Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 152 No. 2526 (2022)

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

  • Tonia Gerber
  • Stéphanie Giezendanner
  • Andreas Zeller
DOI
https://doi.org/10.4414/SMW.2022.w30196
Cite this as:
Swiss Med Wkly. 2022;152:w30196
Published
21.06.2022

Summary

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.

References

  1. Svedahl ER, Pape K, Toch-Marquardt M, Skarshaug LJ, Kaspersen SL, Bjørngaard JH, et al. Increasing workload in Norwegian general practice - a qualitative study. BMC Fam Pract. 2019 May;20(1):68. https://doi.org/10.1186/s12875-019-0952-5
  2. Schweizerisches Gesundheitsobservatorium. Konsultationen in Hausarzt- oder Allgemeinarztpraxen. https://www.obsan.admin.ch/de/indikatoren/konsultationen-hausarzt-oder-allgemeinarztpraxen [Accessed: 08-Feb-2021].
  3. Senn N, Ebert ST, Cohidon C, Diebold M. Analyses et perspectives sur la base des indicateurs du programme SPAM. Obs Doss. 2016;55.
  4. Wille N, Schlup J. Welches sind die wichtigsten Herausforderungen für die FMH. Schweiz Arzteztg. 2020;101(40).
  5. OECD. WHO. OECD Reviews of Health Systems: Switzerland. 2011.
  6. Clausen F. Arztpraxen und ambulante Zentren 2017: Tätigkeit, Zugänglichkeit und räumliche Verteilung. Bundesamt für Stat. 2019.
  7. Jörg R, Lenz N, Wetz S, Widmer M. Ein Modell zur Analyse der Versorgungsdichte: herleitung eines Index zur räumlichen Zugänglichkeit mithilfe von GIS und Fallstudie zur ambulanten Grundversorgung in der Schweiz. Schweizerisches Gesundheitsobservatorium (Obsan). 2019;(1):70.
  8. Osborn R, Squires D, Doty MM, Samak DO, Schneider EC. In New Survey of 11 Countries U.S. Adults Still Struggle with Acces to and Affordability of Health Care. Heal Aff Web. 2016.
  9. Hostettler S, Kraft E. FMH-Ärztestatistik 2020 – die Schweiz im Ländervergleich. 2021;102(12):417-422.
  10. Kotecha S. GP shortages cause “unacceptable” patient waits. BBC News 2020 https//www.bbc.com/news/health-51032691 [Accessed 09-Feb-2021].
  11. Thompson M, Walter F. Increases in general practice workload in England. Lancet. 2016 Jun;387(10035):2270–2. https://doi.org/10.1016/S0140-6736(16)00743-1
  12. Crosbie B, O’Callaghan ME, O’Flanagan S, Brennan D, Keane G, Behan W. A real-time measurement of general practice workload in the Republic of Ireland: a prospective study. Br J Gen Pract. 2020 Jun;70(696):e489–96. https://doi.org/10.3399/bjgp20X710429
  13. Schäfer WL, van den Berg MJ, Groenewegen PP. The association between the workload of general practitioners and patient experiences with care: results of a cross-sectional study in 33 countries. Hum Resour Health. 2020 Oct;18(1):76. https://doi.org/10.1186/s12960-020-00520-9
  14. Ebert ST, Pittet V, Cornuz J, Senn N. Development of a monitoring instrument to assess the performance of the Swiss primary care system. BMC Health Serv Res. 2017 Nov;17(1):789. https://doi.org/10.1186/s12913-017-2696-z
  15. Swiss Medical Association (FMH). FMH-Ärztestatistik. https://www.fmh.ch/themen/aerztestatistik/fmh-aerztestatistik.cfm [Accessed: 2-Mar-2021].
  16. Leung W-C. How to design a questionnaire Wai-Ching. 2006:1-9.
  17. Kraft E. 30 166 Ärztinnen und Ärzte versorgen die Schweizer Bevölkerung. Schweiz Arzteztg. 2010;91(11):431–5. https://doi.org/10.4414/saez.2010.15039
  18. Hostettler S, Kraft E. FMH-Ärztestatistik 2018: Wenig Frauen in Kaderpositionen. Schweiz Arzteztg. 2019;100(12):411–6.
  19. McCarthy M. Sustainable general practice: looking across Europe. Br J Gen Pract. 2016 Jan;66(642):36. https://doi.org/10.3399/bjgp16X683233
  20. Groenewegen PP, Bosmans MW, Boerma WG, Spreeuwenberg P. The primary care workforce in Europe: a cross-sectional international comparison of rural and urban areas and changes between 1993 and 2011. Eur J Public Health. 2020 Sep;30 Suppl_4:iv12–7. https://doi.org/10.1093/eurpub/ckaa125
  21. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2020.
  22. Wickham H, François R, Henry L, Müller K. dplyr: A Grammar of Data Manipulation. R package version 1.0.2. 2020.
  23. Wickham H. ggplot2: Elegant Graphics for Data Analysis. Springer-Verlag New York. 2016.
  24. Venables WN, Ripley BD. Modern Applied Statistics with S. Fourth Edition. Springer, New York. ISBN 0-387-95457-0. 2002.
  25. Federal Statistical Office. Part-time employment in Switzerland 2017. 2019 https://www.bfs.admin.ch/bfs/en/home/news/whats-new.gnpdetail2019-0539.html#id_51833ec3d4c3d4b151da2e7a1094d872 [Accessed: 16-Mar-2021].
  26. Lindemann F, Laukenmann J, Kronenberg R, Streit S. Nachwuchsförderung – Auf gutem Weg, aber noch nicht am Ziel. Prim Hosp Care. 2019;19(9):275–7.
