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The Article in Brief
Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada
Simone Dahrouge , and colleagues
Background Where physician resources are scarce, one way to ensure that individuals have a primary care doctor is to promote larger panel sizes (i.e., more patients per doctor). There is a concern, however, that the quality of primary care may decline at larger panel sizes. This study examines the association between family physicians' panel size, quality of care, and health service use.
What This Study Found Among 4,195 physicians in Ontario, Canada with panel sizes between 1,200 and 3,900 patients, increasing panel size is associated with small decreases in cancer screening, continuity, and comprehensiveness, but little difference in chronic disease management quality or indicators of access to care. Specifically, the likelihood of patients? being up-to-date on cervical, colorectal and breast cancer screening shows relative decreases of 8 percent, 6 percent and 5 percent, respectively, with increasing panel size. Eight chronic care indicators show no significant association with panel size, but increasing panel size is associated with an 11 percent relative increase in hospitalization rates for ambulatory-care-sensitive conditions and an 11 percent decrease in non-emergency department visits. Continuity is highest with medium panel sizes and comprehensiveness has a small decrease with increasing panel size.
Implications
- According to the authors, these findings do not support policy measures such as thresholds or caps that reduce payments to physicians with large panel sizes.
- Physicians who take on larger patient panels may be able to do so without compromising care quality because personal or practice characteristics, such as communication style, organizational climate, and measures to optimize practice access, allow them to provide effective and efficient care.