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Comparing GPs according to their model of practice: are multiprofessional group practices associated with more favourable working conditions?

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Abstract

In the generalized context of general practitioner shortages and transitions towards team-based primary care, we investigated how the different practising models relate to general practitioners’ labour supply. More precisely, we analysed the association between practice models—solo, groups of general practitioners, and multiprofessional groups—and their reported labour supply and level of satisfaction with work-life balance. We used a French cross-sectional survey from 2018 that surveyed a representative national sample of 3,032 self-employed general practitioners about their working conditions. We found that the model of practice was significantly associated with differences in physician labour supply at the intensive margin and that group practice appeared to be positively associated with general practitioners’ reported satisfaction with work-life balance. In terms of weekly working time, only practice in groups of general practitioners was associated with a significantly lower labour supply. However, general practitioners in groups–whether groups of general practitioners or multiprofessional groups–reported more annual leave and seemed more willing to diversify their activity by devoting more time to secondary activities, including salaried activities. Consistently, general practitioners working in groups were also more likely than solo practitioners to report being satisfied with their work-life balance. Although group practice, whether multiprofessionnal or not, seems to be well suited to meeting the new aspirations of general practitioners, those working in multiprofessional groups are associated with a higher level of weekly work supply, which might justify special attention from the public authorities.

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Data availability

The survey methodology has been approved by the French National Council of Statistical Information (Cnis), with label No. 2022_1175_DG75-L002. For a description of the data collected by the French Ministry of Health: https://drees.solidarites-sante.gouv.fr/sources-outils-et-enquetes/00-le-panel-dobservation-des-pratiques-et-des-conditions-dexercice-en.

References

  1. World Health Organization, United Nations Children’s Fund (UNICEF): Operational Framework for Primary Health Care - Transforming vision into action. Geneva (2020)

  2. Dumontet, M., Buchmueller, T., Dourgnon, P., Jusot, F., Wittwer, J.: Gatekeeping and the utilization of physician services in France: Evidence on the Médecin traitant reform. Health Policy 121, 675–682 (2017). https://doi.org/10.1016/j.healthpol.2017.04.006

    Article  PubMed  Google Scholar 

  3. Ono, T., Schoenstein, M., Buchan, J.: Geographic Imbalances in Doctor Supply and Policy Responses. (2014)

  4. OECD: Health at a Glance 2021: OECD Indicators. OECD (2021)

  5. Bachelet, M., Anguis, M.: Les médecins d’ici à 2040 : une population plus jeune, plus féminisée et plus souvent salariée. Etudes Résultats. (2017)

  6. Lambert, T.W., Smith, F., Goldacre, M.J.: Trends in attractiveness of general practice as a career: surveys of views of UK-trained doctors. Br. J. Gen. Pract. 67, e238–e247 (2017). https://doi.org/10.3399/bjgp17X689893

    Article  PubMed  PubMed Central  Google Scholar 

  7. Watson, D.E., Slade, S., Buske, L., Tepper, J.: Intergenerational differences in workloads among primary care physicians: a ten-year. Population-Based Study. Health Aff. (Millwood) 25, 1620–1628 (2006). https://doi.org/10.1377/hlthaff.25.6.1620

    Article  PubMed  Google Scholar 

  8. Crossley, T.F., Hurley, J., Jeon, S.-H.: Physician labour supply in Canada: a cohort analysis. Health Econ. 18, 437–456 (2009). https://doi.org/10.1002/hec.1378

    Article  PubMed  Google Scholar 

  9. Sarma, S., Thind, A., Chu, M.-K.: Do new cohorts of family physicians work less compared to their older predecessors? The evidence from Canada. Soc Sci Med 72, 2049–2058 (2011). https://doi.org/10.1016/j.socscimed.2011.03.047

    Article  PubMed  Google Scholar 

  10. Conseil National de l’Ordre des Médecins: Etude sur l’installation des jeunes médecins. 27 (2019)

  11. Verma, P., Ford, J.A., Stuart, A., Howe, A., Everington, S., Steel, N.: A systematic review of strategies to recruit and retain primary care doctors. BMC Health Serv. Res. 16, 126 (2016). https://doi.org/10.1186/s12913-016-1370-1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yong, J., Scott, A., Gravelle, H., Sivey, P., McGrail, M.: Do rural incentives payments affect entries and exits of general practitioners? Soc Sci Med 214, 197–205 (2018). https://doi.org/10.1016/j.socscimed.2018.08.014

