Research ArticleResearch Briefs

Declining Comprehensiveness of Services Delivered by Canadian Family Physicians Is Not Driven by Early-Career Physicians

M. Ruth Lavergne, David Rudoler, Sandra Peterson, David Stock, Carole Taylor, Andrew S. Wilton, Sabrina T. Wong, Ian Scott, Kimberlyn M. McGrail, Rita McCracken, Emily G. Marshall, Adrian MacKenzie, Alan Katz, Margaret Jamieson, Lindsay Hedden, Agnes Grudniewicz, Laurie J. Goldsmith, Richard H. Glazier, Fred Burge and Doug Blackie
The Annals of Family Medicine March 2023, 21 (2) 151-156; DOI: https://doi.org/10.1370/afm.2945

Article Figures & Data

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Tables

  • Table 1.

    Rate Ratios (95% CI) for Comprehensiveness of Service Settings

    British ColumbiaManitobaOntarioNova Scotia
    UnadjustedAdjustedUnadjustedAdjustedUnadjustedAdjustedUnadjustedAdjusted
    InterceptNA3.72
    (3.54-3.91)    		NA3.26
    (2.92-3.63)    		NA3.1
    (2.9-3.21)    		NA2.26
    (2.06-2.47)
    Years since MD (reference = 10-19 years)
    <100.92
    (0.88-0.96)    		0.9
    (0.86-0.94)    		0.86
    (0.78-0.94)    		0.89
    (0.81-0.97)    		0.92
    (0.89-0.94)    		0.95
    (0.92-0.99)    		0.92
    (0.85-0.98)    		0.96
    (0.88-1.04)
    20-29 (MB: ≥20)0.9
    (0.86-0.93)    		1.02
    (0.98-1.06)    		0.89
    (0.79-0.99)    		1.05
    (0.95-1.16)    		0.96
    (0.93-0.98)    		0.96
    (0.93-1.0)    		0.96
    (0.89-1.03)    		1.0
    (0.93-1.04)
    ≥300.63
    (0.6-0.67)    		0.95
    (0.9-1.01)    		NANA0.8
    (0.77-0.82)    		0.89
    (0.85-0.93)    		0.77
    (0.72-0.83)    		0.86
    (0.77-0.95)
    Year
    2017-2018 (vs 1999-2000)0.49
    (0.47-0.5)    		0.52
    (0.49-0.56)    		0.45
    (0.42-0.48)    		0.48
    (0.42-0.56)    		0.6
    (0.59-0.62)    		0.65
    (0.62-0.68)    		0.69
    (0.67-0.73)    		0.76
    (0.96-0.84)
    Interaction
    Year, <10NA1.25
    (1.15-1.37)    		NA1.13
    (0.96-1.34)    		NA1.13
    (1.06-1.2)    		NA1.07
    (0.94-1.23)
    Year, 20-29 (MB: ≥20)NA0.95
    (0.86-1.03)    		NA0.92
    (0.76-1.12)    		NA1.0
    (0.95-1.06)    		NA0.94
    (0.83-1.08)
    Year, ≥30NA0.87
    (0.78-0.96)    		NANANA0.99
    (0.9-1.05)    		NA1.09
    (0.94-1.26)
    Covariates
    Male (vs female)1.29
    (1.24-1.34)    		1.11
    (1.07-1.16)    		1.69
    (1.54-1.84)    		1.27
    (1.17-1.37)    		1.4
    (1.37-1.43)    		1.22
    (1.19-1.25)    		1.14
    (1.08-1.2)    		0.99
    (0.95-1.06)
    Urban (vs rural)0.75
    (0.72-0.77)    		0.72
    (0.7-0.75)    		0.56
    (0.52-0.6)    		0.54
    (0.5-0.57)    		0.54
    (0.53-0.56)    		0.55
    (0.53-0.56)    		0.9
    (0.85-0.96)    		1.0
    (0.95-1.06)
    Number of contacts (per 100 contacts)1.01
    (1.0-1.01)    		1.0
    (1.0-1.0)    		1.01
    (1.0-1.01)    		1.0
    (1.0-1.01)    		1.0
    (1.0-1.0)    		1.0
    (1.0-1.0)    		1.01
    (1.01-1.01)    		1.01
    (1.0-1.01)
    International MD (vs Canadian MD)0.86
    (0.83-0.9)    		0.9
    (0.87-0.94)    		0.91
    (0.84-0.98)    		0.79
    (0.73-0.84)    		NANANANA
    Unknown MD (vs Canadian MD)0.76
    (0.66-0.87)    		0.83
    (0.73-0.95)    		1.22
    (0.92-1.62)    		1.38
    (1.26-1.52)    		NANANANA

    • MB = Manitoba; MD = Doctor of Medicine; NA = not applicable.

