Deutschland hingegen arbeitete bereits im Jahr 2003 im Schnitt fast jeder fünfte Klinikarzt 60 Wochenstunden oder mehr [ 16 ] . Zum anderen spielen neben der Anzahl der gearbeiteten Stunden auch Faktoren wie die Intensität der Arbeitsbelastung eine entscheidende Rolle.…”

“…Zum anderen spielen neben der Anzahl der gearbeiteten Stunden auch Faktoren wie die Intensität der Arbeitsbelastung eine entscheidende Rolle. Frühere Studien beziehen sich vor allem auf den niedergelassenen Bereich: auch hier zeigt sich [ 16 ] , dass die Arbeitsintensität in Deutschland im internationalen Vergleich hoch ist, mit entsprechenden Auswirkungen auf die Zufriedenheit dieser Gruppe. Österreichische InternistInnen sind relativ zufrieden mit ihrer Arbeitssituation [ 17 ] .…”