Hvorfor velger leger seg bort fra allmennmedisin?

Birkeli, Cecilie Normann; Rosta, Judith; Aasland, Olaf Gjerløw; Rø, Karin Isaksson

doi:10.4045/tidsskr.19.0597

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…The change of work tasks has been one of the explicit reasons for GPs leaving their positions in recent years, causing a massive shortage of primary healthcare services. 34 Our study confirms that GPs report the most moral distress concerning the time used on documentation and administration.…”

Section: Discussionsupporting

confidence: 83%

Moral distress among physicians in Norway: a longitudinal study

Miljeteig,

Førde,

Rø

et al. 2024

BMJ Open

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ObjectivesTo explore and compare physicians’ reported moral distress in 2004 and 2021 and identify factors that could be related to these responses.DesignLongitudinal survey.SettingData were gathered from the Norwegian Physician Panel Study, a representative sample of Norwegian physicians, conducted in 2004 and 2021.Participants1499 physicians in 2004 and 2316 physicians in 2021.Main outcome measuresThe same survey instrument was used to measure change in moral distress from 2004 to 2021. Logistic regression analyses examined the role of gender, age and place of work.ResultsResponse rates were 67% (1004/1499) in 2004 and 71% (1639/2316) in 2021. That patient care is deprived due to time constraints is the most severe dimension of moral distress among physicians, and it has increased as 68.3% reported this ‘somewhat’ or ‘very morally distressing’ in 2004 compared with 75.1% in 2021. Moral distress also increased concerning that patients who ‘cry the loudest’ get better and faster treatment than others. Moral distress was reduced on statements about long waiting times, treatment not provided due to economic limitations, deprioritisation of older patients and acting against one’s conscience. Women reported higher moral distress than men at both time points, and there were significant gender differences for six statements in 2021 and one in 2004. Age and workplace influenced reported moral distress, though not consistently for all statements.ConclusionIn 2004 and 2021 physicians’ moral distress related to scarcity of time or unfair distribution of resources was high. Moral distress associated with resource scarcity and acting against one’s conscience decreased, which might indicate improvements in the healthcare system. On the other hand, it might suggest that physicians have reduced their ideals or expectations or are morally fatigued.

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Section: Discussionsupporting

confidence: 83%

Moral distress among physicians in Norway: a longitudinal study

Miljeteig,

Førde,

Rø

et al. 2024

BMJ Open

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“…This can indicate that the organisation of the services and the physician’s time and tasks, more than lack of economic resources, are drivers for their moral distress. The change of work tasks has been one of the explicit reasons for general practitioners leaving their positions in recent years, causing a massive shortage of primary health care services [31]. Our study confirms that general practitioners report the most moral distress concerning the time used on documentation and administration.…”

Section: Discussionsupporting

confidence: 80%

Resource conflicts leading to moral distress: A longitudinal study among physicians in Norway

Miljeteig,

Førde,

Rø

et al. 2023

Preprint

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BackgroundThe scarcity of resources represents ethical challenges and involves moral distress for health professionals. There are no longitudinal studies of moral distress among representative samples of physicians.MethodSurveys of the Norwegian Physician Panel (NPP) compared the extent of moral distress in 2004 and 2021. Descriptive statistics and regression analysis were used in the study.ResultsResponse rates were 67% (1004/1499) in 2004 and 70% (1639/2316) in 2021. That patient care is deprived due to time constraints is the most severe dimension of moral distress among physicians, and it has increased comparing 2021 with 2004 (68.3% in 2004 to 75.1% in 2021 reported “somewhat” or “very morally distressing”). Moral distress also increased concerning patients who “cry the loudest” get better and faster treatment than others. Moral distress was reduced on statements about long waiting times, treatment not provided due to economic limitations, deprioritisation of older patients, and acting against one’s conscience. Women reported higher moral distress than men in both years, and there were significant gender differences for six statements in 2021 and one in 2004. Though not consistently, the physicians’ age and workplace influenced the reported moral distress.ConclusionIn both years, moral distress among physicians related to scarcity of or unfair distribution of resources was high. Moral distress associated with resource scarcity and acting against one’s conscience decreased, which might indicate improvements in the healthcare system. On the other hand, it might suggest that physicians have reduced their ideals or expectations or are morally fatigued.

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“…Specific attention should be paid to male and female GPs. Low recruitment to primary care is a concurrent issue in Norway 50 69. Improving the working conditions of doctors and ensuring optimal working hours may cause more doctors to choose or to remain in general practice.…”

Section: Discussionmentioning

confidence: 99%

Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys

Rosta

Rø

2023

BMJ Open

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ObjectivesTo compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and 2019 for doctors working in different job positions in Norway.DesignRepeated postal surveys in 2016 and 2019.SettingNorway.ParticipantsRepresentative samples of doctors; the response rates were 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019.Main outcome measuresSelf-reported weekly working hours, proportions with hours above the limitations of EWTD defined as >48 hours/week and time spent on direct patient care.AnalysesLinear mixed models with estimated marginal means and proportions.ResultsFrom 2016 to 2019, the weekly working hours increased significantly for male general practitioners (GPs) (48.7 hours to 50.9 hours) and male hospital doctors in leading positions (48.2 hours to 50.5 hours), and significantly decreased for female specialists in private practice (48.6 hours to 44.9 hours). The proportion of time spent on direct patient care was noted to be similar between genders and over time. In 2019, it was higher for specialists in private practice (66.4%) and GPs (65.5%) than for doctors in other positions, such as senior hospital consultants (43.5%), specialty registrars (39.8%) and hospital doctors in leading positions (34.3%). Working >48 hours/week increased significantly for both male and female GPs (m: 45.2% to 57.7%; f: 27.8% to 47.0%) and hospital doctors in leading positions (m: 34.4% to 57.1%; f: 17.4% to 46.4%), while it significantly decreased for female specialty registrars (13.2% to 6.9%).ConclusionsWorking hours increased significantly for GPs and hospital doctors in leading positions from 2016 to 2019, resulting in increased proportions of doctors with work hours above the EWTD. As work hours above the EWTD can be harmful for health personnel and for safety at work, initiatives to reduce long working weeks are needed.

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Hvorfor velger leger seg bort fra allmennmedisin?

Cited by 6 publications

References 14 publications

Moral distress among physicians in Norway: a longitudinal study

Moral distress among physicians in Norway: a longitudinal study

Resource conflicts leading to moral distress: A longitudinal study among physicians in Norway

Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys

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