How do rural GPs’ workloads and work activities differ with community size compared with metropolitan practice?Matthew R. McGrail A E , John S. Humphreys B , Catherine M. Joyce C , Anthony Scott D and Guyonne Kalb D
A School of Rural Health and Gippsland Medical School, Monash University, Gippsland Medical School, Northways Road, Churchill, Vic. 3842, Australia.
B School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia.
C Department of Epidemiology and Preventive Medicine, Monash University, Monash University, Alfred Hospital, Melbourne, Vic. 3004, Australia.
D Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Alan Gilbert Building, The University of Melbourne, Parkville, Vic. 3010, Australia.
E Corresponding author. Email: email@example.com
Australian Journal of Primary Health 18(3) 228-233 http://dx.doi.org/10.1071/PY11063
Submitted: 3 June 2011 Accepted: 22 August 2011 Published: 23 November 2011
Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors. Self-reported hours worked per usual week across eight workplace settings and on-call/ after-hours workload per usual week were analysed against seven community size categories. Our results showed that a GP’s total hours worked per week consistently increases as community size decreases, ranging from 38.6 up to 45.6 h in small communities, with most differences attributable to work activities of rural GPs in public hospitals. Higher on-call workload is also significantly associated with smaller rural communities, with the likelihood of GPs attending more than one callout per week ranging from 9% for metropolitan GPs up to 48–58% in small rural communities. Our study is the first to separate hours worked into different work activities whilst adjusting for community size and demographics, providing significantly greater insight to the increased hours worked, more diverse activities and significant after-hours demands experienced by current rural GPs.
ReferencesAustralian Bureau of Statistics (2003) ‘ASGC remoteness classification: purpose and use.’ Census Paper No. 03/01. (ABS: Canberra)
Australian Government Department of Health and Ageing (2005) ‘General practice in Australia: 2004.’ (DoHA: Canberra)
Australian Government Department of Health and Ageing (2008) ‘Report on the audit of health workforce in rural and regional Australia, April 2008.’ (Commonwealth of Australia: Canberra)
Australian Government Department of Health and Ageing (2010) ‘Rural clinical schools.’ (DOHA: Canberra) Available at http://www.health.gov.au/clinicalschools [Verified 2 June 2011]
Australian Government Department of Health and Ageing (2011) ‘Rural procedural grants program.’ (DOHA: Canberra) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pr-rpgp [Verified 1 June 2011]
Australian Institute of Health and Welfare (2008) ‘Medical labour force 2006.’ AIHW Cat. no. HWL 42. (AIHW: Canberra)
Australian Institute of Health and Welfare (2010a) ‘Australia’s health 2010.’ Australia’s health series no. 12. Cat. no. AUS 122. (AIHW: Canberra)
Australian Institute of Health and Welfare (2010b) ‘Medical labour force 2008. Bulletin no. 82.’ Cat. no. AUS 131. (AIHW: Canberra)
Australian Medical Workforce Advisory Committee (2005) ‘The general practice workforce in Australia: supply and requirements to 2013.’ Report 2005.2. (AMWAC: Sydney)
French F, Andrew J, Awramenko M, Coutts H, Leighton-Beck L, Mollison J, Needham G, Scott A, Walker K (2006) Why do work patterns differ between men and women GPs? Journal of Health Organization and Management 20, 163–172.
| Why do work patterns differ between men and women GPs?CrossRef | 16869352PubMed |
Gravelle H, Hole AR (2007) The work hours of GPs: survey of English GPs. The British Journal of General Practice 57, 96–100.
Groenewegen PP, Hutten JBF (1991) Workload and job satisfaction among general practitioners: a review of the literature. Social Science & Medicine 32, 1111–1119.
| Workload and job satisfaction among general practitioners: a review of the literature.CrossRef | 1:STN:280:DyaK3M3pslGisQ%3D%3D&md5=f2d8d1e8212854e948ba1e3cfdf23e66CAS |
Humphreys J, Jones J, Jones M, Mildenhall D, Mara P, Chater B, Rosenthal D, Maxfield N, Adena M (2003) The influence of geographical location on the complexity of rural general practice activities. The Medical Journal of Australia 179, 416–420.
Joyce C, McNeil J (2006) Fewer medical graduates are choosing general practice: a comparison of four cohorts, 1980–1995. The Medical Journal of Australia 185, 102–104.
