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Who are the primary health care physicians in British Columbia? 1996/97-2004/05 Watson, Diane; Black, Charlyn, 1954-; Peterson, Sandra; Mooney, Dawn; Reid, Robert J. Aug 31, 2006

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Who are the  Primary Health  Care Physicians in British Columbia?1996/97-2004/05August 2006Diane E Watson PhD MBA Charlyn Black MD ScDSandra Peterson MScDawn Mooney BARobert J Reid MD PhDWHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 2Library and Archives Canada Cataloguing in PublicationWho are the Primary Health Care Physicians in British Columbia? [electronic resource] / Diane Watson ... [et al.].ISBN 1-897085-05-2        1. Physicians (General practice)--British Columbia.  2. Group medicalpractice--British Columbia.  3. Primary health care--British Columbia. I. Watson, Diane II. University of British Columbia. Centrefor Health Services and Policy Research  III. Title.R729.5.G4M334 2006                    610                              C2006-901699-2  3AUGUST 2006Table of ContentsAbout CHSPR ....................................................................... 4Acknowledgements ............................................................. 5Executive Summary ............................................................. 6Introduction .......................................................................... 7Methods ................................................................................ 8Results .................................................................................. 10Discussion ............................................................................ 15References ............................................................................ 18Appendix 1Physicians in Clinical Practice by Type of Practice and Most Recent Registered Specialty, 2004/05 ............... 20Appendix 2PHC Physician Demographics by Health Authority, 2004/05 ..................................................... 22Appendix 3PHC Physicians by Health ServiceDelivery Area, 2004/05 .......................................................... 24Appendix 4PHC Physicians by Health Authority, 2004/05 ................... 27Appendix 5Type of Practice and Most Recent Registered Specialty Classifi cations ..................................................... 32WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 4About CHSPRThe Centre for Health Services and Policy Research (CHSPR) is an independent research centre based at the University of British Columbia. CHSPR’s mission is to stimulate scientifi c enquiry into issues of health in population groups, and ways in which health services can best be organized, funded and delivered. Our researchers carry out a diverse program of applied health services and population health research under this agenda.CHSPR aims to contribute to the improvement of population health by ensuring our research is relevant to contemporary health policy concerns and by working closely with decision makers to actively translate research fi ndings into policy options. Our researchers are active participants in many policy-making forums and provide advice and assistance to both government and non-govern-ment organizations in British Columbia (BC), Canada and abroad. CHSPR receives core funding from the BC Ministry of Health Services to support research with a direct role in informing policy decision-making and evaluating health care reform, and to enable the ongoing development of the BC Linked Health Database. Our researchers are also funded by com-petitive external grants from provincial, national and international funding agencies. Much of CHSPR’s research is made possible through the BC Linked Health Database, a valuable resource of data relating to the encounters of BC residents with various health care and other sys-tems in the province. These data are used in an anonymized form for applied health services and population health research deemed to be in the public interest.CHSPR has developed strict policies and procedures to protect the confi dentiality and security of these data holdings and fully complies with all legislative acts governing the protection and use of sensitive information. CHSPR has over 30 years of experience in handling data from the BC Ministry of Health and other professional bodies, and acts as the access point for researchers wishing to use these data for research in the public interest.For more information about CHSPR, please visit www.chspr.ubc.ca. 5AUGUST 2006This project relied extensively on work underway at the Centre for Health Services and Policy Re-search to use the British Columbia (BC) Linked Health Database to identify physicians who engage in clinical practice. This task has become increasingly challenging given the array of funding sourc-es and corresponding administrative data fi les that have emerged over recent years. The method-ological advancements used to conduct this project also relied on previous work by others in the province, and new contributions by the authors. Colleagues who provided feedback on draft copies of this report are also acknowledged.The BC Ministry of Health provided funding, under the Primary Health Care Transition Fund, to sup-port this project. The results and conclusions are those of the authors and no offi cial endorsement by the Ministry is intended or should be inferred. All analysis and interpretation, and any errors, are the sole responsibility of the authors. This project is part of a larger program of research conducted at the request of the BC Ministry of Health.The Behavioural Research Ethics Board of the University of British Columbia approved the program, and the College of Physicians and Surgeons of British Columbia approved the use of their data to ensure the accuracy of counts and determinations regarding geographic location of physicians. AcknowledgementsWHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 6Most individuals’ fi rst point of contact with the health care system is typically through a physician who delivers compre-hensive care over time. General practitioners-family physi-cians (hereinaft er called general practitioners) most oft en fulfi ll this role for Canadians. It has become increasingly evi-dent, however, that general practitioners may elect to narrow their activities to certain specialized services, or deliver care exclusively in institutional settings such as emergency depart-ments. Conversely, while most specialists provide episodic and specialized services almost exclusively, some may off er services that are fi rst contact, comprehensive and continu-ous, and may be the main coordinator of a patient’s total care. Should any or all of these physicians be described as provid-ing primary health care (PHC)? Since PHC is defi ned by service attributes rather than by professional discipline or location of care, the challenge is to identify physicians who deliver these services. Th is paper describes the population of PHC, PHC-related and specialist physicians in British Columbia, assesses temporal patterns of their supply, and describes their demographic characteristics and geographic distribution. We analyzed data from fi scal years that predate the Health Transition Fund and Primary Health Care Transition Fund, and from the most recent pe-riod for which complete data were available (2004/05).Th ere were 8,558 physicians engaged in part- or full-time clinical practice across British Columbia in 2004/05 (204 physicians per 100,000 or 490 people per physician). Among this provincial workforce, 51 per cent were PHC physicians (105 per 100,000 or 952 people per PHC physician). Th e pro-portion of PHC physicians to total physician supply declined from 55 per cent in 1996/97 to 51 per cent in 2004/05, a trend which is especially important to monitor. Emerging research suggests that higher ratios of PHC physicians to population, and higher ratios of PHC physicians to specialists, improve health outcomes for populations, at a low cost.    