MANITOBA CENTRE FOR HEALTH POLICY
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MANITOBA CENTRE FOR HEALTH POLICY. What’s Up Docs? Population-Based Supply and Use of Family Physicians in Winnipeg, Canada ( 1991/92-2000/01). PRINCIPAL AUTHOR Diane Watson CONTRIBUTORS: Bogdan Bogdanovic, Petra Heppner, Alan Katz Rob Reid, Noralou Roos. Winnipeg, Manitoba, Canada

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Manitoba centre for health policy

MANITOBA CENTRE FOR HEALTH POLICY

What’s Up Docs?Population-Based Supply and Use of Family Physicians in Winnipeg, Canada (1991/92-2000/01)

PRINCIPAL AUTHOR

Diane Watson

CONTRIBUTORS:

Bogdan Bogdanovic, Petra Heppner, Alan Katz

Rob Reid, Noralou Roos


The context

Winnipeg, Manitoba, Canada

Roughly 650,000 people & 600 FP in 1991/92 and 2000/01

Universal access, single payer & first dollar coverage of FP services

The Context


Let s go back in time

FP: Population Ratio for Winnipeg

97 per 100,000 in 1991/92

Manitoba’s Minister of Health cut medical school enrolment Winnipeg Free Press July 31, 1992

Ipsos Reid for Canadian Medical Association: 50% of physicians in Canada said enrolment in medical schools should be cut Winnipeg Free Press June 22, 1993

Surplus?

Let’s Go Back in Time …


Winnipeg free press 2000 01

Supply

Burned-out physicians put pressure on Manitoba Health: Cure sought for family MDs … February 2002

MD shortage kills clinic: Unable to recruit new doctors, city’s oldest walk-in to close its doors … July 2001

Demand/Use

Need a family MD? Check out hotline: Province lists doctors able to take new patients … January 2002

Calls inundate find-a-doctor telephone line: Province adds three operators, extends hours to handle demand … January 2002

Shortage?

Winnipeg Free Press .. 2000/01


Purpose methods

Evaluate temporal changes in supply, availability and use and identify factors that may have contributed to change

Population-based data repository at Manitoba Centre for Health Policy

Anonymized

Primarily FFS; some shadow billing

95 % FFS in 91/92; 93% FFS in 00/01

2 Geographic populations: Winnipeggers & FPs

Purpose/ Methods


Supply of winnipeg fps fps per 100 000

Supply of Winnipeg FPs# FPs per 100,000


Of winnipeggers who visit a fp at least once per annum by age

% of Winnipeggers Who Visit a FP At Least Once per Annum, by Age

9% increase ~ adults 65+ years

11% decline ~ children 5 years or less


Fp visits winnipegger age cohorts

FP Visits/WinnipeggerAge Cohorts

13% increase ~ adults 65+; corresponding decline in specialists use

25% decline ~ children; stable use specialists


Fp visits winnipegger vulnerable populations

FP Visits/WinnipeggerVulnerable Populations


Fp workforce characteristics

Gender structure…stable

Method of remuneration … stable

Scope of Practice…stable

Turnover rate … stable

Age structure …change

Age:Workloads …change

FP Workforce Characteristics


Workforce age structure

Workforce Age Structure

Influence of the Baby Boomers!

Average age: 42.6 -46.4 years


Workloads for the average fp

Workloads for the Average FP

Workloads heavy, but unchanged volume - on average

No temporal measures of time per visit!


Visits per fp per year

Visits per FP per Year

39%

22%

11%

10%

Proportion of Workforce

FP Age


Visits per fp per year1

Visits per FP per Year

-5%

+30%

-20%

-20%

Proportion of Workforce ‘91

39%

22%

11%

10%

25%

39%

20%

10%

Proportion of Workforce ‘01

FP Age


Manitoba centre for health policy

It’s not like FPs are providing less visits over time; they are just not reproducing historic age/productivity relationships

Proportion of Workforce ‘91

39%

22%

11%

10%

25%

39%

20%

10%

Proportion of Workforce ‘01

FP Age


Key messages

Significant trends in FP age:workload may be significantly altering current (future?) landscape

Future Research Agenda

What’s Up Docs?

Is the story true in other jurisdictions?

Forthcoming issue of Can Med Assoc J

www.umanitoba.ca/academic/centres/mchp/reports/reports_03/famphys.htm

Key Messages


Scope of practice of ft ambulatory care fp

Scope of Practice# of FT Ambulatory Care FP


Different fps winnipegger

# Different FPs/Winnipegger


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