Family Physicians Stopping Practice During the COVID-19 Pandemic in Ontario, Canada

Abstract

We conducted 2 analyses using administrative data to understand whether more family physicians in Ontario, Canada stopped working during the COVID-19 pandemic compared with previous years. First, we found 3.1% of physicians working in 2019 (n = 385/12,247) reported no billings in the first 6 months of the pandemic; compared with other family physicians, a higher portion were aged 75 years or older (13.0% vs 3.4%, P <0.001), had fee-for-service reimbursement (37.7% vs 24.9%, P <0.001), and had a panel size under 500 patients (40.0% vs 25.8%, P <0.001). Second, a fitted regression line found the absolute increase in the percentage of family physicians stopping work was 0.03% per year from 2010 to 2019 (P = 0.042) but 1.2% between 2019 to 2020 (P <0.001). More research is needed to understand the impact of physicians stopping work on primary care attachment and access to care.

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.…”

“…Using a mean panel size of 788, the authors estimated that these FPs cared for about 170,000 patients. 5 The authors were unable to show causation given the study methods, but they hypothesized that many FPs advanced their retirement plans during the pandemic because of concerns about their own health, increased practice costs, reduced income, and burnout. 5 Most other health jurisdictions in Canada already have problems with access.…”

“…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. 5 Although the absolute number of FPs in the study who stopped working was small, the impact on patients and communities will likely be substantial. About half of the FPs who stopped working were practising in a patient enrolment model and were responsible for care of rostered patients.…”

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

“…Three percent of family physicians ceased clinical work entirely during the pandemic, an almost doubling of the usual rate of 1.6% per year. 7 In addition, an increasing proportion of Ontario family physicians in every age group and at every career stage is shifting away from comprehensive practice and into focused scopes of practice (such as emergency medicine, sports medicine, palliative care, and more). "Comprehensive practice" is the provision of a broad range of services on a longitudinal basis to a defined panel of patients of all ages, backgrounds, and health conditions.…”

“…6 At the same time, accessibility to primary care physicians for comprehensive care may have been reduced during the pandemic due to reduced clinical service hours among some physicians and a shift towards virtual care, including among a very small subset of physicians who went to a nearly entirely virtual model. 7 The shift toward increasing complexity is occurring while PCCs have been playing a key role in pandemic response, and against a further-reaching background of increasing workload and complexity pre-pandemic. Preliminary results from the early-career primary care (ECPC) study found that in British Columbia, the per-visit workload for community-based family physicians has gone up by 35-50% (1999/00 to 2017/18) based on prescriptions, referrals, and investigations generated by each visit.…”