Dual practice and multiple job holding among Iranian general practitioners: Rate and effective factors

Examining the extent, forms and factors influencing multiple job holding among medical doctors, professional nurses and rehabilitation therapists in two South African provinces: a cross-sectional study

OBJECTIVE

Multiple job holding (MJH), or working in more than one paid job simultaneously, is a common characteristic of health labour markets. The study examined the extent (prevalence), forms and factors influencing MJH among public sector medical doctors, professional nurses and rehabilitation therapists in two South African provinces.

DESIGN

A cross-sectional, analytical study.

SETTING

29 public sector hospitals in the Gauteng and Mpumalanga provinces of South Africa.

PARTICIPANTS

Full-time public sector medical doctors, professional nurses and rehabilitation therapists.

RESULTS

We obtained an overall response rate of 84.3%, with 486 medical doctors, 571 professional nurses and 340 rehabilitation therapists completing the survey. The mean age was 39.9±9.7 years for medical doctors, 43.7±10.4 years for professional nurses and 32.3±8.7 years for rehabilitation therapists. In the preceding 12 months, the prevalence of MJH was 33.7% (95% CI 25.8% to 42.6%) among medical doctors, 8.6% (95% CI 6.3% to 11.7%) among professional nurses and 38.7% (95% CI 31.5% to 46.5%) among rehabilitation therapists. Medical doctors worked a median of 20 (10-40) hours per month in their additional jobs, professional nurses worked 24 (12-34) hours per month and rehabilitation therapists worked 16 (8-28) hours per month. Private practice was the most prevalent form of MJH among medical doctors and rehabilitation therapists, compared with nursing agencies for professional nurses. MJH was significantly more likely among medical specialists (OR 4.3, p<0.001), married professional nurses (OR 2.4, p=0.022) and male rehabilitation therapists (OR 2.4, p=0.005).

CONCLUSION

The high prevalence of MJH could adversely affect the care of public sector patients. The study findings should inform the review and revision of existing MJH policies.

Current knowledge of physicians' dual practice in Iran: A scoping review and defining the research agenda for achieving universal health coverage

BACKGROUND

Physicians' dual practice (simultaneous practice in both public and private sectors) may be challenging for achieving universal health coverage. The purpose of this review is to identify the types of available evidence in physicians' dual practice in Iran and define the research agenda for achieving universal health coverage (UHC).

METHODS

We conducted a scoping review of the literature using Arksey and O'Malley's approach. We searched Embase, PubMed, the Cochrane Library, Scopus, Web of Science core collection, as well as internal databases including the National Magazine Database (Magiran) and the Scientific Information Database (SID) until August 3, 2020. Studies published in Persian or English and investigating physicians' dual practice in the health system of Iran were included. Each step of the study was performed by two of the present researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) recommendations were used to conduct this study and report the findings.

RESULTS

Fourteen studies were included in the current review. The findings were categorized and synthesized into five themes including the forms of dual practice, the extent of dual practice, the motivators and factors affecting dual practice, the policy options, and the consequences of dual practice. There were limited evidence on the nature, types, and prevalence of this phenomenon for different provinces and medical specialties and on health policy options in Iran. There seems to be a methodological gap (a gap in the type of study and its method) in the subject area. Most studies have only used quantitative or qualitative study methods and based on the self-report of research samples in most of the included studies.

CONCLUSIONS

More research is required at national level on the nature, types, and prevalence of this phenomenon, focusing on clarifying the root causes of this phenomenon and on the effects of dual practice on the indicators of accessibility to health services, especially for vulnerable populations, the quality of care provided, and equity, and on complex policy research on health policy options in Iran. The research questions proposed in the present study can help to bridge the knowledge gap in this area. Additional studies should address issues related to the quality of data collection in physicians' dual practice.

Influencing factors on the tendency of general practitioners to join in urban family physician program: a cross-sectional survey on Iranian physicians

Background

Urban family physician program (UFPP) is initiated as pilot by policy makers as a main reform in future of primary health care in Iran. Despite an ongoing pilot implementation of this program from 2012, it remains a main question about providing sufficient number of general practitioners (GPs). This study aimed to investigate the factors which affect GPs’ decision to join in the UFPP.

Methods

In this national cross-sectional study a sample of 666 GPs, using convenience sampling, filled a self-report questionnaire. The multivariate logistic regression was applied to explore the demographic, practice and views determinants of the tendency of GPs to join in the UFPP.

Results

More than half of GPs (58.6%) participated in the study had a positive tendency to join in the UFPP. Older GPs (adjusted OR = 3.72; 95%CI 1.05–13.09), working in public sector (adjusted OR = 2.26; 95%CI 1.43–3.58), lower income level (adjusted OR = 6.69; 95%CI 2.95–15.16), higher economic expectations (adjusted OR = 2.08; 95%CI 1.19–3.63), and higher satisfaction from medicine profession (adjusted OR = 2.00; 95%CI 1.14–3.51) were the main factors which increased the GPs tendency to enter in UFPP.

Conclusions

Decision for joining in the program is mainly affected by GPs’ economic status. This clarifies that if the program can make them closer to their target income, they would be more likely to decide for joining in the program.

The Efficiency of self-employed general practitioners and factors affecting it: a study in Iran

OBJECTIVE

Physicians as an economic firm make use of available resources such as time, human forces and space to provide healthcare services. The current study aimed at estimating the technical efficiency of Iranian self-employed general practitioners (GPs) and its effective factors using data envelopment analysis and regression analysis.

RESULTS

About 2% of the GPs were fully efficient and the remaining (98%) were inefficient. Almost, 2.09% of the physicians had constant returns to scale, and 31.41% and 66.49% of them had increasing and decreasing returns to scale, respectively. According to the regression estimates, gender (female) (β = 3.776, P = 0.072), age (β = 0.475, P = 0.013), practice experience (β = - 0.477, P = 0.015), contract with the insurer (β = - 6.475, P = 0.005) and economic expectations (β = 1.939, P = 0.014) showed significant effect on GPs inefficiency. Most of the GPs surveyed did not optimally allocate their time and physical and human resources to provide their services. Female GPs, older ones, those with fewer practice experience, those with higher economic expectations, and the GPs with no insurance contract were more inefficient. Increasing the insurance coverage of self-employed GPs and providing them with training in office economic management can reduce their inefficiency.