The Impact of the Feminization of the Primary Care Workforce on Service Delivery
The overall goal of this set of objectives is to examine in detail the differences in career trajectories, activity, practice patterns and scopes of practice between male and female PCPs, and to quantify the impact of these differences on current and future service delivery levels.
Objective 1: To determine differences in the activity levels over career trajectories between male and female PCPs and to estimate the resulting differences in productive years of clinical practice.
Question 1.1: On average, what is the yearly percent Full Time Equivalent (FTE) for male versus female PCPs, controlling for age, period, cohort, and practice location?
Question 1.2: How has activity level changed over time (period effect), with age (age effect), and with cohorts of medical school graduates (cohort effect)?
Question 1.3: What is the impact on aggregate service provision of the observed differences in activity male and female PCPs in terms of overall productive years of clinical practice?
Question 1.4: What would be the impact on provision if the feminization trend in primary care continues?
Hypotheses: 1a) Female physicians will work less intensely around child bearing years. 1b) Outside of childbearing years, there will be no difference in intensity of working. 1c) There will be no differences in timing of retirement between male and femle physicians retire, nor the slope of activity decline preceding retirement.
Objective 2: To determine the impact of parental leave(s) and retirement patterns on service supply.
Question 2.1: What proportion of male and female doctors takes one or more parental leaves? What is the average duration of leave? What is the impact on service provision of the average parental leave of male and female PCPs respectively?
Question 2.2: What is the average age at retirement for female compared to male PCPs?
Question 2.3: Does the way in which female PCPs retire differ from that of male PCPs (protracted vs sudden)?
Question 2.4: Have patterns related to maternity leave and retirement changed over time (period effect), with age (age effect), and with cohorts of medical school graduates (cohort effect)?
Hypotheses: 2a) Female physicians will take more parental leaves than male physicians. 2b) Activity will decline prior to parental leave and will, on average, return to pre-leave levels slowly rather than sharply. 2c) There will be no difference in pre-retirement activity levels, or average age at retirement between male and female physicians.
Objective 3: To determine differences in the characteristics of patient populations seen by male compared to female PCPs.
Question 3.1: What are the differences in service population demographics for male versus female PCPs?
3.1.1: What is age distribution (median, mean, proportion over age 65, 75 etc) of patients seen by female versus male PCPs?
3.1.2: What is the gender distribution of patients seen by female versus male PCPs?
Question 3.2: Are female PCPs more or less likely to treat patients who have a higher medical need?
3.2.2: What is the proportion of physician billings represented by the complex chronic conditions fee item?
3.2.3: What percentage of the patient population is grouped in three or more aggregated diagnostic groups (ADGs)? What percentage of the patient population is grouped in one or more of the eight major ADGs?
Question 3.3: How have these habits changed over time and with age?
Hypotheses: 3a) There will be no difference in the age profile, or morbidity level of the patient populations for male versus female doctors. 3b) Female doctors will tend to see more female patients.
Objective 4: To assess variations in referral patterns between male and female PCPs.
Question 4.1: Are female PCPs more or less likely to refer patients to other forms of care, treatment and diagnostics than their male counterparts (surgical, medical, imaging, lab), adjusting for patient need and practice location?
Question 4.3: How have these habits changed over time and with age?
Hypothesis: 4a) No difference between male and female doctors referral patterns once patient characteristics have been accounted for.
Objective 5: To quantify the potential impact of the feminization of the primary care workforce relative to other demographic changes to the workforce, and shifts in activity patterns.
Question 5.1: What is the potential impact of continued feminization relative to other important trends (changes in retirement
patters over time; change in activity levels over time and with age; and changes in patient mix or practice patterns)?
Hypothesis: 5a) Feminization will adversely affect service levels; however other demographic and activity pattern changes will have a more substantial impact.
- Hedden, L., Barer, M. L., Cardiff, K., McGrail, K. M., Law, M. R., & Bourgeault, I. L. (2014). The implications of the feminization of the primary care physician workforce on service supply: a systematic review. Human Resources for Health, 12(1), 32. doi:10.1186/1478-4491-12-32
Academic thesis or dissertation
- Hedden, Lindsay (2015). Beyond Full Time Equivalents: Gender Differences in Activity and Practice Patterns for BC’s Primary Care Physicians (Doctoral dissertation). DOI: 10.14288/1.0221359, accessed from: https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0221359
Presentation of research material (poster/seminar/lecture etc.)
- Hedden, L., Barer, M., Law., M., McGrail, K., Bourgeault, I. (2017, March 11) Is increasing physician supply the key to solving access/provision challenges in primary health care in British Columbia? Paper presented at the Centre for Health Services and Policy Research Annual Conference, Vancouver, BC.
- Hedden, L., Barer, M., Law., M., McGrail, K., Bourgeault, I. (2016, May) The Provision of Out-of-Office and After Hours Care by BC’s Primary Care Physicians. Paper presented at the Canadian Association for Health Services and Policy Research Annual Conference, Toronto, ON.