Of particular note is the speed with which health authorities gained or lost PHC physicians over the eight-year period. Th e largest reduction in per capita supply between 1996/97 and 2004/05 occurred in Vancouver Coastal (14% relative Executive Summarydecline), but this health authority retained the province’s high-est PHC physician-to-population ratio (130 per 100,000). Th e second largest reduction occurred in Fraser (2% relative de-cline), and this health authority had the lowest level of supply in 2004/05 (77 per 100,000 population). In contrast, per capita supply increased 13 per cent in Vancouver Island, a health authority that enjoyed the second highest PHC physician-to-population ratio in 2004/05 (128 per 100,000). Temporal shift s in the number of PHC physicians in clinical practice are attributable to a number of factors—immigration, emigration, entrants and exits, as well as physicians who change specialty designations and practice patterns over time. Variability in PHC physician supply was also dramatic across health service delivery areas, with Vancouver at 153 per 100,000 and Fraser South at 72 per 100,000 in 2004/05.  But it is important to juxtapose measures of supply with geographic diff erences in relative need for health care. Th ere was no association between PHC physician supply and British Columbian’s need for health care in 2004/05. Areas with lower levels of health status did not have more PHC physicians, and areas with higher levels of health status did not have fewer PHC physicians.  Our team has previously documented disparities in the geographic distribution of PHC physicians, but at that time we also documented equity in the utiliza-tion of PHC services. In combination, these results suggest that people move across jurisdictional boundaries to obtain PHC services. Interestingly, when our team combined counts of PHC-related registered nurses and PHC physicians, the extent of variability in supply among this workforce of nurses or physicians is attenuated. Where there are fewer PHC physicians in British Columbia, there are more PHC-related registered nurses, and visa versa.Th ese analyses identify and describe the province’s PHC phy-sicians, and illustrate temporal shift s in their supply. However, current policy and planning activities require more infor-mation than head counts and demographic trends. Future reports by our research team are intended to off er greater in-sight into other important characteristics of PHC physicians, as well as British Columbians’ use of their services.   7AUGUST 2006IntroductionTh e primary health care (PHC) sector is where patients and health care providers meet to resolve short-term health issues and manage chronic health conditions. It is also where disease prevention and health promotion activities are undertaken, and where patients in need of more specialized services are connected with secondary care. Th e unique and distinguishing features of this sector are that its providers deliver fi rst contact care, and services that are responsive, comprehensive, continu-ous and coordinated.1,2 Most individuals’ fi rst point of contact with the health care system is typically through a physician who delivers compre-hensive care over time. General practitioners most oft en fulfi ll this role for Canadians. It has become increasingly evident, however, that general practitioners may elect to narrow their activities to certain specialized services or deliver care exclu-sively in institutional settings such as emergency departments. For example, it been estimated that 15 per cent to 20 per cent of general practitioners in Manitoba do not off er comprehensive or continuous care but work almost exclusively in areas such as eye care, sports injuries or minor surgery. 3Conversely, specialists such as pediatricians, geriatricians and general internists may off er services that are fi rst contact, com-prehensive and continuous, and these physicians may be the primary coordinator of a patient’s total care. Yet, most special-ists provide episodic and specialized services almost exclusively. Th ere are also physicians who work in emergency rooms and off er fi rst contact care, but whose care is not intended to be continuous nor comprehensive. Should any or all of these phy-sicians be described as providing PHC?Since PHC is defi ned by service attributes rather than by professional discipline or location of care, the challenge is to identify physicians who deliver these services. Only then is it possible to describe the patterns of practice among these medical practitioners, the population’s use of their services, and temporal shift s in the receipt or delivery of PHC.Th is paper describes the population of PHC, PHC-related and specialist physicians in British Columbia deemed to be in active clinical practice, assesses temporal patterns of supply of this workforce, and describes the demographic characteristics and geographic dispersion of physicians in three time peri-ods. At the request of the BC Ministry of Health, we analyzed data from fi scal years that predate the Health Transition Fund (1996/97) and Primary Health Care Transition Fund (2000/01), and from the most recent period for which com-plete data were available (2004/05).Th is report relies on new methodologies developed to generate more precise estimates of the number of physicians engaged in clinical practice and most likely to deliver PHC in British Columbia. We rely, and build, upon previous methodologi-cal innovations in the province, particularly work by the BC Ministry of Health to describe physicians according to their type of practice.WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 8Analyses relied on anonymized, provincial administra-tive data housed in the BC Linked Health Database at the University of British Columbia, supplemented with data from the College of Physicians and Surgeons of British Columbia (CPSBC). Physicians were deemed to be in active clinical practice in each fi scal period if they could be identifi ed in the CPSBC database and one or more of the following billing or encounter fi les: Medical Services Plan (MSP)* billing fi les, Alternative Payments Program (APP) fi les documenting claims for individual physicians (e.g. salary, sessional, on call payments),‡ Primary Health Care Organizations encounter fi les, and the Hospital Discharge Abstracts Database. 4Importantly, we excluded physicians appearing in the CPSBC fi le with full registered status and having a British Columbia address, but not appearing in the above-mentioned service fi les (n=471 in 2004/05). Of this group, 45 per cent were regis-tered as general practitioners and likely engaged in non-clini-cal work (e.g. administration, education, research) or deliv-ered clinical care through service agreements funded by APP or solely funded by a health authority. Service agreements under APP fund group practices and other organizations, and it is not possible to identify physicians remunerated solely through these entities.   We used two existing variables, each developed by the BC Ministry of Health and the CPSBC, to classify physicians. A three-step process was undertaken to categorize physi-cians relative to their delivery of PHC by combining data about their registered specialty with information regarding their type of practice. First, each physician was assigned to one of three mutually exclusive groups using information regarding their most recent registered specialty (MRRS). Th e MRRS designation is assigned by the CPSBC to refl ect each practitioner’s self-reported specialty, and is available in the MSP Practitioner File. Th e three mutually exclusive groups were: (1) general practitioners; (2) PHC-related specialties such as obstetrics and gynecology, pediatrics, geriatric medicine, general internal medicine and emer-gency medicine; and (3) other specialties such as derma-tology, neurology and pathology. Second, each physician was assigned to one of three mutu-ally exclusive groups using information regarding their type of practice. Th e type of practice designation represents a physician’s functional specialty. It is a variable developed and computed by the Ministry of Health, and is derived from the analyses of billing practices. One of the unique features of the fee-for-service schedule in British Columbia is that billable fee items, with a small number of exceptions, are assigned to a specialty group. By classifying each fee item that a practitioner has billed, their type of practice is determined by identifying the specialty group under which most of the fee items are billed.5  Th is variable is computed annually and is available in the MSP Practitioner File. Over time, some practice codes have been added or become obsolete.  