Family physician count and service provision in Ontario and Alberta between 2005/06 and 2017/18: a cross-sectional study

Abstract

Background: Five million Canadians lack a family doctor or primary care team. Our goal was to examine trends over time in family physician workforce and service provision in Ontario and Alberta, with a view to informing policy discussions on primary care supply and delivery of services.

Methods: We used cross-sectional analyses in Ontario and Alberta for 2005/06, 2012/13 and 2017/18 to examine family physician provision of service days by provider demographic characteristics and geographic location. A service day was defined as 10 or more clinic visits worth $20 or more on the same calendar day. We included all active family physicians who had evidence of billing in each fiscal year analyzed.

Results: From 2005/06 to 2017/18, the number of family physicians increased by 35.3% in Ontario and 48.7% in Alberta; however, annual average service days per physician declined by 10.6% in Ontario and 5.9% in Alberta. The average daily patient volume remained stable in Ontario and declined in Alberta, and services per population kept pace modestly with population growth in both provinces. Rural areas had the smallest increases in physician counts and largest declines in average annual service days per physician. Physicians in both provinces who had graduated from medical school at least 30 years earlier accounted for more than one-third of the workforce in 2017/18.

Interpretation: Ontario and Alberta experienced rapid growth in the number of family physicians, with the largest increases among those in late career and the lowest increases in rural areas. The decline in service provision among physicians overall and in subgroups in both provinces highlights the importance of measuring activity to inform workforce planning.

Figure 1:

Number of family physicians by sex (A) and by years since medical school graduation (B), Alberta and Ontario, 2005/06, 2012/13, 2017/18.

Figure 2:

Mean number of service days (at least 10 patients) provided by family physicians in Alberta and Ontario, by sex and number of years since graduation, 2005/06, 2012/13 and 2017/18.

Figure 3:

Mean number of service days (at least 10 patients) provided by family physicians in Alberta and Ontario, by population size or rurality of practice location, 2005/06, 2012/13 and 2017/18. CA = census agglomeration, CMA = census metropolitan area, MIZ = metropolitan-influenced zone. See Appendix 1 for definitions.