UBC Faculty Research and Publications

Single and group practices among primary health care physicians in British Columbia McKendry, Rachael; Watson, Diane E.; Goertzen, David; Reid, Robert J.; Mooney, Dawn; Peterson, Sandra Aug 31, 2006

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August 2006S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 2Library and Archives Canada Cataloguing in PublicationSingle and group practices among primary health care physicians inBritish Columbia [electronic resource] / Rachael McKendry ... [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. McKendry, Rachael, 1967-  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 ....................................................................... iAcknowledgements ............................................................. iiExecutive Summary ............................................................. iiiIntroduction .......................................................................... 1Methods ................................................................................ 3Results .................................................................................. 7Discussion ............................................................................ 10Conclusion ............................................................................ 11References ............................................................................ 12Appendix IData Sources for Physician Locations ............................... 13Appendix IIPHC Physicians by Practice Size and Setting ................... 14Appendix IIIProportion of PHC Physicians in Community-Based Group Practices ............................... 16S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE 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.i 5AUGUST 2006AcknowledgementsThe creation of group practice identifi ers for more than 4,000 physicians in each of two fi scal periods is no easy feat; it requires a great deal of work at the conceptual and technical levels, and hours of attention to detail and nuance. This project represents the second time this type of work has been undertaken at CHSPR, and this report documents methodological advances and the result of validation work. This project benefi ted greatly from conceptual advancements in defi ning group practices using the BC Linked Health Database, and from methodological lessons from previous work conducted by Robert Reid and Rachael McKendry. The conceptual and methodological advancements used to create this report were guided by contributions from Diane Watson, Robert Reid, Rachael McK-endry and David Goertzen. Nino Pagliccia, Bogdan Bogdanovic and Sandra Peterson completed the programming required to establish the research data fi le; Charlyn Black developed the method used to refi ne practice groupings with telephone numbers; Jennifer Bow helped create a stan-dardized physician practice fi le; David Goertzen conducted all the analysis required to group and describe practice settings, and Dawn Mooney validated postal codes and created the maps and fi gures. Rachael McKendry and Diane Watson co-wrote the manuscript, and all authors contribut-ed to and approved its content. External academic reviewers and colleagues who provided feed-back on draft copies of this report are also gratefully acknowledged. Special thanks to Chris Balma for his editorial contributions.The BC Ministry of Health provided funding, under the Primary Health Care Transition Fund, to support this project. The results and conclusions are those of the authors and no offi cial endorse-ment by the Ministry is intended or should be inferred. This project is part of a larger program of research conducted at the request of the Ministry.The Behavioural Research Ethics Board of the University of British Columbia approved this initia-tive, and the College of Physicians and Surgeons of British Columbia approved the use of their data to ensure the accuracy of our counts and determinations regarding geographic location of physicians. This report relies primarily on information derived from other organizations. All analysis and inter-pretation, and any errors, are the sole responsibility of the authors. iiS I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 6Th is report off ers an important glimpse into the orga-nization of single-physician and group practices that deliver primary health care (PHC) in British Columbia. It identifi es actively practicing PHC physicians and pinpoints their work locations in order to classify single- and multiple-physician practices, and assesses temporal shift s in the organization of these practices. Perhaps even more signifi cantly, the methods outlined in this report will enable policy-relevant research designed to enhance our understanding of the organization and delivery of PHC across the province.Th is is a descriptive study using administrative data (physician billing, registration and service data from the BC Ministry of Health, and licensure information from the College of Physicians and Surgeons of British Columbia) from fi scal years 1996/97 and 2000/01.Physician data from these sources were linked using common identifi ers and physicians providing PHC services were identifi ed by analysis of their billing practices. Practice location information was identifi ed using workplace postal code and manually compared; PHC physicians with identical addresses were classifi ed as community-based group practices, and those with unique addresses were classifi ed as community-based single-physician