Abstract
BackgroundThere are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care. Anecdotal evidence suggests that physicians are moving away from a community-based comprehensive practice model, which could contribute to shortages. Thus, we aimed to identify and describe how family physicians are currently organizing their primary care practices in a large health region in British Columbia and to examine differences between newer graduates and more established physicians.MethodsData for this cross-sectional study were drawn from an annual physician privileging survey. N = 1017 physicians were invited to participate. We categorized practice style into five distinct groupings and compared features across respondent groups, including personal and practice location characteristics, hospital and teaching work, payment and appointment characteristics, and scope of practice. We discuss the implications of styles of practice and associated characteristics on health workforce policy and planning.ResultsWe received responses from 525 (51.6%) physicians. Of these, 355 (67.6%) reported doing at least some community-based primary care. However, only 112 (21.3%) provided this care full time. Most respondents supplemented community-based work with part-time hours in focused practice, hospitals, or inpatient facilities. We found diversity in the scope and style of practice across practice models. Compared to established physicians, new graduates (in practice less than 10 years) work more weekly hours (more patient care, and paperwork in particular). However, we found no difference between new and established physicians in the odds of providing any or full-time community-based primary care.ConclusionsDespite a lack of formalized structural reform in British Columbia’s primary care system, most physicians are finding alternative ways to model their practice and shifting away from work at single-location, community-based clinics. This shift challenges assumptions that are relied on for workplace planning that is intended to ensure adequate access to longitudinal, community-based family medicine.
Highlights
There are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care
Since federal Medicare legislation was passed in 1966, there have been no substantive structural changes to how primary care is delivered in British Columbia (BC), and it is assumed that the vast majority of physicians are practicing in the “classic” model
An additional nine (0.9%) responses were removed for physicians reporting that they do not provide any patient care, and six (0.6%) were discarded because of incomplete responses to core practice model questions, leaving a final sample of 525 (51.6%)
Summary
There are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care. Since federal Medicare legislation was passed in 1966, there have been no substantive structural changes to how primary care is delivered in British Columbia (BC), and it is assumed that the vast majority of physicians are practicing in the “classic” model. We define this as working in a community-based physician-owned and physician-operated practice, either alone or with a small group of physician colleagues, providing comprehensive full-scope care to a large panel of patients under a feefor-service (FFS) model [11]. Non-physician providers such as registered nurses, nurse practitioners, or other health professionals are not part of classic practices and have not been integrated into the primary care system more broadly
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