Comprehensiveness is falling among family physicians at all career stages in Canada, finds study

In a study published in The Annals of Family Medicine, Canadian researchers describe changes in the comprehensiveness of services delivered by family physicians in four Canadian provinces (British Columbia, Manitoba, Ontario, and Nova Scotia) between 1999/2000 and 2017/2018, and explore if changes differ by the number of years physicians are in practice.

They argue that having an accurate picture of changes in comprehensiveness can inform policy responses. They measured comprehensiveness using province-wide billing data across seven settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anaesthesiology) and seven service areas (pre/post-natal care, pap testing, mental health, substance use, cancer care, minor surgery, and palliative home visits). They found that comprehensiveness declined in all provinces, with greater changes in the number of settings than service areas. Declines were no greater among new-to-practice physicians than those who had 10 or more years of service.

While comprehensiveness has declined over time among physicians entering practice, this decline occurred across all career stages in the study's time periods. Findings are consistent across the four Canadian provinces the team examined. The authors argue that any efforts to enhance or maintain comprehensive family medicine services should address the service delivery contexts in which all primary care physicians are practicing, rather than interventions in training or early practice.

Comprehensive family physician service has declined across multiple Canadian provinces over the last 20-plus years, prompting speculation that this is due to young physicians' lack of interest in delivering comprehensive primary care or that they are receiving inadequate training in providing comprehensive primary care.

Researchers found that family physicians are practicing in fewer settings (e.g. home, long-term care, hospital) but this is not correlated with a physician's number of years in practice. Since this doesn't correlate with the number of years in practice, it suggests that the decrease in comprehensive care is not due to a lack of interest or training specific to younger physicians.