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Health Econ. 2018 Nov;27(11):1859-1867. doi: 10.1002/hec.3786. Epub 2018 Jun 19.

The impact of the 2008/2009 financial crisis on specialist physician activity in Canada.

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Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.


Fee-for-service physicians are responsible for planning for their retirements, and there is no mandated retirement age. Changes in financial markets may influence how long they remain in practice and how much they choose to work. The 2008 crisis provides a natural experiment to analyze elasticity in physician service supply in response to dramatic financial market changes. We examined quarterly fee-for-service data for specialist physicians over the period from 1999/2000 to 2013/2014 in Canada. We used segmented regression to estimate changes in the number of physicians receiving payments, per-physician service counts, and per-physician payments following the 2008 financial crisis and explored whether patterns differed by physician age. The number of specialist physicians increased more rapidly in the period since 2008 than in earlier years, but increases were largest within the youngest age group, and we observed no evidence of delayed retirement among older physicians. Where changes in service volume and payments were observed, they occurred across all ages and not immediately following the 2008 financial crisis. We conclude that any response to the financial crisis was small compared with demographic shifts in the physician population and changes in payments per service over the same time period.


financial markets; health human resources; physician practice patterns; physician supply; reimbursement mechanisms


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