practices. Physicians with work ad-dresses in hospitals or large organizations were also identifi ed and categorized as group or single-physician practitioners. We also identify PHC physicians with only a home address.While the number of active physicians providing PHC in the province remained relatively stable over the study period (4,152 in 1996/97 and 4,183 in 2000/01) this report does note shift s in practice sizes and environment.Th e number of PHC physicians working in community-based group practices in British Columbia increased by three per cent over the fi scal years studied. In 1996/97, 2,294 (55%) physicians were located in 700 group prac-tices. By 2000/01, that number had increased modestly to 2,422 (58%). Th is result varied across health authorities, with some experiencing a net decrease in the number of community-based group practices.Th e number and proportion of PHC physicians working out of large organizations and hospitals also increased over the study period. Th ere were 57 physicians located in large organizations in 1996/97, and 71 in 2000/01. Th e number of hospital-based PHC physicians almost doubled over the period, from 278 to 529, representing an increase of seven to 13 per cent of the total PHC physician workforce. Th e number of PHC physicians in single-physician practices decreased from 1,523 to 987. However, due to limitations of the 2000/01 data, 174 physicians in that year could be assigned only to a home address, and the drop recorded in single-physician practices may be exaggerated. These results are very similar to those found in na-tional physician surveys. However, these survey results only reveal the proportion of physicians in groups by practice type, not the number of groups, their sizes or characteristics.Executive Summaryiii 1AUGUST 2006Canadians strongly support the idea of team-based health care1 and the majority of citizens would prefer that their family doctor work as part of a group.2  Th e team approach to primary health care (PHC), led by doctors, is perceived as the new “centrepiece of the health care system” because it is meant to “be responsive to individual needs, structured to emphasize wellness and prevention, and off er integrated and co-ordinated care by various professionals.”3 Canadians expect professionals to collaborate, to share, critique and use data and information collectively, and thereby attain effi  ciency gains in the health system.4 Th e majority of Cana-dians believe that collaborative and integrated PHC teams would improve quality of patient care (73%) and expedite access to care (69%).5Canadians identify interdisciplinary teams as a solution to the current challenge of fi nding a family doctor and “some hoped that a supportive and collegial team would reduce the burden on doctors, prevent burnout, and encourage health professionals to locate and stay in rural and remote areas.”6 In 1996, 64 per cent of Canadians gave strong ap-proval to group practice arrangements, even if it meant not seeing their regular physician.7  In 2004, fully 86 per cent of Canadians supported requiring health professionals to work in teams that include physicians and other types of health care providers.8 Accordingly, family physicians across the country report they are increasingly practicing in groups,9 though few share offi  ce space with non-physician profes-sionals.10Activities intended to restructure the delivery of PHC ser-vices in Canada have been underway for some time. When public investments declined in the mid-1990s and then rebounded, governments sought guidance from a variety of health care committees and commissions to assist them in the process of restructuring and reinvestment. In terms of guiding reinvestments in PHC, the most noteworthy undertaking of the time was the National Forum on Health, whose deliberations led to the establishment of the Health Transition Fund. In 1997, the National Forum recommend-ed moving toward more integrated health care delivery with PHC as a foundation. Key elements included: tying funding Introductionmechanisms to the health status of patients (such as capita-tion) rather than to volumes of services provided by physi-cians (fee-for-service); using pay to promote a continuum of care from prevention to treatment; and encouraging the use of interdisciplinary teams. 11Between 1997 and 2001, the Health Transition Fund fi nanced pilot or evaluation projects across Canada; 65 of these projects focused on PHC. Four provinces (British Columbia, Ontario, Nova Scotia and Newfoundland) required physicians to work in groups and to move toward interdisciplinary teams as a precondition for funding.12 Toward the end of the Health Transition Fund era, it was evident that a national policy framework and additional investments were needed to kindle and sustain widespread momentum toward PHC renewal, including a transition to more group- and interdisciplinary-based practice. In September 2000, Canada’s First Ministers agreed upon an Action Plan for Health System Renewal that included additional investments to catalyze PHC. Th e Government of Canada announced the Primary Health Care Transition Fund (PHCTF) in 2001, which established a policy framework to guide the investment of $800 million to “support the transitional costs of implementing sustainable, large-scale, primary health care renewal initiatives.”13Objectives of the PHCTF included the establishment of  “in-terdisciplinary primary health care teams of providers, so that the most appropriate care is provided by the most appropriate provider” and collaborations among these