Family Practice Physicians Research Articles

Thoughts of Family Medicine Residents in Elderly Health Rotation: A Qualitative Research

Aim: The care of the elderly becomes more important in the daily practice of family physicians as the elderly population increases. Their needs should be well known, properly assessed, and managed. “Elderly health” training during residency is a rising issue in Turkey, and a rotation is planned for residents in a Dokuz Eylül University Hospital.
 By revealing the residents' opinions regarding the elderly health rotation, our study aimed to identify the areas that could be improved. 
 Methods: The qualitative study included the first 12 residents who had the elderly health rotation. Semi-structured in-depth interviews and descriptive analysis were performed.
 Results: The healthcare approach of family medicine residents to a growing and often complex group of older adults is a skill that must be acquired during residency training. The views of family medicine residents about this rotation were revealed. Main themes include the following: 1) opportunities in the educational process in the elderly health rotation, 2) challenges and constraints experienced in the educational process, 3) recommendations regarding the educational process, 4) tutorial characteristics, and 5) content and structuring of education.
 Conclusions: Efficient training programs for residents about the elderly’s health needs in family medicine residency with interdisciplinary collaboration will make great contributions to improve their quality of life. Further studies are necessary for residents’ perceptions and demands.

Racial/Ethnic Minority Identifying Family Physicians Are More Likely to Work in Solo Practices.

While the overall proportion of family physicians who work in solo practices has been steadily declining, Black, Hispanic/Latino, and Asian family physicians are more likely to work in these settings. Given their association with high levels of continuity and improved health outcomes, and given patient preference for racial concordance with their physicians, policy makers and payors should consider how to support family physicians in solo practice in the interest of promoting access to and quality of care for ethnic/racial minorities.

Association of Evaluation and Management Payment Policy Changes With Medicare Payment to Physicians by Specialty

US primary care physicians (PCPs) have lower mean incomes than specialists, likely contributing to workforce shortages. In 2021, the Centers for Medicare & Medicaid Services increased payment for evaluation and management (E/M) services and relaxed documentation requirements. These changes may have reduced the gap between primary care and specialist payment. To simulate the effect of the E/M payment policy change on total Medicare physician payments while holding volume constant and to compare these simulated changes with observed changes in total Medicare payments and E/M coding intensity, before (July-December 2020) and after (July-December 2021) the E/M payment policy change. Retrospective observational study of US office-based physicians who were in specialties with 5000 or more physicians billing Medicare and who had 50 or more fee-for-service Medicare visits before and after the E/M payment policy change. E/M payment policy changes. Outcomes included physician-level simulated volume-constant payment change, total observed Medicare payment change, and share of high-intensity (ie, level 4 or 5) E/M visits before and after the E/M payment policy change. For each specialty, the median change in each outcome was reported. The payment gap between primary care and specialty physicians was calculated as the difference between total Medicare payments to the median primary care and median specialty physician. The study population included 180 624 physicians. Repricing 2020 services yielded a simulated volume-constant payment change ranging from a 3.3% (-$4557.0) decrease for the median radiologist to an 11.0% ($3683.1) increase for the median family practice physician. After the E/M payment change, the median high-intensity share of E/M visits increased for physicians of nearly all specialties, ranging from a -4.4 percentage point increase (dermatology) to a 17.8 percentage point increase (psychiatry). The median change in total Medicare payments by specialty ranged from -4.2% (-$1782.9) for general surgery to 12.1% ($3746.9) for family practice. From July-December 2020 to July-December 2021, the payment gap between the median primary care physician and the median specialist shrank by $825.1, from $40 259.8 to $39 434.7 (primary care, $41 193.3 in July-December 2020 and $45 962.4 in July-December 2021; specialist, $81 453.1 in July-December 2020 and $85 397.1 in July-December 2021)-a relative decrease of 2.0%. Among US office-based physicians receiving Medicare payments in 2020 and 2021, E/M payment policy changes were associated with changes in Medicare payment by specialty, although the payment gap between primary care physicians and specialists decreased only modestly. The findings may have been influenced by the COVID-19 pandemic, and further research in subsequent years is needed.

National lung cancer screening program feasibility study in Estonia.