    Article  PubMed  Google Scholar 

  13. Asghari, S., Kirkland, M., Blackmore, J., Boyd, S., Farrell, A., Rourke, J., Aubrey-Bassler, K., Godwin, M., Oandasan, I., Walczak, A.: A systematic review of reviews: Recruitment and retention of rural family physicians. Can. J. Rural Med. 25, 20 (2020). https://doi.org/10.4103/CJRM.CJRM_4_19

    Article  PubMed  Google Scholar 

  14. Chevillard, G., Mousquès, J.: Medically underserved areas: are primary care teams efficient at attracting and retaining general practitioners? Soc Sci Med 287, 114358 (2021). https://doi.org/10.1016/j.socscimed.2021.114358

    Article  PubMed  Google Scholar 

  15. Groenewegen, P., Heinemann, S., Greß, S., Schäfer, W.: Primary care practice composition in 34 countries. Health Policy 119, 1576–1583 (2015). https://doi.org/10.1016/j.healthpol.2015.08.005

    Article  PubMed  Google Scholar 

  16. Kringos, D.S., Boerma, W.G.W., Hutchinson, A., Saltman, R.B. eds: Building primary care in a changing Europe. Case studies. European Observatory on Health Systems and Policies, Copenhagen (Denmark) (2015)

  17. Rosenman, R., Friesner, D.: Scope and scale inefficiencies in physician practices. Health Econ. 13, 1091–1116 (2004). https://doi.org/10.1002/hec.882

    Article  PubMed  Google Scholar 

  18. Damiani, G., Silvestrini, G., Federico, B., Cosentino, M., Marvulli, M., Tirabassi, F., Ricciardi, W.: A systematic review on the effectiveness of group versus single-handed practice. Health Policy 113, 180–187 (2013). https://doi.org/10.1016/j.healthpol.2013.07.008

    Article  PubMed  Google Scholar 

  19. Bourgueil, Y., Marek, A., Mousquès, J.: Medical group practice in primary care in six European countries, and the Canadian provinces of Ontario and Quebec: what are the lessons for France? Quest. Déconomie Santé. 8 (2007)

  20. Chaput, H., Monziols, M., Fressard, L., Verger, P., Ventelou, B., Zaytseva, A.: Plus de 80 % des médecins généralistes libéraux de moins de 50 ans exercent en groupe. (2022)

  21. Maier, C., Kroezen, M., Busse, R., Wismar, M., European Observatory on Health Systems and Policies eds: Skill-mix innovation, effectiveness and implementation: improving primary and chronic care. Cambridge University Press, Cambridge, United Kingdom (2022)

  22. Mcguire, T.G.: Chapter 9 - Physician Agency. In: Culyer, A.J. and Newhouse, J.P. (eds.) Handbook of Health Economics. pp. 461–536. Elsevier (2000)

  23. Sloan, F.A.: Physician Supply Behavior in the Short Run. Ind. Labor Relat. Rev. 28, 549 (1975). https://doi.org/10.2307/2521651

    Article  Google Scholar 

  24. Rizzo, J.A., Blumenthal, D.: Physician labor supply: do income effects matter? J. Health Econ. 13, 433–453 (1994). https://doi.org/10.1016/0167-6296(94)90012-4

    Article  CAS  PubMed  Google Scholar 

  25. Showalter, M.H., Thurston, N.K.: Taxes and labor supply of high-income physicians. J. Public Econ. 66, 73–97 (1997). https://doi.org/10.1016/S0047-2727(97)00021-2

    Article  Google Scholar 

  26. Thornton, J., Eakin, B.K.: The utility-maximizing self-employed physician. J. Hum. Resour. 32, 98 (1997). https://doi.org/10.2307/146242

    Article  Google Scholar 

  27. Ikenwilo, D., Scott, A.: The effects of pay and job satisfaction on the labour supply of hospital consultants. Health Econ. 16, 1303–1318 (2007). https://doi.org/10.1002/hec.1220

    Article  PubMed  Google Scholar 

  28. Chanel, O., Paraponaris, A., Protière, C., Ventelou, B.: Take the money and run? Hypothetical fee variations and French GPs’ labour supply: Rev. Économique. 68, 357–377 (2017). https://doi.org/10.3917/reco.683.0357

    Article  Google Scholar 

  29. Clerc, I., L’Haridon, O., Paraponaris, A., Protopopescu, C., Ventelou, B.: Fee-for-service payments and consultation length in general practice: a work–leisure trade-off model for French GPs. Appl. Econ. 44, 3323–3337 (2012). https://doi.org/10.1080/00036846.2011.572858

