Physicians In Public Hospitals Research Articles

Identity Threat, Identity Work, and Identity Construction: A Study of Physicians in Public Hospitals

Identity Threat, Identity Work, and Identity Construction: A Study of Physicians in Public Hospitals

Association between Presenteeism, Associated Factors, and Outcomes among Intern Physicians in Public Hospitals during the COVID-19 Pandemic: A Cross-Sectional Study.

Background and Objectives: Presenteeism, when employees continue to work despite being sick, may have increased among intern physicians during the COVID-19 pandemic due to the necessity of performing unfamiliar tasks. This study aimed to investigate the prevalence of presenteeism among intern physicians (IPs) in Thailand, its associated factors, and outcomes. Material and Methods: A total of 254 IPs participated in this cross-sectional study conducted from June to July 2022. Participants completed a nationwide online questionnaire including demographics, financial status, underlying diseases, hospital location and affiliation, department, resource problems, manpower shortage, workload intensity, presenteeism, and its outcomes. IPs were recruited via various social media platforms. Statistical analysis was performed using multivariable zero-inflated Poisson regression and multivariable linear regression. Results: The average age of IPs was 25.5 years (SD 1.9), and 57.5% were female. The majority of IPs reported dealing with resource problems (74.8%), insufficient manpower (94.9%), and intense workload (83.5%). Presenteeism was prevalent among 63.8% of IPs, with the most common of the diseases being allergic rhinitis (31.3%). IPs with underlying diseases had an increased rate of presenteeism (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) 1.33-4.55). IPs working in community hospitals during their rotations exhibited a lower rate of presenteeism (aOR 0.39, 95% CI 0.16-0.94) compared to other departments within general or regional hospitals. The IPs frequently exposed to insufficient manpower had an increased rate of presenteeism (aOR 4.35, 95% CI 1.02-20.00) compared to those not exposed. Additionally, IPs with presenteeism had more exhaustion (β 1.40, 95% CI 0.33 to 2.46), lower perceived well-being (β -0.65, 95% CI -1.26 to -0.03), and job satisfaction (β -0.33, 95% CI -0.63 to -0.03). Conclusions: During COVID-19, intern physicians in Thailand often exhibit presenteeism due to physical conditions, resource scarcity, and personnel shortages, impacting exhaustion, well-being, and job satisfaction. Recommendations include assessing healthcare workforces, allocating resources more effectively, enforcing policies to promote responsible use of sick leave, and implementing sick leave systems.

Knowledge and practice of the physical activity prescription by generalists and specialist physicians of the city of Kinshasa: a cross-sectional study

BackgroundThe health benefits of regular physical activity (PA) are well documented. However, several people in both developed and developing countries do not meet PA recommendations. Health professionals are believed to be potential PA promoters. The purpose of this study is to gain insight into general and specialist practitioners’ knowledge, practices and PA prescription-related factors in private and public hospitals in Kinshasa.MethodsA multicenter cross-sectional analytical study was conducted among general and specialist practitioners in the Democratic Republic of the Congo’s capital using a declarative and anonymous questionnaire.ResultsOverall, 40.2% of the participants were interested in their patient’s PA, 2.3% prescribed PA, and 0.9% did it correctly. Specialist physicians (SPs) prescribed PA more frequently than general practitioners (GP), and private hospital physicians prescribed PA more frequently than public hospital physicians. Five factors were independently associated with participants in prescribing PA: being in a private hospital increased the likelihood of prescribing PA by twofold (aOR, 1.83; 95% CI, 0.99–3.39; p = 0.055), being an SP increased the likelihood by sixfold (aOR, 6.22; 95% CI, 3.78–10.51; p = 0.000), being an internist increase the likelihood by sixfold (aOR, 5.81; 95% CI, 3.45–9.78; p = 0.000), being cardiologist by a factor of 12 (aOR, 12.91; 95% CI, 4.37–38.15; p = 0.000) and knowing the benefits of PA by a factor of 2 (aOR, 2.29; 95% CI, 1.29–4.08; p = 0.006). The most common reason given for a lack of interest in patients’ PA, followed by a lack of knowledge about current PA prescribing recommendations and a lack of time.ConclusionsSPs and professionals in the private health sector were the most interested in their patients’ PA. A small portion of them actually prescribed it, and only a tiny proportion did it correctly. This bleak picture highlights a need to rethink the undergraduate medical curricula, especially about teachings on the importance and use of PA as a medicine in its own right in disease prevention and treatment.

