Abstract
Objective
Concerns have been raised about doctors shifting jobs from non-profit to for-profit healthcare, leaving non-profit organisations understaffed. This study explores the extent and underlying reasons for such job transitions. A 2024 national survey of Norwegian doctors (n = 1973; 78% response) examined job shifts from non-profit to for-profit healthcare over the past 2 years.
Results
Fifty-one doctors (2.6%) had shifted from non-profit to for-profit healthcare in the past 2 years; 19 (37%) were still working in for-profit healthcare. A third of the doctors working in non-profit healthcare had considered switching to for-profit work (450/1517). This group was younger, less satisfied with their jobs, and reported higher sickness absence. Working hours were most often cited as a very important reason for shifting jobs.
Keywords: Physician engagement, Health workforce, Public health infrastructure
Introduction
Non-profit healthcare is considered one of the pillars of the Scandinavian welfare states. There is an explicit political goal to balance non-profit and for-profit healthcare so that the entire population can feel confident that they will receive high quality health care services when they need it [1]. When for-profit healthcare is growing and compete to employ doctors, concerns have been raised that too many doctors will leave non-profit health care organisations in favour of for-profit work [2]. For public health purposes, it is therefore important to monitor how the doctors themselves assess the labour market and to investigate whether they perceive non-profit healthcare employers as attractive. This study aims to examine the scope and possible causes of doctors shifting jobs from non-profit to for-profit healthcare organisations.
Main text
Material and methods
This study uses data from a survey among Norwegian doctors conducted between March and August 2024. The survey was sent out to 2534 doctors, the list was drawn from the master file of the Norwegian Medical Association, which includes about 95% of all doctors in Norway. The invited doctors were representative of the total physician workforce in terms of age, sex and medical specialty. Seventy-nine percent (N = 2004) answered the questionnaire. For the current analyses, we did not include doctors who were retired or those who did not provide information about their job situation. Thus, this study is based on responses from 1973 practising doctors (78% of the invited doctors).
The doctors participating in the current survey were asked whether they had shifted or considered to shift job from non-profit to for-profit or vice versa during the past 2 years. In this paper, the focus is on the direction non-profit to for-profit organizations. The main reasons for job-shifts were reported as salary/working hours/professional development opportunities/other reasons.
In Norway, the healthcare system is organised as non-profit public (mainly hospitals), non-profit private, or for-profit private providers. A fourth group includes private general practitioners (GPs) and other specialists in private practice; although they are self-employed private entities, they are mainly financed through public grants and reimbursements from the National Social Insurance system to provide services to the general population [3]. In the current survey, doctors defined themselves whether their current workplace (at the survey time) was in non-profit or for-profit healthcare and reported working hours per week and the number of days of sick leave during the last year. Job satisfaction was measured with ten questions from Warr’s scale, each question was ranked from 1 (very dissatisfied) to 7 (very satisfied) [4].
The responses on shifts from non-profit to for-profit organizations in the total sample are presented descriptively in Table 1 with numbers for each category and average values or medians for each group. Variances are shown through the minimum and maximum value and the interquartile ranges.
Table 1.
Norwegian doctors shifting jobs from non-profit to for-profit healthcare organisations 2022–2024 (N = 1973)
| Total answers | Had shifted | Had considered shifting but didn’t | Had not shifted and had not considered shifting | |
|---|---|---|---|---|
| 1929 | 51 (2.6%) | 538 (27.2%) | 1340 (67.9%) | |
| Gender* | ||||
| Woman | 1180 | 33 (2.7%) | 329 (27.1%) | 818 (67.8%) |
| Man | 746 | 18 (2.4%) | 207 (27.1%) | 521 (68.2%) |
| Year of birth, median | 1978 | 1978 | 1981 | 1976 |
| Hours worked per week, average [min–max] (median, interquartile range) | 45.1 [10–80] (45, 40–50) | 39.9 [15–60] (40, 37–45) |
46.1 [10–80] (45, 41–50) |
45 [10–80] (45, 40–50) |
| Days sick leave last year, average (median) | 12.7 (3) | 7.7 (3) | 18.7 (5) | 10.5 (3) |
| Job satisfaction average (standard deviation) | 49.9 (9.9) | 54.5 (9.1) | 43.4 (10.1) | 52.1 (8.8) |
*3 informants stated a different gender identity
Table 2 compares those in the non-profit system who expressed a wish to change to for-profit compared to those who did not wish to change. The analyses were conducted in Stata 18.5 SE.
Table 2.
Norwegian doctors in non-profit health care considering shifting to for-profit healthcare organisations (N = 1517)
| Total answers | Had considered shifting but didn’t | Had not shifted and had not considered shifting | p-value | |
|---|---|---|---|---|
| 1495 | 450 (30.1%) | 1029 (68.8%) | ||
| Gender* | ns | |||
| Woman | 948 | 282 (29.8%) | 656 (69.2%) | |
| Man | 544 | 166 (30.5%) | 372 (68.3%) | |
| Year of birth, average | 1978 | 1980 | 1977 | <0.001 |
| Hours worked per week, average [min–max] (median, interquartile range) |
44.8 [12–80] (44, 40–50) |
45.3 [17–80] (44, 40–50) |
44.7 [12–70] (44, 40–49) |
ns |
| Days sick leave last year, average (median) | 12.8 (3) | 18.5 (5) | 10.1 (3) | <0.001 |
| Job satisfaction average (standard deviation) | 48.8 (10) | 42.6 (9.6) | 51.5 (8.9) | <0.001 |
*3 informants stated a different gender identity
Results
In the total sample, 2.6% (51/1973) of the respondents reported that they had shifted job from non-profit to for-profit healthcare organisations between 2022 and 2024 (Fig. 1).
