Back to Commonwealth Fund survey, 2022
June 8, 2023 — Primary care physicians play a crucial role in Canada’s health care systems. They are typically the first point of contact for patients seeking non-emergency medical care. Results from the 2022 Commonwealth Fund (CMWF) survey reveal the challenges these doctors are experiencing regarding workload, patients’ access to care and integration of care.
Governments across the country made commitments in 2023 to expand access to family health services and to modernize the health care systems with standardized health data and digital tools. These enhancements have the potential to address current challenges in primary health care.
While physicians’ workload increased during the pandemic, access to care remains challenging
In Canada, family doctors played an integral role in the pandemic response. This included a rapid transition to virtual care; participating in testing, treatment and associated services for COVID-19 care; providing education and support to local communities to increase vaccine uptake;Reference1 and, more recently, catching up with non-COVID-19 care on top of full schedules with patient care.
The response to COVID-19 had an impact on primary care physicians. Survey results show that Canadian family doctors worked more hours while seeing fewer patients per week, compared with the CMWF average. Furthermore, a large proportion of physicians across all countries surveyed reported an increased workload compared with before the pandemic (Canada: 77%; CMWF average: 76%). About three-quarters of Canadian physicians felt that the quality of care patients receive throughout the health care system had worsened since March 2020 when the COVID-19 pandemic began, compared with almost two-thirds of all physicians surveyed.
Family physicians’ workload and perceived quality of care
77% of primary care physicians in Canada reported that their workload has increased a lot or somewhat compared with before the COVID-19 pandemic, which is statistically similar to the CMWF average of 76% (a lower percentage is more desirable).
74% of Canadian primary care physicians think that the quality of medical care patients receive throughout the health care system has become worse since March 2020 when the COVID-19 pandemic began, which is significantly below the CMWF average of 63% (a lower percentage is more desirable).
The proportions of primary care physicians who report that their workload has increased a lot or somewhat compared with before the COVID-19 pandemic are as follows: Switzerland, 56%; Sweden, 65%; United States, 65%; France, 72%; CMWF average, 76%; Australia, 76%; Canada, 77%; Netherlands, 80%; New Zealand, 85%; United Kingdom, 91%; and Germany, 93%. A lower percentage is more desirable.
The proportions of primary care physicians who think that the quality of medical care patients receive throughout the health care system has become worse since March 2020 when the COVID-19 pandemic began are as follows: Switzerland, 30%; United States, 49%; Netherlands, 57%; Australia, 58%; CMWF average, 63%; Sweden, 63%; Germany, 67%; Canada, 74%; France, 76%; New Zealand, 77%; and United Kingdom, 79%. A lower percentage is more desirable.
Source
The Commonwealth Fund, 2022 International Health Policy Survey of Primary Care Physicians.
See how Canada compares with peer countries on access to care.
Some of the time that family physicians spend on administrative work may be contributing to their increased workload. More than half of primary care physicians are not satisfied with the amount of time they spend on administrative work (Canada: 57%; CMWF average: 53%). Most of the administrative work may not require physicians’ clinical expertise. From lengthy paperwork such as insurance claims and medical reviews to duplicate forms requested from different organizations, the quantity of non-patient work can reduce family physicians’ availability for patients.
Family physicians’ satisfaction with administrative work
57% of Canadian primary care physicians are not at all satisfied with the time spent on administrative work, which is significantly below the CMWF average of 53% (a lower percentage is more desirable).
The proportions of primary care physicians who are not at all satisfied with the time spent on administrative work are as follows: Sweden, 35%; France, 44%; Australia, 47%; United States, 50%; Switzerland, 50%; CMWF average, 53%; Germany, 54%; Canada, 57%; United Kingdom, 59%; Netherlands, 62%; and New Zealand, 68%. A lower percentage is more desirable.
Source
The Commonwealth Fund, 2022 International Health Policy Survey of Primary Care Physicians.
An analysis by the Canadian Federation of Independent Business found that across Canada, physicians are spending 48.8 million hours each year on administrative tasks.Reference2 Building on current electronic medical record uptake with the implementation of patient-centric, integrated, standardized health data systems and digital tools can ensure that information is shared within and between different care settings. This will help to eliminate redundancy in administrative work, thereby increasing primary care doctors’ efficiency and communication with other practices, specialists, labs and patients. Time saved from administrative tasks can be redirected to providing medical care, which should translate to improved access to primary health care for Canadians.
Improved use of information technology and increased multidisciplinary work can result in more coordinated care
Coordinating patient care is integral to primary health care and involves physicians assessing and organizing care according to their patients’ needs. The survey results show that a large proportion of Canadian family physicians have found it challenging to coordinate care for their patients with specialists and social services. Although 89% of primary care physicians send patient information to specialists, only about half receive information back on changes made to the patient care plans and medication, and less than 20% receive a report with results of the specialist visit within a week of the visit. Compared with physicians in all countries surveyed, fewer Canadian physicians can electronically exchange patient clinical summaries with other health care providers (Canada: 38%; CMWF average: 67%). Better access to health data and medical records with integrated health data systems can improve care coordination among primary care doctors and other health care providers.
See how Canada compares with peer countries on coordination of care.
Working with other types of health professionals (e.g., nurses, nurse practitioners, case managers) can also assist with coordination of care, as well as ease physician workload. Fewer Canadian family physicians (52%) are working with personnel within their practice to monitor, manage and coordinate care for patients with chronic conditions who need regular follow-up care, compared with the CMWF average (65%).
Family physicians’ use of personnel
52% of Canadian primary care physicians use personnel within their practice, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care, which is significantly below the CMWF average of 65% (a higher percentage is more desirable).
The proportions of primary care physicians who use personnel within their practice, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care are as follows: United Kingdom, 94%; Sweden, 89%; New Zealand, 89%; Netherlands, 82%; Australia, 79%; Germany, 68%; CMWF average, 65%; United States, 54%; Canada, 52%; Switzerland, 24%; and France, 22%. A higher percentage is more desirable.
The proportions of primary care physicians who use personnel within their practice, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care, by type of practice, are as follows: private solo practice, 34%; physician group practice, 52%; and community clinic/health centre, 67%.
Source
The Commonwealth Fund, 2022 International Health Policy Survey of Primary Care Physicians.
Family physicians working in group practices and community clinics/health centres were more likely to work with other health professionals. Furthermore, these physicians were more likely to coordinate care with social services or other community providers, or to make home visits. Across the country, commitments have been made to enhance family health teams and improve patient access to primary health care. Current research on reforming primary health care also suggests that health teams can improve quality and coordination of care through the use of a multidisciplinary approach.Reference3
References
- 1.
- Back to Reference 1 in text
- Kiran T, Eissa A, Mangin D, et al; Ontario COVID-19 Science Advisory Table. Brief on Primary Care Part 1: The roles of primary care clinicians and practices in the first two years of the COVID-19 pandemic in Ontario. Accessed January 18, 2023.
- 2.
- Back to Reference 2 in text
- Canadian Federation of Independent Business. Canadian doctors spend over 18 million hours a year on unnecessary administrative work. Accessed March 10, 2023.
- 3.
- Return to reference 3 in text
- O’Reilly P, Lee SH, O’Sullivan M, et al. Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review. PLOS ONE. 2017.