Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study

Abstract

Background: The proportion of women entering medicine has increased in recent years, and understanding the different practice patterns of female and male family physicians (FPs) will provide important information for health workforce planning. We sought to evaluate differences by sex in the supply, payments and clinical activity among FPs in Ontario.

Methods: We conducted a cohort study using claims data from the Ontario Health Insurance Plan. We included all Ontario FPs who submitted claims from 1992 to 2018. We analyzed data using regression analyses for our outcomes of yearly number of FPs, payments, patient visits and distinct patients.

Results: The number of practising FPs increased from 10 370 in 1992 to 14 329 in 2018, with an annual increase of 155 female FPs and 13 male FPs. In 2018, male FPs outnumbered female FPs by 1159. Among male FPs, 32.7% worked less than 1 full-time equivalent (FTE) position, 18.1% worked 1 FTE and 49.2% worked more than 1 FTE, with little change over the 27-year study period. Among female FPs, the percentage of those who worked less than 1 FTE position decreased over time (58.6% in 1998 to 48.3% in 2015), those who worked 1 FTE was stable (22.2%-24.3%) and those who worked more than 1 FTE increased (18.7% in 1998 to 28.0% in 2017). Yearly payments were higher for male FPs than female FPs by 40%-60% overall and by 10%-20% in FPs who worked more than 1 FTE. For FPs who worked 1 FTE or less than 1 FTE, both sexes had similar payment amounts (from 2005-2018). For FPs who worked 1 FTE, female FPs were less likely to receive payments from fee-for-service after 2004, and had 550 fewer visits and 121 fewer patients annually than male FPs.

Interpretation: In Ontario, there are differences by sex in FP supply, payments, percentages of FTE groups, number of patient visits and number of distinct patients. Health administrators should be mindful of these differences when considering FP workforce plans to ensure a stronger primary health care system, with adequate health care delivery for the population.

Figure 1:

The number of active family physicians (FPs) in Ontario, Canada, from 1992 to 2018, by sex. There was a small decrease from 2017 to 2018. This was likely owing to our use of the ICES Physician Database, which had not been updated past 2017 at the time the data were provided to the study team.

Figure 2:

The proportion of (A) male and (B) female family physicians (FPs) working less than 1, 1, or more than 1 full-time equivalents (FTEs) in Ontario from 1992 to 2018.

Figure 3:

Median payment of family physicians (FPs) in Ontario, Canada, from 1992 to 2018 by year, sex and full-time equivalent (FTE). (A) Overall; (B) less than 1 FTE; (C) 1 FTE; (D) more than 1 FTE.

Figure 4:

Proportion of family physicians (FPs) with more than 50% of their payment from fee-for-service (FFS) in Ontario by year and full-time equivalent (FTE). (A) Overall; (B) less than 1 FTE; (C) 1 FTE; (D) more than 1 FTE.

Figure 5:

(A) Median number of visits, (B) median number of patients and (C) median number of visits per patient for family physicians (FPs) who worked 1 full-time equivalent (FTE) in Ontario, Canada, by year and sex.

Figure 6:

Predicted values from multilevel regression models. Models for (A) payment included sex, year, sex–year interaction, physician age, number of patient visits, number of distinct patients seen and number of visits per patient. Models for (B) patients, (C) visits and (D) visits per patient included sex, year, sex–year interaction, physician age and physician full-time equivalent. Values were estimated with variables at their mean. Note: FP = family physician.