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
The Context
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
Let’s Go Back in Time …
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?
Winnipeg Free Press .. 2000/01
• 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?
Purpose/ Methods
• 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
Supply of Winnipeg FPs
# FPs per 100,000
110
No. of Practicing
FPs
100
90
FP FTEs
80
Ambulatory FP
FTEs
70
60
/0
1
20
00
/0
0
19
99
/9
9
19
98
/9
8
19
97
/9
7
19
96
/9
6
19
95
/9
5
19
94
/9
4
19
93
/9
3
92
19
19
91
/9
2
50
% of Winnipeggers Who Visit a FP
At Least Once per Annum, by Age
100%
90%
65+ years
45-64 years
20-44 years
6-19 years
0-5 years
Winnipeg
80%
70%
60%
50%
1991/92
1993/94
1995/96
1997/98
1999/00
9% increase ~ adults 65+ years
11% decline ~ children 5 years or less
FP Visits/Winnipegger
Age Cohorts
7.0
6.0
5.0
4.0
3.0
2.0
65+ years
45-64 years
20-44 years
6-19 years
0-5 years
Winnipeg
19
91
/9
2
19
92
/9
3
19
93
/9
4
19
94
/9
5
19
95
/9
6
19
96
/9
7
19
97
/9
8
19
98
/9
9
19
99
/0
0
20
00
/0
1
1.0
13% increase ~ adults 65+; corresponding decline in
specialists use
25% decline ~ children; stable use specialists
FP Visits/Winnipegger
Vulnerable Populations
9.0
Major Mental
Illness
Diabetes
8.0
7.0
6.0
Other Mental
Illness
Hypertension
5.0
4.0
3.0
2.0
Winnipeg
1.0
3
4
5
6
7
8
9
1
0
/9
/9
/9
/9
/9
/9
/9
/0
00
2
3
4
5
6
7
8
0
2
9
9
9
9
9
9
9
0
/
19
19
19
19
19
19
19
20
99
9
1
FP Workforce Characteristics
•
•
•
•
Gender structure …
Method of remuneration
Scope of Practice …
Turnover rate
…
• Age structure
• Age:Workloads
…
…
stable
… stable
stable
stable
change
change
Workforce Age Structure
700
600
28
65
21
67
25
63
29
58
19
64
500
70
66
72
78
82
400
138
169
185
15
62
81
186
300
248
228
215
218
227
196
100
85
81
88
0
1991/92
1993/94
85
83
20
61
22
66
24
68
90
96
109
214
233
234
179
162
153
26
20
17
199
211
200
19
57
60
1995/96
49
216
184
38
1997/98
1999/00
Influence of the Baby Boomers!
Average age: 42.6 -46.4 years
>70 years
60-69 years
50-59 years
40-49 years
30-39 years
<30 years
Workloads for the Average FP
1991/92 2000/01
Visits per FT day of work
27.9
27.8
Full time days per annum
153
157
Visits per annum
4,198
4,193
Different patients per annum
1,700
1,706
Workloads heavy, but unchanged volume - on average
No temporal measures of time per visit!
Visits per FP per Year
7000
6000
5000
4000
1991/92
3000
2000
39%
1000
22%
11%
40-49
50-59
Proportion of
Workforce
10%
0
<30
30-39
FP Age
60-69
>70
Visits per FP per Year
7000
-5%
6000
+30%
-20%
5000
-20%
4000
1991/92
2000/01
3000
2000
39% 22%
11%
25%
39% 20%
1000
Proportion of
Workforce ‘91
10%
10%
Proportion of
Workforce ‘01
0
<30
30-39
40-49
50-59
FP Age
60-69
>70
It’s not like FPs are providing less visits over
time; they are just not reproducing historic
age/productivity relationships
7000
6000
5000
4000
1991/92
2000/01
3000
2000
39% 22%
11%
25%
39% 20%
1000
Proportion of
Workforce ‘91
10%
10%
Proportion of
Workforce ‘01
0
<30
30-39
40-49
50-59
FP Age
60-69
>70
Key Messages
• 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/re
ports_03/famphys.htm
Scope of Practice
# of FT Ambulatory Care FP
357 361 389 379 390 351
347 329 336 337
53
53
48
48
37
38
41
38
45
49
19
91
/
19 92
92
/
19 93
93
/
19 94
94
/
19 95
95
/
19 96
96
/
19 97
97
/
19 98
98
/
19 99
99
/
20 00
00
/0
1
224 218 211 227 224 225 209 223 218 219
Part Time or
NonAmbulatory
Care
Focused
Scope
Full Scope
# Different FPs/Winnipegger
•
Service # visits 1991/92 ~ 2000/01 10 yr
3 yr
intensity per year
change change
Medium
2–5
1.86 ~
1.81
-3 %
0
High
6–9
2.70
~
2.56
-5 %
-1 %
Intense
10+
3.55
~
3.42
-4 %
-2 %
2.01
~
1.94
-4 %
-2 %
Total