Rural MDs more open to new patients: report

Rural family doctors are twice as likely to say they're accepting new patients as those in cities, according to a new report, which also found that where doctors train might affect their willingness to take on new patients.

The Canadian Institute for Health Information released its report Thursday on factors that contribute to whether family doctors said their practice was open to new patients.

Of the doctors who responded to the survey from rural areas and small towns, 62 per cent who graduated from foreign medical schools and 27 per cent of their Canadian-educated counterparts said they were accepting patients.

In urban areas, 27 per cent of international graduates and 16 per cent of Canadian-educated doctors who responded to the survey said they were accepting patients.

Overall, nearly 47 per cent of doctors surveyed were not accepting new patients.

"There's a quality of a rural physician that they're just more likely to be open," said Yvonne Rosehart, program lead for health human resources at the institute.

"I think its because they know if they say no to you that you really don't have anyone else to go to. If a doctor in Toronto feels their practice is full, I guess there's kind of a sense that there are other doctors in Toronto. But if a doctor in Listowel, Ont., you know, a small town, says no, where do you go then?"

More than 19,000 doctors participated in the survey, which had a response rate of 31.6 per cent.

Age, gender and type of practice play a role

The findings are important for health-care planners, who've heard for years that rural areas are underserviced, Rosehart said.

Governments have responded do the doctor shortage by opening satellite medical schools in rural and northern areas, offering doctors incentives to work in rural areas and training more Canadian doctors, she added.

But more needs to be done to keep physicians in rural areas, the Society of Rural Physicians says.

The group released another study this week that suggested one in seven rural physicians plans to move from their communities within the next two years.

In the latest study, other factors that contributed to the likelihood of doctors accepting new patients were:

• Age.
• Gender.
• Type of practice.

Doctors under 35, who tend to be setting up their practices, and doctors at the end of their careers were more likely to be open to new patients than those between ages 45 and 54, the report's authors found.

Anecdotal evidence suggests older physicians often have a higher work intensity than younger ones.

"It could be a generational difference on what they expect from a work/life balance," Rosehart said.

The findings also indicated that in both rural and urban settings, men were more likely to be open to new patients than their female counterparts — 1.9 times more so in urban areas and 1.4  times more in rural regions.

Social norms influence doctors

Similarly, cultural expectations of foreign-trained doctors might make them more likely to take on new patients than those trained in Canada, said Dr. Peter Hutten-Czapski, who practises in Haileybury, a town 600 kilometres north of Toronto.

The type of practice also seemed to make a difference.

In rural areas, 38 per cent of respondents working in group settings — that is, with other physicians or with health-care professionals such as nurse practitioners and dieticians — said they were open to new patients, compared with 25 per cent of those doctors who work alone.

Dr. Pria Akula, 36, who went to medical school in India, is now working with one other doctor in  Grand Valley, Ont., about 100 kilometres northwest of Toronto.

"I'm a small-town girl," Akula said. "I prefer to be in small towns and that's the reason I'm there."

The survey found a smaller difference among urban physicians, where 18 per cent of respondents in group practice said they were accepting new patients compared with 16 per cent in solitary practice.

Family doctors often act as an entry point to the health care system in Canada, the report's authors noted.

A poll conducted last fall for the College of Family Physicians of Canada suggested that four million Canadians — about 12 per cent of the population — didn't have a family doctor, a slight improvement from a poll in 2007 suggesting five million lacked a family doctor.

The Canadian Institute for Health Information based its report about doctors' willingness to take on new patients on data from the 2007 National Physician Survey. The survey was conducted by the College of Family Physicians, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada.