[Changing market for Oslo physicians. Justification for and consequences of changes in agreements]

During the 1970s the number of salaried general practitioners in Oslo rose to approximately half of all general practitioners in the city. However, during the last ten years, increasing differences in wages between general practitioners on salary and fee-for-service general practitioners has led to difficulties in recruiting doctors to salaried positions. As a result many doctors have negotiated new contracts with the sub-municipalities of Oslo, a typical arrangement being a combination of fee-for-service payment for work with patients and a fixed salary for one or two days per week for work in nursing homes and mother-and-child clinics. General practitioners in four sub-municipalities of Oslo reported better opportunities for recruiting staff, greater autonomy and higher income as the main driving forces behind the changes. The increase in income has indeed been formidable, approximately NOK 100,000-200,000 per year, depending on the specific contract. The number of consultations has increased substantially in centres where general practitioners have switched to fee-for-service payment and waiting lists have been eliminated, partly as a consequence of higher turnover of consultations, and partly because of fewer vacant posts. The economic consequences to the municipalities are more uncertain, and the experiences of auxilliary staff in regard to the charges that have occurred are mixed.