The main aim of the lung cancer screening (LCS) feasibility study was to investigate the plausibility of and bottlenecks to systematic enrolment in family physician practices by evaluating all their patients. In 3 family physician practices, for each individual born in 1947-1966 (target age group 55-74 years), information on ever smoking was gathered by a family physician/nurse. All current and ex-smokers were invited to an 'LCS visit'. In parallel, 2 inclusion criteria were used: (1) current smoker (≥20 pack-years) or ex-smoker (quit <15 years ago and smoking history ≥20 pack-years) and (2) PLCOm2012noRace risk score >1.5. All individuals with elevated lung cancer risk were assigned low-dose computed tomography. Among the total 7035 individuals in the 3 family physician practices, the LCS target age group comprised 1208 individuals, including 649 (46.3-57.1%) males and 559 (42.9-53.7%) females. Of the 1208 applicable age group individuals, 395 (all current or ex-smokers) were invited to the 'LCS visit'. According to either 1 or both the LCS inclusion criteria, 206 individuals were referred to low-dose computed tomography, and 201 (97.6% of those referred) ended up taking it. The estimated participation rate in LCS, based on data from our feasibility study, would have been 87.4%. In LCS, systematic enrolment of individuals by family physicians results in high uptake, and thus, effectiveness of the LCS in the setting of a well-functioning family physician system like in Estonia. Also, the feasibility study provided excellent input to the currently ongoing regional LCS pilot study in Estonia.

Editorial introductions.

Editorial introductions.

A novel virtual simulation training improves providers’ knowledge and confidence to manage obstetric emergencies

Maternal mortality in the United States (US) is rising and many deaths are preventable. We sought to determine the efficacy of virtual simulation training to optimize management of obstetric emergencies within low and moderate volume delivery hospitals that are disproportionately affected by adverse maternal outcomes. The educational platform was designed and deployed within urban non-teaching and rural hospitals, with low and moderate delivery volumes, in the US during the COVID-19 pandemic. Self-paced, interactive, online didactics on postpartum hemorrhage and hypertensive disorders of pregnancy were followed by two, 2-hour live virtual simulation trainings and debriefings. In this innovative simulation modality, participants verbalized actions to their co-participants and the simulation faculty as scenarios evolved with images, vitals and videos displayed on a PowerPoint. Participants completed multiple-choice questionnaires and confidence and attitude surveys prior to, immediately after and 3-months post-training. The multiple-choice questions were evidence-based using information from published guidelines and were validated by local experts. Paired t-tests were performed to asses for changes in knowledge and confidence. From December 2021 to March 2022, four hospitals received training (Table 1). Participants (n=22) were comprised of nurses (59%), certified nurse midwives (14%) and attending physicians (23%) in Obstetrics, Family Practice or Anesthesiology. The survey response rate was 59%. The mean difference in knowledge and confidence scores significantly improved immediately post-training compared to baseline (P < 0.05 for all, Table 2). This improvement was maintained 3 months following the training. Participants reported their preferred training format was hybrid (43%), virtual (35.7%) or in-person (21.4%). Virtual obstetric simulation is feasible and improves knowledge and confidence, which can be retained over time. This educational modality is sustainable, scalable and an accessible format to enhance education and training.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces.

Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. We conducted a retrospective cohort study of family physician practice from 1997/98 to 2017/18. We collected administrative health and physician claims data in British Columbia, Manitoba, Ontario and Nova Scotia. We included all physicians who registered with their respective provincial regulatory colleges as having a medical specialty of family practice or who had billed the provincial health insurance system for patient care as family physicians, or both. We used regression models to isolate the effects of 3-year categories of years in practice (at all career stages), time period and cohort on patient contacts and physician-level continuity of care. Between 1997/98 and 2017/18, the median number of patient contacts per provider per year fell by between 515 and 1736 contacts in the 4 provinces examined. Median contacts peaked at 27-29 years in practice in all provinces, and median physician-level continuity of care increased until 30 or more years in practice. We found no association between graduation cohort and patient contacts or physician-level continuity of care. Recent cohorts of family physicians practise similarly to their predecessors in terms of practice volumes and continuity of care. Because family physicians of all career stages showed declining patient contacts, we suggest that system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.

The Association of Practice Type and the Scope of Care of Family Physicians.

