Predicting the scope of practice of family physicians

Eric Wong; Moira Stewart

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Table 1.

Characteristics of sample of FPs and GPs: Analytic weighting was used; N = 6789.

INDEPENDENT VARIABLE	N (%)	MEAN SCOPE OF PRACTICE SCORE (SD)
Physician-related variables
Physician age,^* y
• < 35	745 (11.0)	8.8 (1.9)
• 35 to 44	2308 (34.0)	8.7 (2.0)
• 45 to 54	2502 (36.9)	8.7 (2.1)
• 55 to 64	965 (14.2)	8.6 (2.2)
• ≥ 65	269 (4.0)	7.6 (2.5)
Years in medical practice^†
• 0 to 10	1679 (24.7)	8.9 (1.9)
• 11 to 20	2452 (36.1)	8.7 (2.1)
• 21 to 30	1986 (29.2)	8.6 (2.2)
• 31 to 40	540 (8.0)	8.3 (2.3)
• > 40	132 (1.9)	7.6 (2.4)
Physician sex
• Male	4472 (65.9)	8.8 (2.1)
• Female	2317 (34.1)	8.3 (2.0)
Additional postgraduate training after family medicine residency
• Yes	2391 (35.2)	8.9 (2.1)
• No	4398 (64.8)	8.5 (2.1)
Physician payment type
• Fee-for-service only	3051 (44.9)	8.3 (2.2)
• Other	3738 (55.1)	8.9 (1.9)
Availability of health care resources to main practice setting
Referral to specialists^‡
• 1 (poor)	503 (7.4)	8.7 (2.1)
• 2	2051 (30.2)	8.8 (2.0)
• 3	2607 (38.4)	8.7 (2.0)
• 4	1252 (18.4)	8.4 (2.2)
• 5 (excellent)	375 (5.5)	8.2 (2.4)
Hospital beds^§
• 1 (poor)	1720 (25.3)	8.7 (2.0)
• 2	2421 (35.7)	8.6 (2.1)
• 3	1738 (25.6)	8.5 (2.1)
• 4	695 (10.2)	8.9 (2.1)
• 5 (excellent)	215 (3.2)	9.3 (2.1)
Practice organization
No. of different types of allied health professionals in main practice setting^\|\|
• 0 to 2	5936 (87.4)	8.8 (2.1)
• 3 to 5	791 (11.7)	8.0 (2.0)
• ≥ 6	62 (0.9)	7.4 (2.1)
Main practice setting
• Private office or clinic	6101 (89.9)	8.7 (2.1)
• Community clinic, CHC, CLSC	468 (6.9)	7.9 (2.2)
• Academic family medicine teaching unit	220 (3.2)	8.9 (1.7)
Practice type
• Solo practice	1619 (23.9)	8.4 (2.2)
• Family physician group practice	4512 (66.5)	8.8 (2.0)
• Family physician–specialist group practice	658 (9.7)	7.9 (2.3)
Geographic variables
Population served^¶
• Urban	4291 (63.2)	8.2 (2.1)
• Semiurban	1363 (20.1)	9.2 (2.0)
• Rural	1135 (16.7)	9.7 (1.6)
Provinces^#
• Newfoundland and Labrador	114 (1.7)	9.0 (1.8)
• Prince Edward Island	68 (1.0)	9.4 (1.6)
• New Brunswick	135 (2.0)	9.7 (1.5)
• Nova Scotia	248 (3.6)	9.4 (1.6)
• Quebec	1450 (21.4)	7.2 (2.0)
• Ontario	2550 (37.6)	8.6 (2.0)
• Manitoba	209 (3.1)	8.8 (2.0)
• Saskatchewan	209 (3.1)	10.1 (1.3)
• Alberta	628 (9.3)	9.3 (1.9)
• British Columbia	1178 (17.4)	9.7 (1.5)