  27. Van den Bussche H. The future problems of general practice in Germany: current trends and necessary measures. Bundesgesundheitsblatt - Gesundheitsforsch - Gesundheitsschutz. 2019;62(9):1129-1137.
  28. Strazdins E, Dwan K, Pescud M, Strazdins L. Part-time in general practice-a remedy to a time-based problem? Fam Pract. 2019 Jul;36(4):511–5. https://doi.org/10.1093/fampra/cmy116
  29. Dayan M, Arora S, Rosen R, Curry N. Is general practice in crisis? Nuff Trust. 2014;349.
  30. Hobbs FD, Bankhead C, Mukhtar T, Stevens S, Perera-Salazar R, Holt T, et al.; National Institute for Health Research School for Primary Care Research. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14. Lancet. 2016 Jun;387(10035):2323–30. https://doi.org/10.1016/S0140-6736(16)00620-6
  31. Pahud O. Ärztinnen und Ärzte in der Grundversorgung - Situation in der Schweiz und im internationalen Vergleich. Analyse des International Health Policy (IHP) Survey 2019 der amerikanischen Stiftung Commonwealth Funds im Auftrag des Bundesamtes für Gesundheit. Schweizerisches Gesundheitsobservatorium (Obsan). 2019;15:160.
  32. Arigoni F, Bovier PA, Sappino AP. Trend of burnout among Swiss doctors. Swiss Med Wkly. 2010 Aug;140:w13070.
  33. DeChant PF, Acs A, Rhee KB, Boulanger TS, Snowdon JL, Tutty MA, et al. Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review. Mayo Clin Proc Innov Qual Outcomes. 2019 Sep;3(4):384–408. https://doi.org/10.1016/j.mayocpiqo.2019.07.006
  34. Blease C, Bernstein MH, Gaab J, Kaptchuk TJ, Kossowsky J, Mandl KD, et al. Computerization and the future of primary care: A survey of general practitioners in the UK. PLoS One. 2018 Dec;13(12):e0207418. https://doi.org/10.1371/journal.pone.0207418
  35. Willis M, Duckworth P, Coulter A, Meyer ET, Osborne M. Qualitative and quantitative approach to assess of the potential for automating administrative tasks in general practice. BMJ Open. 2020 Jun;10(6):e032412. https://doi.org/10.1136/bmjopen-2019-032412
  36. Smits M, Hanssen S, Huibers L, Giesen P. Telephone triage in general practices: A written case scenario study in the Netherlands. Scand J Prim Health Care. 2016;34(1):28–36. https://doi.org/10.3109/02813432.2016.1144431
  37. Klann JG, Szolovits P. An intelligent listening framework for capturing encounter notes from a doctor-patient dialog. BMC Med Inform Decis Mak. 2009;9 Suppl 1(Suppl 1):S3.
  38. Kreimeyer K, Foster M, Pandey A, Arya N, Halford G, Jones SF, et al. Natural language processing systems for capturing and standardizing unstructured clinical information: A systematic review. J Biomed Inform. 2017 Sep;73:14–29. https://doi.org/10.1016/j.jbi.2017.07.012
  39. Celi LA, Marshall JD, Lai Y, Stone DJ. Disrupting Electronic Health Records Systems: The Next Generation. JMIR Med Inform. 2015 Oct;3(4):e34. https://doi.org/10.2196/medinform.4192
  40. Chen JH, Asch SM. Machine Learning and Prediction in Medicine - Beyond the Peak of Inflated Expectations. N Engl J Med. 2017 Jun;376(26):2507–9. https://doi.org/10.1056/NEJMp1702071
  41. Cohidon C, Cornuz J, Senn N. Primary care in Switzerland: evolution of physicians’ profile and activities in twenty years (1993-2012). BMC Fam Pract. 2015 Aug;16(1):107. https://doi.org/10.1186/s12875-015-0321-y
  42. Buddeberg-Fischer B, Stamm M, Buddeberg C, Klaghofer R. The new generation of family physicians—career motivation, life goals and work-life balance. Swiss Med Wkly. 2008 May;138(21-22):305–12.
  43. Biaggi P, Peter S, Ulich E. Stressors, emotional exhaustion and aversion to patients in residents and chief residents - what can be done? Swiss Med Wkly. 2003 Jun;133(23-24):339–46.
  44. Goehring C, Bouvier Gallacchi M, Künzi B, Bovier P. Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a cross-sectional survey. Swiss Med Wkly. 2005 Feb;135(7-8):101–8.
  45. Voltmer E, Kieschke U, Spahn C. Work-related behaviour and experience patterns of physicians compared to other professions. Swiss Med Wkly. 2007 Aug;137(31-32):448–53.
  46. Thier J. Wohlstandsproblem - Teilzeitarbeit. Neue Zürcher Zeitung 2015 https//www.nzz.ch/wissenschaft/bildung/wohlstandsproblem-teilzeitarbeit-118574855 [Accessed 04-Mar-2021].
  47. Hügli-Jost S. Medienmitteilung: Workforce-Studie zur medizinischen Grundversorgung: Hausärztemangel – aber mit Licht am Horizont. mfe, Haus- und Kinderärzte Schweiz. 2020.
  48. Josi R, De Pietro C. Skill mix in Swiss primary care group practices - a nationwide online survey. BMC Fam Pract. 2019 Mar;20(1):39. https://doi.org/10.1186/s12875-019-0926-7
  49. Booker QS, Austin JD, Balasubramanian BA. Survey strategies to increase participant response rates in primary care research studies. Fam Pract. 2021 Sep;38(5):699–702. https://doi.org/10.1093/fampra/cmab070

Most read articles by the same author(s)

1 2 > >>