A new study from Dalhousie University shows that family physicians who entered the profession recently do not accept fewer patients or have less contact with patients than those who started two decades ago.
The analysis counters a misconception that newly trained physicians think more about work-life balance than their more established colleagues, are less career-driven, or are less likely to provide comprehensive and continuous care, according to the study.
The data also suggests areas where improvements could be made to increase patient access to care.
The study, published Monday in the Canadian Medical Association Journalanalyzed data from Nova Scotia, Ontario, Manitoba and British Columbia from 1997 to 2018.
Patient volume peaks in mid-career
She showed that over the course of a family doctor’s career, he tends to start out with fewer patient visits. This number goes up until the doctor has about 27 to 29 years of experience and then starts to go down again. This trend has been consistent over the 20-year study period.
“We see a spike in volume around mid-career, but that has been the case for previous generations as well,” said Dr. Ruth Lavergne, one of the study authors and associate professor in the Department of Family Medicine. of Dalhousie.
“So there have always been changes in the careers of doctors, but doctors who start now don’t work proportionally less than those who started some time ago.”
Dr. Katherine Stringer, head of Dalhousie’s Department of Family Medicine, said one of the reasons early-career physicians across generations tend to have fewer patients than mid-career physicians is that get to know their patients and can therefore spend more time with them.
They also need to add patients’ medical information to record systems, they can hire staff to run a practice, and learn the financial side of running a business.
“There is a lot of stress on our new graduates when they start practicing. So providing them with as many of these supports as possible that can potentially take some of that stress off so they can then focus on connecting with patients, I think maybe the study helps a little bit there.”
Fewer patient visits throughout career
Another finding from the study is that family physicians at all stages of their careers are seeing fewer patients today than 20 years ago due to the increasing complexity of care. He notes a drop of around 25%, or between 515 and 1,736 patient visits per doctor per year.
Lavergne said that doesn’t mean doctors are working less. She said patients are being treated for a greater number of conditions, which could mean the average visit takes longer. Family physicians also coordinate referrals, imaging, and labs, which is more time-consuming administrative work.
Dr. Leisha Hawker, president of Doctors Nova Scotia, said patients are also being discharged from the hospital earlier than before, due to high demand for beds. This means that some issues that would normally be handled by hospital staff are now handled by family physicians.
People are staying home longer while waiting for long-term care, so they rely on family doctors for medical help rather than staff in long-term care facilities.
Long wait times for specialists also mean that family physicians can continue to attend to patient issues until a specialist is available.
“The complexity of medicine is so much higher than it was in previous years and that just means those 10 or 15 minute appointments that used to work don’t really work in family medicine anymore.”
No more labor planning needed
Lavergne said the study highlights the need for workforce planning. If early or late career physicians tend to see fewer patients, more support could be offered during these times, such as using more streamlined referral systems or sharing administrative work with others.
Offering more team-based care to patients who can see other service providers can also help free up doctors to see more patients, Lavergne said.
Lavergne said it’s important for governments to think carefully about the strategies they use to help ease the strain on the system.
“A lot of times during, you know, times of crisis like this, we try to open walk-in clinics or urgent care centers, and I completely understand the motivation to do that and that people really need urgent care,” she said. .
“But if you pull people out of continuous longitudinal care and into those models of care where you don’t see the same patient over time, that can add to duplication and reduce the efficiency of services.”
Hawker said programs that pair new physicians with physicians about to retire can also help early-career physicians get used to the real world of practicing medicine and become more efficient, more rapidly.
This type of program can also provide seamless continuity of patient care so that a new doctor doesn’t have to start from scratch with a patient, she said.
“Evil alcohol lover. Twitter junkie. Future teen idol. Reader. Food aficionado. Introvert. Coffee evangelist. Typical bacon enthusiast.”