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

GP recruitment and retention difficulties challenge the traditional general practice model. Task-shifting and relieving GPs from financial risk have been suggested to make primary care more attractive. In Sweden's multiprofessional team-based primary care system, GPs usually work as salaried employees and there is extensive task-shifting. Salaried employment facilitates mobility, potentially leading to high turnover. The opportunity to work on fixed contracts can also increase turnover rates.

To describe practice turnover rates and examine associations with practice characteristics in a Swedish region.

Analysis of observational register data from Skåne, Sweden (1.4 million residents).

Turnover rates were calculated for 157 primary care practices in 2010-2018. The main dataset included all physicians - permanent and temporary workers - regularly providing care in each month. To understand the role of temporary workers, a supplementary analysis was performed on permanently employed GPs and registrars at 80 public practices in 2019. Associations between turnover and practice characteristics were examined in bivariate analyses and multiple regressions.

Annual practice turnover rates ranged between 20-40% (mean 30%), showing no time trend. The high rates mainly reflected the use of temporary GPs; in the supplementary analysis of permanent GPs and registrars, the mean annual turnover rate in 2019 was 13-15%. Turnover was higher for practices with socially deprived patients or high workload. Private practices had lower turnover conditional on the higher workload.

The results indicate that a primary care system with salaried GPs facilitates GP mobility, which in turn creates barriers to continuity of care.