Comprehensiveness is a defining principle of primary care and Family Medicine but is declining in some settings. This study explores the relationship between practice setting and comprehensiveness among family physicians (FPs). Using 2014 to 2016 American Board of Family Medicine survey data to generate scope of practice (SOP) scores (0 to 30) for FPs. We ran univariate and bivariate analyses for services by practice organization type. Our principal independent variable was practice organization type and dependent variable, the SOP score. Among 25,117 total respondents, FPs at rural health centers (RHC) had the widest scope of practice (SOP score of 17.7) whereas FPs in federal, urgent care and other safety net clinics had the narrowest with mean SOP score of 14.0 or less. Higher rates of FPs practicing in Federally Qualified Health Centers and academic health centers were providing a women's health service, except for deliveries, whereas FPs in rural health centers were providing obstetric services (24%). The proportion of FPs providing newborn care was highest in RHCs and lowest in the urgent care setting (85%, vs 26%). A higher proportion of FPs in RHCs provided joint injections and skin procedures than FPs in other practice organizations. Significant variation in FP comprehensiveness exists across different practice types. FPs in practice types commonly associated with large health systems had narrower breadth of practice, concerning amid increasing practice consolidation. Given associations between comprehensiveness and desirable health care outcomes, policy makers should encourage payment/accountability models that incentivize broader SOP.

The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada

BackgroundFamily practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.MethodsThis mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses’ time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results.DiscussionThis project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.

The impact of care of the elderly certificates of added competence on family physician practice: results from a pan-Canadian multiple case study

BackgroundFamily physicians serve an important role in the care of older adults, and have variable levels of training and comfort navigating this complex patient population. The Care of the Elderly (COE) Certificate of Added Competence offered by The College of Family Physicians of Canada recognizes family physicians with advanced expertise in older adult healthcare. We explored how COE training and certification impacts primary care delivery to older patients, including factors that impact group practice.MethodsWe conducted a secondary analysis of multiple case study data to explore similarities and differences within and across cases. We defined cases as a practice or collective of family physicians working within a defined group of patients in an interconnected community. We analyzed semi-structured interview transcripts (n = 48) from six practice groups of family physicians across Canada using conventional (unconstrained, inductive) content analysis.ResultsWe identified similarities and differences in how COE family physicians function within their group practice and the broader healthcare system. In some cases, COE certifications increased patients’ access to geriatric resources by reducing travel and wait times. Some physicians observed minimal changes in their role or group practice after earning the COE designation, including continuing to largely function as a generalist. While family physicians tended to highly value their COE CAC, this designation was differentially recognized by others.ConclusionsOur findings highlight the impacts and limitations of COE training and certification, including an opportunity for COE family physicians to fill knowledge and practice gaps. As the number of older adults in Canada continues to grow and increasingly rely on primary care services, COE family physicians are uniquely positioned to strengthen the health system’s capacity to deliver specialized geriatric care.

Family physician practice patterns during COVID-19 and future intentions: Cross-sectional survey in Ontario, Canada.

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. Cross-sectional survey. Six geographic areas in Toronto, Ont, aligned with Ontario Health Team regions. Family doctors practising office-based, comprehensive family medicine. Practice operations in January 2021, use of virtual care, and future plans. Of 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 in-person 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, <i>P</i>&lt;.05), among those who did not see symptomatic patients (15.6% no vs 6.5% yes, <i>P</i>&lt;.001), and among those who planned to close their practices in the next 5 years (28.9% yes vs 13.9% no, <i>P</i>&lt;.01). Most family physicians in Toronto were open to in-person care in January 2021, but almost one-fifth were considering closing their practices in the next 5 years. Policy makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention.

Primary health care reforms in Estonia: using financial incentives to encourage multidisciplinary care