Investigating the Communication Apprehension Model of Physicians in Public Hospitals of Yazd City

Background: A good and healthy communication between the physician and patient and the therapeutic staff is the basis of good medical care, and communication skills play an important role in patient's satisfaction and their treatment. The aim of this study was to explore the physicians' communication in public hospitals of Yazd city using phenomenological methods.
 Methods: This qualitative research was conducted using the phenomenology method from January 2021 to August 2022. The location of the study was 2 hospitals affiliated to Shahid Sadoughi University of Yazd. The statistical population included general practitioners and specialists from the government hospitals of Yazd city. Among these doctors, 12 people who had a working experience of more than 11 years and were willing to cooperate with the researcher were selected as the sample using a selective and purposive method. Data were collected through interviews. Lincoln and Guba criteria were used to assess validity and reliability of the research, and these data were analyzed by NVIVO11 software.
 Results: Results demonstrated that physicians' communication pattern consisted of 11 sub-themes: psychological factors; family factors; lack of skills; information disorders; challenges related to patients, colleagues, and medical profession; hospital environment; social harm; and religious factors. These sub-themes were categorized into five main themes: environmental, individual, communicative, cultural, and professional aspects.
 Conclusion: Establishing a proper relationship between the patient and physician is the essential component of a high quality medical care. Improving this relationship will cause patient's more commitment to the treatment, more satisfaction with the medical team, and less medical errors and complaints.

The whole experience of public hospital physicians from several specialties with biopharmaceutical effectiveness, safety, adverse drug reactions and interchangeability: A qualitative study

BackgroundAlthough there is increasing support for biosimilar medicines by the Iraqi Ministry of Health (MOH), there is scarce information about whether physicians accept these medicines and support movement toward replacing reference medicines with their biosimilar counterparts. ObjectivesThe study objectives were to 1) explore in-depth the perceptions of Iraqi physicians working in public hospitals about the difference in effectiveness and safety between biosimilar medicines and their reference biological counterparts, 2) evaluate physicians' barriers to prescribing biosimilar medicines, 3) assess the adherence of physicians to the new pharmacovigilance regulations on reporting biopharmaceutical adverse drug reactions (ADRs) and 4) identify any barriers facing physicians to reporting biopharmaceutical- ADRs. MethodsThis qualitative study included face-to-face and virtual semi-structured interviews involving physicians from different disciplines who had experience with biological or biosimilar medicines. The interviews were conducted between November 6, 2020, and February 7, 2021. Thematic analyses were used to analyze qualitative data generated from the interviews. ResultsThe study sample included 36 physicians (6 women and 30 men) from seven different specialties at ten governmental hospitals mainly in Baghdad, and one physician was from Mosul, Iraq. Because most physicians had insufficient experience with biosimilar medications and were not sure about their effectiveness, the majority were hesitant to prescribe them. Most physicians preferred to prescribe reference biological medicines initially. However, the initial prescribing and switching between a reference and counterpart biosimilar relies on its availability. They chose biosimilar medications that have been approved by the U.S. FDA or EMA. Most physicians were unaware about the new pharmacovigilance regulations to report adverse biopharmaceutical reactions. The physicians tended to underreport biopharmaceutical ADRs and believed that inadequate physician-pharmacist collaboration negatively impacts preventing and reporting ADRs. ConclusionsMedicine procurement in healthcare settings should focus on sustainably securing high-quality biopharmaceuticals rather than looking only at costs to enhance physician experience and patient clinical outcomes. Promoting documentation, monitoring, and physician-pharmacist collaboration is pivotal to prevent, monitor, and treat biopharmaceutical ADRs.

