Colleague absence in general practice: A difference-in-differences analysis of effects on workload and patient access

Although general practitioners (GPs) often avoid taking sick leave out of collegial loyalty, absences are sometimes unavoidable. Such absences may affect colleagues' workload and patients' access to care. We aimed to examine how GP absence affects workload among remaining colleagues and patient access to care within Norwegian group practices.

We conducted a register-based cohort study linking data from the Norwegian General Practitioner register and the Norwegian Control and Distribution of Health Reimbursement database for 2016-2020. The sample included 2890 GP contracts across 1078 practices. Using difference-in-differences and event study models, we compared monthly changes in workload and consultation patterns 6 months before and after a GP's absence in practices with and without absences.

A GP's absence resulted in a modest short-term increase in colleagues' workload, corresponding to 1.43 additional active working hours per month, mainly driven by more consultations with patients listed with other GPs. This increase peaked in the first month and returned to baseline shortly thereafter. Consultations with own patients remained stable. Workload changes were substantially larger and more persistent in practices not employing a locum, and more pronounced in the first month in smaller practices, although these stratified comparisons are observational.

A colleague's absence resulted in small, temporary workload increases for remaining GPs, whereas consultations with their own patients remained stable. The larger workload changes seen in practices without locums and, to some extent, in smaller practices suggest that organizational context shapes how absences are absorbed, a question that warrants further research.