Th e three mutually exclusive type of practice groups were: (1) PHC physicians, which includes medical practitioners with a type of practice designation such as general practice and Pri-mary Health Care Organization physician; (2) PHC-related physicians, which includes medical practitioners with a type of practice designation such as pediatrics, geriatric medicine, general internal medicine, emergency medicine; and (3) other specialists, which includes medical practitioners with a type of practice designation such as dermatology, neurology or pathology. Methods* Th e Medical Services Plan is the funding mechanism used in British Columbia to insure medically necessary services provided by physicians and supplementary health care practi-tioners, laboratory services, and diagnostic procedures. Under the Plan’s billing system, the government pays providers on a fee-for-service basis. ‡ Th e Alternative Payments Program includes two types of claims: remuneration to individual physicians (e.g. claims for salary, sessional, on call, call back 3 hour minimum, call back) and payments made to service organizations. In 2004/05 payments made through the Rural Retention Program and Medical On-Call Availability Program were not included in the Program’s database.  9AUGUST 2006Physicians registered as general practitioners may be classi-fi ed in the PHC-related or specialist type of practice catego-ries in instances where their billing patterns suggest they are functioning in a more focused or specialized area of practice. Appendix 5 summarizes the classifi cation system used in these two steps.Th e third step of classifi cation involved a cross tabulation of MRRS and type of practice in order to cluster physicians into nine discrete groups. Once categorized in this manner, physicians who hold diff erent specialty designations can be described in ways relevant to understanding their contribu-tion to PHC and related services. Our assumption is physi-cians who have a PHC type of practice, irrespective of their specialty designation, represent the bulk of the physician workforce in this sector. Th is report focuses on the workforce of physicians deemed to have a PHC type of practice. Th is population can include general practitioners and other specialists.  Since many health system policy-makers, managers and planners are also interested in the workforce of general practitioners, we briefl y describe the degree to which physicians with this designation have a PHC, PHC-related or specialist type of practice. In order to better understand features of the workforce and geographic dispersion of physicians, we describe the demo-graphic characteristics of PHC physicians and calculate crude ratios per 100,000 population. Denominators were derived from BC Stats PEOPLE 28 and PEOPLE 30 estimates. Infor-mation is provided at the provincial, regional health authority and health service delivery area level. Physicians were as-signed to jurisdictions on the basis of addresses selected from the CPSBC and the MSP Practitioner File using methods described elsewhere.6 We off er sensitivity analyses regarding assignment of physicians to health regions, since these data sources off er an array of potential offi  ce addresses.Physician-to-population ratios were not adjusted to account for diff erences in the age, gender or case-mix structure of regional populations. We did, however, analyze the distribu-tion of physicians relative to population health status. A key aspect of planning for PHC renewal is determining how well the current system responds to the health service needs of the populations it serves. Th erefore, we measured the associa-tion between physician-to-population ratios and the health service needs of the populations who reside in the same jurisdiction. We used premature mortality rate as the primary measure of relative need for health care, since it is generally recognized as the best indicator of population health status7 and has a high level of association with other measures of morbidity.8We measured local supply of PHC physicians and prema-ture mortality rate at concurrent points of time and used the Pearson correlation coeffi  cient to assess the degree of association. Th is report uses premature mortality rate as an ordering framework (from high need to low need) for relevant graphics in the appendices. Th e level and geographic distribution of premature mortality rate in British Columbia, and its association with other measures of health care use, are described in previous Centre for Health Services and Policy Research publications, the British Columbia Health Atlas (2nd edition) and Planning for Renewal: Mapping PHC in British Columbia.WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 10FindingsProvincial LevelIn 2004/05 there were 8,558 physicians in clinical practice in British Columbia, which equates to approximately 204 physi-cians per 100,000 population or 490 people per physician. Table 1 and Figure 1 categorize these physicians by MRRS and type of practice. Appendix 1 shows a similar graphic for each health authority in 2004/05.  Type of practice GPPHC-related specialtyOther specialty TotalPHC Physician 4,233 87 85 4,405PHC-related Physician 412 1,061 81 1,554Other  specialist 52 49 2,498 2,599Total 4,697 1,197 2,664 8,558Table 1: Physicians in Clinical Practice by Type of Practice (TOP) and Most Recent Registered Specialty (MRRS), 2004/05Source for Table 1 and Figure 1: Physician counts: MSP practitioner informa-tion fi le, MSP payment information masterfi le (for fee for service data), Hos-pital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05.PHC-related specialty includes the following MRRS codes: ObGyn, pediat-rics, internal medicine, geriatric medicine, and emergency medicine. PHC physician includes the following TOP specialties: GP, GP (miscellaneous), GP alternative payments at 50%+, PHCO physician, salaried or contract. PHC-related physician includes the following TOP specialties: ObGyn, pediatrics, internal medicine, geriatric medicine, emergency medicine, GP-anesthesia 35%+, methadone program, GP surgical assistant 35%+, GP ObGyn 35%+, and gerontology GP 45%+.Figure 1: Physicians in Clinical Practice by Type of Practice (TOP) and Most Recent Registered Specialty (MRRS), 2004/05               PHC type of  practiceOther specialty type of practicePHC-related type of practiceGeneral practitionerOther specialtyOther specialtyOther specialtyGeneral practitionerPHC-related specialtyPHC-related specialtyGeneral practitionerPHC-relatedspecialtyTypes of PhysiciansIn 2004/05 there were 4,405 PHC physicians in British Columbia, which equates to approximately 105 physicians per 100,000 population, or 953 people per physician. Th ey accounted for the largest portion (51%) of the clinical physi-cian workforce in the province (Figure 1). Th ey represented a very large proportion of the clinical physician workforce in Northern Health Authority (67%) and smaller proportions in Interior (58%), Fraser (54%), Vancouver Island (54%) and Vancouver Coastal (43%) (Appendix 1). Crude ratios of PHC physicians to population ranged from 130 per 100,000 in Vancouver Coastal Health Authority to 77 per 100,000 in Fraser Health Authority. PHC physician supply also varied within each health authority. Vancouver Coastal had the largest variability across its health service delivery areas, with 153 PHC physicians per 100,000 in Vancouver and 80 per 100,000 in Richmond. Fraser Health Authority had the lowest variation across its health services delivery areas, with Fraser North and Fraser South at 81 and 72 PHC physicians per 100,000, respectively.  Appendices 3 and 4 illustrate variability in PHC physician supply across health authorities and health service delivery areas.  Of the workforce of practitioners deemed to be PHC physicians in 2004/05: • 96 per cent were registered as general practitioners (n=4,233);• two per cent had a specialty designation related to PHC (n=87) including pediatrics, obstetrics/gynecology, geri-atrics, general internal medicine or emergency medicine. Not all physicians with these registered specialities were  11AUGUST 2006deemed to be PHC physicians, only those with a general type of practice. Table 1 classifi es these physicians accord-ing to whether their work was deemed to be PHC, related to PHC or specialized;•  and two per cent had another specialty designation (n=85).  