March 26, 2024 — Family physicians are crucial providers of continuous care across a person’s lifespan and are typically the first point of contact for Canadians seeking health care services. This report presents a high-level look at the practice patterns of family physicians today and how they have changed over the last decade.
Information about the changing practice patterns of family physicians is essential for primary care workforce planning. Combining this with information about family physician demographics can help workforce planners understand whether population needs are being met. While this report focuses on clinical practice, it’s important to note that many family physicians work in non-clinical settings, such as academia, teaching, and health systems leadership.
Access to health care, including primary care from a family physician or nurse practitioner, remains a challenge for many Canadians. In 2021, 14.4% of Canadians (4.7 million people) reported that they did not have a regular health care provider.Reference1 At the same time, the average number of patients seen by a family physician per year has decreased, from 1,746 in 2013 to 1,353 in 2021, which is in line with other recent findings.Reference2 Furthermore, the 5-year growth rate in the number of family physicians has slowed, from 12.9% between 2012 and 2016 to 7.7% between 2017 and 2021, while the number of unfilled family medicine residency positions has increased.Reference3 Nevertheless, the supply of family physicians and corresponding rates of access vary across provinces and territories, and even between municipalities.
Family physicians in Canada are reporting increasing challenges in providing care due to increased workloads and administrative demands. In the 2022 Commonwealth Fund survey, Canadian family physicians reported workload and quality of care concerns due to ongoing system-level challenges.Reference4 Over the years, primary care has evolved beyond services provided exclusively by family physicians to encompass interdisciplinary collaboration between providers such as nurse practitioners, pharmacists, midwives and community health workers.Reference5 However, results from the 2022 Commonwealth Fund survey found that just over half of Canadian family physicians (52%) are working with other health professionals (e.g., nurses, case managers) to manage care for patients with chronic conditions, which is lower than the average of all countries surveyed (65%).Reference4
More family physicians are providing services outside of primary care
Over the last 10 years, a growing number of family physicians have been providing services outside of primary care. Traditionally, family physicians have provided care in family medicine (i.e., typical primary care services), but new trends in practice patterns reveal that many newer family physicians are less likely to engage in comprehensive and continuous family practice (see the example below for more details).Reference6 Between 2013 and 2019, the number of family physicians providing services outside of primary care grew slowly but was relatively stable (from 24.8% in 2013 to 25.7% in 2019, excluding Quebec, the Northwest Territories, and Nunavut). However, between 2019 and 2022, there was a notable increase in the number of family physicians practising outside of primary care (from 25.7% in 2019 to 28.3% in 2022).Footnote i
Nearly 30% of family physicians in Canada are now providing services outside of primary care
Nearly 30% (n = 9,506) of Canada’s family physicians practise predominantly outside of primary care. The practice patterns of these family physicians are varied; however, trends in services can be identified. In 2021, the most common focuses of family physiciansFootnote ii were emergency medicine (14.2% , n = 4,765), psychiatry (nearly 5%, n = 1,587), and general surgery (2.1%, n = 710).Footnote iii Since 2013, general surgery has grown in prevalence, alongside steady increases in psychiatry and emergency medicine. Additional trends are presented in the figure below.
Example: What does it mean to be a family physician providing services like a general surgeon?
While still identified as a family physician by their provincial or territorial college, a family physician with a profile of general surgery is someone who focuses on delivering services that are typically billed by general surgeons (e.g., minor surgical procedures) compared with the typical primary care activities of family medicine physicians (e.g., office visits and assessments). Activity/practice profiles were determined by the physicians’ billings to their provincial/territorial health insurance program.
There’s a variety of non–family medicine practice profiles
Multi-panel line graphs depicting the percentage of family physicians in Canada focusing on emergency medicine, psychiatry, cardiology and general surgery from 2013 to 2021. The percentage focused on emergency medicine has remained relatively stable, increasing from 11% in 2013 to 14.2% in 2021. The percentage focused on psychiatry has steadily increased, from 3% in 2013 to 4.7% in 2021. This change is statistically significant. The percentage focused on cardiology has remained relatively stable, declining in recent years from 2.5% in 2013 to 0.5% in 2021. The percentage focused on general surgery has remained low, increasing in recent years from 0.05% in 2012 to 2.1% in 2021.
Notes
*The change is statistically significant (p<0.01) using univariate linear regression modelling.
Physician specialty designations are assigned by the provinces and territories; CIHI’s National Physician Database groups the assigned specialties with their national equivalents. There are 2 methods of defining specialties: by latest certification and by payment plan specialty. CIHI uses the latter for this report.
Excludes Quebec, the Northwest Territories, and Nunavut.
Source
National Physician Database, Canadian Institute for Health Information.
Who are the family physicians providing services outside of primary care?
