title: A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey.
abstract: BACKGROUND
  Many western countries are facing an existing or imminent shortage of primary care physicians especially in rural areas. In Germany, working in rural areas is often thought to be associated with more working hours, a higher number of patients and a lower income than working in urban areas. These perceptions might be key reasons for the shortage. The aim of this analysis was to explore if working time, number of treated patients per week or proportion of privately insured patients vary between rural and urban areas in Germany using two different definitions of rurality within a sample of primary care physicians including general practitioners, general internists and paediatricians.
  
  
  METHODS
  This is a secondary analysis of pre-collected data raised by a questionnaire that was sent to a representative random sample of 1500 primary care physicians chosen by data of the National Association of Statutory Health Insurance Physicians from all federal states in Germany. We employed two different methods of defining rurality; firstly, level of rurality as rated by physicians themselves (urban area, small town, rural area); secondly, rurality defined according to the Organisation for Economic Co-operation and Development.
  
  
  RESULTS
  This analysis was based upon questionnaire data from 715 physicians. Primary care physicians in single-handed practices in rural areas worked on average four hours more per week than their urban counterparts (p < 0.05). Physicians' gender, the number of patients treated per week and the type of practice (single/group handed) were significantly related to the number of working hours. Neither the proportion of privately insured patients nor the number of patients seen per week differed significantly between rural and urban areas when applying the self-rated classification of rurality.
  
  
  CONCLUSIONS
  Overall this analysis identified few differences between urban and rural primary care physician working conditions. To counter future misdistribution of primary care, students should receive practical experience in rural areas to get more practical knowledge on working conditions.
authors: Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany. jost.steinhaeuser@med.uni-heidelberg.de
authors: Jost
authors: J
authors: Steinhaeuser
authors: Stefanie
authors: S
authors: Joos
authors: Joachim
authors: J
authors: Szecsenyi
authors: Antje
authors: A
authors: Miksch
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D007348:Insurance, Health / Q000145:classification / Q000191:economics*; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000191:economics / Q000706:statistics & numerical data* / Q000600:supply & distribution; D011365:Professional Practice Location / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000706:statistics & numerical data; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data