Th e vast majority (90%) of physicians with a general prac-titioner designation were deemed to be PHC physicians (n=4,233). Nine per cent had a type of practice related to PHC (n=412) and one per cent had a type of practice associ-ated with other specialists (n=52). Of the workforce of physi-cians with a specialty designation deemed to be PHC-related, seven per cent had a PHC type of practice (n=87). Of the physicians with other specialty designations, three per cent had a PHC type of practice (n=85).Appendices 1, 3 and 4 illustrate the proportion of physicians (and PHC physicians in particular) by specialty designation at the provincial and health authority levels. Demographic StructureAmong the workforce of PHC physicians in 2004/05, 66 per cent were male and 34 per cent were female. In terms of age structure, two per cent were between 20 and 29 years old, 21 per cent were between 30 and 39 years old, 34 per cent were between 40 and 49 years old, 28 per cent were between 50 and 59 years old, 11 per cent were between 60 and 69 years old, and four per cent were over 70 years old. Younger age categories contained higher proportions of female physi-cians—in the 20 to 29 year age cohort, females made up 61 per cent of the PHC physician workforce. Among the 30 to 39, 40 to 49, 50 to 59 and 60 to 69 year age groups, females made up 46 per cent, 41 per cent, 26 per cent and 13 per cent of PHC physicians, respectively. Appendices 2 and 4 illustrate the demographic structure of the PHC physician workforce by health authority. Figure 2: PHC Physicians in British Columbia by Ageand Sex, 2004/0520-2930-3940-4950-5960-6970-7980-89FemalesMalesNumber of PHC physiciansPhysician age03006009001,2001,500Source: Physician counts: MSP practitioner information fi le, MSP pay-ment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Minis-try of Health 2004/05 data; CPSBC 2004/05.WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 12Distribution Relative to Population Health StatusIf PHC physicians were equitably distributed across the province, we would expect areas with low population health status (high premature mortality rate) to have a higher level of physician supply to meet their additional needs. Conversely, areas with high population health status (low premature mortality rate) would have lower levels of physician supply. Th is would be displayed as a strong, posi-tive association between physician-to-population ratios and premature mortality rate. In 2004/05, there was no association (Pearson coeffi  cient = 0.22, p = 0.47) between the supply of PHC physicians and premature mortality rate across the province (Figure 3). Th ere seems to be no clear link between the geographic dispersion of PHC physicians and the health care needs of populations who reside in their jurisdiction. Figure 3: Crude Ratio of PHC Physicians to 100,000Population Relative to Premature Mortality Rate, 2004/05Standardized premature mortality rate per 1,000 pop.(1996-2000)00501001502001 2 3 4Crude ratio of PHC physicians per 100,000 pop. Health servicedelivery areasTrends Over Time in Physician Supply Between 1996/97 and 2000/01, the workforce of physi-cians in clinical practice in British Columbia increased by 288 medical practitioners (4% relative increase) and the province’s population increased by approximately 220,000 (6% relative increase). While there were in-creases across all physician categories, the smallest gain  occurred in the PHC workforce (23 physicians or 1% relative increase). The supply of PHC-related specialists also increased (52 physicians or 4% relative increase), but the largest gains were among other specialists (213 physicians or 10% relative increase). This pattern of large gains in specialists relative to PHC physicians was evident in all health authorities (Appendix 1). Over the entire timeframe studied (1996/97 to 2004/05) the workforce of physicians in clinical practice in British Columbia increased by 1,024 medical practitioners (14% relative increase) and the population increased by approxi-mately 314,000 (8% relative increase). While there were increases across all physician categories, the smallest gain was in the PHC workforce (276 physicians or 7% relative increase). Th e supply of PHC-related specialists increased (275 physicians or 22% relative increase), but the largest gains were among other specialists (473 physicians or 22% relative increase). Th is pattern of large gains in special-ists relative to PHC physicians was evident in all health authorities (Appendix 1). In 1996/97 there were 4,129 PHC physicians in British Columbia, which translates to 106 PHC physicians per 100,000 population. By 2000/01, there were 4,152 PHC physicians or 101 PHC physicians per 100,000. By 2004/05, there were 4,405 PHC physicians or 105 PHC physi-cians per 100,000. Th is represents a fi ve per cent relative decrease in supply of PHC physicians between 1996/97 and 2000/01 and a four per cent relative increase between 2000/01 and 2004/05. Over the eight years, there were sub-stantive gains and losses in PHC physicians across health authorities and health service delivery areas (Appendix 3). Source: Physician counts: MSP practitioner information fi le, MSP pay-ment information masterfi le (for fee-for-service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Min-istry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats. PMR: BC Vital Statistics Agency; Hospital separations data, BC Ministry of Health. 13AUGUST 2006Table 2 illustrates that the magnitude of physician gains and losses are attenuated, but only somewhat, depending on the methodology of geographic assignment. Th e tallies in the fi rst column are the result of newly developed meth-ods that rely primarily on addresses in CPSBC fi les. When physicians complete annual questionnaires for the College, they disclose work addresses (we selected the most recent). When a work address was not available, we used the ad-dress identifi ed in the MSP fi le. Th e tallies in the second column of Table 2 rely on addresses identifi ed in the MSP fi le as being used for billing and payment.Table 2: Sensitivity Analyses Contrasting Address Information from Two Sources on the Number of PHC Physicians Gained or Lost in Each Health Authority Between 1997/97 and 2000/01Primary source of data used to assign PHC physicians to jurisdictionsHealth authority CSPBC MSPFraser Health +8 -13Vancouver Coastal -82 -46Vancouver Island +45 +44Interior Health +52 +38Northern -2 +3Total +23 +23Temporal shift s in the size of the workforce and/or population resulted in substantive shift s in PHC physician supply in Vancouver Coastal and Fraser health authori-ties. Between 1996/97 and 2004/05, the crude supply of PHC physicians in Vancouver Coastal Health Authority declined from 152 to 130 per 100,000 population (14% relative decline) due to increases in population and loss of physicians (Appendix 3). Th is level of supply, however, remained among the highest across the health authorities. Over the same period, the crude supply in Fraser Health Authority declined from 78 to 77 per 100,000 population (2% relative decline) due to increases in population that outpaced increases in physician supply. Th is level of sup-ply was lowest among the health authorities in both time periods (Appendix 3). Th is analysis is provider based and relates the geographic location of PHC physicians to the size of the population that reside in the same area. It does not consider whether populations cross health authority boundaries to obtain care (which previous work indicates does occur). Th ere-fore, a population-based analysis is necessary to fully understand the utilization of services provided by PHC physicians. Future reports by our research team are in-tended to off er greater insight into this issue.  Fraser Health AuthorityIn 2004/05, 2,043 physicians engaged in clinical practice and had a practice address within Fraser Health Author-ity. Of these, 54 per cent were PHC physicians (n=1,107), which equates to 77 PHC physicians per 100,000 popula-tion. PHC physician-to-population ratios show the least variation in Fraser Health and are among the lowest in the province. Fraser North, Fraser East and Fraser South health services delivery areas have 81, 79 and 72 PHC phy-sicians per 100,000 population, respectively (appendices 3 and 4).  Previous research suggests that residents of this authority are among the healthiest in British Columbia. However, there was two-fold variation in health status measures within Fraser Health Authority. Th e local health area of Hope, with its small and dispersed population, showed the lowest health status, with a premature mortality rate Source: Physician counts: MSP practitioner information fi le, MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 14of 4.12 per 1,000 between 1996 and 2000. By comparison, Delta had a premature mortality rate of 2.18 per 1,000 between 1996 and 2000.  