Do new cohorts of family physicians work less compared to their older predecessors? The evidence from Canada

Sarma, Sisira; Thind, Amardeep; Chu, Man-Kee

doi:10.1016/j.socscimed.2011.03.047

Cited by 37 publications

(36 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two high‐profile commissions on this issue (Kirby, ; Romanow, ) led to the introduction of far‐reaching reforms in the early 2000s within various jurisdictions in Canada (Health Canada, ). In Ontario, primary care moved from solo to group practices, and physicians were incentivized to switch from FFS to alternative incentive‐based payment schemes, in an effort to improve access to and quality of care (Hutchison, Levesque, Strumpf, & Coyle, ; Ricketts, ; Sarma, Thind, & Chu, ). Several new types of primary care delivery models featuring these incentives were introduced over the past decade or so (Hutchison et al, ), with reform models such as FHGs, Family Health Networks, and FHOs representing the engine of change in Ontario and paving the way for other jurisdictions in Canada.…”

Section: The Institutional Contextmentioning

confidence: 99%

Family physician remuneration schemes and specialist referrals: Quasi‐experimental evidence from Ontario, Canada

et al. 2018

Self Cite

View full text Add to dashboard Cite

Understanding how family physicians respond to incentives from remuneration schemes is a central theme in the literature. One understudied aspect is referrals to specialists. Although the theoretical literature has suggested that capitation increases referrals to specialists, the empirical evidence is mixed. We push forward the empirical research on this question by studying family physicians who switched from blended fee-for-service to blended capitation in Ontario, Canada. Using several health administrative databases from 2005 to 2013, we rely on inverse probability weighting with fixed-effects regression models to account for observed and unobserved differences between the switchers and nonswitchers. Switching from blended fee-for-service to blended capitation increases referrals to specialists by about 5% to 7% per annum. The cost of specialist referrals is about 7 to 9% higher in the blended capitation model relative to the blended fee-for-service. These results are generally robust to a variety of alternative model specifications and matching techniques, suggesting that they are driven partly by the incentive effect of remuneration. Policy makers need to consider the benefits of capitation payment scheme against the unintended consequences of higher referrals to specialists.

show abstract

Section: The Institutional Contextmentioning

confidence: 99%

Family physician remuneration schemes and specialist referrals: Quasi‐experimental evidence from Ontario, Canada

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Sociodemographic factors that influence physician labor supply include gender, experience (age), and geography. Female physicians tend to work less total days and hours per day . Older physicians work fewer hours compared to younger ones .…”

Section: Conceptual Frameworkmentioning

confidence: 95%

“…Female physicians tend to work less total days and hours per day. [25][26][27] Older physicians work fewer hours compared to younger ones. 25,28 While the FMG requirement of extended access hours might increase the likelihood that female and older physicians quit the group, PCMH offers the support of allied health professionals and other PCPs, such that each physician could reduce her individual workload compared to solo practice, and still offer more hours at the group level.…”

Section: Con Cep Tualfr Ame Workmentioning

confidence: 99%

Explaining primary care physicians’ decision to quit patient‐centered medical homes: Evidence from Quebec, Canada

Ammi

Diop

Strumpf

2019

Health Services Research

View full text Add to dashboard Cite

Objective To examine the factors explaining primary care physicians’ (PCPs) decision to leave patient‐centered medical homes (PCMHs). Data Sources Five‐year longitudinal data on all the 906 PCPs who joined a PCMH in the Canadian province of Quebec, known there as a Family Medicine Group. Study Design We use fixed‐effects and random‐effects logit models, with a variety of regression specifications and various subsamples. In addition to these models, we examine the robustness of our results using survival analysis, one lag in the regressions and focusing on a matched sample of quitters and stayers. Data Collection/Extraction Methods We extract information from Quebec's universal health insurer billing data on all the PCPs who joined a PCMH between 2003 and 2005, supplemented by information on their elderly and chronically ill patients. Principal Findings About 17 percent of PCPs leave PCMHs within 5 years of follow‐up. Physicians’ demographics have little influence. However, those with more complex patients and higher revenues are less likely to leave the medical homes. These findings are robust across a variety of specifications. Conclusion As expected, higher revenue favors retention. Importantly, our results suggest that PCMH may provide appropriate support to physicians dealing with complex patients.

show abstract

“…Figure 1 presents a flow chart of systematic search used in the study. A total of 22 articles were included for systematic review (Abyad et al, 2007;Al-Khathami, 2012;Avery et al, 2009;Bailey et al, 2005;Buwkamp-Memmer et al, 2013;Clarin, 2007;Curran et al, 2006;Edwards et al, 2006;Grenier et al, 2008;Jones et al, 2003;Kaczorowski et al, 2011;Kersnik, 2001;Kuppersmith et al, 2002;Mistretta, 2007;Morra et al, 2009;Murai et al, 2005;Papic et al, 2012;Pojskic et al, 2001;Sarma et al, 2011Sarma et al, , 2012Sunshine et al, 2010;Wang, 2007). The conceptual model of the research was adopted at this level.…”

Section: Model Instruments and Measurementsmentioning

confidence: 99%

Acceptability of the Urban Family Medicine Project among Physicians: A Cross-Sectional Study of Medical Offices, Iran

Kor

Rashidian

Hosseini

et al. 2016

GJHS

View full text Add to dashboard Cite

Introduction: It is essential to organize private physicians in urban areas by developing urban family medicine in Iran. Acceptance of this project is currently low among physicians. The present research determined the factors affecting acceptability of the Urban Family Medicine Project among physicians working in the private sector of Mazandaran and Fars provinces in Iran.Methods: This descriptive-analytical and cross-sectional study was conducted in Mazandaran and Fars provinces. The target population was all physicians working in private offices in these regions. The sample size was calculated to be 860. The instrument contained 70 items that were modified in accordance with feedback from eight healthcare managers and a pilot sample of 50 physicians. Data was analyzed using the LISREL 8.80. Results:The response rate was 82.21% and acceptability was almost 50% for all domains. The fit indices of the structural model were the chi-square to degree-of-freedom (2.79), normalized fit index (0.98), non-normalized fit index (0.99), comparative fit index (0.99), and root mean square error of approximation (0.05). Training facilities had no significant direct effect on acceptability; however, workload had a direct negative effect on acceptability. Other factors had direct positive effects on acceptability. Conclusion:Specification of the factors relating to acceptance of the project among private physicians is required to develop the project in urban areas. It is essential to upgrade the payment system, remedy cultural barriers, decrease the workload, improve the scope of practice and working conditions, and improve collaboration between healthcare professionals.

show abstract

Do new cohorts of family physicians work less compared to their older predecessors? The evidence from Canada

Cited by 37 publications

References 19 publications

Family physician remuneration schemes and specialist referrals: Quasi‐experimental evidence from Ontario, Canada

Family physician remuneration schemes and specialist referrals: Quasi‐experimental evidence from Ontario, Canada

Explaining primary care physicians’ decision to quit patient‐centered medical homes: Evidence from Quebec, Canada

Acceptability of the Urban Family Medicine Project among Physicians: A Cross-Sectional Study of Medical Offices, Iran

Contact Info

Product

Resources

About