The growth of health-care spending dedicated to doctors has outpaced that on hospitals and drugs in Canada for the past four years, according to a new report. In 2010, physician spending is expected to rise to more than $26-billion, an increase of seven per cent from last year.JIM BOURG
Family physicians who live in rural areas or small towns are more likely to be accepting new patients than their counterparts in urban areas, according to a new report.
It also says that family doctors trained in Canada are less likely to be open to new patients in rural areas than those trained abroad.
The report, released Thursday by the Canadian Institute for Health Information (CIHI), attempts to fill a knowledge gap by building a collection of characteristics shared by doctors who have their practices open to new patients.
The findings are significant because they help inform the debate over the need for more doctors. Family doctors are a critical part of the health-care system because they are often the primary point of access for patients and help prevent patients from going to the emergency room or walk-in clinics for minor problems.
But the report is also stirring a debate among rural and urban doctors who are disputing the validity of its conclusions.
One of the most divisive findings is that 35 per cent of rural family doctors report taking new patients compared with 18 per cent of those in urban areas. In addition, 62 per cent of international medical graduates in rural areas said they were accepting new patients compared with 27 per cent of rural doctors who were trained in Canada.
But the College of Family Physicians of Canada says the report fails to answer many key questions, making it difficult to say that more rural doctors are accepting patients than those in urban settings.
"There are other questions that have to be asked before you can jump to that conclusion," said Calvin Gutkin, the group's executive director and chief executive officer.
The findings are based on results from the 2004 and 2007 National Physician Survey, which measured, among other things, the age, location, area of graduation, gender and type of practice of family physicians.
But Dr. Gutkin said several important issues weren't addressed in the survey, which makes it difficult to draw conclusions about doctors taking new patients. For instance, the survey didn't take into account the number of years a doctor has been in practice, the capacity of a doctor's practice and how many patients he or she already serves. It also doesn't take into account that foreign-trained doctors may be more likely to take new patients because their practices are new and don't have an existing roster of patients.
Dr. Gutkin argues that urban doctors may be just as likely to take new patients as those in rural settings, but are so overrun with requests once they open up shop that they are forced to stop taking them.
But the Society of Rural Physicians of Canada says doctors outside urban areas are equally swamped with new patients when they open a new practice. But rural doctors may be more willing to keep taking on new patients, even if it means working longer hours or going beyond their capacity, because patients in smaller areas have nowhere else to turn, said Peter Hutten-Czapski, past-president of the society and a physician in Haileybury, a community in northern Ontario.
"I think just the reality is in the rural setting it's that much more difficult to turn away patients," Dr. Hutten-Czapski said.
Rural areas also lack the anonymity of big cities, which means doctors have a personal relationship with the community that makes it hard to turn any patients away, he said.
"It's very difficult for us to do that," he said. "I'm not surprised we're much more likely to accept new patients."
The bottom line, according to both Dr. Gutkin and Dr. Hutten-Czapski, is that Canada needs more doctors, nurses and other health-care professionals who can work more efficiently to meet growing demands on the system.
The report also found that younger and older physicians are more likely to accept new patients than those between 45 and 54. Male doctors are also more likely to be taking on new patients, the report found. It also showed that rural doctors working in a group practice were much more likely to take on new patients than those in solo practices - 38 per cent compared with 25 per cent. There was little difference between the number of urban doctors in group or solo practices who are accepting new patients.
Urban doctors who report higher satisfaction with their professional life are more likely to accept new patients than those less satisfied, but that trend didn't extend to the rural environment.
Although they don't answer every question on the subject, the results of the report can inform health policy discussions and also may be used to help evaluate the true extent of Canada's "perceived" shortage of doctors, said Yvonne Rosehart, program lead of health human resources at CIHI.
Ms. Rosehart said the shortage is perceived because there is no established standard dictating how many doctors should be available and how many patients they should serve. It's a subjective issue that can - and often is - interpreted differently by politicians, medical associations and health policy researchers.
A Statistics Canada report released in June reported that 85 per cent of Canadians have a family doctor, and that more than half of those who don't hadn't looked for one.
Ms. Rosehart said policy makers should find ways to get patients to those doctors who are taking new patients and find more effective ways to use existing resources, rather than focus on defining the extent of the shortage.