Among the workforce of PHC physicians in Fraser Health Authority in 2004/05, 97 per cent had a general practitioner designation, two per cent had a specialty designation related to PHC, and one per cent had other specialty designations. Among the PHC physician workforce, 70 per cent were male and 30 per cent were female (appendices 2 and 4). Vancouver Coastal Health AuthorityIn 2004/05, 3,113 physicians engaged in clinical practice and had a practice address within Vancouver Coastal Health Authority. Of these, 43 per cent were PHC physi-cians (n=1,352), which equates to 130 PHC physicians per 100,000 population. Th ere was almost a two-fold variation in PHC physician-to-population ratios across health ser-vice delivery areas in Vancouver Coastal Health Authority, with Vancouver at 153 PHC physicians per 100,000 and Richmond at 80 per 100,000 (appendices  3 and 4). Popu-lations outside of the Vancouver Health Service Delivery Area, however, are likely to use PHC physicians who reside in that jurisdiction.  Among the workforce of PHC physicians in Vancouver Coastal Health Authority in 2004/05, 94 per cent were gen-eral practitioners, three per cent had specialty designations related to PHC, and three per cent had other specialty designations. Among the PHC physician workforce, 58 per cent were male and 42 per cent were female (appendices 2 and 4).  Vancouver Island Health AuthorityIn 2004/05, 1,689 physicians engaged in clinical prac-tice and had a practice address within Vancouver Island Health Authority. Of these, 54 per cent were PHC physicians (n=907), which equates to 128 general prac-tice providers per 100,000 population. There is some variation in supply across health service delivery areas, with South Vancouver Island at 151 PHC physicians per 100,000 and Central Vancouver Island at 98 per 100,000 (appendices 3 and 4). Among the workforce of PHC physicians in Vancouver Island Health Authority in 2004/05, 97 per cent had a general practitioner designation, one per cent had spe-cialty designations related to PHC, and two per cent had other specialty designations. Among the PHC physician workforce, 68 per cent were male and 32 per cent were female. PHC physicians in Vancouver Island Health Authority were older compared to the provincial average. Th e proportion of physicians aged 50 years and older was 49 per cent, in comparison to 43 per cent for the province (appendices 2 and 4).  Interior Health AuthorityIn 2004/05, 1,278 physicians engaged in clinical practice and had a practice address within Interior Health Author-ity. Of these, 58 per cent were PHC physicians (n=747), which equates to 106 PHC physicians per 100,000 popula-tion. Th ere was variation in supply across health service delivery areas, with Kootenay-Boundary at 134 PHC physicians per 100,000 and Th ompson-Cariboo at 90 per 100,000 (appendices 3 and 4). Among the workforce of PHC physicians in Interior Health Authority in 2004/05, 98 per cent had a general practitioner designation, one per cent had a specialty designation related to PHC, and one per cent had other specialty designations. Among the PHC physician work-force, 68 per cent were male and 32 per cent were female. PHC physicians in Interior Health Authority were younger than the provincial average, as the proportion of physicians aged 50 years and older was 38 per cent, compared to 43 per cent for British Columbia (appendices 2 and 4). Northern Health AuthorityIn 2004/05, 435 physicians engaged in clinical practice and had a practice address in Northern Health Authority. Of these, 67 per cent were PHC physicians (n=292), which equates to 96 PHC physicians per 100,000 population. Th ere is some variation in supply across health service delivery areas, with Northwest at 108 PHC physicians per 100,000 and Northeast at 77 per 100,000 (appendices 3 and 4). Relative to the provincial workforce and other health authorities, Northern Health Authority had the highest proportion of PHC physicians.  15AUGUST 2006Among the workforce of PHC physicians in Northern Health Authority in 2004/05, 97 per cent had a general practitioner designation, one per cent had a specialty designation related to PHC, and one per cent had other specialty designations. PHC physicians in the Northern Health were less likely to be female and more likely to be younger. Only 23 per cent were female. Th e proportion of this workforce aged 50 years and older was 39 per cent, in comparison to 43 per cent for the province (appendices 2 and 4).Of the physician workforce who had a type of practice similar to specialists (n=99) in Northern Health, 13 per cent had a family physician designation. Th is is a very high rate when compared to the province as a whole, where only two per cent of the workforce with a type of practice similar to specialists had a family physician designation.Th ere were 8,558 physicians engaged in part- or full-time clinical practice in British Columbia in 2004/05 (204 physicians per 100,000 population or 490 people per physician). Among this provincial workforce, 51 per cent were PHC physicians (105 per 100,000 population or 953 people per physician). Across health authorities, PHC physicians represented a large proportion of the clinical physician workforce in Northern (67%) and a smaller pro-portion in Interior (58%), Vancouver Island (54%), Fraser (54%) and Vancouver Coastal (43%). Th e proportion of PHC physicians to total physician supply declined from 55 per cent in 1996/97 to 51 per cent in 2004/05. Th e supply of PHC physicians and mix of PHC physicians to special-ists are especially important to monitor since emerging research suggests that higher ratios of PHC physicians to population and higher rates of PHC physicians to special-ists improve health outcomes.9,10,11   One of the more intriguing fi ndings is the extent to which PHC physician supply changed at the provincial level, and the speed with which health authorities gained or lost PHC physicians over the eight-year period. Between 1996/97 and 2000/01, there was a fi ve per cent reduction in the PHC physician-to-population ratio in British Co-lumbia, and a four per cent increase between 2000/01 and 2004/05. Th is equates to a one per cent reduction in the PHC physician-to-population ratio in British Columbia over the entire time period. Importantly, this report solely focuses on head counts and relates this to the size of the population who reside in the same geographic area—we do not assess physician productivity nor the delivery of services to patients from other jurisdictions or other providers. Future reports by CHSPR researchers will assess temporal shift s in aggregate supply using metrics of vol-ume and productivity, as well as population-based patterns of use of physician services. Th e most notable reduction in supply between 1996/97 and 2004/05 occurred in Vancouver Coastal (14% rela-tive decline), but this health authority retained the highest PHC physician-to-population ratio in 2004/05 (130 per DiscussionWHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 16100,000) in the province. Th e second largest reduction in supply occurred in Fraser Health (2% relative decline), and this health authority had the lowest level of supply in 2004/05 (77 per 100,000). Supply increased in Northern Health Authority (7% relative increase), Interior Health Authority (12% relative increase) and Vancouver Island Health Authority (13% relative increase). Temporal shifts in the number of PHC physicians in clinical practice are attributable to a number of fac-tors. At the provincial level, change can be attributed to immigration and emigration across jurisdictions, as well as workforce entrants and exits. At the health authority level, change can be attributed to migration within the province, workforce entrants and exits, as well as physicians who relocate their practice to another health region in the province. At the provincial and health authority levels, change can be attributed to the fact that physicians change specialty designations and practice patterns over time. If health authorities seek to determine the underlying causes of the temporal shifts in supply highlighted in this report, CHSPR has data sources that support this type of work.The validity of geographic-based analyses relies on the completeness and accuracy of data regarding each physician’s clinical practice location. The data sources used to create this report contain a number of addresses for each physician. The challenge was to select the geographic location from which each physician deliv-ers the majority of their services, when we know some physicians work from multiple locations, potentially across jurisdictions. This report relies on newly created methods to assign physicians to jurisdictions based on CPSBC self-report data regarding workplace. Sensitiv-ity analysis conducted on our findings regarding gains or losses of