General Practitioners’ Earnings and Practice Variation in a Fee-for-Service System: A Descriptive Registry Study

In Norway, 78% of publicly funded general practitioners (GPs) are self-employed, remunerated through a mix of capitation and fee-for-service, while 22 % are salaried. GPs register consultations and procedures using nationally standardized fees for health services, which allows for variations in earnings. Our study aims to examine whether high and low earning GPs also differ in their earnings per list patient and, if so, identify the specific fees that contribute to this difference. Additionally, we aim to compare practice characteristics between high and low earning GPs. We analyse national registry data from 2021 for all GPs with at least 100 working days (N=2546) and calculate annual earnings from capitation and fees. High earning GPs (upper quartile) have 55% more listed patients than low earning GPs (lower quartile), yet they earn 40% more from fees per patient (average €178 versus €127). Nearly half of the earnings difference per patient can be attributed to high earning GPs more frequently conducting consultations with patients. Still, patients of high earning GPs receive less minutes in consultations yearly (average 35 versus 38 min), due to high earners’ shorter consultation duration (average 15 versus 20 min). The remaining earning difference comes from higher utilization of procedure fees among high earners (average 5.6 versus 3.9 procedures per patient). Prolonged consultation, medication review, and talking therapy are some of the fees that contribute most to this difference. The findings highlight that considerable earning variations are linked to fee utilization and practice styles among GPs.