Abstract Estonia has a historical legacy of large hospital networks and municipality-owned specialist clinics, with a low emphasis on primary health care (PHC). Since the 1990s, a transition towards PHC has occurred, delivering PHC in family physician practices rather than in specialist clinics. The transition has been underpinned by a series of comprehensive healthcare system reforms starting in the late 1990s. The most recent reforms, although lacking a legal basis, have been accompanied by financial incentives including EU structural funds to encourage change. These financial incentives were designed to improve quality of care, encourage working in remote areas, and more. A key focus of PHC reforms has been an emphasis on multidisciplinary care, and the reforms have aimed at increasing the involvement of home nurses, midwives, and physiotherapists in PHC. The reforms have also prioritized PHC centres, with multiple practicing physicians, over single physician practices. Although EU structural funds have supported building the infrastructure for expanded scope of services at PHC level, the uncertainty of long-term funding of expanded services remained a key challenge limiting the success of the reform. Further, the supply of family physicians will be problematic in the future, as the number of permanently vacant positions has quadrupled in the last five years and almost half are 60 years of age or older. As the PHC reform process in Estonia continues until today, it can serve as a case study for other countries interested in strengthening their PHC systems.

The present circumstances of pediatric practice by family physicians in Japan: Cross sectional research.

In Japan, pediatric primary care has often been provided not by general practitioners, but by specialists. Although official pediatric training of general practitioners started in Japan in 2018 no studies to date show the extent to which Japanese general practitioners are committed to pediatric care. We conducted a questionnaire survey on pediatric training and current pediatric practice for family physicians certified by the Japan Primary Care Association. Of 1067 Japan Primary Care Association certified family physicians, 288 (27%) responded to the survey. More than 90% had received at least 3 months of pediatric training. Family physicians who completed 6 or more months of pediatric training provided significantly more pediatric care (p=0.005). However, nearly 40% were currently not involved in pediatric care. Japan Primary Care Association certified family physicians are treating acute and chronic common diseases as well as diseases that may intersect with other departments. However, most respondents indicated there are not many opportunities to learn systematically about the care of these diseases. In Japan, general practitioners are still not actively involved in pediatric care, but they treat patients with diseases that make it difficult to determine the most appropriate department to see and a wide range of age groups. It will become increasingly important to provide learning opportunities and better training environments in these areas with related organizations.

Outcomes of a rural-focussed family practice residency

Purpose: Family medicine physicians play a crucial role in maternity care in community-based settings. However, residency graduates are decreasingly likely to provide delivery services. We explored residency training and graduates' inclusion of obstetrical care in practice by surveying graduates of the Duluth Family Medicine Residency, traditionally producing a high number of graduates serving rural communities and providing obstetrical care.&#x0D; Methods: Graduates (N=48) were surveyed about their provision of maternity care and perceptions of how well the residency prepared them to provide such services. Additional factors that impacted decisions to provide obstetric care (e.g., post-residency training, community size, and if there were obstetricians providing delivery services in their community) were evaluated.&#x0D; Findings: Nearly half of graduates (46%) were providing maternity services, most of whom provided perinatal clinical care (68% provided delivery care and 4% operative deliveries). Seventy-one percent worked in a community with an available obstetrician. Graduates providing obstetric services were more likely to live in rural communities (66% vs 35%, p&lt;0.01). Thirty percent of graduates received extra obstetrical training in residency. Graduates providing obstetric services were more likely to cite that their decision to practice obstetrics was influenced by the number of deliveries performed, interactions with attending obstetricians, and interactions with prenatal and laboring patients during residency compared to those not providing obstetric services.&#x0D; Conclusions: Residency training has an impact on provision of maternity care and potential practice of family physicians in rural communities. Attention to curricular support, particularly exposure to maternity patients, is important for resident comfort in obstetrics.&#x0D; &#x0D;

Impact of educational training and C-reactive protein point-of-care testing on antibiotic prescribing in rural and urban family physician practices in Latvia: a randomised controlled intervention study

