The GP crisis in Norway continues. More than 175,000 people are without a GP, according to the Norwegian Medical Association’s overview. That is twice as many as two years ago, and an increase of 25,000 in just a few months. Fresh medical student Hedda Kristine Orvik is considering becoming a GP in the future, but she is skeptical of the current system. – I would like to be a resource in the district, but it is a big workload and perhaps costs more than it is worth. So we can hope that something is done about it in the next six years, she says. Orvik and his fellow students say that the GP profession has a fringe reputation among students. From what they have heard, the job offers a heavy workload, little free time, and an incredible number of patients to follow up. Medical students at UiT were visited in conversation with the Labor Party’s Cecilie Myrseth (right), who heads the health and care committee at the Storting. Photo: Pål Hansen / news – It’s a rather taxing profession both for yourself and perhaps also for the patients, in the long run. – You are self-employed, so you also run a business. I think many people are not aware of that, says Ovik. But if all GPs are to work 37.5 hours a week, we will need far more than today. And if all of the country’s 4,961 GPs were to gain permanent employment in the municipalities, it would cost in excess of NOK 11 billion. This is revealed in a report from the Directorate of Health. It was Dagens Medisin that mentioned the case first. Don’t want to work yourself to death According to a survey, half of the medical students and doctors undergoing specialization wanted permanent employment if they were to work as a GP after completing their education. As it stands today, 84 per cent of GPs in this country are self-employed. – The young doctors want increased security and predictability. It can be solved in several ways. An example is the municipality of Tromsø, which has made it easier for business operations by increasing the basic subsidy. We want greater freedom of choice between a fixed salary and business operations. Then we need better funding for the scheme, says Nils Kristian Klev, who heads the Association of General Practitioners. The report is clear that permanent employment is an expensive solution and will require far more doctors. The municipalities should therefore consider different alternatives, as Tromsø has done, Klev believes. Another option outlined in the report from the directorate is that only those doctors who are newly qualified and on their way into a specialization course are offered permanent employment. The price tag for this is far less, and is estimated at NOK 240 million. Many will be independent Permanent appointments in the public sector to all GPs cannot save the GP scheme, Klev believes. He points out that most GPs are self-employed, and that many enjoy it. At the same time, he believes that offering new graduates a fixed salary can be a good measure to increase recruitment into the profession. Leader of the Association of General Practitioners Nils Kristian Klev. Photo: General Practitioners’ Association – But it will be significantly cheaper to strengthen the current model than for everyone to move to permanent positions in the public sector, he says. – It must be possible to combine the GP job with a normal life. If you hire permanently, the Working Environment Act applies, and then there are restrictions on how long a working week can be. Some doctors probably want to work something more than 37.5 hours a week. We should find models where this is possible within reasonable limits. One of the solutions could be to do as in Tromsø. There, the municipality has spent 100 million on measures to improve conditions for GPs. Among other things, doctors who want to run a doctor’s office receive financial support when buying a GP practice. They are covered for up to ten sick days a year, and specialist training in general medicine is provided free of charge. The city has long been in a crisis without any available GPs, and people are on waiting lists month after month. However, the new model has had an effect. – Many doctors now want to come to the city after the model was introduced, says Lise Figenschou, GP and shop steward for the general practitioners in Tromsø municipality. Klev is also positive about the model in Tromsø. It makes it possible to work as an entrepreneur with more time for patients without excessively long working days, he believes. The Tromsø model The model introduced in Tromsø municipality includes the following: A substantial increase in basic funding with a 60 per cent increase in the operating subsidy up to 1,000 patients for practicing GPs Financial support for the purchase of a GP practice Coverage of ten sick days/sick child days per years for practicing doctors Specialist training in general medicine is free, as it is in other medical specialties. The budget is NOK 100 million over four years. Announcing measures Cecilie Myrseth (Ap) heads the health and care committee at the Storting. She points out that the GP crisis continues to escalate, and that the workload on today’s GPs must be reduced. – We have to do a lot more so that the students want to choose to become GPs, she says. – This means that we have to put more money into the scheme itself. Young doctors want to work in other ways, they want permanent employment. We also need to see how we can use other health personnel to support what the GP does. Cecilie Myrseth (Ap) met medical students at UiT in Tromsø. She hopes more of them will choose to become GPs when they have completed their studies. Photo: Pål Hansen / news She says the government is “among other things” looking to Tromsø to solve the GP crisis across the country. Myrseth does not want to go into detail about how the government will solve the crisis, but refers to the state budget that comes in October. – This is about ensuring that patients receive the treatment and follow-up that they need, she says. Why is the GP scheme under pressure? A number of evaluations have shown that the introduction of the GP scheme in 2001 was successful and worked as intended. But the scheme now faces major challenges. More and more municipalities are warning of major recruitment challenges and a lack of GPs for the municipality’s residents. Young doctors are reluctant to enter the GP scheme, and experienced GPs are resigning with the desire for a less burdensome working day. The GPs themselves can regulate their workload to a large extent, by adjusting the length of the list down. However, the operating result drops drastically. KS and many municipalities have found that the net cost of transitioning from a commercial operation to a fixed-salaried GP is 800,000 to 1 million per year per doctor. This shows that the current economic structure makes it impossible to have normal working hours as an entrepreneur. Surveys show that the subject of general medicine is experienced as exciting and attractive, for both medical students and those who work in the scheme. But the working days have become too long, and the tasks too many per doctor. The time use survey from 2018 showed that GPs work an average of 55.6 hours a week. 25% work more than 62 hours, and 10% work more than 75 hours a week. The GPs have adopted evenings and weekends to handle the growth in responsibilities and tasks. The demanding workload was confirmed in EY’s evaluation of the GP scheme in 2019. The increase in workload is due to several changes, both in understanding the disease and working methods, in the task portfolio, and in expectations and demands from patients, partners and authorities. Overall, this has led to more work associated with each individual patient. The GPs have ended up in a “twinkle”, where they have to work more and more to be able to fulfill their responsibilities for their patients. The social and political changes have not been followed up with enough new GPs and resources. For the most part, the increase in work is not compensated. Working hours have increased sharply in recent years, while income has remained unchanged. Source: Medical Association
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More young GPs want a normal working day – can cost billions – news Troms and Finnmark