    Article  Google Scholar 

  30. Kalb, G., Kuehnle, D., Scott, A., Cheng, T.C., Jeon, S.-H.: What factors affect physicians’ labour supply: Comparing structural discrete choice and reduced-form approaches: What factors affect physicians’ labour supply? Health Econ. 27, e101–e119 (2018). https://doi.org/10.1002/hec.3572

    Article  PubMed  Google Scholar 

  31. Jakoubovitch, S., Bournot, M.-C., Cercier, E., Truffeau, F.: Les emplois du temps des médecins généralistes. Etudes Résultats. (2012)

  32. Buddeberg-Fischer, B., Stamm, M., Buddeberg, C., Klaghofer, R.: The new generation of family physicians - career motivation, life goals and work-life balance. Univ. Zurich. (2008). https://doi.org/10.5167/UZH-10438

    Article  Google Scholar 

  33. Robelet, M., Serré, M., Bourgueil, Y.: La coordination dans les réseaux de santé : entre logiques gestionnaires et dynamiques professionnelles: Rev. Fr. Aff. Soc. 231–260 (2005). https://doi.org/10.3917/rfas.051.0231

  34. Woodward, C.A.: When a physician marries a physician: effect of physician-physician marriages on professional activities. Can. Fam. Physician Med. Fam. Can. 51, 850–851 (2005)

    Google Scholar 

  35. Dumontet, M., Samson, A.-L., Franc, C.: Comment les médecins choisissent-ils leur lieu d’exercice ? Rev. Fr. Déconomie. XXXI, 221–267 (2017). https://doi.org/10.3917/rfe.164.0221

  36. Holte, J.H., Kjaer, T., Abelsen, B., Olsen, J.A.: The impact of pecuniary and non-pecuniary incentives for attracting young doctors to rural general practice. Soc Sci Med 128, 1–9 (2015). https://doi.org/10.1016/j.socscimed.2014.12.022

    Article  PubMed  Google Scholar 

  37. Polton, D., Chaput, H., Portela, M.: Remédier aux pénuries de médecins dans certaines zones géographiques - Les leçons de la littérature internationale. French Ministry of Health (2021)

  38. Chaput, H., Monziols, M., Fressard, L., Verger, P., Ventelou, B., Zaytseva, A.: Deux tiers des médecins généralistes libéraux déclarent travailler au moins 50 heures par semaine. Etudes Résultats. (2019)

  39. Garattini, L., Badinella Martini, M., Nobili, A.: General practice in the EU: countries you see, customs you find. Eur. J. Health Econ. 24, 153–156 (2023). https://doi.org/10.1007/s10198-022-01549-4

    Article  PubMed  Google Scholar 

  40. Rebnord, I.K., Morken, T., Maartmann-Moe, K., Hunskaar, S.: Out-of-hours workload among Norwegian general practitioners – an observational study. BMC Health Serv. Res. 20, 944 (2020). https://doi.org/10.1186/s12913-020-05773-7

    Article  PubMed  PubMed Central  Google Scholar 

  41. Schäfer, W.L.A., van den Berg, M.J., Groenewegen, P.P.: 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 18, 76 (2020). https://doi.org/10.1186/s12960-020-00520-9

    Article  PubMed  PubMed Central  Google Scholar 

  42. Slade, S., Busing, N.: 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. CMAJ Can. Med. Assoc. J. J. Assoc. Medicale Can. 166, 1407–1411 (2002)

  43. Weeks, W.B., Wallace, A.E.: Rural-urban differences in primary care physicians’ practice patterns, characteristics, and incomes. J. Rural Health 24, 161–170 (2008). https://doi.org/10.1111/j.1748-0361.2008.00153.x

    Article  PubMed  Google Scholar 

  44. Steinhaeuser, J., Joos, S., Szecsenyi, J., Miksch, A.: A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey. BMC Fam. Pract. 12, 112 (2011). https://doi.org/10.1186/1471-2296-12-112

    Article  PubMed  PubMed Central  Google Scholar 

  45. van Hassel, D., Verheij, R., Batenburg, R.: Assessing the variation in workload among general practitioners in urban and rural areas: an analysis based on SMS time sampling data. Int. J. Health Plann. Manage. (2019). https://doi.org/10.1002/hpm.2663

    Article  PubMed  Google Scholar 

  46. Shrestha, D., Joyce, C.M.: Aspects of work - life balance of Australian general practitioners: determinants and possible consequences. Aust. J. Prim. Health 17, 40 (2011). https://doi.org/10.1071/PY10056

