1.0     Profile of Family Physicians
2.0     Practice Profile of Family Physicians
3.0     Obstetrical Care
4.0     Physician Workload, Remuneration and Activities
5.0     Family Physician On-call Responsibilities
6.0     The Practice Environment
7.0     Perceived Access to Medical Care
8.0     Atlantic Canada Family Physicians Looking to the Future
9.0     Demographic Profile of Family Physicians

1.0 A Profile of Family Physicians in Atlantic Canada

1.1 Introduction
An important first step in physician workforce planning is to establish a broad profile of family physicians (FPs) in each region of Canada. This includes the types of practice that FPs are involved in, the settings in which they deliver patient care, and the range of medical services they provide. The following sections will examine the data on a regional basis.

1.2 Who Are Atlantic Canada’s Family Physicians?
The first question of the survey was focussed on finding out how the respondents would describe themselves as family physicians. The results for Atlantic Canada are presented in Table 1.

Table 1 – Atlantic Canada
Self-identified Types of Family Physicians in Atlantic Canada

Based on N=2,242^4
1Atlantic Canada = all FP’s/GP’s in New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland
²Since more than one category could be chosen, the percentages do not add up to 100%.
³ This percentage is based on those respondents who checked off this category only. Some respondents checked off this category and another on the list. If those who checked off this and another category are included, the percentage increases to 81.3%.
⁴ Since disproportionate sampling was used, all results are weighted to ensure equal representation. All results are based on the total population of active family physicians in Atlantic Canada (New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland) (N=2,242). Details about the methodology are available on the CFPC website.

1.3 Types of Family Medicine Practice in Atlantic Canada
The respondents were asked to describe their family medicine practice. The results are summarized in Table 2.

What has become immediately evident from this table is that the majority of FPs were not in solo practice. Only 37.5% were in solo practice, but some of those in solo practice also checked off other categories, suggesting that they were working in more than one type of practice. Further analysis shows that male FPs (42.3%) were more likely than female FPs (26.5%) to be in solo practice.

About 42.6% of Atlantic Canada FPs indicated that they were in group practice. On average, family physician group practices had 4.8 FPs. Those group practices which included both FPs and other physician specialists had a mean of 13.7 FPs. Multidisciplinary practices, which included independent practitioners in other disciplines, had a mean of 5.4 FPs.

Table 2 – Atlantic Canada
Proportions of Family Physicians in Various Types
of Medical Practices in Atlantic Canada

Based on N=2,242
¹ The combined percentage may exceed 100% as some respondents checked off more than one category.

1.4 Family Practice Settings in Atlantic Canada
Another important piece of information in establishing a profile of FPs in Atlantic Canada is their practice settings. The information is presented in Table 3.

The medical practice of some FPs in Atlantic Canada took place in more than one practice setting. While less than half of all family physicians (43.4%) restricted their practice to only one type of practice setting, 18.8% were involved in two settings and 37.8% were involved in more than two settings.

Table 3 – Atlantic Canada
Proportions of Family Physicians in Various Practice Settings
in Atlantic Canada

Based on N=2,242
¹ The combined percentage may exceed 100% as some respondents checked off more than one category.

 

Although 78.6% of FPs were involved in private-office practice, only 42.4% of them had this as their only practice setting.

2.0 Practice Profile of Family Physiciansin Atlantic Canada

2.1 Introduction
The next step was the examination of the kinds of medical services FPs provided as part of their practice, in order to gain some insight into the scope of family practice in Atlantic Canada.

2.2 Scope of Family Medicine Practice in Atlantic Canada
A list of selected medical services was included in the questionnaire and the respondents were asked to indicate which services were part of their practice. FPs were also asked to indicate the percentage of practice time they spent on each medical service. This information will be analyzed and presented at a later date. The list of selected services provided in Atlantic Canada is present in Table 4.

These results suggest that the practice of most FPs in Atlantic Canada is very diverse and multidimensional in nature. The four most frequently selected categories all involved the care of patients in specific age groups. Overall, from the total list of 22 selected services included in this question, FPs in Atlantic Canada indicated that, on average, they provided services in 12.8 categories.

Table 4 – Atlantic Canada
Medical Services Provided by Family Physicians in Atlantic Canada

Based on N=2,242

2.3 Selected Medical Procedures being Performed by Family Physicians
in Atlantic Canada
FPs were asked to indicate which medical procedures they performed as part of their practice from a list of 14 selected procedures. In addition, they were free to add other procedures under the "Other" category. From the results displayed in Table 5, it is clear that there are considerable variations in the proportions of physicians performing various procedures, from a high of 89.2% for pap smears to a low of 2.4% for refraction.

Table 5 – Atlantic Canada
Proportions of Family Physicians in Atlantic Canada Performing
Selected Medical Procedures as Part of Their Medical Practice

Based on N=2,242
¹ The combined percentage may exceed 100% as some respondents checked off more than one category.