teams to “facilitate co-ordination and integration with other health services, i.e., in institutions and in communities.” Subsequently, interdisci-plinary collaboration in PHC was explicitly mentioned in the First Ministers’ Accord14 and 10-Year Plan for Health Care in Canada (2004). All provincial governments now include this as one element of their goals and objectives statements for PHC renewal.15S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 2Th ere is much to be learned about the impact of shift s in the organization of PHC on access to services, continuity of care, patient outcomes, costs and other dimensions of quality. Th is initiative develops a population-based data infrastructure to identify group practices where physicians are likely to practice in teams, thereby building capacity to evaluate the impact of temporal shift s toward team-based PHC in British Columbia. We focus on constructing these measures for the two fi scal pe-riods that predate the Health Transition Fund and PHCTF—1996/97 and 2000/01—in order to describe the nature of PHC physician group practice settings in these baseline periods. Our intent is to create group practice variables that will be useful to future research regarding the eff ect of practice ar-rangments on the delivery and use of PHC and the impact of any temporal shift s on these patterns of delivery. Th e practice settings described in this report focus on physicians who work in single or group practice settings. Th is report is a prelude to examining interdisciplinary teams of health professionals.  Th is report describes the number, type and dispersion of single-physician and group practices in 1996/97 and 2000/01 and assesses temporal shift s in the organization of practices among PHC physicians. It also documents the methods we used to develop data infrastructure to identify practices with a single physician* and practices with multiple physicians (groups) and to accurately report on the geographic location of these practices. Th is project is part of a multi-stage research program designed to build capacity to conduct system-level evaluation of changes in this sector. Th is research program is described more fully on the Centre for Health Services and Policy Research website.* We refer to single-physician practices rather than solo practices because we cannot assume that these physicians do not prac-tice with specialist physicians or other health care providers (e.g. registered nurses, nutritionists, clinical pharmacists, nurs-ing assistants, midwives, physical therapists, social workers, occupational therapists and others). 3AUGUST 2006MethodsIn order to describe temporal and geographic patterns of single-physician and group practices, we (1) identifi ed physicians who were actively engaged in clinical practice and had a general type of practice (TOP) (herein aft er called PHC physicians); (2) grouped these practitioners into single-physician or group practices; (3) validated and refi ned the groupings; and (4) validated information needed to accurately assign practices to geographic loca-tions. Th e project relied on a research data fi le containing geographic information regarding the study population. Th is fi le contained a single variable that described each PHC physician’s TOP, as well as data regarding address locations derived from the Medical Services Plan (MSP) Practitioner fi le and College of Physicians and Surgeons of British Columbia (CPSBC) Address fi le. Th e Behav-ioural Research Ethics Board of the University of Brit-ish Columbia approved the initiative, and the CPSBC approved the use of their data to ensure the accuracy of our determinations regarding geographic location of PHC physicians. Identifying PHC PhysiciansTh e study population of physicians who actively en-gaged in clinical practice was identifi ed using methods described elsewhere.‡ Th e population of PHC physicians was identifi ed using the TOP variable available in the MSP Practitioner fi le.§ Th e methods used by the British Columbia Ministry of Health to create the TOP variable require the use of billing information to categorize each practitioner according to the way they practice, rather than their declared specialty. For example, a physician could report their most recent registered specialty as a family physician, but actually have a billing pattern more closely associated with emergency medicine. He or she would be identifi ed as an emergency medicine physician by TOP, despite his or her registered status as a family physician. In this instance, this physician would not be included in the study population since it focuses on PHC physicians. By comparison, a physician could report their most recent registered specialty as paediatrics, but have a billing pattern more closely associated with general practice. He or she would be identifi ed as a general prac-titioner by TOP, despite his or her registered status as a paediatrician, and would be included in the study popula-tion. British Columbia’s MSP uses TOP methodology for publishing practitioner profi les.16Assigning Addresses to PHC PhysiciansFor each PHC physician in the study population, we selected all available address information from the MSP Practitioner and CPSBC Address fi les. Information about these data sources is provided in Appendix I. Th e CPSBC address (located in BC; most recent eff ective date; identi-fi ed as a work address) was identifi ed for each physician. If a physician did not have a work address in the CPSBC data** (n=472, 11% of the total study population) we used one of three options: (1) we