The increased competition among health plans since the implementation of the National Health Insurance Law has led to the acceleration of secondary/specialty medical services provided at the community level. At the same time, hospitals have expanded their own outpatient specialty medical clinics. As a consequence of these developments, many specialist physicians, especially those whose specialties are offered in both community and hospital outpatient clinics, work for a number of organizations and are employed through several different modes of employment. This phenomenon has implications for the physicians’ work lives, the capacity of health organizations to influence physicians’ behavior, and various aspects of the quality of patient care. The study goals were to:
- Examine the extent of employment in multiple organizational settings
- Characterize the various employment modes in terms of the number of organizations by which physicians are employed, types of contracts, the employer organizations, the location of treatment, the type of remuneration given and the division of time between the hospital and work in the community.
- Examine selected aspects of the process of giving care to patients
- Evaluate the effect of working in several settings on physicians’ work lives, with respect to job overload and burnout, commitment to the principal job, and work satisfaction.
To this end, a survey was conducted during the second half of 2001 among a sample of specialists in six areas of specialization. In selecting the six specialties for the study, the research team deliberately sought to include both specialties in which care is given primarily in community clinics–ophthalmology, dermatology, nose-ear-throat, and gynecology–and specialties for which care is more often given in hospital outpatient clinics– cardiology and general surgery. The study provides a general picture of specialty/secondary care in Israel. Data gathering was done via a mail survey, in which 890 physicians participated (a response rate of 63%).
Key Findings
- Most physicians (84%) in the six specialties studied work in more than one setting, and 42% worked in three or more settings.
- Working in a number of jobs has negative implications in terms of job overload; job burnout from the perspective of physical fatigue and
- cognitive weariness; low satisfaction; and less commitment to the principal job.
- Working in a number of jobs is also linked to a high number of weekly work hours, which also contributes to many of these phenomena.
In light of these findings, it is important to seriously consider the proposals to reduce the number of jobs at which specialist physicians are employed. The findings of this study help quantify the potential for this change to improve the physicians’ quality of life and ability to function.
The findings of this study have been presented to policymakers in the Ministry of Health, the health plans and the Israel Medical Association. The findings have also been presented at professional conferences in Israel and internationally and to the heads of relevant medical specialty societies in Israel.
This study was supported by a grant from the National Institute for Health Services and Health Policy Research.