Table 3 Implementation of values with heterogeneous relevance and associated factors from the perspective of employed general practitioners

continuity: coordination between providers

In most cases, detailed electronic documentation, coordination via practice software and contact with colleagues - even outside regular working hours – is sufficient. Verbal or phone handovers to ensure the flow of information are sometimes carried out but are not desired by all colleagues or occur only by chance. Coordination between providers is more likely to be successful if the providers know each other. However, duplicate anamnesis cannot always be avoided. Coordination is less successful when boundaries are crossed by the employing physicians, such as the changing medications without employed GPs knowledge and information sharing.

continuity: knowing the patients

Most employed GPs know their patients well, e.g. their names, working- and living-conditions and their relationships by asking the patients or other providers. Older patients with home-visits and/or social problems are known better than others: ‚I know my patients, I know them by name. […] maybe not for every patient, if somebody has the flu I don’t care, but if somebody has a special situation, or if somebody has been beaten, or if there is something to organize – or with child-rearing issues I really know about every step they take“.

The changing duration of the physician-patient-relationship seems to play a greater role in getting to know patients at the beginning of the relationship and becomes less important as the relationship continues. A holistic approach to patients, a high motivation of employed GPs, frequent consultations on a regular basis, having an own patient base and a sufficient consultation time can contribute to the knowledge about patients. The relevance of the availability of employed GPs (e.g. by phone or time in the practice) for patient knowledge is controversial.

continuity: duration of the physician-patient-relationship

It mostly depends on the willingness of the employed and employing physician to extend the employment contract.

continuity: care by a reference provider

Some employed GPs have their own patient base through disease management programs and health screenings. The reasons for this, despite low interest, are the desire not to burden colleagues and the emotional closeness to patients. Other employed GPs report a change in providers, because the process structures in their practices do not allow for care by reference physicians without increasing availability. Care by employing physicians without the consent of employed GPs and the increasing transfer of patients from employing physicians to employed GPs also contribute to care without reference physicians.

waiting times

Manifestation depends mostly on physician assistants and patients. Employed GPs try to reduce waiting times by working quickly and recommending doctors with higher availability to their patients. However, waiting times are unsatisfactory because office procedures leave no time for assessments, home visits, or requests, and the unselected patient population makes planning difficult. In two medical centers, rapid care for emergency patients is achieved by assigning doctors exclusively to acute consultations.

medical autonomy

Some employed GPs experience their work as self-sufficient, medically free, and independent. In some practices, employed GPs have the opportunity to make medical decisions regardless of financial consequences, as this is part of the practice culture. Others report that they have little influence, e.g. on patient selection. Some have implicit or explicit guidelines to consider profitability. However, some of them refuse to provide services if they do not consider them medically useful or if the consultation time is too short. For services not covered by the statutory health insurance, the “selling” of services does not correspond to the self-image of employed GPs.