Extent and nature of dual practice engagement among Iran medical specialists

Mahboubeh Bayat,Iraj Harirchi,Mahmoud Khodadost,Ebrahim Jaafaripooyan,Mehdi Yaseri,Azad Shokri,Elmira Mirbahaeddin,Ali Akbari-Sari,Roghayeh Khalilnezhad,Gholamhossein Salehi Zalani

doi:10.1186/s12960-018-0326-4

Abstract

BackgroundDual practice (DP) by medical specialists is a widespread issue across health systems. This study aims to determine the level of DP engagement among Iran’s specialists.MethodsA pre-structured form was developed to collect the data about medical specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes, and eventually a combination of the first name, surname, and father’s name.ResultsA total of 48 345 records were collected for 30 273 specialists from 858 (93%) hospitals out of total 925 hospitals. Sixteen thousand eight hundred forty-nine (69% of) specialists were non-faculty members and 6317 (26% of) specialists were employed on a contract basis. Eleven thousand six hundred and thirty-eight (47.7% of) specialists were engaged in DP on total. Female specialists had 0.78 times less DP chance; faculties compared to non-faculties had 0.65 times more DP chance and full-time geographic specialists compared to non-full-time specialists had 0.15 times more DP chance. DP was more frequent in specialists with higher age and more job experience and in provinces with more population, deprivation, and higher number of specialists per facility (P < 0.05).ConclusionsThe level of DP is relatively high among Iran medical specialists, especially in geographic full-time specialists. However, they are totally banned and they receive extra payment for being full-time; restrictive regulations and financial incentives without considering other factors might not eliminate DP in specialists and it should be addressed based on conditions of each country and regions inside the country.

Highlights

Dual practice (DP) by medical specialists is a widespread issue across health systems
Status of the study specialists A total of 48 345 records were collected for 30 273 specialists from 858 (93%) hospitals out of total 925 hospitals from which 24 414 specialists were considered based on the definition of this study
Dual practice status A total of 11 638 (48%) public sector specialists were engaged in dual practice from which 9575 were in service through Ministry of Health and Medical Education (MOHME) and 62% of non-full-time specialists had multiple job holdings (Table 3)

Summary

Introduction

Dual practice (DP) by medical specialists is a widespread issue across health systems. Kiwanuka et al define DP for healthcare professionals as having more than one medical job inside or outside public sector facilities [3]. In Austria, 100% of specialists work in both public and private sectors at the same time, followed by 90% in Ireland, 80% in Bangladesh, 71% in Egypt, 70% in Indonesia, 65.7% in Australia, 61% in the UK, 43% in Portugal, 38% in New Zealand, and 37% in Denmark, and income increase is reported as the main reason for DP [1, 2, 4, 6,7,8,9]. The income gap between the specialists in the public and private sectors is the main reason to encourage physicians to leave the public sector or work simultaneously in the public and private sectors.

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