Exploring the Longitudinal Work Patterns of Family Physicians From 2005-2019 – An Ontario Alberta Collaboration
Bibliographic record
Abstract
Context: There is growing concern about the supply and distribution of Family Physicians (FPs) in Canada. With an aging FP workforce and preference for part-time practice, securing access to care for remains a dilemma for patients and funders of health care in many parts of the country. Survey data suggests physicians are working in less in recent decades. Our study highlights the actual trend in health services provided by FPs and aims to inform policy discussions on FP supply. Objective: To determine the trend in service provision among 12,000 FPs in Ontario and 3500 in Alberta. Study Design and Analysis: This was a descriptive observational study. We calculated the number of service days provided by FPs for each year in Ontario and Alberta using our previously published method. One service day is defined as 10 or more clinic visits per day valued at >20$. Dataset: De-identified linked FP claims from Alberta Health and the Ontario Health Insurance Program for 2005-2019 inclusive. Population Studied: All FPs in Ontario and Alberta were included if they had evidence of 10 or more billings 3 days per week for at least 46 weeks. FPs with no billings and Alberta FPs with shadow-billings were excluded. Intervention/Instrument: n/a. Outcome Measures: Average service days provided by FPs, and FP practice characteristics. Results: In both Ontario and Alberta, the average service days per provider decreased over time among both male and female providers, and across all levels of experience. The decline in service days per provider was most pronounced in those most experienced (30+ years). From 2005 to 2018, in Ontario and Alberta, respectively, female FPs on average reduced service days by 16.8 and 45.44; male providers reduced service days by 9.5 and 27 service days per year. The next most pronounced decline was among those with 10-19 years in practice in Ontario (25.6 male, 13.3 female) and those with 20-29 years experience in Alberta (8.56 male, 10.3 female). The smallest declines were found in new graduates (0-9 years in practice). Conclusions: Service days provided by FPs in Ontario and Alberta appear to be declining differentially across FP subgroups. These results highlight important implications for accessing care and FP supply planning. Learning Objectives: To understand the trend in primary care provider work supply based on service provision. To understand the utility of a service day definition to calculate physician supply.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.007 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".