The data on which this study is based are comprehensive, almost complete and reliable. The differences shown are therefore real. However, it is not certain that use of fees always reflects practice. Misuse may occur; e.g. inappropriate time fees may be claimed, but doctors may also forget to claim fees that they are entitled to. The latter probably occurs among the least experienced – i.e. doctors in training – and most often with fees that are used relatively seldom.
Motivation to take on OOH duties will vary from doctor to doctor. Even if many rGPs find OOH work interesting and financially rewarding, there are many who see this as a heavy duty that comes in addition to a long working day. Other doctors will more often have economic motives for taking on OOH duties. This may be an explanation for the difference found between rGPs and other doctors for type of contacts.
RGPs solve problems over telephone and through simple contacts more often than other doctors, whereas other doctors make sick calls or see patients in the office more often than rGPs.
This study confirms that rGPs participate least in OOH services in large and central municipalities (2, 3). This is probably because doctors in larger municipalities have more opportunities to pass on their duty work to someone else. There is also a relatively large proportion of other doctors who take on duties in OOH services in the smallest and least central municipalities. This is probably because doctors in training take on more duties in OOH services in these municipalities (12). The time curves also show that other doctors have more patient contacts than rGPs at all times of the day and almost all year. The difference is largest in the summer vacation when rGPs were responsible for only 37.5 % of contacts.
Patients are the ones to choose if they wish to contact OOH services or not, doctors on duty therefore have little or no influence over which patients they treat. This is illustrated by the lack of difference in sex and age between patients treated by rGPs and other doctors. The distribution of diagnoses was also close to identical, even though other doctors had a tendency to use more general and unspecific diagnoses. This may be because they feel somewhat more uncertain about making diagnoses.
Claiming of fees varies only slightly between rGPs and other doctors and there is no difference between the sexes. Older doctors claim slightly less compensation through fees than younger doctors. This can probably be explained by experience and that older doctors trust their clinical judgement more than the younger ones.
However, there is a large variation in use of time fees. This is a fee that doctors can claim if a consultation lasts for more than 20 min (30 min for sick calls). Doctors in training use this fee twice as often as rGPs who are also general practice specialists; other doctors use the fee 75 % more often than rGPs. Taking the similarity of patients into account, this is a large difference. Many problems at OOH services can be handled simply and quickly and it seems like rGPs manage these tasks better than other doctors.
RGPs also have more frequent contact with home nurses and other health professionals. They know the community and local organization of health services and can therefore make agreements about follow-up and in general cooperate with other parts of the services to a greater extent. RGPs also discuss more often with next-of-kin and offer conversational therapy to psychiatric patients more frequently. Other doctors on call admit more patients to psychiatric care and also use laboratory services somewhat more often than rGPs.
Doctors in training claim the laboratory and time fees most often, but claim some other fees to a notably low extent. One explanation may be that they forget to claim compensation because they have not become well enough acquainted with the fee system.
It may seem as if less experienced doctors are the most restrictive with respect to giving patients sick leave, while general practice specialists are the most liberal.
Forgetting to claim fees is not a likely explanation, as most medical record systems automatically generate fees for sick leave when a form for sick leave is generated.
One possible explanation is that experienced rGPs are used to handling sick leaves so that they to a larger extent complete the treatment, including the sick leave, and to a lesser degree leave this to rGPs (other colleagues) the next working day. We do not know if inexperienced doctors are more affected by a stronger emphasis on reducing sick leaves (from authorities and managers), while experienced doctors trust their own judgement to a larger extent.