Fig. 1.
Job-shifts between non-profit and for-profit sector among Norwegian doctors 2022–2024
Job satisfaction, weekly working hours and sick leave among those who shifted from non-profit to for-profit, among those who considered to shift and among those who had no desire of shifting is shown in Table 1. Those who reported job-shift to the for-profit sector, reached a level of job-satisfaction similar to those who had not considered to shift, and had shorter workweeks and lower sick-leave. Only 19 of the 51 (37%) who reported job-shift from non-profit to for profit worked in for-profit healthcare in 2024.
In 2024, 77% of the surveyed doctors defined their current working position as non-profit health care (n = 1517) (this group included 1172 hospital doctors and 109 GPs). Another 4% (n = 80) combined work in non-profit and for-profit healthcare organisations, and 3% of the doctors (n = 57) worked exclusively in for-profit healthcare (in this group 27 were self-employed, 3 were hospital doctors and 3 GPs). Another 319 (16%) were self-employed specialists having a reimbursement contract from the National Social Insurance system (228 of these were GPs).
Among the 1517 doctors who worked in non-profit healthcare organisations in 2024, 30% (n = 450) had considered to shift to for-profit. These doctors were younger, had higher sickness absence and lower job satisfaction than those doctors who had not considered to shift, while weekly working hours were the same (Table 2).The most important reasons for shifting or wanting to shift from non-profit to for-profit healthcare organisations were working hours (67%), salary (35%) and professional development opportunities (29%).
Since the number of respondents solely working in for-profit healthcare at the time of the survey was small, the data documenting job shifts from for-profit to non-profit give uncertain estimates and hampers a meaningful description of their situation. Forty-seven participants reported that they had shifted from for-profit to non-profit healthcare, of whom 36 currently worked in non-profit healthcare organisations. Twelve respondents had shifted both ways (to and from for-profit organisations), of which 11 worked in non-profit healthcare in 2024. Doctors who worked in for-profit healthcare organisations had similar motivations for wanting to shift to non-profit work; 62% reported working hours, 24% salary, and 29% professional development opportunities.
Discussion
This study provides a novel insight into the scope and underlying factors of doctor’s job shifts from non-profit to for-profit healthcare organisations in Norway.
A main finding is that less than three per cent of the doctors had shifted from non-profit to for-profit jobs between 2022 and 2024. This is consistent with analyses in the Norwegian Medical Association’s membership register (Anders Taraldset, personal communication). However, ten times as many had considered to shift from non-profit to for-profit but had not done so. This group had higher sickness absence and lower job satisfaction than the other doctors. Working hours were often cited as an important reason for shifting job between non-profit and for-profit actors. Those who reported job-shift to the for-profit sector, reached a level of job-satisfaction similar to those who had not considered to shift. From other studies, we know that young doctors often experience more stress than their older colleagues, and research has found increasing differences in working hours between doctors working in non-profit and for-profit hospitals [5]. Shifting job often result in more favourable working conditions [6, 7]. Thus, the group reporting stress and less job-satisfaction may be the most motivated to shift employer if a commercial healthcare provider establishes itself in an area. It will therefore be important to monitor the proportion of doctors who are considering job shifts between sectors.
Conclusion
In a national representative survey panel, about three per cent of the doctors had shifted job from non-profit to for-profit healthcare organisations over a two-year period, while a third of the doctors working in non-profit healthcare organisations had considered it. Working hours were stated as the most important motivation for job shift.
Limitations
The main strength of this study is the use of a national panel that is representative of Norwegian doctors. Validated questionnaire was used to inquire about job satisfaction. The response rate was 78%. On the other hand, all information was self-reported, the questions were of a general nature, and the groups were small and partly overlapping. We were therefore unable to carry out comparative analyses, and we could only to a limited extent describe the direction of the job shifts, or describe job shifts among doctors in different age groups and positions.
Few doctors who participated in the study worked in for-profit healthcare organizations. This could reflect the fact that the for-profit healthcare sector in Norway is small compared to the public healthcare system, although we cannot rule out that privately employed doctors were underrepresented in this study. It would have strengthened our study if we had statistical power to documented whether doctors in for-profit healthcare services seeks jobs in non-profit healthcare and what they want to achieve from such a sectorial shift. The reasons why doctors in non-profit versus for-profit healthcare want to shift job to the other sector should be investigated more closely.
Acknowledgements
Not applicable.
Abbreviation
- GP
General practitioners
Author contributions
FB, BB, KIR and EH initiated and designed the study. EAF conducted the analyses and drafted the manuscript. All authors interpreted the results and contributed to refining the manuscript. All authors read and approved the final manuscript.
Funding
This study was funded by the Institute for Studies of the Medical Profession. No external financial support was received.
Data availability
The data that support the findings of this study were used under license for the current study and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission from Institute for Studies of the Medical Profession.
Declarations
Ethics approval and consent to participate
The survey among Norwegian doctors were exempted from submission to the Regional Committee for Medical Research Ethics (IRB 0000 1870). Approval for data protection was obtained from the Norwegian Social Data Service (Reference 19521). All subjects provided written consent to participate in the survey. The data were stored and analysed in accordance with international ethical guidelines for medical research.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
The data that support the findings of this study were used under license for the current study and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission from Institute for Studies of the Medical Profession.