Do recent family physician graduates practice differently? A longitudinal study of primary care visits and continuity in four Canadian provinces

Background: Complaints about lack of access to family physicians (FPs) has led to concerns about the role recent physician graduates have had in changes in the supply of primary care services in Canada. This study investigates the impact of career stage, time period, and graduation cohort on family physician practice volume and continuity over two decades. Methods: Retrospective-cohort study of family physician practice from 1997/98 to 2017/18. Administrative health and physician claims data were collected in British Columbia, Manitoba, Ontario and Nova Scotia. The study included all physicians registered with their respective provincial regulatory colleges with a medical specialty of family practice and/or billed the provincial health insurance system for patient care as family physicians. Median polish analysis of patient contacts and physician-level continuity was completed to isolate years-in-practice, period, and cohort effects. Results: Median patient contacts per provider fell over time in the four provinces examined. In all four provinces, median contacts increased with years in practice until mid-to-late-career and declined into end-of-career. We found no relationship between graduation cohort and practice volume or FP-level continuity. Interpretation: Recent cohorts of family physicians practice similarly to predecessors in terms of practice volumes and continuity of care. Since FPs of all career stages show declining patient contacts, system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.