Remuneration and organization in general practice: Do GPs prefer private practice or salaried positions?

Abstract

Objective. In Norway the default payment option for general practice is a patient list system based on private practice, but other options exist. This study aimed to explore whether general practitioners (GPs) prefer private practice or salaried positions. Design. Cross-sectional online survey (QuestBack). Setting. General practice in Norway. Intervention. Participants were asked whether their current practice was based on (1) private practice in which the GP holds office space, equipment, and employs the staff, (2) private practice in which the GPs hire office space, equipment, or staff from the municipality, (3) salary with bonus arrangements, or (4) salary without bonus arrangement. Furthermore, they were asked which of these options they would prefer if they could choose. Subjects. GPs in Norway (n = 3270). Main outcome measures. Proportion of GPs who preferred private practice. Results. Responses were obtained from 1304 GPs (40%). Among these, 75% were currently in private practice, 18% in private practice with some services provided by the municipality, 4% had a fixed salary plus a proportion of service fees, whereas 3% had salary only. Corresponding figures for the preferred option were 52%, 26%, 16%, and 6%, respectively. In multivariate logistic regression analysis, size of municipality, specialty attainment, and number of patients listed were associated with preference for private practice. Conclusion. The majority of Norwegian GPs had and preferred private practice, but a significant minority would prefer a salaried position. The current private practice based system in Norway seems best suited to the preferences of experienced GPs in urban communities.

Key Words::

• Capitation
• fee for service
• general practice
• Norway
• private practice
• remuneration

Acknowledgements

The authors would like to thank Olaf Gjerløw Aasland, Ivar Sønbø Kristiansen, Jan Abel Olsen, Per Stensland, and Birgit Abelsen for their valuable comments and suggestions on the design of the study and/or interpretation of the results.

Funding

The costs of data collection were covered by a grant from the Norwegian Research Council.