GP turnover in a multiprofessional team-based primary care system: evidence from Sweden.

Area of Science:

• Primary Care Research
• Health Services Management
• General Practice Workforce Studies

Background:

• General Practitioner (GP) recruitment and retention are significant challenges in primary care.
• Sweden's model features multiprofessional teams, salaried GPs, and task-shifting, influencing workforce dynamics.
• Salaried employment and fixed contracts may increase GP mobility and turnover.

Purpose of the Study:

• To quantify primary care practice turnover rates in a Swedish region.
• To investigate associations between practice characteristics and GP turnover.
• To understand the impact of temporary versus permanent GP employment on turnover.

Main Methods:

• Analysis of observational register data from 157 primary care practices in Skåne, Sweden (2010-2018).
• Calculation of annual practice turnover rates, including permanent and temporary physicians.
• Supplementary analysis of permanently employed GPs and registrars (2019) and regression analyses for practice characteristics.

Main Results:

• Annual practice turnover rates averaged 30% (range 20-40%), with no discernible time trend.
• High turnover was primarily driven by temporary general practitioners (GPs).
• Turnover was higher in practices serving socially deprived populations or facing high workloads; private practices showed lower turnover when controlling for workload.

Conclusions:

• A primary care system employing salaried general practitioners (GPs) can foster greater GP mobility.
• Facilitated GP mobility, while potentially beneficial for workforce flexibility, presents challenges to continuity of patient care.
• Strategies to enhance continuity of care are needed within systems that promote GP mobility.