Changes in Family Physicians Over Time in Alberta, Canada: A 16-Year Population-Based Cohort Study

Most studies evaluating access to primary care have focused on changes in family physicians (FPs), with less exploration of patient differences over time. We examined both physicians and patients, including changes over time in the age and medical complexity of people seeing FPs.

We conducted a population-based cohort study using administrative health data, including physician claims and hospital data, examining patients cared for by FPs providing comprehensive primary care from 2004 to 2020 in Alberta, Canada. We assessed changes in FPs and used validated algorithms to examine changes in comorbidity among adults cared for by those physicians.

There were notable changes in FPs over time including more physicians who were women (46.7% in 2020 vs 39% in 2004; P < .001) and trained in low/middle-income countries (17.2% vs 6.3%; P < .001). Patient age and number of comorbidities increased over time. The proportion aged 61-80 years increased from 16.1% in 2004 to 22.1% in 2020 (P < .001). Those with ≥5 comorbid conditions increased from 2.8% to 5.2% (P < .001). There were changes in physician practice over time including decreases in average days worked each year (167 in 2004, 156 in 2020; P = .007) and number of adult patients seen each day (23 vs 20; P < .001).

From 2004 to 2020, there were substantial changes in the characteristics and practices of FPs. In addition, there were notable trends in the characteristics of their patients, including an increasing proportion of older adults, often with more complex comorbidities.