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Part-time doctors are working full-time hours to get through their workload, according to a study of hundreds of GP's diaries.
The research project, by the Royal New Zealand College of General Practitioners, surveyed 400 doctors' diaries over two weeks and found those with 22 hours of patient contact time a week generally ended up working the full 40 hours.
It came down to the amount of time needed for clinical follow-up work, such as patient referrals and checking test results.
Full-time GPs ended up working far more than their 40 hours - something Luke Bradford, a Tauranga-based GP and medical director at the college, said the industry had known but never quantified.
His own experience was no different.
When he presented the results of the Your Work Counts study at the GP24 conference in Wellington in July, he included a slide of reasons for doing the job. On it was a picture of two of his children asleep on his examination couch on a Saturday - "a fairly typical thing", he told RNZ.
Luke Bradford presenting the results of the Your Work Counts study at the GP24 conference in July in Wellington. Photo: Supplied / RNZCGP
"They knew where the chocolate biscuits were, and then they'd fall asleep whilst I worked, because in order to be able to see the patients in normal working hours, the volume of other work spills into weekends and evenings."
The study found 70 percent of GPs were working weekends, with admin work making up about 40 percent of work done on Sundays.
About 55 percent of their time was spent on patient consults and 31 percent on follow-up work.
There was also an increased workload over the colder months.
GPs working full-time were, on average, working 50 hours a week in summer but 55.5 hours a week in winter.
Bradford said the digital age had brought the expectation of immediacy.
According to a survey of his own clinic, on average, each patient required two emails per year - so with 1600 patients, its 3200 emails a year on top of everything else.
Traditionally, doctors were not paid for non-patient facing work.
"A lot of GPs will feel that they're doing 45 percent of their work without being paid, and that leads to a resentment of it," Bradford said.
Angus Chambers, a Christchurch-based GP and chairperson of GenPro, which represents general practice owners, said the job had changed fundamentally over the past three decades.
Doctors were required to write more notes for legal or compliance reasons, there were more medicines available to prescribe and a larger variety of tests to order, along with a 20 percent increase in number of times people visited the doctor compared with 15 years ago.
"Quite a lot of us do actually pay for those extra hours," he said. "But it means that your business ... gets less and less profitable.
"A lot of people who are owners will just wear it and do it."
Hauora Taiwhenua Rural Health Network chairperson Fiona Bolden said doctors in small towns were often on-call for entire weekends.
"So the reality of that is that you could be working all day, doing a really heavy day, and then still be on-call all night, and then need to go to work again the next day."
So why do it? Bolden said doctors cared deeply about their communities, and the work was varied and interesting, particularly after-hours.
But it did interrupt their sleep, exercise and family time.
"You're often called away from events with your family and your children," she said.
"When my children were young, they were quite used to coming out on call-outs with me, leaving them in the car while I went and did whatever I needed to do."
She said rural communities tended to have more elderly people and higher levels of deprivation, increasing the workload, but making it all the more important.
Health Minister Shane Reti previously acknowledged the challenges facing primary care, but said the government was investing more money in health than ever before.