assigned the physician to the address of the hospital at which they had the majority of records, if they had any hospital service record(s) (n=268, 6%); (2) we assigned physicians to their MSP Practitio-ner fi le address if it was diff erent from the CPSBC home address and they had no hospital service record(s) (n=26, 1%); or (3) we assigned the physician to the CPSBC home ‡ Practicing physicians include those who billed MSP, those who were paid through the Alternative Payments Program, and those who did not receive these forms of remuneration but who could be identifi ed as clinically active via Hospital Discharge Abstracts Database records. Th ese methods are described in a report by Watson et al. (forthcoming, 2006). Th e development and validation of an information system to identify and describe physicians in clinical practice in British Columbia. Centre for Health Services and Policy Research, University of British Columbia.  § Physicians included in the study population include those who have a TOP of general practice, GP (miscellaneous), GP alter-native payments at 50 per cent, Primary Health Care Organi-zations physician, Salaried physician or contract. Th is includes the following TOP codes: 00, 55, 61, 63 and 70.**Th is only occurred in the 2001 CPSBC data. A work address was identifi ed for all physicians in the cohort in the 1997 CPSBC data.S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 4address, if they had an identical address in the MSP Prac-titioner address fi le and did not have any hospital service record(s) (n=174, 4%). We found four physicians whose work addresses were incorrectly coded as home addresses (e.g. the BC Cancer Agency was coded as a home address). We treated these as work addresses and refer to addresses identifi ed in this manner as ‘assigned’ addresses. PHC physicians who had service records only in the Hospital Discharge Abstract Database were assigned to the address of the hospital at which they had the most service records. Physicians were excluded from the analysis if this assigned address was out of the province.‡‡Assigning PHC Physician Addresses to a Type of SettingEach PHC physician was assigned to one of four mutually exclusive settings: hospital; large organization; community or home. PHC physicians were assigned to either hospi-tals or large organizations using detailed methods.§§ PHC physicians located in community settings at the same ad-dress were identifi ed as community-based group practices by manually matching identical city/town, as well as street name, number and suite. Physicians in community settings with a unique address were categorized as single-physician practices. To calculate the proportion of PHC physicians in community-based practice, we divided the number of physicians in this practice setting by the total number of PHC physicians.  Refi ning and Validating Methods Used to Assign PHC Physicians to GroupsUsing Telephone NumbersIn accordance with the methodology used in a previous project,17 telephone numbers were used to refi ne prac-tice groupings. Since it is likely that PHC physicians with identical addresses may have diff erent telephone num-bers, we reviewed data from the largest group practice (20 practitioners and multiple telephone numbers). By searching the World Wide Web, we determined that this practice location had identifi able ‘cells’—smaller groups of physicians within the larger group—and that each cell had its own telephone number. Most of the PHC physicians at the address in our adjusted address fi le were also current members of the practice. Th rough this type of analysis we determined that group practices across the province seemed to fall into one of three  categories: (1) one address with one telephone number; (2) multiple addresses with one telephone number; and (3) one address with multiple telephone numbers. Most groups fell into categories 1 and 3. Th ose that fell in to category 2 mostly consisted of practices where one or more physician had a street ad-dress, while the other physician(s) had a post offi  ce box as an address. ‡‡ Th e large proportionate increase in hospital-based group practices may be due to our assigning hospital addresses to physicians who had only a home address in the CPSBC data but had at least one hospital record in the Hospital Discharge Abstracts Database in 2000/01.§§ A list of hospitals obtained from the Ministry of Health was used to distinguish physicians in most hospital-based practices. Most hospitals found in the CPSBC and MSP practitioner fi les were included in the list of hospitals from the Ministry of Health (e.g. CFB Hospital, Esquimalt). Th e only Ministry-identifi ed hospital not categorized as a hospital in our exercise was GF Strong Centre because it is a specialized, rehabilitative facility.  Physicians with practices categorized as large organizations were non-hospital fa-cilities whose main function was not primary care delivery, such as the BC Cancer Agency and the BC Centre for Disease Control. Large organizations also included WorkSafeBC (Workers’ Compensation Board). Some physicians had only a home address listed in the CPSBC fi le. Th ese addresses were categorized as ‘only home address’. Th ese physicians were included in the total number of PHC physicians but were excluded from the counts of group and single-physician practices. 