Characteristics of patients attached to near-retirement family physicians: a population-based serial cross-sectional study in Ontario, Canada

Abstract

Objectives: Population ageing is a global phenomenon. Resultant healthcare workforce shortages are anticipated. To ensure access to comprehensive primary care, which correlates with improved health outcomes, equity and costs, data to inform workforce planning are urgently needed. We examined the medical and social characteristics of patients attached to near-retirement comprehensive primary care physicians over time and explored the early-career and mid-career workforce's capacity to absorb these patients.

Design: A serial cross-sectional population-based analysis using health administrative data.

Setting: Ontario, Canada, where most comprehensive primary care is delivered by family physicians (FPs) under universal insurance.

Participants: All insured Ontario residents at three time points: 2008 (12 936 360), 2013 (13 447 365) and 2019 (14 388 566) and all Ontario physicians who billed primary care services (2008: 11 566; 2013: 12 693; 2019: 15 054).

Outcome measures: The number, proportion and health and social characteristics of patients attached to near-retirement age comprehensive FPs over time; the number, proportion and characteristics of near-retirement age comprehensive FPs over time.

Secondary outcome measures: The characteristics of patients and their early-career and mid-career comprehensive FPs.

Results: Patient attachment to comprehensive FPs increased over time. The overall FP workforce grew, but the proportion practicing comprehensiveness declined (2008: 77.2%, 2019: 70.7%). Over time, an increasing proportion of the comprehensive FP workforce was near retirement age. Correspondingly, an increasing proportion of patients were attached to near-retirement physicians. By 2019, 13.9% of comprehensive FPs were 65 years or older, corresponding to 1 695 126 (14.8%) patients. Mean patient age increased, and all physicians served markedly increasing numbers of medically and socially complex patients.

Conclusions: The primary care sector faces capacity challenges as both patients and physicians age and fewer physicians practice comprehensiveness. Nearly 15% (1.7 million) of Ontarians may lose their comprehensive FP to retirement between 2019 and 2025. To serve a growing, increasingly complex population, innovative solutions are needed.

Keywords: health policy; health services accessibility; human resource management; physicians; primary health care.

Figure 1

Cohort creation: Patients (A) and physicians (B). (A) Patient is considered VR to the physician with whom the majority of their primary care core visits were made over the preceding 2-year period (Jaakkimainen et al 2021). Numerator=the number of patients virtually rostered to a physician. Denominator=all unique patients the same physician had seen over 2 years. Physician CoC <10% corresponds to low CoC (Jaakkimainen et al 2021). Comprehensive FP: comprehensive scope of primary care practice. At least 50% of prior year’s billings are four core primary care services in at least seven different primary care activity areas (Schultz and Glazier 2017). Focused FP: Narrowed scope of practice, such as sports medicine, palliative care, hospitalist. Other: Not comprehensive and not focused practice. <44 days: worked less than 44 days/year. (B) Numerator = the number of patients virtually rostered to a physician. Denominator = all unique patients the same physician had seen over 2 years. Physician CoC < 10% corresponds to low CoC (Jaakkimainen et al 2021). Comprehensive FP: Comprehensive scope of primary care practice. At least 50% of prior year’s billings are for core primary care services in at least seven different primary care activity areas (Schultz and Glazier 2017). Focused FP: Narrowed scope of practice, such as sports medicine, palliative care, hospitalist. Other: Not comprehensive and not focused practice, or worked less than 44 days/year. CHC, community Health Centre; CoC, physician-level continuity of care; FP, family physician; LTC, long-term care; VR, virtually rostered.

Figure 2

Comprehensive family physicians by near-retirement group, year and sex. Total Ns (all comprehensive family physicians) for 2008, 2013 and 2019 are 7673, 8050 and 9377, respectively.