CHC—community health centre, CLSC—centre local de services communautaires.
↵* Mean (SD) physician age was 46.2 (9.5) years.
↵† Mean (SD) number of years in practice was 18.0 (9.6) years.
↵‡ Availability of specialists for referral was scored on a 5-point Likert scale (with 1 being poor and 5 being excellent). Mean (SD) Likert score for availability of specialists was 2.9 (1.0).
↵§ Access to hospital beds was scored on a 5-point Likert scale (with 1 being poor and 5 being excellent). Mean (SD) Likert score for access to hospital beds was 2.3 (1.1).
↵|| The mean (SD) number of allied health professionals in the main practices settings was 1.1 (1.3).
↵¶ This referred to the population primarily served by the respondent’s practice, as selected by the respondent. The original categories of inner city and urban-suburban were collapsed into urban; small town was collapsed into semiurban; and rural, geographically isolated, and remote were collapsed into rural.
↵# Complete-case analysis excluded all respondents from the territories.

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Table 2.

Results of univariable and multivariable analyses with complete case analysis: N = 6789.

INDEPENDENT VARIABLES (REFERENCE CATEGORY)	UNADJUSTED β (UNSTANDARDIZED REGRESSION COEFFICIENT)	STANDARD ERROR OF UNADJUSTED β	UNADJUSTED R²	ADJUSTED β (UNSTANDARDIZED REGRESSION COEFFICIENT)	STANDARD ERROR OF ADJUSTED β	ADJUSTED R²(% OF TOTALR²EXPLAINED)
Physician-related variables
Physician age	−0.24^*	0.04	0.005^*	−0.16^*	0.04	0.002 (0.6)^*
Years in medical practice^†	−0.25^*	0.04	0.006^*
Male physician sex	8.55^*	0.82	0.016^*	6.20^*	0.72	0.006 (1.7)^*
Additional postgraduate training after family medicine residency	6.97^*	0.82	0.011^*	3.22^*	0.68	0.002 (0.6)^*
Payment via fee-for-service only	−10.12^*	0.78	0.024^*	−7.88^*	0.68	0.016 (4.6)^*
Availability of health care resources to main practice setting
Specialists	−2.08^*	0.40	0.004^*	−1.13^*	0.35	0.001 (0.3)^‡
Hospital beds	1.09^*	0.37	0.001^‡	0.97^‡	0.36	0.001 (0.3)^‡
Practice organization
No. of different types of allied health professionals in main practice setting	−2.84^*	0.30	0.013^*	1.33^*	0.31	0.002 (0.6)^*
Main practice setting (private office)			0.010^*			0.009 (2.6)^*
• Community clinic, CHC, CLSC	−12.32^*	1.55		−11.87^*	1.50
• Academic family medicine teaching unit	2.24^§	2.22		8.97^*	1.90
Practice type (solo practice)			0.019^*			0.007 (2.0)^*
• Family physician group practice	6.58^*	0.93		5.35^*	0.81
• Family physician–specialist group practice	−7.30^*	1.49		1.95^§	1.32
Geographic variables			0.095^*			0.110 (31.3)^*
Population served (urban)
• Semiurban	16.43^*	0.96		17.20^*	0.86
• Rural	24.57^*	1.03		23.96^*	0.97
Provinces (Quebec)			0.195^*			0.195 (55.6)^*
• Newfoundland and Labrador	28.75^*	2.83		26.89^*	2.59
• Prince Edward Island	35.07^*	3.62		29.91^*	3.28
• New Brunswick	39.73^*	2.63		37.65^*	2.40
• Nova Scotia	34.64^*	2.00		34.54^*	1.85
• Ontario	21.87^*	0.96		27.31^*	0.94
• Manitoba	26.33^*	2.16		26.07^*	1.97
• Saskatchewan	47.54^*	2.16		48.29^*	1.99
• Alberta	33.54^*	1.39		35.52^*	1.31
• British Columbia	40.00^*	1.14		43.68^*	1.14