5AUGUST 2006Based on these new insights, we refi ned the assigned ad-dress for each physician in the 1996/97 and 2000/01 study populations. Group practices that fell into categories 1 and 3 were grouped by location, since use of information regarding telephone numbers would not alter deci-sions regarding their practice setting. Physicians that fell into category 2 (multiple addresses with one telephone number) were assigned to a single address, usually the street address. Sixty-three physicians in 1996/1997 and 61 in 2000/2001 fell into category 2. Without the telephone number validation, they would have been assigned to single-physician practices, artifi cially infl ating the propor-tion of single-physician practicesValidating Geographic LocationWe used a two-step process to identify and correct errors in postal codes prior to geo-coding the practice settings to local health areas, health service delivery areas and health authorities. First, data regarding the city/town name were used to validate postal codes. Th e city/town name was used as the standard, since recall and coding error is more likely to occur with postal codes. When errors were detected, postal code information from Canada Post was used to correct them. Th en, assigned addresses were sorted by local health area to identify and correct cases in which addresses in a single city/town were assigned to more than one local health area.  Concurrent Validity We report that 55 per cent of PHC physicians in 1996/97 worked in community-based group practice settings in British Columbia. By comparison, results of the National Family Physician Survey conducted by the College of Family Physicians of Canada in 1997/98 indicate that 56 per cent of practitioners in British Columbia worked in group practice settings.18 In that same year, 45 per cent of family physicians across the nation self-reported that they worked in group practice settings.19We report that 58 per cent of PHC physicians in 2000/01 worked in community-based group practice settings. By comparison, results of the National Physician Survey*** conducted in 2004 indicate that 64 per cent of family physicians worked in group practice settings in British Co-lumbia. In that same year, 61 per cent of family physicians across the nation self-reported that they worked in group practice settings.20Our results indicate that the proportion of PHC physicians in group practice settings increased across the province between 1996/97 and 2000/01. By 2000/01, 58 per cent worked in community-based group practices and 14 per cent were based in hospitals or large organizations. An additional 24 per cent were in single-physician, commu-nity-based practice settings.††† By comparison, results of the National Family Physician Survey indicate that 31 and 26 per cent of family physicians in Canada worked in solo  practices‡‡‡ in 1998 and 2004.21, 22Th e Physician Resource Questionnaire conducted by the Canadian Medical Association reports a slightly diff erent picture among the family physician population. Self-re-port survey results from 1998, 2001 and 2003 indicate a decline in the proportion of family physicians who worked in group settings (62%, 56% and 51%, respectively). Th e proportion of family physicians reporting being in a solo practice was 33, 19 and 18 per cent, respectively.23, 24, 25 Although we reported a decline in the number of single community-based practice physicians (from 37% to 24% from 1996/97 to 2000/01), the drop in number is not of the same magnitude reported by the Canadian Medical As-sociation (33% to 19% from 1998 to 2001). Th is could be the result of using diff erent defi nitions of a group practice. Th e Physician Resource Survey defi ned groups as “shared patients and/or expenses”26 unlike this project, which de-*** Results of the National Family Physician Workforce Survey in 2001 do not report statistics regarding practice setting in a format that are comparable to our community-based group practice variable.††† Four per cent of physicians (n=174) could be assigned only to a home address and therefore could not be assigned to a single-physician or group practice.‡‡‡ Th ese surveys used the term ‘solo’ practice to identify physicians practicing alone.S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 6fi nes a group practice as more than one physician with an identical address. Some of the physicians we have identi-fi ed as belonging to single-physician practices may actually share patients with other specialist physicians.Th ere are only slight diff erences between our results and those of national self-report surveys. Th ese diff erences may relate to at least three measurement issues. First, we focus on PHC physicians, which include family physicians and those with other specialty designations who have a general TOP. Overall, 96 per cent of the PHC physicians in our study population were family physicians. We also exclude family physicians that have a TOP that is more specialized in nature. Second, we conducted a population-based analysis of the PHC physician workforce and did not rely on a survey sample. Our results are not infl uenced by response bias. Th ird, there are slight diff erences in time periods between our study and these national surveys. Insofar as there have been temporal increases or declines in the proportion of physicians in group practice settings, these changes infl uence the degree to which there will be concordance between our estimates and survey results.      7AUGUST 2006ResultsIn 1996/97, there were 4,152 PHC physicians actively engaged in clinical practice with an assigned address in British Columbia (see Appendix II, Table 1 for counts of PHC physicians across BC and in each health author-ity).