Keeping doors open: A cross-sectional survey of family physician practice patterns during COVID-19, needs, and intentions

  1. Tara Kiran
  2. Rick Wang
  3. Curtis Handford
  4. Nadine Laraya
  5. Azza Eissa
  6. Pauline Pariser
  7. Rebecca Brown
  8. Cheryl Pedersen

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Abstract

Objective

To determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors.

Methods

Between March and June 2021, we conducted a cross-sectional survey using email, fax, and phone of 1,186 family doctors practicing comprehensive family medicine in Toronto, Ontario. We asked about practice patterns in January 2021, use of virtual care, and practice intentions.

Results

Of the 1,016 (86%) that responded to the survey, 99.7% (1001/1004) indicated their practice was open in January 2021 with 94.8% (928/979) seeing patients in-person and 30.8% (264/856) providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on phone visits and an additional 5.8% on video and 7.5% on email. 17.2% (77/447) were planning to close their current practice in the next five years. There was a higher proportion of physicians who worked alone in a clinic among those who did not see patients in-person (27.6% no vs 12.4% yes, p<0.05), did not see symptomatic patients (15.6% no vs 6.5 % yes, p<0.001), and those who planned to close their practice in the next 5 years (28.9% yes vs 13.9% no, p<0.01).

Interpretation

The vast majority of family physicians in Toronto were open to in-person care in January 2021 but almost one-fifth are considering closing their practice in the next five years. Policy-makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention.

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  1. ScreenIT

    SciScore for 10.1101/2021.12.20.21267918: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The project was reviewed by institutional authorities at Unity Health Toronto and deemed to neither require Research Ethics Board approval nor written informed consent from participants.
    Consent: The project was reviewed by institutional authorities at Unity Health Toronto and deemed to neither require Research Ethics Board approval nor written informed consent from participants.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has strengths and limitations. We conducted a systematic survey of all family physicians practicing in 6 geographic areas in Toronto and achieved an 86% response rate on our core questions of whether or not a practice was open and seeing patients in-person. However, our sample is open to non-response bias; it is possible that those who did not respond were more likely to be closed or not seeing patients in-person. As well, family physicians self-reported on whether they were open or closed and may have been reluctant to disclose their practice closure. Physician self-report may also have been different from patient perceptions of whether a practice was open; the latter may be influenced by longer wait times during the pandemic, but our study was not designed to assess this. Despite our extensive outreach and high response rate, we had fewer respondents working in enhanced or straight fee-for-service models relative to population distribution. Neighbourhoods in Toronto were differently affected by COVID-1939 and our survey did not explore the impact of neighbourhood context on family physician decisions. Results may also not be generalizable to other contexts. Finally, we asked respondents to reflect on practice patterns 2-5 months prior to the time of the survey which may have influenced accuracy of recall. It is also worth noting that there is no Canadian data we are aware of on how specialist physician practices responded to the pandemic. Conclusion: Our survey fo...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.12.20.21267918v1 on medRxiv