Family physician practice patterns during COVID-19 and future intentions

Abstract

Objective To determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors.Design Cross-sectional survey.Setting Six geographic areas in Toronto, Ont, aligned with Ontario Health Team regions.Participants Family doctors practising office-based, comprehensive family medicine. Main outcome measuresPractice operations in January 2021, use of virtual care, and future plans. ResultsOf the 1016 (85.7%) individuals who responded to the survey, 99.7% (1001 of 1004) indicated their practices were open in January 2021, with 94.8% (928 of 979) seeing patients in person and 30.8% (264 of 856) providing inperson care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on telephone visits, 5.8% on video appointments, and 7.5% on e-mail or secure messaging. Among respondents, 17.5% (77 of 439) were planning to close their existing practices in the next 5 years. There were higher proportions of physicians who worked alone in clinics among those who did not see patients in person (27.6% no vs 12.4% yes, P<.05), among those who did not see symptomatic patients (15.6% no vs 6.5% yes, P<.001), and among those who planned to close their practices in the next 5 years (28.9% yes vs 13.9% no, P<.01).This article has been peer reviewed. Cet article a fait l'objet d'une révision par des pairs.

Family medicine’s stress test

“…There was a higher proportion of physicians who worked alone in a clinic among those who did not see patients in person (27.6% no vs 12.4% yes, P<.01). 4 While most FPs kept their practices open, a second study from the same researchers published earlier this autumn showed a more worrisome pandemic trend 5 that was also supported by the current study. 4 Kiran et al found that about 3% of the more than 12,000 practising FPs in Ontario stopped working during the first 6 months of the pandemic-twice as many as in the previous decade.…”

“…4 While most FPs kept their practices open, a second study from the same researchers published earlier this autumn showed a more worrisome pandemic trend 5 that was also supported by the current study. 4 Kiran et al found that about 3% of the more than 12,000 practising FPs in Ontario stopped working during the first 6 months of the pandemic-twice as many as in the previous decade. Physicians stopping work were more likely to be aged 75 years or older, practise fee-for-service, have patient panel sizes under 500, and work less than other FPs in the previous year-factors that are likely correlated and consistent with FPs who are heading into retirement.…”

“…A large, cross-sectional survey of FPs across the greater Toronto area (with an excellent response rate of 85.7%) published in this issue (page 836) by Kiran et al reveals that FPs did remarkably well in being accessible and caring for their patients during the second wave. 4 Of those who responded, 99.7% indicated their practices were open in January 2021, with 94.8% seeing patients in person and 30.8% providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on the telephone and an additional 5.8% on video and 7.5% on e-mail.…”

Characteristics of Walk-In Clinic Physicians and Patients in Ontario, Canada: A Cross-Sectional Study

“…Fewer new family medicine graduates are choosing to pursue longitudinal family practice, 10,11 and more are leaving practice. 14 In an upcoming study of walk-in clinic physicians’ perspectives, scheduling flexibility, a desire to practice episodic care, the demand for walk-in care, and the fee-for-service payment model motivated the choice to practice in a walk-in setting. 65 Paradoxically, physician workforce diversion to walk-in clinics and other alternatives may further reduce access to longitudinal primary care, ensuring that demand for walk-in clinics remains high.…”

“…10–13 In 2021, 1 in 5 family physicians in Toronto were considering closing their practices in the next 5 years, and only 5% indicated they were actively seeking to grow their practices. 14 Reasons for leaving practice included health concerns, financial pressures, burnout, retirement, and other work options in or outside of medicine. 15–17 As a result, access to longitudinal primary care is likely to worsen in the coming decade.…”