|Year : 2019 | Volume
| Issue : 1 | Page : 217
Descriptive study of economic behavior of general practitioners in Iran: Practice income, hours of work, and patient visits
Mohsen Bayati1, Arash Rashidian2
1 Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Information, Evidence and Research, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
|Date of Submission||17-Sep-2017|
|Date of Acceptance||10-Feb-2018|
|Date of Web Publication||10-Dec-2019|
School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran
Source of Support: None, Conflict of Interest: None
Background: Although there is a critical need for information on economic performance of Iranian general practitioners (GPs) in health policymaking, there is not any scientific evidence in this area. Therefore, in the present report, the characteristics of economic behaviors of Iranian GPs were described. Methods: This was a cross-sectional study in 2015, in which the data were collected from 666 GPs. The variables including monthly gross income, hours of work, and patient visits were studied as the measures of economic behavior of GPs. Descriptive statistics, t-test, and Analysis of Variance were used for analyzing the data. The statistical analysis was performed by STATA12. Results: The annual income of the GPs understudy was 26,000 US dollar (USD) (82,680 purchasing power parity [PPP]). The ratio of this value to gross domestic product per capita and minimum wage of Iran in 2015 was 4.8 and 9.2, respectively. On average, every GP in Iran has an income of 2188.1 USD (6958.16 PPP), works 142 h, and visits an average of 494 patients/month. The results showed that the economic behavior of Iranian GPs has a significant difference in terms of gender, age, marital status, practice experience, practice location, type of practice, being a family physicians, and working in different settings (P < 0.05). Conclusions: The Iranian GPs understudy work less than their counterparts in other (compared) countries. The studied GPs had a higher income (adjusted by hours of work and countries' per capita income) than their counterparts in other (studied) countries. Moreover, there are inequalities between GPs in terms of income, the volume of services provided and the work hours.
Keywords: Family practice, general practitioners, health-care economics and organizations, office visits, private practice
|How to cite this article:|
Bayati M, Rashidian A. Descriptive study of economic behavior of general practitioners in Iran: Practice income, hours of work, and patient visits. Int J Prev Med 2019;10:217
|How to cite this URL:|
Bayati M, Rashidian A. Descriptive study of economic behavior of general practitioners in Iran: Practice income, hours of work, and patient visits. Int J Prev Med [serial online] 2019 [cited 2020 Jun 3];10:217. Available from: http://www.ijpvmjournal.net/text.asp?2019/10/1/217/272623
| Introduction|| |
Physicians, as main suppliers in health-care market, affect the demand side of health-care market by their decisions. Hence, their decisions lead resources flow in the health system. In other words, their behaviors affect total health expenditure, quality, and quantity of health-care services. Hence, physicians' behavior is the main issue in health economics.
Economic behaviors of physicians can be defined by some characteristics of their economic performance such as practice income, pricing behavior, labor supply, type of provided services, and so on.,, Understanding these characteristics of physician behaviors helps health managers in better policy making for health system and addressing many health-care system challenges.
In Iran's health-care system, general practitioners (GPs) as main primary health-care providers play a pivotal role in the resource consumption. Although there is a critical need for information on economic behaviors of Iranian GPs in health policymaking, there is not any scientific evidence on economic performance of GPs in Iran.
The present report describes the characteristics of economic behaviors of Iranian GPs.
| Methods|| |
A self-administered questionnaire was developed based on the aim of the study and the literature review. To finalize the instrument, a pilot study was conducted on 67 GPs. Content and more details of the instrument can be found from Bayati et al., 2015 (ref).
There was not an updated and perfect sampling-frame of GPs in Iran. In addition, GPs information in private sector was unavailable. Hence, the required data were collected by two surveys during two congresses of Iranian Society of GPs (ISGP). Iranian GPs throughout the country should participate in ISGP's congresses for receiving the retraining score which is necessary for prolonging the medical practice license. Thus, it can be assumed that the participated GPs in the congress will be representative of Iranian GPs. However, due to nonrandom sampling, generalizability of findings should be considered with caution.
The two surveys were performed using convenience sampling method during the two seasonal congresses of ISGP in 2015.
The developed questionnaires were distributed among 1142 participated GPs in the two congresses, and 599 completed questionnaires were gathered at an appointed time. The response rate was 52.4%. A total of 666 observations (in the two surveys and pilot study) were analyzed.
