Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
BMC Fam Pract. 2012 Mar 28;13:26. doi: 10.1186/1471-2296-13-26.
There are continued concerns over an adequate supply of family physicians (FPs) practicing in Canada. While most resource planning has focused on intake into postgraduate education, less information is available on what postgraduate medical training yields. We therefore undertook a study of Family Medicine (FM) graduates from the University of Toronto (U of T) to determine the type of information for physician resource planning that may come from tracking FM graduates using health administrative data. This study compared three cohorts of FM graduates over a 10 year period of time and it also compared FM graduates to all Ontario practicing FPs in 2005/06. The objectives for tracking the three cohorts of FM graduates were to: 1) describe where FM graduates practice in the province 2) examine the impact of a policy introduced to influence the distribution of new FM graduates in the province 3) describe the services provided by FM graduates and 4) compare workload measures. The objectives for the comparison of FM graduates to all practicing FPs in 2005/06 were to: 1) describe the patient population served by FM graduates, 2) compare workload of FM graduates to all practicing FPs.
The study cohort consisted of all U of T FM postgraduate trainees who started and completed their training between 1993 and 2003. This study was a descriptive record linkage study whereby postgraduate information for FM graduates was linked to provincial health administrative data. Comprehensiveness of care indicators and workload measures based on administrative data where determined for the study cohort.
From 1993 to 2003 there were 857 University of Toronto FM graduates. While the majority of U of T FM graduates practice in Toronto or the surrounding Greater Toronto Area, there are FM graduates from U of T practicing in every region in Ontario, Canada. The proportion of FM graduates undertaking further emergency training had doubled from 3.6% to 7.8%. From 1993 to 2003, a higher proportion of the most recent FM graduates did hospital visits, emergency room care and a lower proportion undertook home visits. Male FM graduates appear to have had higher workloads compared with female FM graduates, though the difference between them was decreasing over time. A 1997 policy initiative to discount fees paid to new FPs practicing in areas deemed over supplied did result in a decrease in the proportion of FM graduates practicing in metropolitan areas.
We were able to profile the practices of FM graduates using existing and routinely collected population-based health administrative data. Further work tracking FM graduates could be helpful for physician resource forecasting and in examining the impact of policies on family medicine practice.
加拿大一直存在家庭医生（FP）供应不足的问题。尽管大多数资源规划都集中在研究生教育的入学上，但对于研究生医学培训的成果，信息却较少。因此，我们对多伦多大学（U of T）的家庭医学（FM）毕业生进行了一项研究，以确定通过健康管理数据跟踪 FM 毕业生可能为医生资源规划提供哪些信息。这项研究比较了三个 FM 毕业生队列在 10 年期间的情况，并将 FM 毕业生与 2005/06 年安大略省所有执业 FP 进行了比较。跟踪三个 FM 毕业生队列的目的是：1）描述 FM 毕业生在省内的工作地点；2）研究一项旨在影响省内新 FM 毕业生分布的政策的影响；3）描述 FM 毕业生提供的服务；4）比较工作量指标。2005/06 年将 FM 毕业生与所有执业 FP 进行比较的目的是：1）描述 FM 毕业生服务的患者人群；2）比较 FM 毕业生与所有执业 FP 的工作量。
研究队列包括所有在 1993 年至 2003 年间开始并完成培训的多伦多大学 FM 研究生培训生。这是一项描述性的记录链接研究，其中 FM 毕业生的研究生信息与省级卫生管理数据相关联。根据管理数据确定了研究队列的综合护理指标和工作量指标。
1993 年至 2003 年期间，有 857 名多伦多大学 FM 毕业生。尽管多伦多大学 FM 毕业生的大部分工作地点在多伦多或周边大多伦多地区，但安大略省的每个地区都有来自多伦多大学的 FM 毕业生。从事进一步急诊培训的 FM 毕业生比例已从 3.6%增加到 7.8%。1993 年至 2003 年期间，最近一批 FM 毕业生中进行医院就诊、急诊护理的比例较高，而进行家访的比例较低。男性 FM 毕业生的工作量似乎高于女性 FM 毕业生，尽管他们之间的差距随着时间的推移而缩小。1997 年的一项政策举措降低了在供应过剩地区执业的新 FP 支付的费用，这导致在大都市地区执业的 FM 毕业生比例下降。
我们能够使用现有的、常规收集的基于人群的健康管理数据来描绘 FM 毕业生的实践情况。进一步跟踪 FM 毕业生的工作可能有助于预测医生资源，并检查政策对家庭医学实践的影响。