Analysis of patients’ demand for professional conduct by residents in public hospitals based on expectations

Objective: This study aims to reveal patients’ demand for professional conduct by physicians in public hospitals in terms of 22 elements in five dimensions, namely, the principles of life value, integrity fairness and justice, rationality, and honesty, based on the theory of social expectations and from the perspective of patients. Methods: More than 1500 patients were selected from 34 public hospitals in Shandong Province, China to participate in a questionnaire survey. A Chi-square test, logistic regression analysis, and other methods were used to analyze the survey data, such as satisfaction with residents’ medical services and demand for professional conduct. Results: About 79.5% of the patients expressed that the medical services provided by residents in public hospitals were above the “average” level. There was statistical significance for age, educational level, occupation, and satisfaction with inpatient services (P < 0.05). In the ranking of moral elements, four elements related to honesty, three elements related to rationality, two elements related to kindness (righteousness), and one element related to life value ranked in the top 10 elements, all with average scores above 4.70. Conclusion: The social evaluation mechanism for professional conduct by residents in public hospitals should be strengthened, and the standardized training system for the professional conduct of residents in public hospitals should be improved.

Unravelling the nexus between creative self-efficacy, humble leadership, innovative work behaviour and job performance amongst physicians in public hospitals

PurposeThe study aims to examine the relationship between innovative work behaviour (IWB) and JP amongst physicians in Iraq public hospitals. The study also determines the effects of creative self-efficacy (CSE) and humble leadership (HL) on IWB. Besides, the study investigates the mediating role of IWB on the relationship between CSE and JP as well as between HL and JP.Design/methodology/approachA total of 332 respondents participated in the survey, although 173 responses were utilised after data screening. The study employs the structural equation modelling via partial least squares (PLS-SEM) to ascertain the relationship between the variables.FindingsEvidence from the study indicates that IWB has a positive relationship with JP, whilst CSE and HL are significant determinants of IWB amongst physicians in Iraq public hospitals. The study provides evidence that IWB plays a positive mediating role in the relationship between CSE and JP as well as between HL and JP amongst physicians in Iraq public hospitals.Originality/valueThe study implies that the JP of physicians in Iraq public hospitals can be enhanced by IWB, whilst the latter can be improved by CSE and HL. The influences of CSE and HL on JP can be boosted by IWB. Hence, efforts to promote IWB should be vigorously pursued by Iraq public hospitals to foster the physicians' JP.

Investigating the challenges of physicians' participation in accreditation programs from the perspective of physicians in public hospitals

Investigating the challenges of physicians' participation in accreditation programs from the perspective of physicians in public hospitals

Organizational environment as a factor of physicians’ psychological well-being

IntroductionThe importance of ensuring the well-being of physicians is determined by the serious changes in medical organizations that transform the traditional “doctor - patient” relationship and set different indicators of the medical care quality (Melnyk et al., 2020; Sandy et al., 2019; Tawfik et al., 2019).ObjectivesThe main objective was to study the characteristics of the well-being of physicians working in public and commercial medical institutions. The difference in these “environments” is the degree of independence and responsibility in the course of diagnosis and treatment.MethodsThe study involved 102 people: 66 of them are employees at public hospitals, 36 –at commercial medical centers. The respondents were offered a methodic package aimed to diagnose: career orientations; the degree of satisfaction with various work aspects; severity of burnout symptoms; subjective assessment of their work.ResultsThe estimating factor analysis identified 3 factors (73% of the total variance of the data) –such as emotional acceptance of one’s work, stress and tension, intellectual workload. The indicator of emotional exhaustion among physicians of commercial centers is significantly higher than that of doctors of public hospitals, which indicates a greater emotional involvement in the situation of providing paid services (p≤0.007).ConclusionsThe main direction of psychological work with physicians of commercial institutions is teaching them to regulating the emotional state and to master communicative techniques. An important part of psychological support of physicians in public hospitals is to provide a favorable psychological climate that ensures the professional growth and adherence to humane principles of working with patients.DisclosureNo significant relationships.

Development and validation of an instrument in job evaluation factors of physicians in public hospitals in Beijing, China.