    Article  PubMed  Google Scholar 

  47. Fournier, C., Frattini, M.-O., Naiditch, M.: Dynamiques et formes du travail pluriprofessionnel dans les maisons et pôles de santé - Recherche qualitative dans le cadre des Expérimentations des nouveaux modes de rémunération en maisons et pôles de santé (ENMR). Irdes (2014)

  48. Bourgeois, I., Fournier, C.: Contractualiser avec l’Assurance maladie : un chantier parmi d’autres pour les équipes des maisons de santé pluriprofessionnelles: Rev. Fr. Aff. Soc. (2020). https://doi.org/10.3917/rfas.201.0167

    Article  Google Scholar 

  49. Cassou, M., Mousquès, J., Franc, C.: General practitioners’ income and activity: the impact of multi-professional group practice in France. Eur. J. Health Econ. 21, 1295–1315 (2020). https://doi.org/10.1007/s10198-020-01226-4

    Article  PubMed  Google Scholar 

  50. Zaytseva, A., Verger, P., Ventelou, B.: United, can we be stronger? Did French general practitioners in multi-professional groups provide more chronic care follow-up during lockdown? BMC Health Serv. Res. (2022). https://doi.org/10.1186/s12913-022-07937-z

    Article  PubMed  PubMed Central  Google Scholar 

  51. Anguis, M., Bergeat, M., Pisarik, J., Vergier, N., Chaput, H.: Quelle démographie récente et à venir pour les professions médicales et pharmaceutique ? Constat et projections démographiques. French Ministry of Health (2021)

  52. Bergeat, M., Vergier, N., Verger, P.: Quatre médecins généralistes sur dix exercent dans un cabinet pluriprofessionnel en 2022. Etudes Résultats DREES Fr. Minist. Health (2022)

  53. Arnaud, F., Lefebvre, G., Mikou, M., Portela, M.: Les dépenses de santé en 2021 – édition 2022 - Résultats des comptes de la santé. French Ministry of Health, Paris (2023)

    Google Scholar 

  54. Cassou, M., Mousquès, J., Franc, C.: General Practitioners activity patterns: the medium-term impacts of Primary Care Teams in France. Health Policy 136, 104868 (2023). https://doi.org/10.1016/j.healthpol.2023.104868

    Article  PubMed  Google Scholar 

  55. Mikol, F., Franc, C.: Gender differences in the incomes of self-employed French physicians: The role of family structure. Health Policy 123, 666–674 (2019). https://doi.org/10.1016/j.healthpol.2019.05.002

    Article  PubMed  Google Scholar 

  56. Reynard, R.: La qualité de vie dans les territoires français. Rev. OFCE. 145, 33–48 (2016). https://doi.org/10.3917/reof.145.0033

    Article  Google Scholar 

  57. Deveugele, M.: Consultation length in general practice: cross sectional study in six European countries. BMJ 325, 472–472 (2002). https://doi.org/10.1136/bmj.325.7362.472

    Article  PubMed  PubMed Central  Google Scholar 

  58. Sebai, J., Yatim, F.: Les maisons de santé pluriprofessionnelles en France : une dynamique réelle mais un modèle organisationnel à construire: Rev. Fr. Adm. Publique. No 164, 887–902 (2018). https://doi.org/10.3917/rfap.164.0887

    Article  Google Scholar 

  59. Cailleux, J.-L., Casse, D., Doguet, J.-F., Dole, G., Brejcha, C., Lheureux, A., Maillot, C., Ngombi, M., Ngouato, A.: L’accessibilité des soins de premier recours : faut-il supprimer l’exercice libéral isolé. Ecole Hautes Études En Santé Publique. 40 (2008)

  60. Wolinsky, F.D.: Why physicians choose different types of practice settings. Health Serv. Res. 17, 399–419 (1982)

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Clarke, D., Romano, P., Wolf, M.: The Romano-Wolf Multiple Hypothesis Correction in Stata., https://docs.iza.org/dp12845.pdf, (2019)

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  1. CESP, Inserm UMR 1018, Team Primary Care and Prevention, 16, Avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France

    Myriam Biais & Carine Franc

  2. Institute for Research and Information in Health Economics (IRDES), 21 – 23 rue des Ardennes, 75019, Paris, France

    Matthieu Cassou & Carine Franc

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  1. Myriam Biais
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  2. Matthieu Cassou
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Correspondence to Carine Franc.

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Biais, M., Cassou, M. & Franc, C. Comparing GPs according to their model of practice: are multiprofessional group practices associated with more favourable working conditions?. Eur J Health Econ (2024). https://doi.org/10.1007/s10198-024-01687-x

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