Younger doctors seeing fewer patients
Need for work-life balance a factor in looming shortage of physicians: study
Primary care physicians trying to achieve the holy grail — work-life balance — are exacerbating patient access problems because they’re working less than previous generations of such doctors, a new University of B.C. study shows.
The authors warn that if the supply of primary care doctors (also called family doctors or general practitioners) doesn’t grow substantially, “ever-shrinking practices will result in an increasing number of people who have difficulty finding a regular source of primary care.”
The Canadian Community Health Survey showed over 16 per cent of B.C. residents don’t have a regular primary care doctor. And practice sizes in B.C. — the number of patients per primary care doctor — are the second-lowest in Canada, says Laura Heinze, spokeswoman for the B.C. Ministry of Health.
Using Medical Services Plan billing and other data for the years from 2005 to 2012, the study authors showed that even though there were about 13 per cent more primary care doctors during the seven-year period, overall visits with patients shrunk 14 per cent and the number of patients in each practice declined by 10 per cent.
The study cohort consisted of 6,579 primary care doctors who bill on a fee-for- service basis (as opposed to a minority of physicians who collect salaries); 2,469 were female and 4,110 were male. Fourteen per cent of the doctors were over age 65, according to the study published in Health Affairs, a major international health policy journal.
The feminization of medicine — surging numbers of female doctors who generally work less because of family responsibilities — is one factor in the shrinking productivity phenomenon as is the fact that, just like the general population, the proportion of older doctors is growing. But while feminization and the aging physician workforce are both contributing to the decline in services per physician “neither change was as influential as the reduction of per physician activity levels over time. That’s the primary driver,” lead author Lindsay Hedden said.
Asked if medical schools should start accepting fewer females, she said that would be a terrible idea, especially since patients appear to have more favourable opinions of female physicians.
“Patient satisfaction surveys show this. Female doctors spend more time with patients, they have different practice styles,” Hedden said.
The situation is dire not only because so many people don’t have a regular family doctor but also because of the growing population; it increased by about 350,000 during the duration of the study alone.
The B.C. situation is far from unique as demand for physician services all across North America is growing faster than the supply of doctors. But Hedden and her co-authors noted it’s possible the shortage of doctors will hit Canada even harder than the U.S. because Canada has a paucity of nurse practitioners and physician assistants providing primary care services.
Hedden said B.C., in particular, is on the “low end of the spectrum, not too interested in introducing different types of health-care providers.”
She said the government should be using the data in the study for its health human resource planning, taking into account that doctors now enrol far fewer patients in their practices.
Heinze said that while the government respects how demanding medicine is and that doctors need a reasonable work/life balance, it is necessary to find solutions. The government believes answers will be found in team-based care involving doctors, nurses and other health professionals, along with urgent care centres.
The decline in annual numbers of patient contacts and unique patients over the study period was substantial, the study says. On average, doctors had 115 fewer patient contacts per year and 38 fewer unique patients. (Unique patients refers to the number of individuals in a doctor’s practice while the number of contacts refers to the overall number of visits.)
The current study echoes results in the Canadian National Physician Survey showing that between 2004 and 2014, the number of hours spent on direct patient care were reduced by 10.2 per cent.
As well, the current study reinforces findings by researchers at the University of Montreal who showed that paying doctors higher fees doesn’t do much to benefit patients looking for doctors and wanting to have faster access to them. The Quebec results were said to reflect an economic theory called target income hypothesis: that is, people aspire to a certain level of income; once they reach it, they feel comfortable enough to adjust — downward — their workload.
“What our study shows is that as the unit price of services rose, physicians — who are overwhelmingly self-employed entrepreneurs — adjusted their work practice to improve their quality of life instead of opting to earn (even) more,” concluded researchers in a commentary accompanying their study in Healthcare Policy.
Dr. Trina Larsen Soles, president of Doctors of B.C., said productivity and physician fees is a “complex equation given that physicians today are expected to do much more within a regular workday than even a decade ago.”
There is far more paperwork to do and primary care physicians have more variation in their practices, she said, with some doctors taking care of geriatric and palliative patients, meaning that “the ability to see individual patients in their office becomes limited.”
Female doctors spend more time with patients, they have different practice styles.