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Research ArticleResearch Brief

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

Tara Kiran, Michael E. Green, C. Fangyun Wu, Alexander Kopp, Lidija Latifovic, Eliot Frymire, Rahim Moineddin and Richard H. Glazier
The Annals of Family Medicine September 2022, 20 (5) 460-463; DOI: https://doi.org/10.1370/afm.2865
Tara Kiran
1Department of Family and Community Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
2MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
3ICES Central, Toronto, Ontario, Canada
4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
MD, MSc
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  • For correspondence: tara.kiran@utoronto.ca
Michael E. Green
5Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
6Health Services and Policy Research Institute, Queens University, Kingston, Ontario, Canada
7ICES Queens, Kingston, Ontario, Canada
MD, MPH
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C. Fangyun Wu
3ICES Central, Toronto, Ontario, Canada
MSc, MAcc
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Alexander Kopp
3ICES Central, Toronto, Ontario, Canada
BA
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Lidija Latifovic
2MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
8Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
MSc
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Eliot Frymire
6Health Services and Policy Research Institute, Queens University, Kingston, Ontario, Canada
7ICES Queens, Kingston, Ontario, Canada
MA
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Rahim Moineddin
1Department of Family and Community Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
3ICES Central, Toronto, Ontario, Canada
PhD
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Richard H. Glazier
1Department of Family and Community Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
2MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
3ICES Central, Toronto, Ontario, Canada
4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
8Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
MD, MPH
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    Figure 1.

    Number of family physicians per 1,000 who were actively practicing from January to March in a given year but who had 0 primary care visits between April and September of that year, 2010-2020. Observed numbers and fitted regression line with 95% CIs.

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    Table 1.

    Characteristics of All Family Physicians in Ontario, Canada Active in 2019 and Comparison of Characteristics Between Those With No Outpatient Visits During the First 6 Months of the COVID-19 Pandemic (March-September 2020) and Those With Any Visits

    CharacteristicAll Family
    Physicians
    Active in 2019
    Family Physicians With
    Any Outpatient Visits From
    March to September 2020
    Family physicians With
    No Outpatient Visits
    March to September 2020
    P Value
    Physician age group, yn = 12,247 (%)n = 11,862 (%)n = 385 (%)
    ≤444,320 (35.3)4,188 (35.3)132 (34.3)<0.001
    45-645,746 (46.9)5,644 (47.6)102 (26.5)
    65-741,718 (14.0)1,618 (13.6)100 (26.0)
    ≥75454 (3.7)404 (3.4)50 (13.0)
    Missing9 (0.1)8 (0.1)1 (0.3)
    Physician age, y
    Mean ± SD51 ± 1351 ± 1356 ± 16<0.001
    Physician sex
    Female5,861 (47.9)5,674 (47.8)187 (48.6)0.775
    Male6,386 (52.1)6,188 (52.2)198 (51.4)
    Model of care
    PEM: Non-team capitation3,114 (25.4)3,052 (25.7)62 (16.1)<0.001
    PEM: Enhanced fee-for-service2,854 (23.3)2,769 (23.3)85 (22.1)
    PEM: Team-based capitation2,893 (23.6)2,825 (23.8)68 (17.7)
    Non-PEM: Straight fee-for-service3,099 (25.3)2,954 (24.9)145 (37.7)
    Missing287 (2.3)262 (2.2)25 (6.5)
    Rurality (RIO)
    Big cities (0)5,971 (48.8)5,773 (48.7)198 (51.4)0.399
    Smaller cities (1 – 9)3,338 (27.3)3,245 (27.4)93 (24.2)
    Small towns (10 – 39)1,817 (14.8)1,756 (14.8)61 (15.8)
    Rural (≥40)1,111 (9.1)1,079 (9.1)32 (8.3)
    Missing10 (0.1)9 (0.1)1 (0.3)
    Physician panel size group
      <1001,847 (15.1)1,761 (14.8)86 (22.3)<0.001
    100-4991,378 (11.3)1,310 (11.0)68 (17.7)
    500-9992,369 (19.3)2,287 (19.3)82 (21.3)
    1,000-1,4992,980 (24.3)2,917 (24.6)63 (16.4)
    1,500-1,9991,899 (15.5)1,858 (15.7)41 (10.6)
    ≥2,0001,487 (12.1)1,467 (12.4)20 (5.2)
    Missing287 (2.3)262 (2.2)25 (6.5)
    Physician panel size
    Mean ± SD1,097 ± 8291,106 ± 829788 ± 741<0.001
    Median (IQR)1,059 (417-1,580)1,069 (437-1,588)673 (114-1,259)<0.001
    Days with ≥1 billing, no.
    March – Sept 2019 Mean ± SD100 ± 35101 ± 3573 ± 35<0.001
    March – Sept 2020 Mean ± SD109 ± 42109 ± 420 ± 0
    Total visits, no.
    March – Sept 2019 Mean ± SD2,061 ± 1,7952,087 ± 1,8031,266 ± 1,281<0.001
    March – Sept 2020 Mean ± SD1,703 ± 1,6741,758 ± 1,6720 ± 0<0.001
    Percent of virtual visits
    March – Sept 20192.02.00.07<0.001
    March – Sept 202066.066.0
    • PEM = patient enrollment model; RIO = Rurality Index of Ontario.

    • Notes: The total number of billing days for the study period including weekends and holidays was 203 days (29 weeks). Rurality categorized using the Rurality Index of Ontario. See Kralj B. Measuring Rurality — RIO2008 BASIC: Methodology and Results. Ontario Medical Association; 2009. Accessed Sep 22, 2020. https://content.oma.org//wp-content/uploads/2008rio-fulltechnicalpaper.pdf

Additional Files

  • Figures
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  • SUPPLEMENTAL DATA IN PDF FILE BELOW

    Supplemental Figure 1. Primary care visits December 31, 2019 to September 29, 2020 compared to the same period in 2019 stratified by type of visit (office, virtual, home).
    Supplemental Figure 2. Histogram of the number of physicians by the ration of total visits during the first 6 months of the COVID-19 pandemic (March to September 2020) to total visits during the same time period in 2019.
    Supplemental Figure 3.
    Variation within and between patient enrollment models in the ratio of total visits during the first 6 months of the COVID-19 pandemic (March to September 2020) tot total visits during the same time period in 2019.
    Supplemental Figure 4. Percentage of all family physicians within a sub-region who had no patient visits between March 11, 2020 and September 29, 2020.
    Supplemental Figure 5. Percentage of family physicians who were actively practicing from January to March but who had primary care visits between April and September in the given year, 2010-2020.

    • Kiran_Supp.pdf
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The Annals of Family Medicine: 20 (5)
The Annals of Family Medicine: 20 (5)
Vol. 20, Issue 5
September/October 2022
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Family Physicians Stopping Practice During the COVID-19 Pandemic in Ontario, Canada
Tara Kiran, Michael E. Green, C. Fangyun Wu, Alexander Kopp, Lidija Latifovic, Eliot Frymire, Rahim Moineddin, Richard H. Glazier
The Annals of Family Medicine Sep 2022, 20 (5) 460-463; DOI: 10.1370/afm.2865

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Family Physicians Stopping Practice During the COVID-19 Pandemic in Ontario, Canada
Tara Kiran, Michael E. Green, C. Fangyun Wu, Alexander Kopp, Lidija Latifovic, Eliot Frymire, Rahim Moineddin, Richard H. Glazier
The Annals of Family Medicine Sep 2022, 20 (5) 460-463; DOI: 10.1370/afm.2865
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