BackgroundJob evaluation has been widely used to establish a foundation for internal equity and other human resource functions. The United Kingdom adopts the National Health Service (NHS) Job Evaluation scheme to determine the pay bands for most NHS staff and ensure equal pay for work of equal value. The challenges of recruiting and retaining physicians in Chinese public hospitals have heightened the need for a reliable job evaluation system to ensure the equality of physician compensation. The aim of this study was to construct job evaluation factors of physicians in Chinese public hospitals based on the NHS Job Evaluation scheme and to examine the reliability and validity of the established system.MethodsQuestionnaire surveys and statistical analyses were used to determine the job evaluation factors for physicians. The preliminary screening of the evaluation factors was based on a literature review, focused interviews with physicians and the Delphi method. Based on the results of preliminary screening, a questionnaire with 25 factors was designed to survey physicians regarding the importance of each factor in physician job evaluation. After the pretest, final questionnaire data were collected from 900 physicians by adopting a stratified sampling from 6 tertiary public hospitals in Beijing. A principal component analysis was used for factor extraction and structural validity analysis. The reliability was determined using Cronbach’s alpha.ResultsThe results of the principal component analysis showed that the 25 physician job evaluation factors were grouped into the 5 dimensions of Task Characteristics, Knowledge, Responsibility, Effort/Environment, and Skills. The Cronbach’s alpha coefficients of the five dimensions ranged from 0.841 to 0.909, which indicated a high level of reliability. The result of the factor analysis indicated fair structural validity. The content validity was established by building onto the NHS Job Evaluation scheme and other well-established job evaluation systems.ConclusionsOur study indicates that the Chinese version of physician job evaluation is an instrument with fair reliability and validity, which fully reflects the characteristics of physicians in Chinese public hospitals. This system can provide an important basis for developing a physician compensation plan and ensuring internal equity in healthcare organizations.

A Study of the Relationship Between Job Satisfaction and Work Engagement of Physicians in Public Hospitals

To understand the level of job satisfaction and work engagement of physicians in public hospitals, to analyze the interaction between job satisfaction and work engagement, and to discuss how each dimension of job satisfaction affects work engagement so as to provide information and reference for improving the level of work engagement of physicians in public hospitals. Covering 6 public hospitals in Sichuan (3 tertiary-level hospitals and 3 secondary-level hospitals), 638 questionnaires were obtained from physicians through convenient sampling for data description and analysis. Pearson correlation method was used to analyze the correlation between job satisfaction and work engagement, and multiple linear stepwise regression method was used to analyze work engagement and the influencing factors of each dimension. With regard to job satisfaction, physicians showed high levels of satisfaction in personal safety (3.77±0.87), leadership identification and support (3.59±0.77), and job pressure (3.51±0.81). The mean points of work engagement and each dimension were as follows: total mean points of work engagement (4.02±0.99), dedication (4.21±1.13), absorption (4.19±1.08) and vigor (3.63±1.04). In job satisfaction, salary and benefits, work environment, social recognition, organizational management, leadership identification and support are positively correlated to work engagement and all dimensions. In job satisfaction, 5 dimensions, including social recognition, leadership recognition and support, work achievement, personal safety and organizational management, had a significant influence on work engagement and all dimensions. Emphasis on the high-level needs for recognition and self-actualization of doctors, doctor-patient communication, and personal development of doctors may improve doctors' job satisfaction and work engagement.

PP194 Research On The Correlation Mechanism Between The Psychological Contract Of Physicians In Public Hospitals And Their Turnover Intention

IntroductionGuiding and motivating doctors' attitudes and behaviors in the public welfare of public hospitals is the key to promoting medical reform. This study explored the correlation between the hospital responsibilities perceived by physicians and their turnover intention in Chinese public hospitals, as well as the moderating effects of variables such as sex, hospital level, working period, department, and reason for career choice on the correlation models.MethodsA pre-developed, reliable, and valid scale for the physicians’ psychological contract was developed. Survey data from 123 public hospitals in three provinces in the east, central, and west areas of China were analyzed. The authors constructed and tested the correlation mechanism model and then analyzed the effects of particular variables.ResultsThe fulfillment of hospital transactional and developmental responsibility had a significant negative effect on the intent of physicians to leave the hospital and front-line clinical practice, respectively. Working pleasure, fairness perception, and occupational satisfaction were mediator variables in the impact. In addition, hospital level, working period, department, and reason for career choice had a moderating effect on the correlation mechanism model, with the effects varying between different paths.ConclusionsThe fulfillment of hospital transactional responsibility had a more negative effect on the intent of physicians to leave the hospital than other responsibilities, whereas fulfillment of hospital developmental responsibility had a more negative impact on the intent of physicians to leave front-line clinical practice. Furthermore, the results suggested that hospital administrators need to consider the differences between various types of physicians in order to improve the effects of guidance and motivation in these health professionals.

