Evolution of self-employed physician production: Cohort, career-course, and feminization effects

This article examines cohort, career-course, and feminization effects on general practitioners' (GPs) medical production. Using quasi-exhaustive French medico-administrative data collected every three years between 2005 and 2021, we estimate gender-specific intra- and intercohort trends in a standardized index of medical visits, while accounting for various contextual changes, such as patient aging and declining medical density. Our findings reveal that successive birth cohorts of GPs have exhibited increasingly higher levels of medical production, particularly among females, thereby narrowing the gender gap, although it persists even among the most recent cohorts. While feminization remains one of the key demographic shifts affecting current medical production, we show that the gender gap has significantly declined, albeit at an irregular pace, across cohorts of GPs who started their careers between the 1970s and the 2020s. Furthermore, as expected, intracohort trends in GP medical production follow an inverted U-shaped curve, although the production decline at the end of the career is less pronounced among female GPs. Overall, our results challenge common beliefs about younger generations of physicians and suggest that the current shortage of medical services is not related to a decline in the individual production among recently established young GPs, but remains essentially an issue of anticipating workforce needs.