Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemMedicine in Australia: Balancing Employment and Life (MABEL)(WILEY-BLACKWELL, 2011-03)
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ItemHow do rural GPs' workloads and work activities differ with community size compared with metropolitan practice?(CSIRO PUBLISHING, 2012)Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors. Self-reported hours worked per usual week across eight workplace settings and on-call/ after-hours workload per usual week were analysed against seven community size categories. Our results showed that a GP's total hours worked per week consistently increases as community size decreases, ranging from 38.6 up to 45.6h in small communities, with most differences attributable to work activities of rural GPs in public hospitals. Higher on-call workload is also significantly associated with smaller rural communities, with the likelihood of GPs attending more than one callout per week ranging from 9% for metropolitan GPs up to 48-58% in small rural communities. Our study is the first to separate hours worked into different work activities whilst adjusting for community size and demographics, providing significantly greater insight to the increased hours worked, more diverse activities and significant after-hours demands experienced by current rural GPs.
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ItemWho should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data(WILEY, 2012-02)OBJECTIVE: The objective of this study was to define an improved classification for allocating incentives to support the recruitment and retention of doctors in rural Australia. DESIGN AND SETTING: Geo-coded data (n = 3636 general practitioners (GPs)) from the national Medicine in Australia: Balancing Employment and Life study were used to examine statistical variation in four professional indicators (total hours worked, public hospital work, on call after-hours and difficulty taking time off) and two non-professional indicators (partner employment and schooling opportunities) which are all known to be related to difficulties with recruitment and retention. MAIN OUTCOME MEASURES: The main outcome measure used for the study was an association of six sentinel indicators for GPs with practice location and population size of community. RESULTS: Four distinct homogeneous population size groups were identified (0-5000, 5001-15,000, 15,001-50,000 and >50,000). Although geographical remoteness (measured using the Australian Standard Geographical Classification-Remoteness Areas (ASGC-RA)) was statistically associated with all six indicators (P < 0.001), population size provided a more sensitive measure in directing where recruitment and retention incentives should be provided. A new six-level rurality classification is proposed, based on a combination of four population size groups and the five ASGC-RA levels. A significant increase in statistical association is measured in four of six indicators (and a slight increase in one indicator) using the new six-level classification versus the existing ASGC-RA classification. CONCLUSIONS: This new six-level geographical classification provides a better basis for equitable resource allocation of recruitment and retention incentives to doctors based on the attractiveness of non-metropolitan communities, both professionally and non-professionally, as places to work and live.
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ItemWHAT FACTORS INFLUENCE THE EARNINGS OF GENERAL PRACTITIONERS AND MEDICAL SPECIALISTS? EVIDENCE FROM THE MEDICINE IN AUSTRALIA: BALANCING EMPLOYMENT AND LIFE SURVEY(WILEY-BLACKWELL, 2012-11)To date, there has been little data or empirical research on the determinants of doctors' earnings despite earnings having an important role in influencing the cost of health care, decisions on workforce participation and labour supply. This paper examines the determinants of annual earnings of general practitioners (GPs) and specialists using the first wave of the Medicine in Australia: Balancing Employment and Life, a new longitudinal survey of doctors. For both GPs and specialists, earnings are higher for men, for those who are self-employed and for those who do after-hours or on-call work. GPs have higher earnings if they work in larger practices, in outer regional or rural areas, and in areas with lower GP density, whereas specialists earn more if they have more working experience, spend more time in clinical work and have less complex patients. Decomposition analysis shows that the mean earnings of GPs are lower than that of specialists because GPs work fewer hours, are more likely to be female, are less likely to undertake after-hours or on-call work, and have lower returns to experience. Roughly 50% of the income gap between GPs and specialists is explained by differences in unobserved characteristics and returns to those characteristics.
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ItemAustralian doctors' satisfaction with their work: results from the MABEL longitudinal survey of doctors(WILEY, 2011-01-03)OBJECTIVE: To compare the level and determinants of job satisfaction between four groups of Australian doctors: general practitioners, specialists, specialists-in-training, and hospital non-specialists. DESIGN, PARTICIPANTS AND SETTING: National cross-sectional questionnaire survey as part of the baseline cohort of a longitudinal survey of Australian doctors in clinical practice (Medicine in Australia - Balancing Employment and Life [MABEL]), undertaken between June and November 2008, including 5193 Australian doctors (2223 GPs, 2011 specialists, 351 hospital non-specialists, and 608 specialists-in-training). MAIN OUTCOME MEASURES: Job satisfaction scores for each group of doctors; the association between job satisfaction and doctor, job and geographical characteristics. RESULTS: 85.7% of doctors were moderately or very satisfied with their jobs. There were no differences in job satisfaction between GPs, specialists and specialists-in-training. Hospital non-specialists were the least satisfied compared with GPs (odds ratio [OR], 0.56 [95% CI, 0.39-0.81]). For all doctors, factors associated with high job satisfaction were a good support network (OR, 1.72 [95% CI, 1.41-2.10]), patients not having unrealistic expectations (OR, 1.48 [95% CI, 1.25-1.75]), and having no difficulty in taking time off work (OR,1.48 [95% CI, 1.20-1.84]). These associations did not vary across doctor types. Compared with GPs, on-call work was associated with lower job satisfaction for specialists (OR, 0.48 [95% CI, 0.23-0.98]) and hospital non-specialists (OR, 0.25 [95% CI, 0.08-0.83]). CONCLUSION: This is the first national survey of job satisfaction for doctors in Australia. It provides an important baseline to examine the impact of future health care reforms and other policy changes on the job satisfaction of doctors.