PP193 Research On The Correlation Mechanism Between The Psychological Contract Of Physicians In Public Hospitals And Their Medical Professionalism

IntroductionGuiding and motivating doctors' attitudes and behaviors in the public welfare of public hospitals is the key to promoting medical reform. This study explored the correlation between the hospital responsibilities perceived by physicians and their medical professionalism practices in Chinese public hospitals, and the moderating effects of variables such as sex, hospital level, working period, department, and reason for career choice on the correlation model.MethodsA pre-developed, reliable, and valid scale for the physicians’ psychological contract was developed. Survey data from 123 public hospitals in three provinces in the east, central, and west areas of China were analyzed. The authors constructed and tested the correlation mechanism model and then analyzed the effects of particular variables.ResultsThe fulfillment of hospital ideological responsibility has a significant positive effect on physicians' medical professionalism practices, with occupational satisfaction mediating the effect. In addition, hospital transactional, developmental, and relational responsibility can improve physicians’ medical professionalism practices through fairness perception and work pleasure. Hospital level, working period, department, and reason for career choice had a moderating effect on the correlation mechanism model, with the effects varying between different paths.ConclusionsThe fulfillment of hospital responsibilities can have a positive effect on physicians’ practices of medical professionalism, especially in the domain of ideological responsibility where the largest and most direct impact was observed. Furthermore, the results suggested that hospital administrators need to consider the differences between various types of physicians in order to improve the effects of guidance and motivation in these health professionals.

Junior doctors: when fresh blood fast-tracks the fight against COVID-19

On 11 March 2020, the WHO declared COVID-19 as a Public Health Emergency of International Concern. In Europe, particularly in France, hospitals were urged to take prompt measures: cancellation of...

Should I stay or should I go? The role of leadership and organisational context for hospital physicians\u2019 intention to leave their current job

BackgroundPhysician turnover is a concern in many health care systems globally. A better understanding of physicians’ reasons for leaving their job may inform organisational policies to retain key personnel. The aim of this study was to investigate hospital physicians’ intention to leave their current job, and to investigate if such intentions are associated with how physicians assess their leaders and the organisational context.MethodsData was derived from a survey of 971 physicians working in public hospitals in Norway in 2016. The data was analysed using descriptive statistics and multivariate analysis.ResultsWe found that 21.0% of all hospital physicians expressed an intention to leave their current job for another job. An additional 20.3% of physicians had not made up their mind whether to stay or leave. Physicians’ perceptions of their leaders and the organisational context influence their intention to leave their hospital. Respondents who perceived their leaders as professional-supportive had a significantly lower probability of reporting an intention to leave their job. The analysis suggests that organisational context, such as department mergers, weigh in on physicians’ considerations about leaving their current job. Social climate and commitment are important reasons why physician stay.ConclusionsA professional-supportive leadership style may have a positive influence on retention of physicians in public hospitals. Further research should investigate how retention of physicians is associated with performance related to organisational and leadership style.

Dual practice of public hospital physicians in Vietnam.

Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing exclusively in the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians' dual practice and incorporate the topic in policy debates on health reform.

Organisational silence among nurses and physicians in public hospitals.

