Effect of dual practice on service delivery time by surgeons in the Islamic Republic of Iran: multi-level analysis of a national survey, 2016

Abstract

Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice (DP), i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services. Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons. Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age. Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 (standard deviation 0.33) hours full-time equivalent (FTE) on health care service delivery. Specialists with DP had long service delivery time (β = 0.427). Female specialists (β =-0.049) and full-time specialists (β =-0.082) spent less time on health care service delivery. Permanent specialists had higher FTE (P < 0.001) and as the population increases, FTE increases (P < 0.05). Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.

Current knowledge of physicians’ dual practice in Iran: A scoping review and defining the research agenda for achieving universal health coverage

“…Another underlying factor of dual practice was gender. Dual practice rates were higher in males than females; these findings were reported in four studies [10][11][12]15].…”

“…In densely-populated and more deprived provinces and in the context in which private sectors participate more in service provision and delivery, the rate of dual practice was significantly higher than that in other studied provinces [10,15,16]. Cultural attitudes about physicians' professional identities, work experience and academic level of specialists, public sector control approaches, existing infrastructures to meet the population's needs in the public sector, and regional characteristics of health care entities were among the critical factors affecting dual practice [5,12].…”

“…Forms. Six studies examined the simultaneous employment of physicians in the public and private sectors [9][10][11][12][13][14]. Four studies were conducted to examine the employment of physicians and specialists in more than one place of service delivery [5,10,15,16].…”

“…Extent. Five studies reported the rates of dual practice for general practitioners and medical specialists [5,11,12,15,21]. These rates were reported to be 18.65% for general practitioners working in both public or private sectors, 26.17% for general practitioners working in two or more job places (either public or private) [11], 57% for surgeons working in the public sector, 70% for non-full-time specialists in multiple job holdings, 58% for non-faculty member specialists in multiple job holdings, 69% for urinary tract and genital and neurosurgery [21], 63.1% for surgical specialists in other service locations [12], 47.7% for specialists in various medical specialties [15], and 42.3% for public medical specialists in the private sector [5].…”

“…It was indicated that full-time specialists and female specialists spent less time providing services than full-time general practitioners. Surgeons spent more time in private than public hospitals due to financial incentives and earning more money [12].…”