PHC physicians across health authorities suggests that our estimates are somewhat attenuated using more traditional methods of assigning physicians to jurisdictions using billing data. The BC Ministry of Health has established methods of assigning physicians to geographic locations based on the health authority from which the majority of their patients are derived. Future work might compare (cross-validate) these ap-proaches to assess the robustness of the findings pre-sented here, and to learn more about the geographic distribution of physician supply and delivery of medical services.Across health authorities, there was almost a two-fold vari-ability in PHC physician supply in 2004/05, with Vancou-ver Coastal Health Authority at 130 per 100,000 and Fraser Health Authority at 77 per 100,000. Variability was also dramatic across health service delivery areas, with Vancou-ver at 153 per 100,000 population and Fraser South at 72 per 100,000 population. But, it is important to juxtapose measures of supply with geographic diff erences in relative need for health care. Th erefore, we took a glimpse at the level of equity in geographic distribution of PHC physi-cians relative to population health status. Across all health service delivery areas in the province, we found no association between PHC physician supply and British Columbians’ need for health care in 2004/05—com-munities with lower levels of health did not have more PHC physicians, and communities with higher levels of health did not have f ewer PHC physicians. Our team has previously documented disparities in geographic distribu-tion of PHC physicians, but at that time we also document-ed equity in utilization of PHC services. In combination, these results suggest that people move across jurisdictional boundaries to obtain the PHC services they need. Th e extent of this mobility has been estimated in a report our research group released in early 2005.12When counts of PHC-related registered nurses and PHC physicians were combined in another CHSPR report,13 variability in supply among the workforce of nurses or physicians is attenuated. Where there are fewer PHC physicians in British Columbia, there are more PHC-related registered nurses, and visa versa. In 2000/01, we counted 3,179 registered nurses and 4,152 physicians that provided PHC-related services in British Colum-bia—registered nurses represented 43 per cent of the PHC workforce of physicians and nurses at a period of time that predates policy objectives to enhance the interdisciplinary mix of providers delivering PHC.   17AUGUST 2006It is also interesting to consider the workforce of physi-cians registered as general practitioners in 2004/05, since anecdote and evidence indicate that many of these physicians may elect to narrow their activities to certain specialized services. We determined that 90 per cent of these physicians had a PHC type of practice, nine per cent had a type of practice related to PHC, and one per cent had a type of practice associated with other specialities in 2004/05. Th is compares to 92 per cent, eight per cent, and 0.1 per cent, respectively in 1996/97, which suggests slow movement toward sub-specialization within the general practitioner workforce.Using new methodology, these analyses identify and describe the supply of physicians in order to identify those most likely to deliver PHC. Moreover, we focus on those who deliver clinical services. It is important to acknowl-edge, however, that population-based administrative data sources have not yet been suffi  ciently developed to substantiate the degree to which physicians deliver all of the core functions of PHC—fi rst contact care, and ser-vices that are responsive, comprehensive, continuous and coordinated.  While this report focuses on counting the number of PHC physicians in historic periods, current policy and plan-ning activities related to PHC require more information than head counts and demographic trends. Future reports by our research team are intended to off er greater insight into the workloads and other important features of general type of practice physicians, as well as the population’s use of their services. Th at work will rely on the methods described here. As mentioned, the unique and distinguishing features of PHC physicians is that they deliver fi rst contact care, and services that are responsive, comprehensive, continuous and coordinated. In an attempt to identify, count and de-scribe PHC physicians, these analyses rely on billing pat-terns to determine type of practice or functional specialty. Th is method of identifying PHC physicians was adopted due to the unique structure of administrative data in Brit-ish Columbia. Th e use of other methods might be appro-priate in order to validate or refi ne this work. For example, one author of this report (Watson) has described the comprehensiveness of services delivered by general practi-tioners by assessing the frequency and scope of diagnostic codes used by physicians in Manitoba.14 Physicians’ role in delivering PHC could also be described by assessing referral patterns to determine the degree to which physi-cians are the fi rst point of contact. However, this type of work is only worthwhile if it is a priority among the policy, management and practice communities.  Th ere is still much to learn about the health of British Co-lumbians and the many facets of their PHC system. Th ere is also much work to be done to improve the administra-tive data infrastructure in British Columbia—particularly in relation to data from alternative funding sources and the timeliness of those data—to support PHC planning and evaluation. Future reports by our research team are intended to off er greater insight into other important char-acteristics of PHC physicians, as well as British Columbi-ans’ use of their services. WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 18References1  Starfi eld, B. Primary care: concept, evaluation and policy. New York: Oxford University Press: 1992.2  Watson DE, Broemeling A-M, Reid RJ, Black C. A re-sults-based logic model for PHC: Users guide to a re-sults-based logic model for PHC: Laying an evidence-based foundation to guide performance measurement, monitoring and evaluation. Centre for Health Services and Policy Research. Vancouver, British Columbia: 2004.3  Watson DE, Bogdanovic B, Heppner P, Katz A, Reid R, Roos N. Supply, availability and use of general prac-titioners in Winnipeg [monograph on the Internet]. Winnipeg (MB): Manitoba Centre for Health Policy, University of Manitoba; 2003 [cited 2005 Feb 10]. Available from: http://www.umanitoba.ca/centres/mchp/reports/pdfs/famphys.pdf4  Watson DE et al. . Methods to develop and validate a physician resource database to support health services and policy research. Centre for Health Services and Policy Research. Vancouver, British Columbia: 2006.5  Starr D. Verhulst L. A guide to the interpretation of the Medical Services Plan practitioner profi les. British Columbia Ministry of Health. Victoria, British Colum-bia: 2003. 6  McKendry R. Watson D. Goertzen D. Reid RJ. Mooney D. Solo and group practice among physi-cians who have a general type of practice, 1996/97 and 2000/01. Vancouver, BC: Centre for Health Services and Policy Research. Vancouver, British Columbia: Forthcoming.7  Birch S, Eyles J. (1991). Needs-based planning of health care: A critical appraisal of the literature. Ham-ilton, ON: Centre for Health Economics and Policy Analysis, McMaster University. Report no. 91-5.8  McGrail KM, Schaub P, Black C. Th e British Colum-bia Health Atlas. 2nd ed. Vancouver (BC): Centre for Health Services and Policy Research, University of British Columbia; 2004. Report No. CHSPR 04:12. Available from http://www.health-atlas.chspr.ubc.ca9  Farmer FL et al., Poverty, primary care, and age-spe-cifi c mortality. Journal of Rural Health 7, no. 2 (1991): 153-169.10  Shi L. Primary care, specialty care, and life chances. In-ternational Journal of Health Services 24, no. 3 (1994): 431-458.11 Shi L, Macinko J, Starfi eld B, Politzer R. Xu J. Primary care, race, and mortality in US states. Social Science & Medicine 61 (2005) 65-75.12  Watson DE, Krueger H, Mooney D, Black C. Planning for renewal: Mapping PHC in British Columbia. Cen-tre for Health Services and Policy Research. Vancou-ver, British Columbia: 2005.13  Wong ST, Watson DE, Young E, Mooney D, MacLeod M. Who are the primary health care registered nurses in British Columbia? [monograph on the Internet]. Vancouver (BC): Centre for Health Services and Policy Research.  