3.0 Obstetrical Care in Atlantic Canada

Several questions in the 1997 National Family Physician Survey were devoted to obstetrical care. The results are summarized in Tables 6 and 7. Given the complexity of the questions and the great variety of response patterns, the data need further and more detailed analysis. The following sections provide the results of the initial analysis based on the total population of FPs in Atlantic Canada.

3.1 Types of Obstetrical Care Being Provided in Atlantic Canada

Table 6 – Atlantic Canada
Proportions of Family Physicians Providing Various Types
of Obstetrical Care in Atlantic Canada

Based on N=2,242
¹ The combined percentage may exceed 100% as some respondents checked off more than one answer.

 

The results of each row are expressed in terms of the total FP population in Atlantic Canada. Of all FPs in Atlantic Canada, 64.9% indicated that obstetrical care was part of their practice, and 3.7% even provided high-risk obstetrical care.

For those respondents who provided more than prenatal care, they were asked to indicate the types of obstetrical care they provided. A smaller proportion provided intrapartum care than either newborn or postpartum care.

3.2 Intrapartum Care in Atlantic Canada
Initial analysis indicated that 25.0% of FP/GPs in Atlantic Canada provided intrapartum care, and that they delivered on average 38.5 babies per year. A preliminary analysis of intrapartum care providers by sex revealed significant differences, in that male FPs delivered on average 34.5 babies per year, while female FPs delivered 44.7 babies per year.

Table 7 – Atlantic Canada
Family Physicians Providing Intrapartum Obstetrical Care in Atlantic Canada

Based on N=2,242
Note: for 1.9% (n=42), their sex is unknown
¹ Not all family physicians who said that they provide intrapartum care indicated their average number of deliveries per year

We will continue to explore this data further, looking at populations served, their training, future plans, and practice patterns of physicians who do or do not include obstetrical care in their practice.

4.0 Physician Workload, Remuneration and Activities in Atlantic Canada

4.1 Introduction
A number of questions in the CFPC National Family Physician Survey dealt with issues concerning physician workload and remuneration. The initial analyses are presented below.

4.2 Physician Workload in Atlantic Canada
An important aspect to any physician workforce study is the ability to quantify the types of activities physicians engage in and the number of hours spent in each activity. The CFPC National Family Physician Survey asked FPs to indicate the number of hours they worked in an average week, excluding on-call activities.

FPs in Atlantic Canada reported that they worked 55.7 hours per week on the average. A preliminary analysis of the data indicates that further analysis by sex of respondent indicates that male FPs worked on average 58.2 hours per week, while female FPs worked 49.6 hours per week. Office-based patient care occupied the bulk of the workweek for most FPs. Besides direct patient care, CME was the activity engaged in by the majority of family physicians. More detailed analyses will be conducted at a later date.

4.3 Physician Remuneration in Atlantic Canada
Considerable discussion on health care reform focuses on how physicians should be remunerated. Various alternatives to fee-for-service have been proposed. This survey examined how FPs were remunerated. The results are shown in Table 8.

Table 8 – Atlantic Canada
Family Physician Professional Income from
Various Types of Remuneration¹ in Atlantic Canada

Based on N=2,242
¹ Remuneration for clinical services other than on-call services.
² The combined percentage may exceed 100% as some respondents checked off more than one answer.
³Cell size is 5 or less; # not provided to protect confidentiality.

 

Fee-for-service payment was still by far the dominant mode of payment for FPs in Atlantic Canada, with 86.1% of physicians receiving this form of payment, which made up 84.9% of their income on average. However, for those family physicians who were reimbursed in a form other than fee-for-service, a sizeable proportion of their income was from alternative payment mechanisms. For example, of the approximately 22.1% of FPs who were remunerated by salary, about 47.2% of their total income was derived from this source.

5.0 Family Physicians On-call Responsibilities in Atlantic Canada

5.1 Introduction
No study of the physician workforce or medical practice is complete without an examination of on-call activities. However, no other aspect of a physician’s medical practice is more difficult to capture by means of a survey than on-call activities. The CFPC National Family Physician Survey included a series of questions designed to study the on-call responsibilities of FPs in each region of Canada and to quantify the time spent on such activities. What has become evident from the results is that the FPs who provided on-call coverage were doing so in a wide range of settings and arrangements. The results presented below are only an initial examination of the data. More detailed analyses will be conducted to truly understand the scope and nature of on-call activities.

5.2 Overview of On-Call Activities in Atlantic Canada
The respondents were asked if they provided on-call coverage. As shown in Table 9, 89.0% of FPs participated in some form of on-call activity.

Table 9 – Atlantic Canada
Proportion of Family Physicians in Atlantic Canada
Participating in On-Call Activities

Based on N=2,242

 For the purpose of this summary report, it suffices to note that general on-call for shared patients was the most common on-call arrangement in Atlantic Canada. The respondents indicated that they spent, on average, 24.6 hours per week in general on-call arrangements. If these hours are added to the approximately 58.2 hours worked per week, it would mean that fps in Atlantic Canada worked, on average, 82.8 hours per week.

