[Modes of consultant employment in Israel]

One of the features of modern clinical practice is the shift of secondary care from hospitals to the community clinics. This phenomenon and the competition among health plans, has accelerated the development of secondary medicine at the community level, and increased the activity of outpatient clinics in acute-care hospitals. Consequently, many consultants are working in more than one setting within the framework of different modes of employment.

To examine the extent of consultants' employment in multiple organizational settings, and their modes of employment in each setting (i.e. weekly work hours, type of contract, mode of remuneration, and the division of time between community and hospital work).

A mail survey was conducted on a representative sample of 50% of consultants in six selected specialties: ophthalmology, dermatology, ear-nose-and-throat, gynecology, cardiology and general surgery (response rate 63%, n=890).

Most (84%) of the consultants worked in more than one organizational setting, and more than 40% of them work in three or more settings. Nearly all the consultants (98%) work for a public sector employer in their primary job. Furthermore, in their secondary job, most consultants work for a public sector employer, usually a health fund (67% of them). When physicians' third jobs were examined, the high proportion (42%) of physicians engaged in private practice was prominent. The average number of weekly work hours of practice (including on-call hours) was 48 hours in the primary job and 63 hours in all jobs. The average duration of weekly work time was 52 hours not including on-call hours.

The findings justify serious consideration of the proposal to reduce the number of jobs at which consultants work in order to improve both their clinical effectiveness and quality of work life.