Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 5 2019 05 15 882 892 Mahboubeh BAYAT Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran AND Gerash University of Medical Sciences, Gerash, Iran Roghaye KHALILNEJAD Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran Ali AKBARI-SARI Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Iraj HARIRCHI Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Gholamhossein SALEHI ZALANI Gerash University of Medical Sciences, Gerash, Iran S. Elmira MIRBAHAEDDIN Telfer School of Management, University of Ottawa, Ontario, Canada Mahmoud KHODADOST Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Ebrahim JAFARI POOYAN Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mehdi YASERI Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Azad SHOKRI Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran 2019 05 15 Background: Dual practice by surgery specialists is a widespread issue across health systems. This study aimed to determine the level of dual practice engagement and its related factors among Iran’s surgery specialists. Methods: A pre-structured form was developed to collect the data about surgery specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes and eventually a combination of the first name, surname and father's name. Multilevel logistic regression was used to assessing the association between dual practice with study variables. Results: Overall, 14931 surgeons were participated (93% response rate) and 6405 (57% of) engaged in DP on total. Urinary tract & genital and neurosurgery specialties had the highest rank with 69%. DP was more frequent in specialists with higher age and experience, populated provinces, higher deprivation, and share of private hospitals. Faculty physicians (OR=0.69), full-time geographic physicians (OR=0.17), specialists with more than 25 years’ experience (OR=2.59) and age more than 40 yr (OR=1.3) had significant association with dual practice. Conclusion: Multi-approach strategy is needed to control dual practice through tax regulations, income cap, and limitations in work hours and number of visits in private sector.       https://ijph.tums.ac.ir/index.php/ijph/article/view/17123 https://ijph.tums.ac.ir/index.php/ijph/article/download/17123/6384