The main variables we used for indicating the economic behaviors of GPs were consisted of monthly gross income, monthly hours of work, and monthly patient visits. To convert IR Rial to US dollar (USD), based on the Central Bank of Iran database, the average exchange rate in 2015 was used (1 USD = 29,960 Rial). Also for converting income values into purchasing power parity (PPP), comparable common currency unit, we used PPP conversion factor. Descriptive statistics, t-test, and analysis of variance were employed to test for difference in mean GPs' behaviors across categories of demographic and practice variables.
| Results|| |
In terms of age, most GPs were in the age group of 46–55 years (35%). The mean of GPs' practice experience was 13.3 (standard deviation = 8.7) years. Most of them were married (81%) and about half of them were female (46%). Regarding the practice setting, the highest frequencies were respectively those of offices, private and public clinics. More than half of the GPs (55%) were only working in private centers. Only 10% of surveyed GPs were family physicians. In terms of practice location, 37.7% of GPs worked in Tehran, 26% in other province center, and 36.3% in other cities and villages.
In [Table 1], the monthly gross income of GPs can be seen as the most important feature of economic behavior of physicians, based on other demographic and practice variables. On average, every GP in Iran has an income of 2188.1 USD (6958.16 PPP). There was a great disparity between GPs in terms of their income. Results of the mean difference test showed that GPs who were male, married, and those in middle-aged groups (36–45 and 46– 55-year groups), with higher practice experience, working in offices and working in both public and private settings had higher monthly income (P< 0.05).
|Table 1: Monthly gross income (USD) of Iranian general practitioners based on demographic and practice variables|
Click here to view
The results of the variable of monthly hours of work are shown in [Table 2]. On average, a GP works 142 h/month. The results showed that GPs who were male, family doctor, and those working in smaller towns/village, public sector worked more than others (P< 0.05). Furthermore, GPs working in rental offices, other organizations and 6–10 years practice experience group worked less than others (P< 0.05).
|Table 2: Monthly hours of work of Iranian GPs based on demographic and practice variables|
Click here to view
[Table 3] shows the number of monthly patient visits of GPs as another feature of the economic behavior of doctors. In the present study, any GP visits an average of 494 patients/month. That number was very different based on other variables. Younger GPs, family physicians, and GPs working in smaller towns/village and public sector provided more visits than others (P< 0.05). As well as GPs working in offices, and those in 6–10-year practice experience group had less visits than others (P< 0.05).
|Table 3: Monthly patient visits of Iranian general practitioners based on demographic and practice variables|
Click here to view
| Discussion|| |
The annual income of the GPs under study was 26,000 USD (82,680 PPP). The ratio of this value to the gross domestic product (GDP) per capita of Iran was 4.8.
According to Medscape physician compensation report (2015), the annual income of primary care/family physicians in the USA was reported to be 195,000 (USD). The ratio of this value to GDP per capita of America (2015) was between 3.4% and 3.9%.
Given that this ratio is approximately 4.8 for GPs in the present study, it can be said that regarding Iran's economic power, the actual incomes of GPs in Iran is slightly more than the corresponding figure for American GPs. It should be noted that other factors such as exchange rates, inflation, and other economic variables have to be considered in this comparison. Hence, this finding must be expressed with caution.
As an interesting and more reasonable comparison, the average income of GPs compared to the minimum wage in Iran in 2015 was about 9.2. The income ratio of GPs in America to the minimum wage was 11.8. According to Samson, this ratio was 5.3 for GPs in France in 2010. Based on this comparison, the incomes of GPs in this study compared to the minimum wage were less than the corresponding figure for American GPs and much higher than the one for French GPs.
Male GPs were earning almost $1000 more than female ones. This result can be found in other previous studies.,,, For example, in a study in Australia, it was stated that, averagely, female GPs earned 25% less than the annual incomes of male physicians.
Married GPs earned almost $600 more than single GPs. The difference is reasonable because married people have the financial responsibility for their families; so, they work harder.
GPs working in offices had higher incomes. It has been stated in many studies that since self-employed doctors have more freedom in practice, they usually can earn more income.,
GPs who work in both public and private sectors (viz., dual practice) have much more income than others.
Findings related to other characteristics of the economic performance of GPs showed that each physician was working an average of 142 h a month and had 494 visits monthly. A study of GPs in France reported the number of visits and the hours of work to be 389 and 198, respectively. In another study, the working hours of GPs in Australia were reported 170 h/month. The average hours of work for the self-employed and employees family physicians in America were 198 and 180 h, respectively. According to these comparisons, it can be said that Iranian GPs understudy work less than their counterparts in other countries.
