Rising workload or rising work pressure in general practice in the Netherlands.

Background: General practice in the Netherlands seems to be in a crisis. Worries about shortages of GP's, the first strike of general practitioners in 2001 and the rapid increase of triage systems in out of hours care are signs that work pressure and/or workload are rising. But systematic evidence of this is not presented yet. Aim: To investigate change in work stress and workload in general practice over the past ten years. Also relationships between subjective and objective work stress are analysed, Method: A comparison is made of results of the first and second Morbidity Survey in General practice held in 1988 and 2001 respectively. In both surveys participated more than 100 practices with 160/190 GP 's and 330,000/400,000 listed patients respectively. The GP's registered diagnosis and type of consultation for all consultations during one year. During six weeks consultation length was registered. Further an extensive postal survey was held with a.o. questions around work satisfaction, working hours, task delegation and the Maslach Burnout Inventory. Diaries were kept during 1 week. Results: The consultation rate rose from 3.2 per patient per year to 3.9. At the same time there was a shift from home visits to less time demanding office hours consultations. The average working week remained about 50 hours for a full-time working GP. Consultation length did not change either. Task delegation increased by professionalisation of practice assistants, the introduction of practice nurses and out-of-hours triage systems. Work satisfaction decreased, however, and higher scores were reached on the Maslach Burnout Inventory. Conclusions: The crisis in general practice seems to be caused by rising work pressure rather than rising workload.(aut. ref.