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ItemProfessional satisfaction in general practice: does it vary by size of community?(WILEY, 2010-07-19)OBJECTIVE: To investigate whether the level of professional satisfaction of Australian general practitioners varies according to community size and location. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, population-level national survey using results for a cohort of 3906 GPs (36% were "rural" participants) from the first wave of a longitudinal study of the Australian medical workforce, conducted between June and November 2008. Geographical differences in levels of professional satisfaction were examined using five community size categories: metropolitan, > or = 1 million residents; regional centre, 50,000-999,999; medium-large rural, 10,000-49,999; small rural, 2500-9999; and very small rural, < 2500. MAIN OUTCOME MEASURES: Level of professional satisfaction expressed by GPs working in different sized communities with respect to various job aspects. RESULTS: Professional satisfaction of GPs did not differ by community size for most aspects of the job. Overall satisfaction was high, at about 85% across all community sizes. Satisfaction with remuneration was slightly higher in smaller rural towns, even though the hours worked there were less predictable. Professional satisfaction with freedom of choosing work method, variety of work, working conditions, opportunities to use abilities, amount of responsibility, and colleagues was very high across all community sizes, while difficulties with arranging locums and the stress of running the practice were commonly reported by GPs in all community sizes. CONCLUSIONS: GPs working in different sized communities in Australia express similar levels of satisfaction with most professional aspects of their work.
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ItemThe "Medicine in Australia: Balancing Employment and Life (MABEL)" longitudinal survey - Protocol and baseline data for a prospective cohort study of Australian doctors' workforce participation(BIOMED CENTRAL LTD, 2010-02-25)BACKGROUND: While there is considerable research on medical workforce supply trends, there is little research examining the determinants of labour supply decisions for the medical workforce. The "Medicine in Australia: Balancing Employment and Life (MABEL)" study investigates workforce participation patterns and their determinants using a longitudinal survey of Australian doctors. It aims to generate evidence to support developing effective policy responses to workforce issues such as shortages and maldistribution. This paper describes the study protocol and baseline cohort, including an analysis of response rates and response bias. METHODS/DESIGN: MABEL is a prospective cohort study. All Australian doctors undertaking clinical work in 2008 (n = 54,750) were invited to participate, and annual waves of data collections will be undertaken until at least 2011. Data are collected by paper or optional online version of a questionnaire, with content tailored to four sub-groups of clinicians: general practitioners, specialists, specialists in training, and hospital non-specialists. In the baseline wave, data were collected on: job satisfaction, attitudes to work and intentions to quit or change hours worked; a discrete choice experiment examining preferences and trade-offs for different types of jobs; work setting; workload; finances; geographic location; demographics; and family circumstances. DISCUSSION: The baseline cohort includes 10,498 Australian doctors, representing an overall response rate of 19.36%. This includes 3,906 general practitioners, 4,596 specialists, 1,072 specialists in training, and 924 hospital non-specialists. Respondents were more likely to be younger, female, and to come from non-metropolitan areas, the latter partly reflecting the effect of a financial incentive on response for doctors in remote and rural areas. Specialists and specialists in training were more likely to respond, whilst hospital non-specialists were less likely to respond. The distribution of hours worked was similar between respondents and data from national medical labour force statistics. The MABEL survey provides a large, representative cohort of Australian doctors. It enables investigation of the determinants of doctors' decisions about how much, where and in what circumstances they practice, and of changes in these over time. MABEL is intended to provide an important resource for policy makers and other stakeholders in the Australian medical workforce.
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ItemA randomised trial and economic evaluation of the effect of response mode on response rate, response bias, and item non-response in a survey of doctors(BIOMED CENTRAL LTD, 2011-09-05)BACKGROUND: Surveys of doctors are an important data collection method in health services research. Ways to improve response rates, minimise survey response bias and item non-response, within a given budget, have not previously been addressed in the same study. The aim of this paper is to compare the effects and costs of three different modes of survey administration in a national survey of doctors. METHODS: A stratified random sample of 4.9% (2,702/54,160) of doctors undertaking clinical practice was drawn from a national directory of all doctors in Australia. Stratification was by four doctor types: general practitioners, specialists, specialists-in-training, and hospital non-specialists, and by six rural/remote categories. A three-arm parallel trial design with equal randomisation across arms was used. Doctors were randomly allocated to: online questionnaire (902); simultaneous mixed mode (a paper questionnaire and login details sent together) (900); or, sequential mixed mode (online followed by a paper questionnaire with the reminder) (900). Analysis was by intention to treat, as within each primary mode, doctors could choose either paper or online. Primary outcome measures were response rate, survey response bias, item non-response, and cost. RESULTS: The online mode had a response rate 12.95%, followed by the simultaneous mixed mode with 19.7%, and the sequential mixed mode with 20.7%. After adjusting for observed differences between the groups, the online mode had a 7 percentage point lower response rate compared to the simultaneous mixed mode, and a 7.7 percentage point lower response rate compared to sequential mixed mode. The difference in response rate between the sequential and simultaneous modes was not statistically significant. Both mixed modes showed evidence of response bias, whilst the characteristics of online respondents were similar to the population. However, the online mode had a higher rate of item non-response compared to both mixed modes. The total cost of the online survey was 38% lower than simultaneous mixed mode and 22% lower than sequential mixed mode. The cost of the sequential mixed mode was 14% lower than simultaneous mixed mode. Compared to the online mode, the sequential mixed mode was the most cost-effective, although exhibiting some evidence of response bias. CONCLUSIONS: Decisions on which survey mode to use depend on response rates, response bias, item non-response and costs. The sequential mixed mode appears to be the most cost-effective mode of survey administration for surveys of the population of doctors, if one is prepared to accept a degree of response bias. Online surveys are not yet suitable to be used exclusively for surveys of the doctor population.