Is attending birth dying out?: Trends in obstetric care provision among primary care physicians in British Columbia

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Figure 1.
Adjusted proportion of physicians who billed for 1 or more deliveries and any obstetric care, by study year
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Figure 2.
Adjusted proportion of physicians’ billing activity that is classified as obstetric care provision, by study year

Table 1.

Demographic characteristics for full study cohort (N = 6579) and bivariate results

CHARACTERISTIC	MALE PHYSICIANS, N = 4110 (62.7%)	FEMALE PHYSICIANS, N = 2469 (37.3%)	TOTAL, N = 6579
Mean (SD) age, y, in 2011–2012^*	53.6 (12.7)	46.6 (11.0)	51.0 (12.5)
Age group in 2011–2012,^† n (%)
• < 35 y	293 (7.1)	383 (15.5)	676 (10.3)
• 35 to < 45 y	761 (18.5)	712 (28.8)	1473 (22.4)
• 45 to < 55 y	1115 (27.1)	769 (31.1)	1884 (28.6)
• 55 to < 65 y	1102 (26.8)	463 (18.8)	1565 (23.8)
• ≥ 65 y	839 (20.4)	142 (5.8)	981 (14.9)
Trained internationally,^‡ %	1370 (33.3)	580 (23.5)	1950 (29.6)
Practice rurality in 2011–2012,^§ %
• Metropolitan	1885 (45.9)	1269 (51.4)	3154 (47.9)
• Urban dominated	877 (21.3)	496 (20.1)	1373 (20.9)
• Rural dominated	557 (13.6)	309 (12.5)	866 (13.2)
• Not active	759 (18.5)	365 (14.8)	1124 (17.1)
Compensation (averaged for 2005–2006 to 2011–2012)
• Mean (SD) total compensation,^ǁ $	232 122 (146 994)	148 434 (101 222)	200 715 (137 780)
• Mean (SD) alternative payments,^{^¶} $	33 486 (59 059)	28 106 (50 099)	31 467 (55 922)
Attended any deliveries,^# n (%)	503 (12.2)	458 (18.6)	961 (14.6)
Provided any prenatal or postnatal care,^** n (%)	1256 (30.6)	1081 (43.8)	2337 (35.5)
Proportion (SD) of care related to obstetrics^††	1.4 (3.9)	4.6 (9.8)	2.7 (7.2)

↵* Wilcoxon-Mann-Whitney Z = −21.1, P < .0001.
↵† ² = 452.1, P < .0001.
↵‡ ² = 71.7, P < .0001.
↵§ ² = 12.7, P = .0053. Missing: 62 (0.9%)—30 (1.2%) female physicians, 32 (0.8%) male physicians.
↵ǁ Wilcoxon-Mann-Whitney, Z = −23.7, P < .0001.
↵¶ Wilcoxon-Mann-Whitney, Z = −3.3, P = .0006.
↵# ² = 52.3, P < .0001.
↵** ² = 128.0, P < .0001.
↵†† Computed only for those who included any obstetric care in their practices; ANOVA (analysis of variance) F = 195.5, P < .0001. Demographic data presented were previously published in Hedden et al.⁴²

Table 2.

Multivariate models for the odds of providing obstetric care (2005–2006 to 2011–2012)

VARIABLES	MODEL

	DELIVERIES, OR (95% CI)	ANY OBSTETRIC CARE, OR (95% CI)
Female sex	0.84 (0.72–0.98)^*	1.46 (1.27–1.69)^†
Year (continuous)	0.92 (0.89–0.95)^†	0.92 (0.89–0.95)^†
Female sex–year interaction	1.05 (1.02–1.09)^‡	1.02 (0.99–1.04)
Rurality-time interaction
• Metropolitan	0.98 (0.94–1.01)	1.01 (0.98–1.04)
• Urban	0.97 (0.93–1.00)	0.96 (0.92–1.00)^*
Age, y
• 35 to < 45 y	0.76 (0.69–0.85)^†	0.78 (0.71–0.86)^†
• 45 to < 55 y	0.79 (0.70–0.88)^†	0.76 (0.68–0.84)^†
• 55 to < 65 y	0.63 (0.55–0.71)^†	0.68 (0.61–0.76)^†
• ≥ 65 y	0.36 (0.30–0.44)^†	0.50 (0.44–0.58)^†
Rurality
• Metropolitan	0.29 (0.24–0.35)^†	0.52 (0.43–0.63)^†
• Urban	0.71 (0.58–0.87)^*	0.84 (0.68–1.04)
International training	1.30 (1.08–1.56)^*	1.69 (1.39–2.05)^†
Rurality-training interaction
• Metropolitan-international	0.70 (0.55–0.89)^*	0.80 (0.64–0.99)^*
• Urban-international	0.80 (0.63–1.02)	0.87 (0.68–1.10)
Higher proportion of alternative payments	0.35 (0.30–0.41)^†	0.30 (0.27–0.33)^†
Higher proportion of contacts with female patients aged 18–44 y	14.26 (10.78–18.87)^†	2.79 (2.18–3.58)^†
Higher proportion of contacts with patients with ≥ 1 major ADGs	0.44 (0.73–1.20)	0.34 (0.28–0.41)^†
Higher proportion of contacts with patients in the lowest income quintile	0.48 (0.32–0.60)^†	0.67 (0.53–0.86)^*

Table 3.

Multivariate model for the proportion of billings related to obstetric care

VARIABLES	OR (95% CI)
Female sex	1.25 (1.09–1.43)^*
Year (continuous)	0.96 (0.94–0.99)^*
Female sex–year interaction	1.02 (1.00–1.04)
Rurality-time interaction
• Metropolitan	0.98 (0.95–1.00)
• Urban	0.95 (0.92–0.98)^*
Age, y
• 35 to < 45	0.84 (0.78–0.91)^†
• 45 to < 55	0.80 (0.73–0.88)^†
• 55 to < 65	0.75 (0.68–0.84)^†
• ≥ 65	0.76 (0.66–0.87)^‡
Rurality
• Metropolitan	0.87 (0.73–1.02)
• Urban	1.11 (0.92–1.33)
International training	0.92 (0.76–1.10)
Rurality-training interaction
• Metropolitan-international	0.88 (0.72–1.09)
• Urban-international	0.81 (0.65–1.02)
Higher proportion of alternative payments	1.43 (1.23–1.65)^†
Higher proportion of contacts with female patients aged 18–44 y	1329.42 (955.18–1850.29)^†
Higher proportion of contacts with patients ≥ 1 major ADGs	1.49 (1.12–1.97)^*
Higher proportion of contacts with patients in the lowest income quintile	0.78 (0.56–1.11)