14  Watson DE, Bogdanovic B, Heppner P, Katz A, Reid R, Roos N. Supply, availability and use of general prac-titioners in Winnipeg [monograph on the Internet]. Winnipeg (MB): Manitoba Centre for Health Policy, University of Manitoba; 2003 [cited 2005 Feb 10]. Available from: http://www.umanitoba.ca/centres/mchp/reports/pdfs/famphys.pdf 19AUGUST 2006 20WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCHAppendix 1: Physicians in Clinical Practice by Type of Practice and Most Recent Registered Specialty, 2004/05British ColumbiaN=8,558Fraser HealthN=2,043Interior HealthN=1,278 Northern HealthN=435Vancouver Coastal HealthN=3,113Vancouver Island HealthN=1,689Source: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05.               PHC type of practiceOther specialty type of practicePHC-related type of practiceGeneral practitionerOther specialtyOther specialtyOther specialtyGeneral practitionerPHC-related specialtyPHC-related specialtyGeneral practitionerPHC-relatedspecialty 21JUNE 20061996/97 2004/05Most recent registered specialty ChangeType of practice GPPHC-related specialtyOther specialty Total GPPHC-related specialty Other specialty Total No. %British ColumbiaPHC physician 3,893 73 163 4,129 4,233 87 85 4,405 276 7%PHC-related physician 342 916 21 1,279 412 1,061 81 1,554 275 22%Other specialist 5 36 2,085 2,126 52 49 2,498 2,599 473 22%Total 4,240 1,025 2,269 7,534 4,697 1,197 2,664 8,558 1,024 14%FraserPHC physician 955 8 28 991 1,072 21 14 1,107 116 12%PHC-related physician 86 179 2 267 115 221 16 352 85 32%Other specialist 1 7 439 447 10 12 562 584 137 31%Total 1,042 194 469 1,705 1,197 254 592 2,043 338 20%Vancouver Coastal PHC physician 1,323 47 88 1,458 1,271 42 39 1,352 -106 -7%PHC-related physician 102 468 14 584 125 502 45 672 88 15%Other specialist 2 17 932 951 8 22 1,059 1,089 138 15%Total 1,427 532 1,034 2,993 1,404 566 1,143 3,113 120 4%Vancouver IslandPHC physician 734 10 24 768 877 11 19 907 139 18%PHC-related physician 97 136 4 237 108 182 12 302 65 27%Other specialist - 8 378 386 8 9 463 480 94 24%Total 831 154 406 1,391 993 202 494 1,689 298 21%Interior PHC physician 617 6 10 633 729 9 9 747 114 18%PHC-related physician 49 106 1 156 52 125 7 184 28 18%Other specialist 1 4 264 269 13 6 328 347 78 29%Total 667 116 275 1,058 794 140 344 1,278 220 21%Northern PHC physician 264 2 13 279 284 4 4 292 13 5%PHC-related physician 7 27 0 34 12 31 1 44 10 29%Other specialist 1 0 70 71 13 0 86 99 28 39%Total 272 29 83 384 309 35 91 435 51 13%Missing locationPHC physician 0 0 0 0 0 0 0 0 0 -PHC-related physician 1 0 0 1 0 0 0 0 -1 -Other specialist 0 0 2 2 0 0 0 0 -2 -Total 1 0 2 3 0 0 0 0 -3 -Physicians in Clinical Practice by Type of Practice and Most Recent Registered Specialty, 1996/97 to 2004/05Source: Physician counts: MSP practitioner information fi le, MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05.PHC-related specialty includes the following MRRS codes: ObGyn, pediatrics, internal medicine, geriatric medicine, and emergency medicine. Primary health care physician includes the following TOP specialties: GP, GP (miscellaneous), GP alternative payments at 50%+, PHCO physician, salaried or contract. PHC-related physician includes the following TOP specialties: ObGyn, pediatrics, internal medicine, geriatric medicine, emergency medicine, GP-anesthesia 35%+, methadone program, GP surgical assistant 35%+, GP ObGyn 35%+, and gerontology GP 45%+. 22Appendix 2: PHC Physician Demographics by Health Authority, 2004/05WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH050150200250300350400450FemalesMalesFraser HealthPHC physicians by age and sexNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician age100Fraser HealthPHC physicians by sexMalesFemalesVancouver Coastal HealthPHC physicians by age and sex050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageVancouver Coastal HealthPHC physicians by sexFemalesMalesSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. 23JUNE 2006Northern HealthPHC physicians by age and sex050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageVancouver Island HealthPHC physicians by age and sex050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageInterior HealthPHC physicians by age and sex050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageVancouver Island HealthPHC physicians by sexFemalesMalesInterior HealthPHC physicians by sexFemalesMalesNorthern HealthPHC physicians by sexFemalesMalesSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. 24Appendix 3: PHC Physicians by Health Service Delivery                      Area, 2004/05WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCHThe crude ratio of primary health care (PHC) physicians per 100,000 population was calculated by dividing the number of these physicians in each health service delivery area by the total popula-tion in that area. Physician counts were derived from the Medical Services Plan practitioner and payment information files, as well as hospital, primary health care organizations and alternative payments to physicians data. Population counts were derived from PEOPLE 30.The ‘type of practice’ identifier was used to identify doctors who practice as PHC physicians. On the following pages, we further examine these PHC physi-cians by detailing their most recent reported specialties.CoastalNorth Shore -Coast GaribaldiFraser NorthFraser SouthRichmondVancouver FraserVancouverHealth service delivery areaHealth authority120130140150708090100110VancouverSouth IslandKootenay BoundaryEast KootenayNorth IslandN. Shore/Coast Gar.NorthwestOkanaganCentral IslandNorthern InteriorThompson CaribooFraser NorthRichmondFraser EastNortheastFraser South1531511341311211131081049898908180797772Data classified by natural breaks (Jenks optimization algorithm)Health service delivery areaNameCrude Ratio of PHC physicians per 100,000 pop. Vancouver         IslandNorthernPart ofVancouverCoastalInteriorVancouverCoastalFraserNorthern InteriorNortheastNorthwestThompson - CaribooEastKootenayKootenay -BoundaryOkanaganPart ofNorth Shore -Coast GaribaldiNorth IslandCentral IslandNorth Shore -Coast GaribaldiFraser EastSouthIslandSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats. 25Appendix 3: PHC Physicians by Health Service Delivery                      Area, 2004/05JUNE 2006This map shows BC’s health service delivery areas sized by their population instead of their area. Shape and contiguity is preserved as much as possible. An area the size of this square     is equivalent to 2,000 people (2001).VancouverSouth IslandCentralIslandNorth IslandN. Shore/Coast GaribaldiNorthwestNortheastThompsonCaribooOkanaganFraser EastKootenayBoundaryEastKootenayRichmondFraser SouthFraser NorthNorthernInteriorPHC physicians: crude ratio per 100,000 population708090100110120130140150Individual HSDA valueOverall HA valueFraser NorthFraser EastFraser SouthRichmondN. Shore-Coast Gar.Central I.Thompson-CaribooOkanaganNortheastNorthernInteriorNorthwestE. KootenayKootenay-BoundaryNorth I.South I.VancouverStandardized premature mortality rate per 1,000 pop.(1996-2000)00501001502001 2 3 4Crude ratio of PHC physicians per 100,000 pop. Health servicedelivery areasPHC physicians: crude ratio per 100,000 population and standardized premature mortality rate (PMR)PHC physicians: crude ratio per 100,000 populationPHC physicians: crude ratio per 100,000 populationCrude ratio151-15372-8190-98104-113121-134BCOverallFraser VancouverCoastalVancouverIsland Interior NorthernSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats. PMR: BC Vital Statistics Agency; Hospital separations data, BC Ministry of Health; PEOPLE 28, BC Stats, all 1996-2000 data.General practitioner PHC-relatedspecialistFraser HAVancouver Coastal HAVancouver Island HAInterior HANorthern HABritish ColumbiaRichmondN. Shore/Coast Gar.Fraser SouthOkanaganFraser NorthSouth IslandCentral IslandFraser EastEast KootenayVancouverNorth IslandKootenay BoundaryThompson CaribooNortheastNorthern InteriorNorthwestPHC physicians: head counts and proportions by most recent registered specialty (MRRS)HSDAs amd HAs are ordered by premature mortality rate (PMR)Number of physicians:1500 1000 50 90%20%10% 15%5%0% 95% 100%0Types of physicians (MRRS), by percent of HSDA workforce:Otherspecialist 26WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCHPopulation PHC Physicians Ratio per 100,000HSDA1996/97 2004/05 % Change 1996/97 2004/05 Change 1996/97 2004/05%ChangeFraserFraser South 542,707 626,227 15% 387 454 67 71 72 2%Fraser North 489,636 554,439 13% 420 447 27 86 81 -6%Fraser East 231,345 260,161 12% 184 206 22 80 79 0%Overall 1,263,688 1,440,827 14% 991 1,107 116 78 77 -2%Vancouver Coastal