Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022

PLAIN-LANGUAGE SUMMARY

Original Research 

More Ontario Family Physicians Focus on Narrow Specialties, Fewer Provide Comprehensive Care 

Background and Goal:Having family physicians who deliver comprehensive care is critical for addressing evolving population health needs. This study examined long‑term shifts toward focused practice among family physicians in Ontario, Canada, as well as changes in the number of comprehensive family physicians relative to population growth.

Study Approach: Researchers linked multiple Ontario health‑administrative data sets to track practice patterns for every general practitioner or family physician from fiscal years 1993/94 through 2021/22. Analyses were stratified by physician sex and years in practice. A physician was classified as providing comprehensive care if, in a given year, they worked at least 44 billed days, devoted more than 50% of billings to core primary care services, and met the threshold for diversity of primary care activity areas. Physicians who did not meet all three criteria were grouped as follows: focused practice (for example, hospitalist work or emergency medicine); low volume, with fewer than 44 billed days; other primary care roles; a fourth group had no billings for the year. 

Main Results:

• The proportion of family physicians working in focused roles rose to 19.2% in 2021/22, up from 7.7% in 1993/94.

• Emergency medicine accounted for 37% of focused doctors in 2021/22, followed by hospitalist care at 26.5% and addiction medicine at 8.3%.

• Although the overall supply of family physicians climbed from 104 to 118 per 100,000 residents during the study period, the supply offering comprehensive care fell from 71 to 64 per 100,000. 

• Of the additional 6,310 family physicians who entered the workforce during the study period, 39.5% were in focused practice.

• In 2021/22, 60% of focused practice physicians were male and 40% were female. The focused practice group had fewer average days worked at 156 days compared with 196 days for the comprehensive practice group.

Why it Matters:Amid ongoing efforts to address current and impending challenges in access to primary care, findings from this study underscore the limitations of using family physician head counts in workforce planning. Knowing how many family physicians move into focused roles and how the proportion providing comprehensive care has declined can guide policy and practice changes, including better payments aligned with system goals, practice support, job flexibility, team-based care and cross-sectoral workforce planning to make comprehensive family practice the most attractive option to family physicians.     

Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022 

Hina Ansari, PhD, MSc, et al

MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada 

Visual Abstract