Ansari Hina, Glazier Richard H, Schultz Susan E, Green Michael E, Premji Kamila, Frymire Eliot, Daneshvarfard Maryam, Jaakkimainen Liisa, Kiran Tara
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Ann Fam Med. 2025 May 27;23(3):181-190. doi: 10.1370/afm.240377.
An adequate supply of family physicians who deliver comprehensive care is critical for addressing evolving population health needs, fostering health equity, and ensuring a cost-effective health system. Little is known about current trends of family physicians choosing focused practice and concurrent changes in comprehensive family physician numbers relative to population growth.
We conducted a repeated cross-sectional population-based study using administrative data to understand sex-stratified trends in focused practice from 1993/1994 through 2021/2022 in Ontario, Canada, accounting for population growth. For each fiscal year, we identified all active family physicians and classified them by practice type, leveraging a previously published algorithm on comprehensiveness.
The proportion of family physicians in focused practice increased from 7.7% (856/11,103) in 1993/1994 to 19.2% (3,351/17,413) in 2021/2022. The 3 most prevalent focused practice types at the end of the study period were emergency (37.0%), hospitalist (26.5%), and addiction (8.3%) medicine. A greater proportion of focused practice physicians were male (60.1%) vs female (39.9%) in 2021/2022. Over the study period, the number of family physicians increased from 104 to 118 per 100,000; however, the number of comprehensive family physicians decreased from 71 to 64 per 100,000. Of the additional 6,310 family physicians who entered the workforce, 39.5% (2,495/6,310) were in focused practice.
Over the study period, there was a decrease in the percentage of comprehensive family physicians and a substantial increase in family physicians pursuing focused practice, particularly in emergency and hospitalist medicine. Research and policy work is needed to understand and address the complex factors driving these trends.
拥有足够数量提供全面医疗服务的家庭医生对于满足不断变化的人群健康需求、促进健康公平以及确保卫生系统的成本效益至关重要。目前对于家庭医生选择专科化执业的趋势以及综合家庭医生数量相对于人口增长的同期变化了解甚少。
我们利用行政数据开展了一项基于人群的重复横断面研究，以了解1993/1994年至2021/2022年期间加拿大安大略省按性别分层的专科化执业趋势，并考虑了人口增长因素。对于每个财政年度，我们确定所有在职家庭医生，并根据执业类型进行分类，采用先前发表的关于全面性的算法。
专科化执业的家庭医生比例从1993/1994年的7.7%（856/11,103）增至2021/2022年的19.2%（3,351/17,413）。研究期末最常见的三种专科化执业类型是急诊医学（37.0%）、住院医师（26.5%）和成瘾医学（8.3%）。2021/2022年，专科化执业医生中男性比例（60.1%）高于女性（39.9%）。在研究期间，家庭医生数量从每10万人104名增至118名；然而，综合家庭医生数量从每10万人71名降至64名。在新增的6310名进入劳动力队伍的家庭医生中，39.5%（2495/6310）从事专科化执业。
在研究期间，综合家庭医生的比例有所下降，而从事专科化执业的家庭医生大幅增加，尤其是在急诊医学和住院医师领域。需要开展研究和政策工作，以了解和应对推动这些趋势的复杂因素。