6.0 The Practice Environment in Atlantic Canada

6.1 Introduction
Another important purpose of the CFPC National Family Physician Survey was the collection of baseline data on the types of communities in which FPs practised and their patient populations.

6.2 Geographic Characteristics of Patient Population in Atlantic Canada
Physician maldistribution is one of the most vexing issues facing health care planners and rural residents. The first step in addressing the issue of maldistribution is the collection of information on practice locations and the characteristics of their patient populations. To this end, the survey respondents were asked to indicate the postal codes of their practice locations. Using these postal codes, it was possible to convert them into longitude and latitude coordinates using the 1996 Statistics Canada postal code conversion file.¹ The geographic distribution of the survey respondents is depicted in Figure 1. Survey respondents were also asked to check off the patient populations they served. The results in relation to the geographic characteristics of patient populations in Atlantic Canada are presented in Table 10.

1Some respondents could not be included on the map as they did not provide a complete postal code.

Table 10 – Atlantic Canada
Proportions of Family Physicians in Atlantic Canada
Serving Patient Populations with Various Geographic Characteristics

1 It is important to note that the combined percentage does not equal 100%, as some respondents checked off more than one answer.

7.0 Perceived Access to Medical Care in Atlantic Canada

7.1 Introduction
Although universal access is one of the main guiding principles of Canada’s health care system, some Canadians do not have ready access to needed medical care. This is a major concern to many health planners and health care consumers. This survey attempted to explore this issue by asking FPs about perceived problems of access to medical care in their communities.

7.2 Accessibility to Medical Care in Atlantic Canada
The respondents were asked if they felt there was an accessibility problem to medical care in their Atlantic Canada communities. The results presented in Table 11 indicate that almost three quarters (73.5%) of the respondents in Atlantic Canada felt that there was an accessibility problem in the community they serve.

Table 11 – Atlantic Canada
Perceived Problems of Access to Medical Care in Atlantic Canada

Based on N=2,242

 

Those respondents who answered "yes" to accessibility problems were asked to indicate whether the problem was related to insufficient numbers of family physicians or insufficient numbers of consultant specialists. The results are shown in Table 12. Of those who felt that there was an access problem, 71.8% indicated that the problems were related to shortages of family physicians in their communities, while 68% felt that the problem was related to a lack of consultant specialists.

Table 12 – Atlantic Canada
Types of Perceived Problems of Access to Medical Care in Atlantic Canada

Based on N=1,649
¹ The combined percentage may exceed 100% as some respondents checked off more than one answer.

The respondents were then asked to provide more information on the perceived causes for these problems. Table 13 provides a general summary of the perceived reasons for accessibility problems in the communities served by the respondents. This data will be further analyzed and available at a later date.

Table 13 – Atlantic Canada
Reasons for Perceived Problems of Access
to Family Physicians in Atlantic Canada

Based on N=976^1
1 N represents the total number of valid open-ended responses for this question

8.0 Atlantic Canada Family Physicians Looking to the Future

8.1 Introduction
While information about current access is important, it is also vital to begin looking into the future in order to identify potential problem areas or issues, around which proactive workforce and educational strategies can be built. To this end, the CFPC National Family Physician Survey asked the respondents what changes, if any, they intended to make to their medical practice over the next two years. Although information based upon intention must be interpreted with caution, as intention may not become reality, it can serve as a marker to identify potential problems that may need to be addressed. The results from questions about current accessibility problems and family physician future plans provide some preliminary indications of potential health care crises that may be imminent.

8.2 Atlantic Canada Family Physicians Contemplating Changes in the Next Two Years
The CFPC National Family Physician Survey asked FPs in Atlantic Canada what changes they were planning to make in their practice in two main areas: changes in practice location and changes to their practice. The results are presented in Table 14.

The great majority of FPs in Atlantic Canada planned no changes to their practice in the next two years. However, approximately 30% of FPs in Atlantic Canada were planning some significant changes to their practice within the next two years.

Approximately 15.6% of family physicians in Atlantic Canada were thinking about relocating their practices. Among these physicians, 5.2% planned on leaving Canada. If this is combined with the 5.3% of family physicians who planned to retire in the next two years, in addition to those who planned on leaving medical practice for other reasons (3.0%), it would represent a sizeable attrition in the family physician workforce.

The reasons for making these significant changes will be further analyzed, and the results will be available at a later date.

Table 14 – Atlantic Canada
Proportions of Family Physicians in Atlantic Canada
Contemplating Changes to Their Practice in the Next Two Years

Based on N=2,242
¹ The combined percentage may exceed 100% as some respondents checked off more than one category.
²This percentage is based on those respondents who checked off this category only. Some respondents checked off this category and another on the list. If those who checked off another category are included, the percentage increases to 83.1%.

9.0 Demographic Profile of Family Physicians in Atlantic Canada

Table 15 summarizes the overall demographic profile of family physicians in Atlantic Canada.

Table 15 – Atlantic Canada
General Demographics of Family Physicians in Atlantic Canada

Based on N=2,242

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