Measuring workload of Swiss general practice: a five-yearly questionnaire-based survey on general practitioners’ self-reported working activities (2005–2020)

Abstract

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.

Impact of primary care physicians working part-time on patient care: A scoping review

“…Proposed factors contributing to this development are demographical changes in the workforce such as the increased proportion of female PCPs, and the rise of part-time (PT) work connected to shifting generational interests among younger PCPs from career-oriented perspectives to improved work-life balance [ 1–3 ]. Lastly, changes in how primary care is organised may enable this development, as primary care is moving away from PCPs working in full-time (FT) single-handed practices towards more extensive group practices with two or more PT PCPs [ 4 ].…”

Fatores individuais e contextuais associados à permanência e à carga horária de médicos em serviços de Atenção Primária à Saúde do município de São Paulo

“…(122) Na Suíça, por exemplo, que possui um dos maiores percentuais de trabalhadores em jornadas parciais da Europa, estudo transversal de médicos atuantes na APS mostrou que a carga horária passou de 50 horas por semana em 2005 para 43 horas em 2015. (52) Se por um lado a flexibilização é considerada uma estratégia de recrutamento de médicos para APS, mantendo a ocupação das vagas provisionadas em percentis elevados na capital paulista, por outro pode comprometer a continuidade do cuidado. (59,143) A repercussão é complexa e estudo anterior mostrou que médicos mais especializados e com maior experiência profissional preferem atuar no setor privado.…”

“…A flexibilização da carga horária inicial -que era obrigatoriamente cumprida em período integral de 40 horas-foi modificada na Política Nacional da Atenção Básica (PNAB) a partir de 2011, permitindo a contratação em jornadas parciais, o que pode favorecer a dupla prática e diminuir a inserção do médico na APS,(12) principalmente nos grandes centros urbanos do país (43). Estudos realizados na última década em países desenvolvidos apontam que mudanças na demografia médica -como a distribuição segundo gênero, faixa etária e perfil de especialização-podem exacerbar ou atenuar a falta de profissionais e, consequentemente, o funcionamento dos serviços de APS (50)(51)(52). Pesquisas mais abrangentes, que acompanhem um maior número de médicos da APS e considerem um leque maior de variáveis, ainda são necessárias.…”