BackgroundAlthough self-limiting viral infections are predominant, children with acute infections are often prescribed antibiotics by family physicians. The aim of the study is to evaluate the impact of two interventions, namely C-reactive protein point-of-care testing and educational training, on antibiotic prescribing by family physicians.MethodsThis randomised controlled intervention study included acutely ill children consulted by 80 family physicians from urban and rural practices in Latvia. The family physicians were divided into two groups of 40. The family physicians in the intervention group received both interventions, i.e. C-reactive protein point-of-care testing and educational training, whereas the family physicians in the control group continued to dispense their standard care. The primary outcome measure was the antibiotic prescribing at the index consultation (delayed or immediate prescription) in both study groups. The secondary outcome was CRP testing per study group. Patient- and family physician- related predictors of antibiotic prescribing were analysed as associated independent variables. Practice location effect on the outcomes was specially addressed, similar to other scientific literature.ResultsIn total, 2039 children with acute infections were enrolled in the study. The most common infections observed were upper and lower respiratory tract infections. Overall, 29.8% (n = 607) of the study population received antibiotic prescription. Our binary logistic regression analysis did not find a statistically significant association between antibiotic prescriptions and the implemented interventions. In the control group of family physicians, a rural location was associated with more frequent antibiotic prescribing and minimal use of CRP testing of venous blood samples. However, in the intervention group of family physicians, a rural location was associated with a higher level of C-reactive protein point-of-care testing. Furthermore, in rural areas, a significant reduction in antibiotic prescribing was observed in the intervention group compared with the control group (29.0% (n = 118) and 37.8% (n = 128), respectively, p = 0.01).ConclusionOur results show that the availabilty of C-reactive protein point-of-care testing and educational training for family physicians did not reduce antibiotic prescribing. Nevertheless, our data indicate that regional variations in antibiotic-prescribing habits exist and the implemented interventions had an effect on family physicians practices in rural areas.

Barriers to and Systems Solutions for Increasing Early Childhood Home Visiting Referrals by Health Care Providers Serving Urban and Rural Communities.

Early childhood home visiting (ECHV) is an evidence-based prevention strategy that directly impacts maternal and child health by mitigating the poor outcomes associated with socioeconomic disadvantage and adverse childhood experiences that disproportionately affect marginalized populations. Despite its promise, health care providers in many communities do not routinely refer patients to these services. This qualitative study examined barriers to health care providers' referrals to ECHV services and identified systems-level strategies to overcome those barriers through semistructured interviews with 37 health care providers in New Mexico. Most participants were pediatricians or family practice physicians working in hospitals or community-based primary care settings, and the majority served rural communities. Barriers included insufficient knowledge about ECHV programs; lack of trust of program providers; time constraints; concerns about available funding; lack of a standardized referral process; and concerns about stigma and messaging. Five systems-level recommendations were developed to improve practice: (1) educating health care providers; (2) developing messaging prompts for providers to use when talking with patients about ECHV; (3) increasing engagement among providers and ECHV programs; (4) standardizing referral systems within practices; and (5) promoting universal referrals. Additional research is ongoing to determine the degree to which these health promotion strategies increase referrals and participation in ECHV.

Inpatient Diagnosis of Delirium and Encephalopathy: Coding Trends in 2011-2018.

Ten medical societies have called for scientific literature to integrate research on delirium and encephalopathy, while physicians continually debate how to accurately document diagnoses of acute confusional states. To promote this integration, we evaluated trends in diagnoses of delirium and encephalopathy among hospitalized adults and physician specialties, incorporating transitions to the Diagnostic and Statistical Manual of Mental Disorders-5 and the International Classification of Disease, tenth edition. Using the 2011-2018 IBM MarketScan datasets, we identified delirium/encephalopathy patients aged ≥18 years using International Classification of Disease 9/10 codes among hospitalized patients. We identified physician specialties associated with the hospitalization and comorbidities within one year before the diagnosis of delirium or encephalopathy. Log-binomial models were used to evaluate diagnostic trends, adjusting for age, gender, insurance, and comorbidities. We identified 10,509 hospitalized patients with a diagnosis of delirium and 94,438 with encephalopathy between 2011 and 2018. Although the number of patients with either diagnosis increased over time, the use of delirium diagnosis was less than it was for encephalopathy compared with 2011 after adjusting for covariates (adjusted risk ratio 0.45; 95% confidence interval 0.43 to 0.48). During the 8 years, neurologists and internists increased their use of both diagnoses, whereas only psychiatrists increased their use of delirium. Family practice physicians and nurse practitioners presented no significant change in either diagnosis for this timeframe. Our results suggest that refined diagnostic codes and criteria may alter trends among clinicians in diagnosing delirium and/or encephalopathy. Additional diagnostic clarity may be necessary to support refined diagnoses among family practice physicians and nurse practitioners.

