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Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study

Ya-Ping Jin, Mayilee Canizares and Yvonne M. Buys
May 17, 2022 10 (2) E420-E429; DOI: https://doi.org/10.9778/cmajo.20210068
Ya-Ping Jin
Department of Ophthalmology and Vision Sciences (Jin, Buys) and Dalla Lana School of Public Health (Jin), University of Toronto; Schroeder Arthritis Institute (Canizares), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ont.
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Mayilee Canizares
Department of Ophthalmology and Vision Sciences (Jin, Buys) and Dalla Lana School of Public Health (Jin), University of Toronto; Schroeder Arthritis Institute (Canizares), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ont.
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Yvonne M. Buys
Department of Ophthalmology and Vision Sciences (Jin, Buys) and Dalla Lana School of Public Health (Jin), University of Toronto; Schroeder Arthritis Institute (Canizares), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ont.
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  • Figure 1:
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    Figure 1:

    The number of active family physicians (FPs) in Ontario, Canada, from 1992 to 2018, by sex. There was a small decrease from 2017 to 2018. This was likely owing to our use of the ICES Physician Database, which had not been updated past 2017 at the time the data were provided to the study team.

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    Figure 2:

    The proportion of (A) male and (B) female family physicians (FPs) working less than 1, 1, or more than 1 full-time equivalents (FTEs) in Ontario from 1992 to 2018.

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    Figure 3:

    Median payment of family physicians (FPs) in Ontario, Canada, from 1992 to 2018 by year, sex and full-time equivalent (FTE). (A) Overall; (B) less than 1 FTE; (C) 1 FTE; (D) more than 1 FTE.

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    Figure 4:

    Proportion of family physicians (FPs) with more than 50% of their payment from fee-for-service (FFS) in Ontario by year and full-time equivalent (FTE). (A) Overall; (B) less than 1 FTE; (C) 1 FTE; (D) more than 1 FTE.

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    Figure 5:

    (A) Median number of visits, (B) median number of patients and (C) median number of visits per patient for family physicians (FPs) who worked 1 full-time equivalent (FTE) in Ontario, Canada, by year and sex.

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    Figure 6:

    Predicted values from multilevel regression models. Models for (A) payment included sex, year, sex–year interaction, physician age, number of patient visits, number of distinct patients seen and number of visits per patient. Models for (B) patients, (C) visits and (D) visits per patient included sex, year, sex–year interaction, physician age and physician full-time equivalent. Values were estimated with variables at their mean. Note: FP = family physician.

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    Table 1:

    Demographic characteristics of family physicians in Ontario, Canada, from 1992 to 2018

    CharacteristicMean ± SDMedian (IQR)Range
    Overall
     No. of physicians11631 ± 1487.210922 (10441–14748)10191–14739
     Age, yr48.4 ± 2.3349.4 (56.9–50.4)43.6–50.8
     Sex, female, %35.3 ± 6.234.4 (29.8–40.8)26.1–46.0
    Female FPs
     No. of physicians4193 ± 12893759 (3037–5198)2722–6710
     Age, yr43.9 ± 2.444.9 (42.2–46.0)38.9–46.8
    Male FPs
     No. of physicians7439 ± 309.07377 (7156–7711)7094–8029
     Age, yr50.9 ± 2.951.8 (48.9–53.5)45.3–53.9
    • Note: FP = family physician, IQR = interquartile range, SD = standard deviation.

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    Table 2:

    Model outputs from multilevel regression analysis

    VariablePayments, $No. of patientsNo. of visitsNo. of visits per patient
    EstimateSEp valueEstimateSEp valueEstimateSEp valueEstimateSEp value
    Female FPs v. male FPs*−11021.01721.4< 0.0001−494.418.0< 0.0001−986.136.0< 0.00010.40.0< 0.0001
    Increase per year in male FPs
     1992–2004140.882.40.087627.70.8< 0.0001−2.71.60.09640.00.0< 0.0001
     2005–201318730.099.7< 0.0001−40.70.9< 0.0001−166.82.0< 0.00010.00.0< 0.0001
     2014–2018−9785.6210.1< 0.0001−24.41.8< 0.0001−96.14.1< 0.0001−0.10.0< 0.0001
    Differences in slopes (increase per year) for female FPs v. male FPs
     1992–2004−10.1133.40.9395−0.51.10.662216.32.6< 0.00010.00.00.6022
     2005–2013−5300.3152.8< 0.000117.71.3< 0.000150.52.9< 0.00010.00.00.3173
     2014–20184866.0318.6< 0.00018.42.7< 0.000137.86.1< 0.00010.00.00.2625
     Age, yr†550.141.5< 0.0001−22.40.5< 0.0001−4.20.9< 0.00010.10.0< 0.0001
     No. of visits†28.50.1< 0.0001–––––––––
     No. of patients†7.20.3< 0.0001–––––––––
     No. of visits per patient†1136.196.8< 0.0001–––––––––
     FTE†–––1458.85.1< 0.00015229.711.4< 0.00011.40.0< 0.0001
    • Note: FP = family physician, FTE = full-time equivalent, SE = standard error.

    • ↵* This is the difference when all covariates are set to their overall means and should not be interpreted as female FPs having $11 021 less earnings than male FPs.

    • ↵† Variables centred at their overall means.

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CMAJ Open: 10 (2)
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1 Apr 2022
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Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study
Ya-Ping Jin, Mayilee Canizares, Yvonne M. Buys
Apr 2022, 10 (2) E420-E429; DOI: 10.9778/cmajo.20210068

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Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study
Ya-Ping Jin, Mayilee Canizares, Yvonne M. Buys
Apr 2022, 10 (2) E420-E429; DOI: 10.9778/cmajo.20210068
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