New doctors working as hard as previous generation, study finds

A new study from Dalhousie University shows that family doctors who entered the profession recently are not taking on fewer patients or having less contact with patients than those who started out two decades ago.

The analysis counters a misconception that recently trained physicians think more about work-life balance than their more established colleagues, are less career-motivated or are less likely to provide comprehensive and continuous care, the study says.

The data also hints at areas where improvements could be made to increase patient access to care.

The study, published in the Canadian Medical Association Journal on Monday, analyzed data from Nova Scotia, Ontario, Manitoba and British Columbia from 1997 to 2018.

Patient volume peaks in mid-career

It showed that over the course of a family physician's career, they tend to start out with fewer patient visits. That number increases until the doctor has about 27 to 29 years of experience, then begins to drop off again. That trend has been consistent over the 20-year period of study.

"We do see peak volume around mid-career, but this has been true of preceding generations as well," said Dr. Ruth Lavergne, one of the authors of the study and an associate professor in Dalhousie's Department of Family Medicine.

"So there's always been changes over the course of physicians' careers but doctors starting out now aren't working proportionately less than those starting out some time ago."

Dr. Katherine Stringer, the head of Dalhousie's Department of Family Medicine, said one of the reasons early-career doctors across the generations tend to have fewer patients than mid-career physicians is that they are getting to know their patients, so may spend longer with them.

They also must add patients' medical information to record systems, they may be hiring staff to run a practice and learning the financial side of operating a business.

"There's a lot of stresses on our new graduates as they begin practice. So providing them with as many of those supports as possible that can potentially take some of those stresses away so that they can then focus on patient contacts, I think that the study perhaps helps a bit there."

Fewer patient visits throughout career

Yet another finding from the study is that family physicians at all career stages see fewer patients today than they did 20 years ago due to the increasing complexity of care. It notes a drop of about 25 per cent, or between 515 and 1,736 patient visits per doctor per year.

Lavergne said that doesn't mean doctors are working less. She said patients are being treated for a larger number of conditions, which might mean the average visit takes more time. Family doctors also co-ordinate referrals, imaging and labs, which amount to more time-consuming administrative work.

Dr. Leisha Hawker, the president of Doctors Nova Scotia, said patients are also discharged from hospital earlier than they used to be, due to the high demand for beds. That means some issues that normally would be dealt with by hospital staff are now dealt with by family doctors.

People stay in their homes longer while waiting for long-term care, so they rely on family physicians for medical help rather than staff at long-term care facilities.

Long wait times for specialists also mean family doctors may continue dealing with patient issues until a specialist is available.

"The complexity of medicine is just so much higher than it was in the previous years and it just means that those 10-, 15-minute appointments that used to work don't really work anymore in family medicine."

More workforce planning needed

Lavergne said the study highlights the need for workforce planning. If doctors in early or late stages of their career tend to see fewer patients, more support could be offered during those periods by, for instance, using more streamlined referral systems or sharing administrative work with others.

Offering more team care to patients who can see other service providers can also help free up physicians to see more patients, Lavergne said.

Lavergne said it's important that governments think carefully about what strategies they are using to help alleviate pressure on the system.

"Oftentimes during, you know, periods of crisis like this, there's a move to try to open walk-in clinics or urgent care centres, and I fully understand the motivation to do that and that people really do need care urgently," she said.

"But if you're pulling people out of ongoing longitudinal care and into these care models where you don't see the same patient over time, that can add to duplication and reduce the efficiency of services."

Hawker said programs that pair new doctors with doctors who are about to retire can also help early-career doctors get used to the real world of practising medicine and become more efficient, more quickly.

That type of program can also provide seamless continuity of care for patients so a new doctor doesn't have to start from scratch with a patient, she said.