RE: Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces
References
Rudoler, D. et al. (2022). Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces. Canadian Medical Association Journal, 194(48), E1639-46. https://doi.org/10.1503/cmaj.220439
Smart, K. (2022, May 9). Critical family physician shortage must be addressed: CMA. The Canadian Medical Association. https://www.cma.ca/news-releases-and-statements/critical-family-physician-shortage-must-be-addressed-cma
Lee, J. (2022, April 27). Concerns grow as more and more Albertans can’t find a family doctor. The Canadian Broadcasting Corporation. https://www.cbc.ca/news/canada/calgary/fewer-family-doctors-accepting-new-patients-1.6432767
We would like to thank David Rudoler et al for their article entitled Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces (1).
We appreciate their work as it contributes to the ongoing discussion around recent physician graduate work patterns and how they potentially impact patient access to family physicians. Access to continuous primary care remains an ongoing concern across Canada (2). Rudoler et al’s retroactive cohort concluded that at least up until 2018, newer cohorts of family physicians practice similarly to their predecessors in terms of practice volume and continuity of care.
To further the dialogue, we wanted to highlight a recent survey completed in 2022 with family medicine residents at the University of Alberta. In our survey, which had a 52.2% response rate (N=80), we explored intentions to practice clinic based longitudinal care through taking on a patient panel as one indication of providing continuity of care. 72.6% of residents reported that prior to entering residency they had anticipated that they “definitely” or “probably” would take on a patient panel, however when asked about their intentions in the next five years, that number decreased to 38.8%.
If these results at all reflect true resident intentions, this is indeed a worrisome finding for primary care.
There may be a few reasons for the differences in our survey results as compared to Rudoler’s findings. First, it may be that only more recently we are seeing a change in resident practice intentions. For instance, COVID-19 may have exacerbated long standing issues including lack of support for clinicians who practice longitudinal care in the community. We would argue that this is plausible. The family medicine crisis is worsening . In Alberta from 2020-2022 there was a ~50% reduction in primary care network physicians accepting new patients (3).
There are also limitations with survey data, including a potential discrepancy between stated intentions and the actual practices of learners upon graduation.
Finally, continuity of care can be defined in different ways. In Rudoler et al., provincial billing data, specifically the proportion of total annual contacts that all patients seen by a family physician had with that physician was used to define continuity. We wonder if this fully encapsulates the issue of lack of patient access to family physicians. Patients having access to a family physician willing to provide clinic-based longitudinal care over their lifespan may be an improved definition for continuity.