More family doctors choose focused practice over comprehensive care

Background and goal: This study examined long‑term shifts toward focused practice among family physicians in Ontario, Canada, as well as changes in the number of comprehensive family physicians relative to population growth.

Study approach: Researchers linked multiple Ontario health‑administrative data sets to track practice patterns for every general practitioner or family physician from fiscal years 1993/94 through 2021/22. Analyses were stratified by physician sex and years in practice. 

Main results:

• The proportion of family physicians working in focused roles rose to 19.2% in 2021/22, up from 7.7% in 1993/94.

• Emergency medicine accounted for 37% of focused doctors in 2021/22, followed by hospitalist care at 26.5% and addiction medicine at 8.3%.

• Although the overall supply of family physicians climbed from 104 to 118 per 100,000 residents during the study period, the supply offering comprehensive care fell from 71 to 64 per 100,000. 

• Of the additional 6,310 family physicians who entered the workforce during the study period, 39.5% were in focused practice.

• In 2021/22, 60% of focused practice physicians were male and 40% were female. The focused practice group had fewer average days worked at 156 days compared with 196 days for the comprehensive practice group.

Why it matters: Amid efforts to address current and impending challenges in access to primary care, findings from this study underscore the limitations of using family physician head counts in workforce planning. Knowing how many family physicians move into focused roles and how the proportion providing comprehensive care has declined can guide policy and practice changes, including better payments aligned with system goals, practice support, job flexibility, team-based care and cross-sectoral workforce planning to make comprehensive family practice the most attractive option to family physicians.