During our trip, we spent most of our time with general practice physicians (GP), who are the backbone of the Norwegian healthcare system. They are truly the “gatekeepers” who provide access into the system for their patients. Furthermore, the GPs are “generalists” in every sense of the word. Their scope of practice includes routine primary care visits, pregnancy checkups and deliveries, acute visits, home visits, EMS, and urgent/emergency care. In my opinion, the GPs embody the idea of a “doctor” from back in the days when there was only one doctor in a town that played the role of surgeon, obstetrician, and family physician.
Now, let’s take a look at how the primary care system is structured. As I said above, the GPs are the backbone of the healthcare system. Each GP is responsible for a “list” of patients which they must purchase from either the government or a retiring physician. The “list” comprises the panel of patients for which the GP is primarily responsible and will generally range from 800-1300 patients. Each GP serves within a municipality which, depending on the population, will have multiple GPs. In addition to having a panel of patients, GPs must also fulfill a “public role” which can take up to about 20-30% of their time and includes positions such as EMS coordinator, director of public health, nursing home physician, etc. Furthermore, the GPs in a municipality must all take turns covering the “legevakt” (translates as “doctor watch”) which is akin to an after-hours urgent care center. A typical workday involves seeing patients 8am to 3 or 4 pm. If it is a GP’s day to staff the legevakt, they will then stay on duty until 10pm, which makes for a long workday.
Let’s take Asta, our host in Larsenes as an example. She works in an office with two other GPs, and together they server about 3,300 patients in their municipality. Her personal list is about 1,200 patients. On a typical day, she will see patients from 8-3 and spend the rest of her day filling out paperwork (yes… they have it just as bad as we do here in the US). Her municipality and the neighboring two share the responsibility for the legevakt. What this means, is that she has an evening shift there once every 7-10 days. For her “public service” she is the director of public health and outreach in her municipality and is responsible for compiling the annual statistics for the area. On top of all of this, (perhaps because she had a tendency to over-do it) she picks up one or two shifts in the Emergency Department at the regional hospital about 1.5 hours away from her clinic (in a “moonlighting” type of system) – purely because she wants to refine her acute care skills.
The role of a GP in Norway is really quite unique. In my mind, I was picturing them function as a family medicine physician or an outpatient internal med doc. In reality, they do so much more that I would have thought. Their scope of practice is quite broad, and most GPs take the position after only a year and a half long internship. Honestly, I’m not sure if I would feel prepared to handle as much as they do after only a year and a half more training (ask me in 15 months and my story may change…. but for now I stand by that statement). Seeing as I’ve rambled on far too long in this post, my next post will look at their role as a “gatekeeper.”