Dr. Benjamin Chan used Ontario Health Insurance Plan billing data to track the participation rates of general practitioners and family physicians in 6 nonoffice settings across Ontario to track this decline in comprehensiveness. Chan extracted demographic variables and the numbers of physicians providing inpatient hospital visits, house calls, emergency work, nursing–home visits, deliveries, anesthesia or exclusively office work.
He found that the proportion of physicians practising exclusively in their offices increased from 14% in 1989/90 to 24% in 1999/00 (p <0.001). In 1999/2000, recent graduates were more likely than older physicians to be involved in emergency medicine work (40% v. 5%), whereas older physician were more likely than recent graduates to make house calls and nursing-home visits (57% and 20% v. 37% and 11%).
Chan concludes that there has been a decline in the provision of comprehensive care by Ontario’s general practitioners and family physicians and states that many may conclude that desire for quality family time and the increased complexity of medical care dictates that the “ideal” of the “super-FP” who can do everything is unrealistic. He also discusses the fact that alternatives such as group family practices or "family practice networks" can help meet the need for comprehensive primary care. These options, however, rely on a solid core of physicians who work in at least one nonoffice setting, a core Chan warns is eroding.
p. 429 The declining comprehensiveness of primary care
— B.T.B Chan
Journal
Canadian Medical Association Journal