Skill mix in primary care, working hours, time used on management, and burnout among general practitioners

Skill mix in primary care is increasing, but introducing new roles to general practice is challenging. Concerns have been raised that the skill mix may add to the general practitioners' (GPs') workload. This study examined whether the skill mix was associated with GPs' working hours, time used on management, and burnout.

In total, 1659 GPs working in 1045 practices completed a survey assessing working hours, time spent on management and administration, and burnout. Burnout was assessed by the Maslach Burnout Inventory (MBI). A composite score of quartile points was calculated for the three subscales of the MBI, and a score ≥9 was categorized as a high level of burnout. Skill mix was measured as the number of nurses, secretaries, and other healthcare professionals (OHCPs) per GP in practice. OHCPs constituted a broad staff category comprising, among others, physiotherapists, midwives, pharmacists, and psychologists. Associations were investigated by generalized linear models for binary outcomes.

Employment of nurses was associated with a lower probability of burnout, whereas employment of OHCPs was associated with a higher probability of burnout. The latter was found only in partnership GPs, where employment of OHCPs was also associated with an increased number of hours used on management. Skill mix was unrelated to the number of working hours per week.

Task-shifting from GPs to nurses might unburden GPs exposed to high workload, but the results suggest caution when it comes to employing OHCPs in primary care, although causality cannot be determined. Studies with experimental designs are needed to clarify causal mechanisms.