One in 10 rural GPs work late hours

Concern as new study reveals one in 10 rural GPs working until after 10pm

Dr Brendan Crosbie

Irish general practitioners (GPs) are working a 10-hour day, excluding break-time, with two-thirds of that time spent in patient consultations, reveals a major new real-time assessment of general practice workload.

Urban, rural and mixed practice GPs in the prospective study, self-recorded their routine practice activities as they happened — excluding on-call duties — and are seeing on average of 25 patients per day for an average consultation duration of 14 minutes and 53 seconds.

Published online today in the British Journal of General Practice, the comprehensive study shows 60 per cent of GP partners recording a finishing time after 6pm while 10 per cent of rural GPs recorded finishing times after 10pm. Another 4 per cent are still working after 11pm.

This study highlights the significant number of hours being worked by GPs across all demographics, particularly older GPs, and those in more senior roles. Older and more senior-ranked GPs are working longer hours relative to their younger and more junior colleagues.

The average duration of a two-session working day, excluding break-time and out-of-hours/on-call activity, was 9.9 hours.

Non-consultation activities including paperwork, telephone calls and administrative work accounted for almost a third of general practice workload.

“How do we sustain this workload going forward?” queried lead author, Dr Brendan Crosbie.

With the significant number of hours worked by GPs, Dr Crosbie points to international studies showing that this leads to GP burnout and adverse outcomes for patients.

He believes it raises questions for the future sustainability of rural general practice.

The longer consultation time carried out by GPs, in keeping with the 15-minute duration of clinical consultation recommended by the Royal College of General Practitioners, is to be welcomed and should be protected by future workload planning strategies to optimise patient safety, particularly in more complex consultations, urge Dr Crosbie and co authors Drs Michael Edmund O’Callaghan, Stuart O’Flanagan, David Brennan, and Gavin Keane. Dr William Behan acted as project supervisor.

The pattern of longer session lengths and later finishing times observed among the over 55-year age category highlights the challenge of replacing this cohort of GPs approaching retirement age, they caution.

The results are particularly relevant given that nearly one-third of GPs in Ireland are older than 55 years and will be approaching retirement age in the next decade.

The co-authors consider maintaining manageable workload levels to be an essential tenet of any future attempt to increase recruitment and retention rates of GPs in Ireland.

They believe information provided by this comprehensive assessment of GP workload can help inform the future planning and delivery of general practice in Ireland.

Clinical paperwork is the largest contributor to the non-consultation workload.

Almost one and a half hours is the average time spent on house calls but those aged 55 years or more spent a greater proportion of their time on house calls, relative to their younger counterparts.

Similarly, both rural and male GPs spent a greater proportion of time on house calls than their urban and female counterparts, respectively.

A smartphone-based time management software programme (Time Doctor) was used by participants to self-record data in real-time.

A total of 243 participants were enrolled in the study, of which 123 (50.6%) were included for final data analysis for, ‘A real-time measurement of general practice workload in the Republic of Ireland: a prospective study’.

valerie.ryan@imt.ie

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