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Patients switching physicians involves costs to the patients because of less continuity of care. From a theoretical model we derive that inferior physician quality as perceived by patients, implies patient shortage for the physician and more patients switching physicians. By means of a unique panel data set covering the entire population of Norwegian general practitioners (GPs) and estimation methods that adjust for potential endogeneities, we find that the occurrence of patient shortage increases the proportion of patients switching physicians by 50%. A competing hypothesis that GPs with a shortage of patients experience less switching because of superior access is rejected by data. To assist patients in making informed decisions, we suggest that the number of switches a physician experiences should be made public., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: The aim of the study was to explore whether or not the influx of patients to a GP's practice is associated with satisfaction with the GP., Design: Persons in the Norwegian Living Condition Survey answered a questionnaire on satisfaction with their GP. The data on satisfaction were merged with registered information on the GPs and the GPs' patient lists from the National Insurance Administration, with registered information on the sample's sociodemographic background, and on their resident municipality from Statistics Norway., Setting: A representative sample of 2326 persons answered the questionnaire. This constituted persons in the survey who had visited their GP during the last six months., Main Outcome Measure: Satisfaction with the GP's interpersonal skills, the GP's medical skills, the GP's use of time, general accessibility to the GP, and the GP's role as a gatekeeper., Results: Persons listed with a GP who experience patient shortage were less satisfied than others along four dimensions of satisfaction: the GP's interpersonal skills, the GP's medical skills, the GP's referral practices, and the consultation lengths the GP offered. The GP's age and gender, characteristics of the patient, and characteristics of the organization of primary care had minor influence., Conclusion: Whether or not a GP experiences patient shortage is associated with patient satisfaction. Whether or not the lower patient satisfaction is a result of patient shortage or vice versa is not known.

From a theoretical model we predict that only physicians with quality characteristics perceived as inferior by patients are willing to embark on waiting time reductions. Because of variation in these quality characteristics among physicians, market equilibrium is likely to show a range of waiting times for physician services. This hypothesis is supported by results from a study of Norwegian general practitioners. Since the waiting time offered by a physician influences the number of patient-initiated consultations, a policy implication of our study is that the distinction between patient-initiated and physician-initiated consultations may be less clear-cut than often assumed in the literature.