Joyce CM, Scott A, Jeon S-H, Humphreys J, Kalb G, Witt J, Leahy A (2010) The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey - protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation. BMC Health Services Research 10, 50
| The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey - protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation.CrossRef | 20181288PubMed |
Kuehnle D, Scott A, Cheng T, Jeon S, Sivey P, Leahy A (2010) ‘Mabel user manual: Wave 1 release.’ (Melbourne Institute of Applied Economics and Social Research: Melbourne)
Laurence C, Williamson V, Sumner K, Fleming J (2010) ’Latte rural‘: the tangible and intangible factors important in the choice of a rural practice by recent GP graduates. Rural and Remote Health 10, 1316
Lepnurm R, Dobson R, Backman A, Keegan D (2007) Factors associated with career satisfaction among general practitioners in Canada. Canadian Journal of Rural Medicine 12, 217–230.
Magee L, Robb AL, Burbidge JB (1998) On the use of sampling weights when estimating regression models with survey data. Journal of Econometrics 84, 251–271.
| On the use of sampling weights when estimating regression models with survey data.CrossRef |
McGrail MR, Humphreys JS (2009) Geographical classifications to guide rural health policy in Australia. Australia and New Zealand Health Policy 6, 28
| Geographical classifications to guide rural health policy in Australia.CrossRef | 19995449PubMed |
McGrail MR, Humphreys JS, Scott A, Joyce C, Kalb G (2010) Professional satisfaction in general practice: Does it vary by community size? The Medical Journal of Australia 193, 94–98.
Murdoch J (2006) Making it pay and helping us stay: the viability of a rural general practice in New Zealand. The New Zealand Medical Journal 119, 2346
O’Brien N, Armstrong P, Mcloughlin M, Byrne M, Murphy A (2005) A comparative study on attitudes, towards the provision of out-of-hours care, of the spouses of general practitioners participating, or not, in a rural out-of-hours co-op. Irish Medical Journal 98, 267–269.
Pegram RW, Humphreys JS, Calcino G (2006) Primary medical care workforce enumeration in rural and remote areas of Australia: time for a new approach? The Australian Journal of Rural Health 14, 24–28.
| Primary medical care workforce enumeration in rural and remote areas of Australia: time for a new approach?CrossRef | 16426429PubMed |
Queensland Health (2010) ‘Rural generalist pathway.’ Available at http://www.health.qld.gov.au/ruralgeneralist/ [Verified 2 June 2011]
Raymont A, Lay-Yee R, Pearson J, Davis P (2005) New Zealand general practitioners’ characteristics and workload: the National Primary Medical Care Survey. The New Zealand Medical Journal 118, 1475
Ricketts TC (2000) The changing nature of rural health care. Annual Review of Public Health 21, 639–657.
| The changing nature of rural health care.CrossRef | 1:STN:280:DC%2BD3M%2FhsVCqtw%3D%3D&md5=c70dc098469e2e211421ed36fca8c91aCAS | 10884968PubMed |
Robinson M, Slaney G, Jones G, Robinson J (2010) GP proceduralists: ‘the hidden heart’ of rural and regional health in Australia. Rural and Remote Health 10, 1402
Rural Doctors Association of Australia (2010) ‘Federal election position statement.’ Available at http://www.rdaa.com.au/Uploads/Documents/Federal%20Election%20Position%20Statement%202010_20101014024915.pdf [Verified 2 June 2011]
Shanafelt T, Balch C, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny P, Sloan J, Freischlag J (2009) Burnout and career satisfaction among American surgeons. Annals of Surgery 250, 463–471.
Slade S, Busing N (2002) Weekly work hours and clinical activities of Canadian family physicians: results of the 1997/98 National Family Physician Survey of the College of Family Physicians of Canada. Canadian Medical Association Journal 166, 1407–1411.
Van Ham I, Verhoeven AAH, Groenier KH, Groothoff JW, De Haan J (2006) Job satisfaction among general practitioners: A systematic literature review. The European Journal of General Practice 12, 174–180.
| Job satisfaction among general practitioners: A systematic literature review.CrossRef | 17127604PubMed |
Wainer J (2004) Work of female rural doctors. The Australian Journal of Rural Health 12, 49–53.
| Work of female rural doctors.CrossRef | 15023221PubMed |
Weeks WB, Wallace AE (2008) Rural-urban differences in primary care physicians’ practice patterns, characteristics, and incomes. The Journal of Rural Health 24, 161–170.
| Rural-urban differences in primary care physicians’ practice patterns, characteristics, and incomes.CrossRef | 18397451PubMed |
Wordsworth S, Skatun D, Scott A, French F (2004) Preferences for general practice jobs: a survey of principals and sessional GPs. The British Journal of General Practice 54, 740–746.
World Health Organization (2006) ‘The world health report 2006: working together for health’ (WHO: Geneva)