Aile hekimlerinin el hijyenine yönelik inanç ve uygulamalarının incelenmesi

Amaç: Bu çalışmada aile hekimlerinin el hijyeni konusunda inanç ve uygulamalarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Tanımlayıcı tipte olan bu araştırmada aile hekimlerine online anket uygulanmıştır. El Hijyeni İnanç Skalası (EHİS) ve El Hijyeni Uygulamaları Envanteri (EHUE) kullanılmıştır. Bulgular: Kadınların hem EHİS hem de EHUE ölçek puanları erkeklerin puanlarından anlamlı şekilde yüksek olduğu görülmüştür (p&amp;lt;0,001). EHİS puanının ve cinsiyetin EHUE puanını yordadığı görülmüştür. Yine EHUE puanının ve cinsiyetin EHİS puanını yordadığı görülmüştür. Sonuç: El hijyeni inancı ile uygulama arasında pozitif bir ilişki olduğu görülmektedir. Hekimlerin el hijyeni konusunda farkındalıklarını arttıracak hatırlatmaların eğitim aracılığı ile yapılması inançlarında iyi yönde değişikliğe yardımcı olabilecektir.

Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas: 18 Months into the COVID-19 Pandemic.

Given the significant turmoil during the COVID-19 pandemic, the authors evaluated burnout and other types of emotional distress experienced by family physicians in Kansas during the second year of the pandemic. The authors compared findings of this study to a similar study conducted 3 months into the pandemic. A cross-sectional online survey of 272 actively practicing family physicians in Kansas was conducted from September 15 to October 18, 2021. A 34-item questionnaire was used to measure the physicians' levels of burnout, personal depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, Mann-Whitney U test/independent samples t-test, χ2, adjusted odds ratio, and immersion-crystallization methods were used to analyze the data. The response rate was 48.9% (n = 133). In aggregate, 69.2% of respondents reported at least 1 manifestation of professional burnout in 2021 compared with 50.4% in 2020; P ≤ .01). The 2021 respondents were at higher odds of experiencing burnout compared with 2020 respondents (aOR = 1.86; 95% CI, 1.00 to 3.57; P = .046). The respondents who reported at least 1 manifestation of professional burnout were more likely to screen positive for depression (aOR = 1.87; 95% CI, 1.31-2.66; P ≤ .01), report higher levels of anxiety (aOR = 1.53; 95% CI, 1.04-2.24; P = .013), and higher levels of stress (aOR = 1.39; 95% CI, 1.17-1.66; P ≤ .001). As the COVID-19 pandemic continued, there are significant and worsening rates of professional burnout and other forms of emotional distress among family physicians. These findings suggest timely need for appropriate psychological supports.

The same, only different: Using physician billing data from four provincial payment systems to describe family physician practice patterns in Canada.

ObjectivesIn Canada physician payment systems and associated billing data vary across provinces. We used linked billing data to develop comparable measures of family physician (FP) service volume, continuity, and comprehensiveness in each of four provinces, with the goal of describing changing patterns over time, relevant to workforce planning policy. ApproachWe accessed linked population and physician registry data, vital statistics, physician billing data, hospital and emergency department records, and (where available) laboratory and prescription drug records in four Canadian provinces from 1996/7 to 2017/8. We tracked changes in primary care physician service volume (patient visits), continuity, and comprehensiveness over two decades, and explored the impacts of career stage and graduation cohort on patterns observed. We also quantified changes in the volume of services that required FP coordination, review, administration, and/or follow-up, reporting changes in service volume per-capita, per community-based family physician and per physician visit. ResultsVisit volume and continuity per provider fell over time in the four provinces examined. Visits increased with years in practice until mid-to-late-career and declined into end-of-career. We found no relationship between graduation cohort and practice volume, continuity, or comprehensiveness of care. Over this time period, the number of FPs per-capita has grown, but the number in comprehensive, community-based practice has remained constant. While primary care visits have declined, the number of prescriptions, lab tests, emergency department visits, and specialist visits per capita have all increased. When expressed per community-based FP, and particularly per community-based FP patient visit, the increases in workload range from 36.1% for lab tests to 55.0% for ED follow-up. Increases in service volume are greatest among patients ages 80 and older, a rapidly-growing population segment. ConclusionLinked data capturing changes in practice patterns and workload suggest that even with an increasing per-capita supply of family physicians, additional resources will be needed to ensure all patients can access comprehensive primary care. Information on the various roles family physicians fill and demographic change will strengthen workforce planning.