The study shows that the total average working hours for general practitioners has increased by approximately one hour per week from 2000 to 2008, and that the women GPs account for this increase. For them, the weekly working time increased by five hours, while the working hours of their male colleagues remained approximately unchanged during this period.
It may appear that one main reason for this increase is found in the observation that many women change from working part-time (less than 37.5 hours per week) to full-time employment (37.5 hours per week or more). If so, this is concurrent with the development among the population as a whole in which women devote more time to work than previously, even though we can observe a reduction among mothers of small children (12). During the relevant period, the average age of the women veterans increased from 43 to 51 years (data not shown), which is likely to imply that the time required for care of small children is reduced, with concomitant opportunities for working longer hours and having a longer list of patients.
Doctors in general work long hours (1, 2, 6, 7). GPs are likely to work longer hours than most other groups of professions in Norway, even though a comparison must be made with some reservations. For example, in 2005 a total of 6 per cent of the population as a whole worked more than 48 hours per week (13), whereas in our sample this proportion amounted to 28 per cent in 2004 (69/250). In 2008, employed Norwegians had a contractual working week of 34.3 hours on average (14), while our 246 GPs in the same year had an average working week of 46.4 hours. In a survey of general practitioners in 11 countries undertaken in 2009, the Norwegian Knowledge Centre for the Health Services found that a group of 774 Norwegian GPs (response rate: 56 per cent) who were asked: «How many hours per week do you work as a list-patient GP?» reported an average of 40.4 hours, compared to 37.8 hours in Sweden and 48.6 hours in France (15), for example. This six-hour difference between this survey and our study may have been caused by inclusion of medical work other than just list-patient activity in the doctors‘ responses.
The strength of our study is found in its basis in repeated measurements of the same GPs in 2000, 2002, 2004, 2006 and 2008. This enables us to assess the extent to which the introduction of the list-patient scheme in 2001 has had an impact on the doctors‘ weekly working hours. However, the study also has some weaknesses. Being cohort-based, the GPs who respond at any given time will not be fully representative of all GPs. On the other hand, the differences are minor, and the disadvantages are to a large extent counterbalanced by the advantage of having access to repeated measurements. The age of the respondents also reflects the fact that the panel comprises two cohorts, one of which consists of doctors who received their authorizations prior to 2000, where most of those aged 70 or above gradually will disappear, and a second cohort of doctors who received their authorizations after 2000. Over an eight-year period some doctors will also work intermittently in functions other than that of a GP. We have also estimated the weekly working hours with the aid of general linear modelling (GLM), with repeated measurements for those who responded to all five rounds (data not shown), and found approximately the same values as those emerging from the independent measurements presented above.
Self-reported working hours may obviously deviate from the actual number of hours worked. We are unable to say whether the respondents in our sample have a tendency to overestimate or underestimate their own working hours (16), or whether there are any gender-based differences in the patterns of self-reporting. As noted above, the level of precision in the phrasing of the questions pertaining to the various components of the working hours was increased in 2006 (secondary positions are mentioned explicitly) and even further in 2008 (special reference to on-call work). We may assume, however, that most respondents have previously included these components, mainly because the phrasing of the questions has consistently focused on eliciting the total number of hours worked per week. For example, the time spent on «updating professional skills», a question which was not included until 2008, corresponds to a similar reduction in the time spent on «paperwork» in 2006 (data not shown). The relatively stable reporting of total working hours and the proportion of time spent directly working with patients indicate that the doctors on the whole have included secondary positions and on-call work in their reporting.
Certain background variables that are likely to have an effect on working hours, such as local variations in the patients? need to see a doctor (9, 17) or the doctors? need to take care of their own children (1), are not reflected in our data material.
It is conceivable that longer patient lists would result in higher workloads, but this does not appear to be the case for our women GPs, since the proportion who perceives their workloads as unacceptable decreases, while the length of the patient lists remains approximately stable. It is also conceivable that some of the doctors increase their working hours but keep the same patient list, and thereby reduce their perceived workloads. Shorter lists may allow more time for each patient as well as more time for other activities. This could possibly explain some of the reduction in the perception of unacceptable workloads in our sample. However, we believe that the key explanation must be that the list-patient scheme has provided each individual doctor with a better opportunity to manage his or her workload.