MANITOBA CENTRE FOR HEALTH POLICY

1. MANITOBA CENTRE FOR HEALTH POLICY What’s Up Docs?Population-Based Supply and Use of Family Physicians in Winnipeg, Canada (1991/92-2000/01) PRINCIPAL AUTHOR Diane Watson CONTRIBUTORS: Bogdan Bogdanovic, Petra Heppner, Alan Katz Rob Reid, Noralou Roos

2. Winnipeg, Manitoba, Canada Roughly 650,000 people & 600 FP in 1991/92 and 2000/01 Universal access, single payer & first dollar coverage of FP services The Context

3. FP: Population Ratio for Winnipeg 97 per 100,000 in 1991/92 Manitoba’s Minister of Health cut medical school enrolment Winnipeg Free Press July 31, 1992 Ipsos Reid for Canadian Medical Association: 50% of physicians in Canada said enrolment in medical schools should be cut Winnipeg Free Press June 22, 1993 Surplus? Let’s Go Back in Time …

4. Supply Burned-out physicians put pressure on Manitoba Health: Cure sought for family MDs … February 2002 MD shortage kills clinic: Unable to recruit new doctors, city’s oldest walk-in to close its doors … July 2001 Demand/Use Need a family MD? Check out hotline: Province lists doctors able to take new patients … January 2002 Calls inundate find-a-doctor telephone line: Province adds three operators, extends hours to handle demand … January 2002 Shortage? Winnipeg Free Press .. 2000/01

5. Evaluate temporal changes in supply, availability and use and identify factors that may have contributed to change Population-based data repository at Manitoba Centre for Health Policy Anonymized Primarily FFS; some shadow billing 95 % FFS in 91/92; 93% FFS in 00/01 2 Geographic populations: Winnipeggers & FPs Purpose/ Methods

6. Supply of Winnipeg FPs# FPs per 100,000

7. % of Winnipeggers Who Visit a FP At Least Once per Annum, by Age 9% increase ~ adults 65+ years 11% decline ~ children 5 years or less

8. FP Visits/WinnipeggerAge Cohorts 13% increase ~ adults 65+; corresponding decline in specialists use 25% decline ~ children; stable use specialists

9. FP Visits/WinnipeggerVulnerable Populations

10. Gender structure … stable Method of remuneration … stable Scope of Practice … stable Turnover rate … stable Age structure … change Age:Workloads … change FP Workforce Characteristics

11. Workforce Age Structure Influence of the Baby Boomers! Average age: 42.6 -46.4 years

12. Workloads for the Average FP Workloads heavy, but unchanged volume - on average No temporal measures of time per visit!

13. Visits per FP per Year 39% 22% 11% 10% Proportion of Workforce FP Age

14. Visits per FP per Year -5% +30% -20% -20% Proportion of Workforce ‘91 39% 22% 11% 10% 25% 39% 20% 10% Proportion of Workforce ‘01 FP Age

15. It’s not like FPs are providing less visits over time; they are just not reproducing historic age/productivity relationships Proportion of Workforce ‘91 39% 22% 11% 10% 25% 39% 20% 10% Proportion of Workforce ‘01 FP Age

16. Significant trends in FP age:workload may be significantly altering current (future?) landscape Future Research Agenda What’s Up Docs? Is the story true in other jurisdictions? Forthcoming issue of Can Med Assoc J www.umanitoba.ca/academic/centres/mchp/reports/reports_03/famphys.htm Key Messages

17. Scope of Practice# of FT Ambulatory Care FP

18. # Different FPs/Winnipegger