    • Note: There were missing data on place of graduation in Nova Scotia and incomplete data in Ontario; therefore, this variable was excluded from modeling in these provinces.

  • Table 2.

    Rate Ratios (95% CI) for Comprehensiveness of Service Areas

    British ColumbiaManitobaOntarioNova Scotia
    UnadjustedAdjustedUnadjustedAdjustedUnadjustedAdjustedUnadjustedAdjusted
    Intercept  NA4.56
    (4.46-4.65)    		  NA4.57
    (4.36-4.78)    		  NA4.99
    (4.86-5.13)    		  NA3.72
    (3.55-3.9)
    Years since MD (reference = 10-19 years)
    <100.99
    (0.98-1.01)    		1.02
    (1.0-1.04)    		0.96
    (0.93-0.99)    		1.01
    (0.98-1.05)    		1.0
    (0.98-1.01)    		0.99
    (0.97-1.02)    		1.02
    (0.98-1.05)    		1.03
    (0.99-1.07)
    20-29 (MB: ≥20)0.98
    (0.97-0.99)    		0.99
    (0.97-1.01)    		0.94
    (0.9-0.97)    		1.02
    (0.97-1.06)    		0.97
    (0.96-0.99)    		0.97
    (0.95-1.0)    		0.98
    (0.95-1.01)    		0.98
    (0.95-1.02)
    ≥300.89
    (0.88-0.91)    		0.92
    (0.89-0.95)    		  NA  NA0.89
    (0.87-0.9)    		0.9
    (0.88-0.93)    		0.87
    (0.84-0.9)    		0.87
    (0.81-0.93)
    Year
    2017-2018 (vs 1999-2000)0.93
    (0.93-0.94)    		0.99
    (0.97-1.01)    		0.9
    (0.88-0.92)    		0.97
    (0.93-1.02)    		0.93
    (0.92-0.94)    		0.95
    (0.93-0.98)    		0.89
    (0.87-0.91)    		0.95
    (0.9-1.0)
    Interaction
    Year, <10  NA1.0
    (0.97-1.03)    		  NA0.97
    (0.92-1.02)    		  NA1.06
    (1.02-1.1)    		  NA1.04
    (0.97-1.11)
    Year, 20-29 (MB: ≥20)  NA0.98
    (0.95-1.0)    		  NA0.92
    (0.86-0.99)    		  NA1.0
    (0.96-1.03)    		  NA0.98
    (0.92-1.05)
    Year, ≥30  NA1.01
    (0.97-1.05)    		  NA  NA  NA1.04
    (1.0-1.08)    		  NA1.07
    (0.98-1.16)
    Covariates
    Male (vs female)1.03
    (1.02-1.04)    		0.97
    (0.96-0.98)    		1.02
    (0.99-1.04)    		0.92
    (0.9-0.95)    		1.01
    (1.0-1.02)    		0.96
    (0.95-0.98)    		0.99
    (0.97-1.02)    		0.91
    (0.89-0.94)
    Urban (vs rural)0.96
    (0.94-0.97)    		0.92
    (0.91-0.93)    		0.93
    (0.9-0.95)    		0.88
    (0.85-0.9)    		0.89
    (0.88-0.91)    		0.88
    (0.86-0.9)    		0.91
    (0.89-0.94)    		0.96
    (0.93-0.98)
    Number of contacts (per 100 contacts)1.0
    (1.0-1.0)    		1.0
    (1.0-1.0)    		1.0
    (1.0-1.0)    		1.0
    (1.0-1.0)    		1.0
    (1.0-1.0)    		1.0
    (1.0-1.0)    		1.0
    (1.0-1.0)    		1.0
    (1.0-1.01)
    International MD (vs Canadian MD)1.03
    (1.02-1.04)    		1.01
    (1.00-1.02)    		1.0
    (0.97-1.03)    		0.94
    (0.92-0.96)    		  NA  NA  NA  NA
    Unknown MD (vs Canadian MD)0.97
    (0.93-1.01)    		0.95
    (0.91-0.99)    		1.0
    (0.85-1.16)    		1.01
    (0.86-1.19)    		  NA  NA  NA  NA

    • MB = Manitoba; MD = Doctor of Medicine; NA = not applicable.

    • Note: There were missing data on place of graduation in Nova Scotia and incomplete data in Ontario; therefore, this variable was excluded from modeling in these provinces.

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