To define the underlying reasons that lead physicians and nurses who provide patient care and treatment, to maintain silence in their work and how they perceive the consequences of such silence in public hospitals. The concept of organisational silence is described as employees' avoidance of stating his/her opinions, thoughts and suggestions, which would improve the organisation and enable it to provide better processes or services. This concept has been examined more frequently in the international literature in the past decade, and it has drawn attention as one of the most important barriers to employees' contributions to their organisation. Descriptive and cross-sectional study. The study sample consisted of 601 physicians and nurses who work in five hospitals with bed capacities of 100 or more. The data were collected using a two-part form: an introductory information form and an organisational silence scale. Administrative and organisational topics were prominent among the reasons for employees of healthcare organisations to remain silent for both physicians and nurses. The results of this study should be considered by physicians and nurses to realise and improve themselves. Also, decision makers and managers of public hospitals might evaluate and remove organisational and communicative barriers to employees' contributions to their organisations based on these results. Physicians and nurses are responsible for the fulfilment of highly important tasks for their organisations. Their contributions help their organisations remain competitive, improve the health services, ensure and sustain patient safety. Hence, these results will provide information to facilitate an understanding of the topics, causes and consequences of organisational silence among physicians and nurses, two key healthcare professions, and will be helpful in the development of medical and nursing human resources in clinical settings.

Comparison of stress levels between physicians working in public and private hospitals in Johor, Malaysia.

ObjectivesPhysicians are known to experience a high level of stress due to the profession itself, as well as due to factors related to the workplace, patient care, and work-life balance. Owing to the nature of public and private hospitals in Malaysia, physicians working in different settings are expected to have different levels of stress. However, there is no study to validate this assumption. The present study aimed to compare stress levels between physicians working in public and private hospitals in the state of Johor, Malaysia.MethodsParticipants were selected via stratified sampling. Participants completed an online questionnaire comprising demographic details and the Health Professional Stress Inventory. Scores on each domain and the aggregate scores were compared between physicians in public and private hospitals using a univariate analysis adjusted for potential confounders.ResultsThe overall stress level between physicians in public and private hospitals was similar. However, physicians in private hospitals experienced a higher stress level related to patient care responsibilities and professional uncertainty as compared to those in public hospitals.ConclusionPhysicians from private hospitals experience stress in different aspects of their profession as compared to physicians in public hospitals, especially with reference to patient care and career uncertainty. Measures should be taken to relieve the stress of physicians and thus improve their wellbeing.

Dual Practice of Public Hospital Physicians in Vietnam

Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing in only the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians’ dual practice and incorporate the topic in policy debates on health reform.

Public-on-private dual practice among physicians in public hospitals of Tigray National Regional State, North Ethiopia: perspectives of physicians, patients and managers

BackgroundPhysicians who work in the private sector while also holding a salaried job in a public hospital, known as “dual practice,” is one of the main retention strategies adopted by the government of Ethiopia. Dual practice was legally endorsed in Tigray National Regional State, Ethiopia in 2010. Therefore, the aim of this study was to explore the extent of dual practice, reasons why physicians engage in it, and its effects on public hospital services in this state in northern Ethiopia.MethodsA cross-sectional study using mixed methods was conducted from February to March 2011 in six geographically representative public hospitals of Tigray National Regional State. A semi-structured, self-administered questionnaire was distributed to all physicians working in the study hospitals, and an interviewer-administered, structured questionnaire was used to collect data from admitted patients. Focus group discussions were conducted with hospital governing boards. Quantitative and qualitative data were used in the analysis.ResultsData were collected from 31 physicians and 449 patients in the six study hospitals. Six focus group discussions were conducted. Twenty-eight (90.3%) of the physicians were engaged in dual practice to some extent: 16 (51.6%) owned private clinics outside the public hospital, 5 (16.1%) worked part-time in outside private clinics, and 7 (22.6%) worked in the private wing of public hospitals. Income supplementation was the primary reason for engaging in dual practice, as reported by 100% of the physicians. The positive effects of dual practice from both managers’ and physicians’ perspectives were physician retention in the public sector. Ninety-one patients (20.3%) had been referred from a private clinic immediately prior to their current admission-a circular diversion pattern. Eighteen (19.8%) of the diverted patients reported that health workers in the public hospitals diverted them.ConclusionsCircular diversion pattern of referral system is the key negative consequence of dual practice. Physicians and hospital managers agreed that health worker retention was the main positive consequence of dual practice upon the public sector, and banning dual practice would result in a major loss of senior physicians. The motive behind the circular diversion pattern described by patients should be studied further.