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Family physician practice patterns during COVID-19 and future intentions: Cross-sectional survey in Ontario, Canada
Tara Kiran1, Ri Wang2, Curtis Handford3
1Vice-Chair of Quality and Innovation in the Department of Family and Community Medicine (DFCM) at the University of Toronto in Ontario, Associate Professor in the Faculty of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto, Scientist in the MAP Centre for Urban Health Solutions at St Michael's Hospital in Toronto and a staff physician in the DFCM at St Michael's Hospital. tara.kiran@utoronto.ca.
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.
Design:
Cross-sectional survey.
Setting:
Six geographic areas in Toronto, Ont, aligned with Ontario Health Team regions.
Participants:
Family doctors practising office-based, comprehensive family medicine.
Main Outcome Measures:
Practice operations in January 2021, use of virtual care, and future plans.
Results:
Of the 1016 (85.7%) individuals who responded to the survey, 99.7% (1001 of 1004) indicated their practices were open in January 2021, with 94.8% (928 of 979) seeing patients in person and 30.8% (264 of 856) providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on telephone visits, 5.8% on video appointments, and 7.5% on e-mail or secure messaging. Among respondents, 17.5% (77 of 439) were planning to close their existing practices in the next 5 years. There were higher proportions of physicians who worked alone in clinics among those who did not see patients in person (27.6% no vs 12.4% yes, P<.05), among those who did not see symptomatic patients (15.6% no vs 6.5% yes, P<.001), and among those who planned to close their practices in the next 5 years (28.9% yes vs 13.9% no, P<.01).
Conclusion:
Most family physicians in Toronto were open to in-person care in January 2021, but almost one-fifth were considering closing their practices in the next 5 years. Policy makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention.
Insights
Most Toronto family physicians remained open for in-person visits during the pandemic. However, nearly 20% plan to close practices within five years, signaling a potential physician shortage.
Area of Science:
- Family Medicine
- Public Health
- Pandemic Response
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery, particularly for primary care physicians.
- Understanding practice continuity and future intentions of family physicians is crucial for healthcare system planning.
Purpose of the Study:
- To assess the extent of practice closures or reduced in-person visits by family physicians during the pandemic.
- To investigate future practice intentions and factors influencing these decisions.
- To inform policy regarding physician recruitment and retention.
Main Methods:
- A cross-sectional survey was conducted among office-based, comprehensive family physicians in six geographic areas of Toronto, Ontario.
- Data collected in January 2021 focused on practice operations, virtual care utilization, and future practice plans.
Main Results:
- Nearly all surveyed practices (99.7%) remained open in January 2021, with 94.8% offering in-person visits.
- Physicians spent a significant portion of clinical time on virtual care (58.2% telephone, 5.8% video, 7.5% e-mail).
- 17.5% of respondents planned to close their practices within five years, with solo practitioners and those not seeing symptomatic patients more likely to plan closures.
Conclusions:
- While most family physicians maintained in-person care during the pandemic, a substantial proportion are considering practice closures.
- These findings highlight an impending family physician shortage, necessitating proactive policy interventions.
- Further research is needed to identify factors supporting physician recruitment and retention in primary care.
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