Salaried and fee-for-service general practitioners: is there a difference in patient turnover?

OBJECTIVE: To compare use of working hours, patient turnover, and patient characteristics in two general practitioner groups which differed in contractual arrangements and income levels (partly fee-for-service vs. salary). DESIGN: Cross-sectional study of all patient contacts during one week. PARTICIPANTS: All general practitioners (GPs) in Oslo (N = 263) with contracts with the municipality. 83% participated. MAIN OUTCOME MEASURE: Time spent in various types of work and patient turnover; the number of patients seen per hour of consultation time. RESULTS: Fee-for-service GPs worked almost exclusively with patients in their own practice, while salaried GPs spent more time out of office (consultation-based patient work constituting 55% of the working hours). The fee-for-service group registered on average 2.68 consultations per hour of patient contact (95% confidence interval: 2.51-2.84). The corresponding numbers for the salaried group were 2.37 (2.24-2.50). Salaried GPs had somewhat more telephone consultations per hour (2.01 vs 1.66 for fee-for-service GPs), leaving a picture of two GP groups with small differences in patient turnover. The two patient populations were remarkably similar and so was the general practitioners' own evaluation of the consultations. CONCLUSIONS: Over a number of years the GPs in Oslo have practised under different contractual arrangements. As a consequence of different expectations and incentives it was expected that consultation activity and patient populations had evolved differently. This proved not to be the case.