The demographics of the family physicians providing services outside of primary care have evolved in the last decade as new family physicians have joined the workforce. The overall family physician workforce is becoming younger and more female, and it remains concentrated in urban areas. Incoming family physicians may prefer more balanced work arrangements compared with previous generationsReference7 and are less likely to engage in comprehensive and continuous family practice.Reference6
Family physicians providing services outside of primary careFootnote iv are
- Predominately later in their career, but less so than in the past — in 2021, 71% had graduated from medical school more than 10 years ago, while in 2013, 78% had graduated from medical school more than 10 years ago
- Slightly more likely to be male, but less so than in the past — in 2021, 53% were male, while in 2013, 56% were male
- More likely to be located in an urban area, which has remained consistent over the last 9 years — in 2021, 83.6% were practising in urban areas, while in 2013, 82.2% were practising in urban areasFootnote v
The demographic characteristics of family physicians providing services outside of primary care are further illustrated below.
The cohort of family physicians providing services outside of primary care is becoming younger and more female, and remains concentrated in urban areas
Multi-panel bar graphs depicting changes in the demographics (years of experience, sex and location) of family physicians in Canada providing services outside of primary care from 2013 to 2021. The proportion of newer family physicians (10 years or less since graduation) increased from 22% in 2013 to 29% in 2021. This change is statistically significant. The proportion of females increased from 43% in 2021 to 47% in 2021. This change is statistically significant. The proportion in urban areas remained stable at 82% in 2013 and 84% in 2021.
Notes
*The change is statistically significant (p<0.01) using univariate linear regression modelling.
Data on years of experience and sex of family physicians excludes Quebec, the Northwest Territories, and Nunavut.
Data on location of family physicians excludes Quebec, Saskatchewan, Alberta, the Northwest Territories, and Nunavut.
Source
National Physician Database, Canadian Institute for Health Information.
The path forward
This report provides a high-level summary of changes in practice patterns among Canadian family physicians over time. Further examination of these trends at the provincial/territorial and regional levels will help inform planning and strategies that support a fit-for-purpose primary care workforce across the country.
Key to this will be examining
- The use of integrated team-based approaches to primary care, including considering the mix and scopes of providers on the team (e.g., nurse practitioners, pharmacists, social workers, midwives, occupational therapists) to continuously improve access to primary care in Canada
- The impact of the changes in the demographics and health needs of Canadians, family physicians and other primary care providers themselves at various geography levels
- The role of different payment models to support equitable access to primary care for all Canadians
- The impact of fragmented data on health workforce well-being, recruitment and retention, and on quality of care; and strategies to drive improvements in this workforce data
Related resources
- Learn more about CIHI’s Physician Scope of Practice Methodology.
- Find further information about the supply, workforce, inflow/outflow and provincial/territorial trends of Canada’s health workforce in CIHI’s Quick Stats tool.
- Learn more about CIHI’s physician-related data holdings.
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Footnotes
i.
To use a scope of practice measure, an individual physician’s practice activity is compared with their peers’ typical scope of practice. This results in a value (between 0 and 100 when scaled) that describes the difference between the individual’s expected scope of practice and their actual scope of practice. The lower the scaled scope of practice value, the closer the physician’s practice is to the average scope of practice of their peers, and vice versa.
ii.
Excluding Quebec, the Northwest Territories, and Nunavut.
iii.
Physician specialty designations are assigned by the provinces and territories; CIHI’s National Physician Database groups the assigned specialties with their national equivalents. There are 2 methods of defining specialties: by latest certification and by payment plan specialty. CIHI uses the latter for this report.
iv.
Excluding those with missing data and family physicians in Quebec, the Northwest Territories and Nunavut.
v.
Excluding Quebec, Saskatchewan, Alberta, the Northwest Territories and Nunavut.
References
1.
Statistics Canada. Access to health care. Accessed January 23, 2024.
2.
Rudoler D, et al. Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces. Canadian Medical Association Journal. 2022.
3.
Duong D, Vogel L. Ontario, Quebec and Alberta lead record family medicine residency vacancies. Canadian Medical Association Journal. 2023.
4.
Canadian Institute for Health Information. Commonwealth Fund survey, 2022. Accessed January 23, 2024.
5.
Aggarwal M, Hutchison B, Abdelhalim R, Glazier R, Baker GR. The evolution of primary care transformation across Canada (2012–2021): A multiple comparative case study of 13 jurisdictions. Annals of Family Medicine. 2023.
6.
Freeman TR, Boisvert L, Wong E, Wetmore S, Maddocks H. Comprehensive practice. Canadian Family Physician. 2018.
7.
Glauser W, Tepper J. Can family medicine meet the expectations of millennial doctors?. Healthy Debate. 2016.