LEFO - Legeforskningsinstituttet

Institute for Studies of the Medical Profession

IPOQ 2013: Research on health and working conditions of the medical profession

Eva Bejerot

Governance and working conditions of physicians
7. november 2013

Eva Bejerot is an associate professor of work science, and a researcher at the Department of Psychology, Stockholm University. Her interests are primarily the role of managerial ideas and technologies in public sector reforms, with special reference to their implications for various professional groups.

Governance and working conditions of physicians
The present study examine four forms of control and physicians' perception of the work conditions. The forms of control that are included in these analyses vary between counties, depending on the political majority in the county councils. Diagnose related groups (DRG) is a basis for hospital reimbursement for medical treatment in about half of all counties, a system that is handled by National Board of Health and Welfare, but is based on a Nordic system (NordDRG). Patient choice is the system that makes it possible for patients to choose health care providers. The county councils decide on the scope of this option. The care guarantee is a national agreement between the government and The Swedish Association of Local Authorities and Regions governing waiting times for patients in primary and hospital care. Various forms of treatment programs, recommendations and guidelines are designed to make operations more uniform and can be considered a form of standardization. Here the evidence-based medicine is an important part and the actors are primarily the government agencies of SBU and National Board of Health and Welfare.
A questionnaire was sent to a random selection of 3000 physicians in Sweden in 2010. The response rate was 53 per cent. In order to create a uniform study group only hospital doctors are included in this analysis (n=878). Questions where put on the influence of the control systems mentioned above, influence and contributing to dilemmas in practical work with patients.
The results showed that compensation based on DRG as well as care guarantees had negative relation to doctors working conditions. Treatment programs/guidelines on the other hand, had positive relation to work conditions. The patient's right to choose health care providers had very low, but positive relation to work environment. There were some differences between promoted and unpromoted physicians. The differing patterns of physicians with and without managerial positions can be understood in terms of the systems either facilitating management work or reducing influence and contributing to dilemmas in practical work with patients.

Contact us for more information about Eva Bejerot´s study.
You can also look at the website of the Swedish research project "Professioner i fokus - Fakta om professioners arbetsvillkor" here, or contact project manager Eva Bejerot directly.