Declining Comprehensiveness of Services Delivered by Canadian Family Physicians Is Not Driven by Early-Career Physicians

M Ruth Lavergne; David Rudoler; Sandra Peterson; David Stock; Carole Taylor; Andrew S Wilton; Sabrina T Wong; Ian Scott; Kimberlyn M McGrail; Rita McCracken; Emily G Marshall; Adrian MacKenzie; Alan Katz; Margaret Jamieson; Lindsay Hedden; Agnes Grudniewicz; Laurie J Goldsmith; Richard H Glazier; Fred Burge; Doug Blackie

doi:10.1370/afm.2945

Declining Comprehensiveness of Services Delivered by Canadian Family Physicians Is Not Driven by Early-Career Physicians

Ann Fam Med. 2023 Mar-Apr;21(2):151-156. doi: 10.1370/afm.2945.

Authors

M Ruth Lavergne^{1

2}, David Rudoler^{3

4}, Sandra Peterson⁵, David Stock⁶, Carole Taylor⁷, Andrew S Wilton⁸, Sabrina T Wong^{5

9}, Ian Scott^{10

11}, Kimberlyn M McGrail⁵, Rita McCracken¹⁰, Emily G Marshall^{12

13}, Adrian MacKenzie^{6

12}, Alan Katz^{14

15}, Margaret Jamieson¹⁶, Lindsay Hedden¹⁷, Agnes Grudniewicz¹⁸, Laurie J Goldsmith^{17

19}, Richard H Glazier^{8

16

20

21}, Fred Burge²², Doug Blackie^{23

24}

Affiliations

¹ Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.) ruth.lavergne@dal.ca.
² Canada Research Chairs Program, Tier II Primary Care, Ottawa, Ontario, Canada (M. R. L.).
³ Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada (D. R.).
⁴ Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada (D. R.).
⁵ The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.).
⁶ Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada (D. S., A. M.).
⁷ University of Manitoba, Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada (C. T.).
⁸ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (A. S. W., R. H. G.).
⁹ National Institute of Nursing Research, Division of Intramural Research (this work was completed while at the University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada) (S. T. W.).
¹⁰ The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada (I. S., R. M.).
¹¹ The University of British Columbia, Centre for Health Education Scholarship, Vancouver, British Columbia, Canada (I. S.).
¹² Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (E. G. M., A. M.).
¹³ Dalhousie University, Primary Care Research Unit, Department of Family Medicine, Halifax, Nova Scotia, Canada (E. G. M.).
¹⁴ University of Manitoba, Department of Family Medicine, Winnipeg, Manitoba, Canada (A.K.).
¹⁵ University of Manitoba, Department of Community Health Sciences, Winnipeg, Manitoba, Canada (A. K.).
¹⁶ University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada (M. J., R. H. G.).
¹⁷ Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada (L. H., L. J. G.).
¹⁸ University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada (A. G.).
¹⁹ GoldQual Consulting, Ontario, Canada (L. J. G.).
²⁰ St Michael's Hospital, Toronto, Ontario, Canada (R. H. G.).
²¹ University of Toronto, Department of Family and Community Medicine, Toronto, Ontario, Canada (R. H. G.).
²² Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.).
²³ Royal Roads University, School of Leadership Studies, Victoria, British Columbia, Canada (D. B.).
²⁴ Doug Blackie Consulting, Inc, Edmonton, Alberta, Canada (D. B.).

Abstract

We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians.

Keywords: Canada; cohort effect; comprehensive health care; family medicine; primary care; scope of practice.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

British Columbia
Female
Humans
Manitoba
Ontario
Physicians, Family*
Pregnancy

Grants and funding

155965/CIHR/Canada