Male GPs work almost 50 h more than female ones every month and have almost more 80 visits (with low significance). In two studies in France and Australia, it was found that female GPs worked less hours than male physicians.,, It was also demonstrated that the number of visits done by female GPs in France was significantly less than that of male practitioners. According to their study, men do over 1500 visits/year more than women. The reason for this difference in behavior is the difference in their preferences and responsibilities.,
Regarding the practice location, the more we go from Tehran to small towns and villages, the higher the number of hours and visits will be done. For example, GPs in Tehran almost work 40 h less than those in other towns and villages and do <300 visits. In smaller practice locations, GPs do traditional practice and visits, and this is the reason why the number of the visits done is higher compared to cities like Tehran where physicians provide more diverse and time-consuming services.
Family physicians work almost 25 h and do 500 visits/month more than other GPs. On average, GPs working in offices do 150 less visits/month than other GPs while GPs working in public clinics do 500 more visits than others. The reason is that self-employed GPs often have more freedom. Conversely, GPs working in the public sector, especially in public clinics or family physicians, have to visit patients at certain times in the clinic, and they usually face with a very high demand by patients.
Like other studies, this study has some limitations as well as some strengths. Given that there was no accurate and up-to-date sampling frame of GPs in Iran, convenience sampling was used which may limit the generalizability of the results.
Despite its limitations, this study was the only research carried out on the economic behavior of GPs in Iran and provides useful information for health policymakers. This was a descriptive study about GPs' performance. For deeper analysis of GPs behavior determinants, further works are needed. Also for more evidence related to GPs economic behavior in Iran.,
| Conclusions|| |
This study aimed to describe the economic behavior of GPs in Iran. Three important variables, including income, work hours, and number of visits were evaluated as the measures reflecting the economic performance of physicians. Descriptive findings of this study in different groups in terms of gender, age, practice experience, practice location, and type of practice provide valuable information by itself to health policymakers so that they would have a clearer and more scientific picture of the behavior of GPs as the main providers of health services in the country.
On average, the income of GPs in Iran with regard to the country's economic power (GDP per capita), especially considering their work hours, is in good condition compared to their counterparts in other countries. However, there is disparity and inequality between income, the volume of services provided and the work hours among GPs that should be taken into consideration.
We would like to thank the Board of Directors of the Iranian Society of GPs for their support in the data gathering process during the two congresses. We would also like to thank Dr. Akbari Sari and Dr. Emamgholipour, for their useful and constructive recommendations.
Financial support and sponsorship
This was supported by Tehran University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Preker AS. Public Ends, Private Means: Strategic Purchasing of Health Services. Washington, D.C.: World Bank Publications; 2007.
Rizzo JA, Zeckhauser RJ. Pushing incomes to reference points: Why do male doctors earn more? J Econ Behav Organ 2007;63:514-36.
Rizzo JA, Zeckhauser RJ. Reference incomes, loss aversion, and physician behavior. Rev Econ Stat 2003;85:909-22.
Samson AL. Low-Income Self-Employed GPs: A Preference for Leisure? HEDG, 10/12 Department of Economics. UK: University of York; 2010.
Esteves-Sorenson C, Snyder J. The gender earnings gap for physicians and its increase over time. Econ Lett 2012;116:37-41.
Spencer ES, Deal AM, Pruthi NR, Gonzalez CM, Kirby EW, Langston J, et al.
Gender differences in compensation, job satisfaction and other practice patterns in urology. J Urol 2016;195:450-5.
Cheng TC, Scott A, Jeon SH, Kalb G, Humphreys J, Joyce C, et al.
What factors influence the earnings of general practitioners and medical specialists? Evidence from the medicine in Australia: Balancing employment and life survey. Health Econ 2012;21:1300-17.
Dumontet M, Le Vaillant M, Franc C. What determines the income gap between French male and female GPs – The role of medical practices. BMC Fam Pract 2012;13:94.
Bayati M, Rashidian A. Target income and its determinants for general physicians: An instrumental variables approach. Int J Health Care Manage 2018;11:260-8.
Bayati M, Rashidian A, Akbari Sari A, Emamgholipour S. General practitioners' views on key factors affecting their desired income: A principal component analysis approach. Med J Islam Repub Iran 2017;31:41.
[Table 1], [Table 2], [Table 3]