Local public health physicians in Norway from 1994 to 2002 : workload, work content, and interaction : a story of everyday life in primary health care
Permanent link
https://hdl.handle.net/10037/1796Date
2008-03-07Type
Doctoral thesisDoktorgradsavhandling
Author
Pettersen, Betty JohanneAbstract
Avhandlingens tema er utviklingen innenfor lokal samfunnsmedisinsk legetjeneste fra 1994 til 2002. Desentraliserings- og liberaliseringsreformer i primærhelsetjenesten, endringer i helseforhold og etterspørsel etter helsetjenester endret arbeidsarenaen for samfunnsmedisinerne, og gav økonomiske, organisatoriske og faglige utfordringer. Avhandlingen er basert på tre tverrsnittsundersøkelser, gjennom postale spørreskjema, blant leger som arbeidet i eller hadde arbeidet i lokal samfunnsmedisin i alle norske kommuner og bydeler i 1994, 1999 og 2002, og på en intervjubasert studie blant leger i primærhelsetjenesten, lokalsykehus og sentralsykehus. Studien beskriver og analyserer den lokale samfunnsmedisinerens arbeid og rammebetingelser, i forhold til arbeidsmengde, arbeidsinnhold, mobilitet i arbeidsmarkedet og legers erfaringer med og oppfatning av samhandling. Det ble flere samfunnsmedisinske legestillinger og flere leger i dem, ved at stillingene ble delt i mindre stillingsandeler. Kvinner doblet sin representasjon i den samfunnsmedisinske arbeidsstokken. Majoriteten av legene arbeidet i kombinerte posisjoner mellom samfunns- og allmennmedisin (87%). Den estimerte totale arbeidstid innen samfunnsmedisin gikk ned, - til fordel for klinisk arbeid, og var avhengig av avlønningsform, hvorvidt de hadde spesialitet i samfunnsmedisin og kommunestørrelse. De reduserte sine oppgaver innenfor administrasjon og ledelse og evaluerte sin ledelseskompetanse heller konservativt og lavere i 1999 enn i 1994. Gjennomtrekken i stillingene og antall vakanser steg. En stabil kjerne av leger var i samfunnsmedisinsk stilling gjennom hele perioden, og utgjorde om lag en tredjedel av alle samfunnsmedisinerne i 2002. Spesialitet i samfunnsmedisin syntes å være rekrutterende og stabiliserende. Der var noen signaler på bedre fremtidig stabilitet blant samfunnsmedisinere i 2002 enn tidligere.
Strukturelle reformer i klinisk medisin, reformer i offentlig administrasjon, faglig utvikling og utviklingen av den medisinske profesjonen syntes å bidra til disse endringene. Den gode samhandling er avhengig av personlige og faglige preferanser og av ståsted i helsetjenestene. Local Public Health Physicians in Norway from 1994 to 2002. Workload, work content, and interaction. A story of everyday life in primary health care.
The theme of this thesis is the development of local public health physicians’ services during the 1990s and the early 2000s. Decentralisation and liberalisation reforms in primary health care, changes in the public’s health and demands for health services changed the working arena for the local public health physician, giving financial, organisational and professional challenges. The thesis is based upon three cross-sectional surveys based on postal questionnaires among physicians currently working or having worked in local public health medicine in all Norwegian municipalities in 1994, 1999 and 2002, and on interviews of physicians working in general practice and in community and regional hospitals. The study describes and analyses the local public health physician’s work and framework, related to workload, work content, mobility in the labour marked and physicians’ conduct to and experience with professional interaction between the health care levels.
The number of positions and of physicians working in public health increased over the study period, but the estimated total weekly hours decreased over the study period, for the benefit of clinical work and depending on remuneration model, speciality in community medicine and municipality size. Most physicians (87%) worked in positions where they combined public health with general practice. They reduced their administrative tasks and evaluated their own managerial competence somewhat lower in 1999 than in 1994. Women doubled their presence in the public health physician work force. The turnover-rate per year and the number of vacancies increased. There were signals of higher future stability between public health physicians in 2002 than earlier.
Structural reforms in clinical medicine, reforms in public administration, professional development and the medical professions development are important to understand the findings in this study. To improve interaction between physicians it seems important to take into account that good interaction depends on personal and professional preferences and on what level the physician is working on.
Description
Papers 1, 2 and 4 of the thesis are not available in Munin, due to publishers' restrictions. Paper 3 is not published at the time of thesis inclusion in Munin:
1. Pettersen BJ; Johnsen R. "More physicians in public health: Less public health work?" Scandinavian Journal of Public Health, Vol. 33, No. 2, 91-98 (2005). (Sage) Available at http://dx.doi.org/10.1080/14034940410019181
2. Pettersen B; Hofoss D. "Are public health physicians fading out of management?" The European Journal of Public Health 2007 17(6):642-645. (Oxford University Press) Available at http://dx.doi.org/10.1093/eurpub/ckm031
3. Pettersen BJ; Johnsen R. "Changes in contractual systems for clinical care also affect local public health. - A nine years follow-up of physicians’ mobility in the public health labour market." (Submitted)
4. Pettersen BJ; Johnsen R. "Legers oppfatning av samhandlingen mellom nivåene i helsetjenesten." [In Norwegian. Translated title: "Physicians' experience with and attitudes to interaction between health care levels"]. Tidsskrift for Den norske legeforening, 2007 Mar 1; 127(5):565-8. Available at http://www.tidsskriftet.no/index.php?seks_id=1494816
1. Pettersen BJ; Johnsen R. "More physicians in public health: Less public health work?" Scandinavian Journal of Public Health, Vol. 33, No. 2, 91-98 (2005). (Sage) Available at http://dx.doi.org/10.1080/14034940410019181
2. Pettersen B; Hofoss D. "Are public health physicians fading out of management?" The European Journal of Public Health 2007 17(6):642-645. (Oxford University Press) Available at http://dx.doi.org/10.1093/eurpub/ckm031
3. Pettersen BJ; Johnsen R. "Changes in contractual systems for clinical care also affect local public health. - A nine years follow-up of physicians’ mobility in the public health labour market." (Submitted)
4. Pettersen BJ; Johnsen R. "Legers oppfatning av samhandlingen mellom nivåene i helsetjenesten." [In Norwegian. Translated title: "Physicians' experience with and attitudes to interaction between health care levels"]. Tidsskrift for Den norske legeforening, 2007 Mar 1; 127(5):565-8. Available at http://www.tidsskriftet.no/index.php?seks_id=1494816
Publisher
Universitetet i TromsøUniversity of Tromsø
Series
ISM skriftserie / Universitetet i Tromsø, Institutt for samfunnsmedisin, nr 97, 2008Metadata
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- Doktorgradsavhandlinger (Helsefak) [716]
- ISM skriftserie [161]
Copyright 2008 The Author(s)
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