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BMJ Open. 2019 Sep 24;9(9):e030477. doi: 10.1136/bmjopen-2019-030477.

Practice patterns among early-career primary care (ECPC) physicians and workforce planning implications: protocol for a mixed methods study.

Author information

1
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada ruth_lavergne@sfu.ca.
2
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
3
Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada.
4
University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
5
Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
6
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
7
School of Leadership Studies, Royal Roads University, Victoria, British Columbia, Canada.
8
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
9
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
10
Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
11
First Five Years group, College of Family Physicians of Canada, Toronto, Ontario, Canada.
12
Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada.
13
Department of Community Health and Epidemiology and WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada.
14
Department of Family Medicine, University of Western Ontario, London, Ontario, Canada.
15
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
16
Department of Family Practice, Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, British Columbia, Canada.
17
School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
18
School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

INTRODUCTION:

Canadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but little evidence to support or refute this. The goal of this study is to inform primary care planning by: (1) identifying values and preferences shaping the practice intentions and choices of family medicine residents and early career PCPs, (2) comparing practice patterns of early-career and established PCPs to determine if changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs) or period effects (changes over time across all PCPs) and (3) integrating findings to understand the dynamics among practice intentions, practice choices and practice patterns and to identify policy implications.

METHODS AND ANALYSIS:

We plan a mixed-methods study in the Canadian provinces of British Columbia, Ontario and Nova Scotia. We will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyse survey data collected by the College of Family Physicians of Canada. We will also analyse linked administrative health data within each province. Mixed methods integration both within the study and as an end-of-study step will inform how practice intentions, choices and patterns are interrelated and inform policy recommendations.

ETHICS AND DISSEMINATION:

This study was approved by the Simon Fraser University Research Ethics Board with harmonised approval from partner institutions. This study will produce a framework to understand practice choices, new measures for comparing practice patterns across jurisdictions and information necessary for planners to ensure adequate provider supply and patient access to primary care.

KEYWORDS:

graduate medical education; health workforce; mixed methods, family medicine; primary health care

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