Skoðanir lækna á starfssviðum sérgreina V : aukið starfssvið, virðing heimilislækninga og áætlanirum verkaskiptingu 1991

Abstract

During 1960 there was an expansion of specialization and doctors working in hospitals in Iceland. At the same time there was an increasing lack of general practitioners (GP). In a report from 1968 by a committee of the city council of Reykjavik it was claimed that this evolution was because of lack of status by GPs. After 1970, health authorities, The Icelandic Medical Association and The Faculty of Medicine decided to change this process by new legislation on general practice, by building new health centers, by establishing a chair at The Faculty of Medicine and that vocational training in general practice could be accepted as a speciality. As planned and hopefully expected there was an increase of young doctors who became specialists in general practice. During the last decade there was however much greater (and probably unexpected) relative increase in the number of specialists in other fields compared to that in general practice. This background has led to conflicts and debates between GPs and other specialists on non-physical territoriality. In 1986 a study was published by one of the authors (LB) about non-physical territoriality in the health care in Sweden. Similar studies were later carried out in the other Nordic countries in 1988. This paper is the last of five subsequent articles with the results from Iceland, dealing with the questions of expansion of specialities, status of general practice and health care programs. A self-administrated questionnaire was mailed to 185 physicians in seven specialities. Total response rate was 81%. Many doctors, especially oto-laryngologists were of the opinion that the area of responsibility of general practice was expanding at the expense of other specialities, and this expansion would not be advantageous for the patients. GPs disagreed on that opinion (p<0.001). GPs themselves thought that their speciality had a lower status than other specialities. General agreement was on the statement that general practice as a speciality would increase the status of this discipline. Specialists in other disciplines thought that it would increase the status of the health centers if they were working there together with GPs. The GPs were of the opposite opinion (p<0.001) but agreed that such a cooperation would not lower the status of the health centers! 73% of those who expressed their opinion agreed that local health care programs, clarifying the division of tasks between general practice and other specialities were favourable regarding the cooperation of these specialities. We hope that this research on territoriality in health care may lead to better understanding of the behaviour and reactions of health care personnel and advantage should be taken of these results in the organization of health care in the future.

Í þessari rannsókn eru athugaðar skoðanir lækna á útþenslu og stöðu (status) heimilislækninga og áætlanagerða um verkaskiptingu sérgreina. Fram kemur að aðrir en heimilislæknar telja að aukin umsvif heimilislækninga séu á kostnað annarra sérgreina. Heimilislækningar virðast njóta sömu virðingar og aðrar sérgreinar innan stéttarinnar eða þjóðfélagsins, en heimilislæknarnir sjálfir eru efins um að svo sé. Ágreiningur er á milli heimilislækna og sérfræðinga um nánari samvinnu á heilsugæslustöðvum. Flestir eru sammála um gagnsemi áætlanagerða um verkaskiptingu. Þessi grein er sú síðasta af fimm í ritröðinni um skoðanir lækna á starfssviðum sérgreina (1-4). Í fyrri greinum kom fram að faghópar hafa almennt tilhneigingu til þess að hasla sér eins stóran völl á sínu sviði og mögulegt er (conceptual eða non-physical territorial behaviour). Þessi hneigð skiptir miklu máli varðandi ágreining sem skapast getur þegar nýjar sérgreinar fara yfir á svið þeirra sem fyrir eru.