Richmond 155,005 172,714 11% 142 139 -3 92 80 -12%N. Shore - Coast Gar. 255,139 271,082 6% 289 305 16 113 113 -1%Vancouver 546,211 593,174 9% 1,027 908 -119 188 153 -19%Overall 956,355 1,036,970 8% 1,458 1,352 -106 152 130 -14%Vancouver IslandSouth Vancouver Island 331,761 346,523 4% 421 523 102 127 151 19%Central Vancouver Island 233,459 247,461 6% 221 243 22 95 98 4%North Vancouver Island 116,744 116,596 0% 126 141 15 108 121 12%Overall 681,964 710,580 4% 768 907 139 113 128 13%Interior Okanagan 295,007 323,396 10% 271 335 64 92 104 13%East Kootenay 79,083 81,397 3% 77 107 30 97 131 35%Kootenay Boundary 81,625 79,718 -2% 92 107 15 113 134 19%Thompson Cariboo 213,880 219,483 3% 193 198 5 90 90 0%Overall 669,595 703,994 5% 633 747 114 95 106 12%Northern Northeast 64,721 66,222 2% 46 51 5 71 77 8%Northern Interior 155,508 153,760 -1% 134 150 16 86 98 13%Northwest 90,212 84,030 -7% 99 91 -8 110 108 -1%Overall 310,441 304,012 -2% 279 292 13 90 96 7%British ColumbiaOverall 3,882,043 4,196,383 8% 4,129 4,405 276 106 105 -1%Sources: Physician counts: MSP practitioner information fi le, MSP payment information master fi le (for fee-for-service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 1996/97 and 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 1996/97 and 2004/05. Population counts: PEOPLE 28 and PEOPLE 30, BC Stats.PHC Physicians by Health Service Delivery Area, Change1996/97 to 2004/05 27Chart is sized to represent the number of PHC physicians in the health authority and is divided by the MRRS of these physicians.MRRS is a PHC-related specialtyMRRS isan otherspecialtyMRRS is general practitionerN=1,107N=206N=454N=447050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageFraser EastFraser NorthFraserSouthBritish ColumbiaN=4,405N=1,107MalesFemalesSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), hospital discharge abstracts database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats.PHC physicians: Head countsPHC physicians: Head counts and proportions by most recent registered specialty (MRRS)PHC physicians: Crude ratio per 100,000 population with head counts and proportions by most recent registered specialty (MRRS)Crude ratio151-15372-8190-98104-113121-134By sex By age and sexHopeMissionMapleRidgeChilliwackAbbotsfordLangleyDeltaBurnabySurreyAppendix 4: PHC Physicians by Health Authority, 2004/05JUNE 2006PHC Physicians in Fraser Health Authority, , 2004/05 28PHC Physicians in Vancouver Coastal Health Authority, 2004/05WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCHPart of North Shore -Coast GaribaldiChart is sized to represent the number of PHC physicians in the health authority and is divided by the MRRS of these physicians.MRRS is a PHC-related specialtyMRRS isan otherspecialtyMRRS is general practitionerN=1,352N=908N=139N=305North Shore -Coast GaribaldiRichmondVancouverBritish ColumbiaN=4,405N=1,352MalesFemales050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageWest VancouverNorth VancouverPHC physicians: Head countsPHC physicians: Head counts and proportions by most recent registered specialty (MRRS)PHC physicians: Crude ratio per 100,000 population with head counts and proportions by most recent registered specialty (MRRS)Crude ratio151-15372-8190-98104-113121-134By sex By age and sexSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats.Perspective view: exact scale will varySecheltSquamishGibsonsBella Coola 29PHC Physicians in Vancouver Island Health Authority, 2004/05JUNE 2006Chart is sized to represent the number of PHC physicians in the health authority and is divided by the MRRS of these physicians.MRRS is a PHC-related specialtyMRRS isan otherspecialtyMRRS is general practitionerN=907British ColumbiaN=4,405N=141N=243N=523N=907MalesFemales050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats.PHC physicians: Head countsPHC physicians: Head counts and proportions by most recent registered specialty (MRRS)PHC physicians: Crude ratio per 100,000 population with head counts and proportions by most recent registered specialty (MRRS)Crude ratio151-15372-8190-98104-113121-134By sex By age and sexPort HardyComoxPort AlberniCampbell RiverDuncanNanaimoVictoriaCourtenayCentral IslandSouth IslandNorth IslandLadysmithParksvilleSidney 30PHC Physicians in Interior Health Authority, 2004/05WHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCHChart is sized to represent the number of PHC physicians in the health authority and is divided by the MRRS of these physicians.MRRS is a PHC-related specialtyMRRS isan otherspecialtyMRRS is general practitionerN=747N=107N=107N=198N=335ThompsonCaribooOkanaganKootenayBoundaryEastKootenayBritish ColumbiaN=4,405N=747MalesFemales050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats.PHC physicians: Head countsPHC physicians: Head counts and proportions by most recent registered specialty (MRRS)PHC physicians: Crude ratio per 100,000 population with head counts and proportions by most recent registered specialty (MRRS)Crude ratio151-15372-8190-98104-113121-134By sex By age and sexSalmon ArmVernonKamloops KelownaCranbrookWilliams LakeNelsonPenticton 31PHC Physicians in Northern Health Authority, 2004/05JUNE 2006Chart is sized to represent the number of PHC physicians in the health authority and is divided by the MRRS of these physicians.MRRS is a PHC-related specialtyMRRS isan otherspecialtyMRRS is generalpractitionerN=292N=91N=150N=51British ColumbiaN=4,405N=292MalesFemales050100150200250300350400450FemalesMalesNumber of PHC physicians20-2930-3940-4950-5960-6970-7980-89Physician ageSource: Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 2004/05); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 2004/05 data; CPSBC 2004/05. Population counts: PEOPLE 30, BC Stats.PHC physicians: Head countsPHC physicians: Head counts and proportions by most recent registered specialty (MRRS)PHC physicians: Crude ratio per 100,000 population with head counts and proportions by most recent registered specialty (MRRS)Crude ratio151-15372-8190-98104-113121-134By sex By age and sexSmithersFort St. JohnTerraceQuesnelPrince RupertPrince GeorgeFort NelsonNortheastNorthwestNorthernInterior 32Appendix 5: Type of Practice and Most Recent Registered Specialty Classifi cationsWHO  ARE  T H E  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B R I T I S H  CO LUMB I A ?CENTRE FOR HEALTH SERVICES AND POLICY RESEARCHPHC physicians  00 General Practice 55 GP (miscellaneous) 56 GP (90%+) 61 GP Alternative payments at 50%+ 63 PHCO Physician 70 Salaried physician or contactPHC-related physicians  24 Geriatric Medicine 15 Internal Medicine 52 Internal Medicine-GP at 50%+ 14 Paediatrics 27 Pediatrics-GP at 50%+ 05 Obstetrics and Gynaecology 28 Emergency Medicine 53 GP - Anesthesia 35%+ 58 Methadone Program at 10%+ 59 GP Surgical assist at 35%+ 60 GP Ob and Gyn at 35%+ 65 Gerontology GP 45% (Inc 00,22,27,52)Other specialists  01 Dermatology 02 Neurology 44 Rheumatology 45 Clinical Immunology & Allergy 26 Procedural cardiologist 06 Ophthalmology 07 Otolaryngology 09 Neurosurgery 10 Orthopaedic Surgery 11 Plastic Surgery 12 Cardio and Thoracic Surgery 13 Urology 47 Vascular Surgery 48 Thoracic Surgery 08 General Surgery 22 General Surgery-GP at 50%+ 19 Paediatric Cardiology 46 Medical Genetics 03 Psychiatry 04 Neuropsychiatry 18 Anaesthesia 16 Radiology 33 Nuclear Medicine 71 Interventional Radiology 17 Pathology 29 Medical Microbiology 21 Public Health 23 Occupational Medicine 20 Physical Medicine and RehabGeneral practitioners  00 Family PracticePHC-related specialties  24 Geriatric Medicine 15 Internal Medicine 14 Paediatrics 05 Obstetrics and Gynaecology 28 Emergency MedicineOther specialties 01 Dermatology 02 Neurology 44 Rheumatology 45 Clinical Immunology and Allergy 06 Ophthalmology 07 Otolaryngology 09 Neurosurgery 10 Orthopaedic Surgery 11 Plastic Surgery 12 Cardio and Thoracic Surgery 13 Urology 47 Vascular Surgery 48 Thoracic Surgery 08 General Surgery 19 Paediatric Cardiology 46 Medical Genetics 03 Psychiatry 04 Neuropsychiatry 18 Anaesthesia 16 Radiology 33 Nuclear Medicine 17 Pathology 29 Medical Microbiology 21 Public Health 23 Occupational Medicine 20 Physical Medicine and RehabMost Recent Registered Specialty Type of PracticeCentre for Health Services and Policy ResearchThe University of British Columbia429 – 2194 Health Sciences MallVancouver, B.C. Canada  V6T 1Z3Tel:  604.822.4969Fax:  604.822.5690Email: enquire@chspr.ubc.cawww.chspr.ubc.caAdvancing world-class health services and policy research, training and data resources on issues that matter to Canadians

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