Resident and early-career family physicians’ focused practice choices in Canada: a qualitative study

Kabir, Monisha; Randall, Ellen; Mitra, Goldis; Lavergne, M. Ruth; Scott, Ian; Snadden, David; Jones, Lori; Goldsmith, Laurie J.; Marshall, Emily Gard; Grudniewicz, Agnes

doi:10.3399/bjgp.2021.0512

Cited by 24 publications

(32 citation statements)

References 23 publications

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“…24 The reasons for shifts away from comprehensive primary care are numerous and complex. Early results from Canadian research have shown they include: 9,25 Lack of the interprofessional team-based supports necessary to respond to trends in older patient age, increasing patient complexity independent of age, and increasing complexity in managing chronic diseases.…”

Section: Resultsmentioning

confidence: 99%

Brief on Primary Care Part 2: Factors Affecting Primary Care Capacity in Ontario for Pandemic Response and Recovery

Mangin¹,

Premji²,

Bayoumi³

et al. 2022

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About Us: The Ontario COVID-19 Science Advisory Table is a group of scientific experts and health system leaders who evaluate and report on emerging evidence relevant to the COVID-19 pandemic, to inform Ontario's response. The Science Advisory Table's mandate is to provide summaries of relevant scientific evidence to public health and health care professionals, as well as the general public, by integrating information from existing scientific tables, Ontario's universities and agencies, and the best global evidence. The Science Advisory Table is hosted by Public Health Ontario (PHO). Aligned with PHO's mandate, the Science Advisory Table provides credible and independent scientific and technical advice to inform government and the broader public about COVID-19 and to help prepare for and respond to future public health emergencies.

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Section: Resultsmentioning

confidence: 99%

Brief on Primary Care Part 2: Factors Affecting Primary Care Capacity in Ontario for Pandemic Response and Recovery

Mangin¹,

Premji²,

Bayoumi³

et al. 2022

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“…Solutions to FP workforce shortages identified in the literature focus on addressing deterrents to the practice of comprehensive primary care, including perceived poor respect for primary care as a profession, inadequate compensation, and inadequate administrative and interdisciplinary health supports to manage increasing patient complexity. 22,[41][42][43] Our finding of a shift toward APP models underscores the desire among comprehensive FPs for financial stability and teambased supports. Further, we identified large numbers of patients with chronic diseases and complex social needs, all of which are highly amenable to team-based care.…”

Section: Discussionmentioning

confidence: 98%

“…1,16–21 Rather, primary care physicians increasingly favor episodic care settings, such as walk-in clinics, 6 and focused scopes of practice, such as sports medicine or hospitalist care. 22–27 Moreover, the concentration of women in primary care may further reduce capacity, with research finding women spend more time with patients 28 and receive more patient requests than men. 29,30…”

Section: Introductionmentioning

confidence: 99%

Trends in patient attachment to an aging primary care workforce: a population-based serial cross-sectional study in Ontario, Canada

Premji

Green

Glazier

et al. 2023

Preprint

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Background: Population aging 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. Objectives: To explore temporal trends in early career, mid-career, and near-retirement comprehensive primary care physician characteristics, the medical and social needs of their patients, and the workforce's capacity to absorb patients of near-retirement physicians. Gender-based workforce trends and trends around alternative practice models were also explored. Design: A serial cross-sectional population-based study 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). Exposure(s): Changes in the comprehensive FP workforce over three time periods. Main Outcome(s) and Measure(s): The number and proportion of patients attached to near-retirement comprehensive FPs; the number and proportion of near-retirement comprehensive FPs; the characteristics of patients and their comprehensive FPs. Results: Patient attachment to comprehensive FPs increased over time. The overall FP workforce grew, but the proportion practicing comprehensiveness declined from 77.2% (2008) to 70.7% (2019), with shifts into other/focused scopes of practice across all physician career stages. 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 comprehensive FPs. 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 near-retirement comprehensive FPs served markedly increasing numbers of medically and socially complex patients. Conclusions and Relevance: Primary care is foundational to high-performing health systems, but the sector faces capacity challenges as both patients and physicians age and fewer physicians choose to practice comprehensiveness. Nearly 15% (1.7 million) of Ontarians with a comprehensive FP may lose their physician to retirement by 2025. To serve a growing and increasingly complex patient population, innovative solutions that extend beyond simply growing the FP workforce are needed.

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“…Within the Canadian context, Myhre et al [ 66 ] identified that geographic factors (e.g. rural location, community size, distance to a large hospital), personal physician characteristics, professional education, and patient factors influenced scope of practice, while Kabir et al [ 67 ] discovered that training, organisational structure, inadequate remuneration, workload, professional satisfaction, and the amount of patient care required per treatment influenced scope of practice. Additionally, Myles et al [ 68 ] reported that geography, the practice environment, the needs of those within communities, and regional and jurisdictional variations in healthcare delivery were key elements in determining scope of practice of family physicians in Ontario, Canada.…”

Section: Discussionmentioning

confidence: 99%

Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review

et al. 2022

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Introduction A well-functioning health system delivers quality services to all people when and where they need them. To help navigate the complex realm of patient care, it is essential that health care professions have a thorough understanding of their scope of practice. However, a lack of uniformity regarding scope of practice across the regulated health professions in Australia currently exists. This has led to ambiguity about what comprises scope of practice in some health care professions in the region. Objective The objective of this review was to explore the literature on the factors that influence scope of practice of the five largest health care professions in Australia. Methods This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the five largest health care professions in Australia. The search was conducted using the following databases: AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE (Excerpta Medica Database), MANTIS (Manual, Alternative and Natural Therapy Index System), MEDLINE, PubMed, and SCOPUS. Additional data sources were searched from Google and ProQuest. Results A total of 12 771 publications were identified from the literature search. Twenty-three documents fulfilled the inclusion criteria and were included in the final analysis. Eight factors were identified across three professions (nursing & midwifery, pharmacy and physiotherapy) that influenced scope of practice: education, competency, professional identity, role confusion, legislation and regulatory policies, organisational structures, financial factors, and professional and personal factors. Conclusion The results of this study will inform a range of stakeholders including the private and public arms of the healthcare system, educators, employers, funding bodies, policymakers and practitioners about the factors that influence scope of practice of health professions in Australia.

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Resident and early-career family physicians’ focused practice choices in Canada: a qualitative study

Cited by 24 publications

References 23 publications

Brief on Primary Care Part 2: Factors Affecting Primary Care Capacity in Ontario for Pandemic Response and Recovery

Brief on Primary Care Part 2: Factors Affecting Primary Care Capacity in Ontario for Pandemic Response and Recovery

Trends in patient attachment to an aging primary care workforce: a population-based serial cross-sectional study in Ontario, Canada

Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review

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