Factors associated with open practices: results from the Canadian National Family Physician Survey.

abstract

OBJECTIVE: Closed and conditionally closed practices appear to be increasing in many parts of Canada as reflected in the fact that more and more patients report difficulties finding family physicians who accept new patients. But the extent of, nature of, and factors related to open, closed, and conditionally closed practices are still largely unknown. DESIGN: This study used data from the 2001 National Family Physician Workforce Survey for secondary analysis. Chi-square tests and logistic regression were used to examine factors related to FPs' decisions to keep their practices open or to close them. SETTING: Private offices, clinics, community health centres, and academic family medicine practice units in Canada. PARTICIPANTS: Of 10,325 FPs surveyed, 2360 respondents who practised in emergency departments, hospitals, nursing homes, homes for the aged, walk-in clinics, and more than one setting were excluded. Overall response rate was 51.2%. MAIN OUTCOME MEASURES: Practice status (open, conditionally closed, and closed), restrictions placed on conditionally closed practices, and factors associated with open practices. RESULTS: The odds of having an open practice increased if respondents were male, younger than 35, working fewer hours at the time, or working in a group practice that included other types of physicians. Family physicians in rural and remote areas were much less likely than those in urban centres to close their practices. Conversely, FPs were more likely to close their practices when they perceived their communities to have good emergency department services and when other FPs in the community also had closed their practices. CONCLUSION: Demographic and practice characteristics of physicians have an effect on whether practices are open, conditionally closed, or completely closed. But the broader practice environment, determined by such factors as geographic location and medical services available in the community, is equally important.