§§§ By 2000/01, there were 4,183 of these providers. Th ese head counts slightly diff er from those documented in forthcoming CHSPR reports, though all of these reports relied on the same conceptual approach in identifying the population of PHC physicians. By necessity, this project relied on a data extract drawn prior to the fi nal stages of the development and refi nement of an information system to identify physicians. Between 1996/97 and 2000/01, the number of PHC physicians in community-based group practices in British Columbia increased from 2,294 to 2,422, representing an increase from 55 to 58 per cent of the total workforce of PHC physicians. Conversely, the proportion of PHC physicians in commu-nity-based practice in settings with no other PHC physicians declined from 1,523 to 987, representing a decline from 37 to 24 per cent of the total PHC physician workforce. Th e decline in single-physician practices was accompanied by the appearance of physicians who provided only a home address (as indicated in the CPSBC Address File). Th ere were 174 physicians who could not be assigned a work address in 2001. Appendix II includes counts of PHC physicians, by practice type and setting, at the provincial and health authority levels.  By comparison, the number of PHC physicians located in hospitals increased from 278 to 529, representing an in-crease from seven to 13 per cent of the total workforce.**** Th e number of PHC physicians located in large organiza-tions increased from 57 to 71, representing an increase from one to two per cent of the total workforce (Appendix II, Table 1). Figure 1 shows the proportion of PHC physi-cians by practice setting in each year.§§§ Physicians who had a designated offi  ce address outside of British Columbia may have, for example, left  the province toward the end of the fi scal period. In these instances, we did not include these physicians in our study population. **** Of the 529 hospital-based physicians identifi ed in 2000/01, 268 or 51 per cent had only a home address listed in the CPSBC address fi le. Th ey were assigned to the hospital at which they had the most service records. 05001,0001,5002,0002,5003,0003,5004,0004,5001996/97 2000/012,294(55%)1,523(37%)2,422(58%)278 (7%)987(24%)529(13%)57 (1%)71 (2%)174 (4%)Total: 4,152 Total: 4,183Large organization-based physiciansHome address only physiciansHospital-based physiciansCommunity-based single-physician practice physiciansCommunity-based group practice physiciansNumber of physiciansPhysician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), hospital separations file, primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01.Figure 1: PHC Physicians in British Columbia, by Practice SettingSource: Physician counts: MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (BC Linked Health Database 1996/97 and 2000/01), MSP practitioner fi le; primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01; CPSBC 1996/07 and 2000/01.S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 8Community-Based Group PracticesAcross the province, the number of community-based group practices increased from 700 to 710 (See Figure 2). Appendix II, Table 2 describes these temporal patterns of group practices at the provincial and health authority levels.Figure 2 illustrates the net gain  (n=10) in community-based practices between 1996/97 and 2000/01. Th e number of group practices with two to three physicians declined by 19, the number of practices with four to fi ve physicians increased by 17, and the number of practices with six to nine physicians increased by ten. Th e number of group practices with ten or more physicians increased by two over the study period.An increase in the number of community-based group practices was not evident in all health authorities. Interior, Vancouver Coastal, and Vancouver Island health authorities saw net increases (5, 2, and 10 respectively) between 1996/97 and 2000/01. Th e Fraser and Northern health authorities saw net declines of six and one group practices, respectively. Th e decline in small community-based group practices was refl ected across most health authorities. Interior Health Authority was the exception, where the number of small practices increased from 69 to 74 over the period. In-terior was also the only jurisdiction to experience a decline in the number of mid-size group practices over the study period, from 19 to 17. Th e largest increase in practices of this size was recorded in the Vancouver Island Health Authority, which gained nine practices, from 18 in 1996/97 to 27 in 2000/01. Practices with six to nine PHC physicians declined in the Interior Health Authority, increased in the Fraser, Vancouver Coastal and Vancouver Island health authorities, and remained stable in the Northern Health Authority. Th e number of very large community-based group practices (10 or more physicians) declined slightly in the Fraser and Vancouver Island health authorities, increased slightly in the Interior and Vancouver Coastal health authorities, and remained stable in the Northern Health Authority (see Appendix II, Table 2). 1996/97 2000/01Total: 700 Total: 7106-9 physician group10+ physician group4-5 physician group2-3 physician group0100200300400500600700800Number of practices516(74%)497(70%)112(16%)129(18%)53 (8%) 63 (9%)19 (3%) 21 (3%)Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), hospital separations file, primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01.Figure 2: Community-Based PHC Group Practices in British Columbia, by Practice SizeSource: Physician counts: MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (BC Linked Health Database 1996/97 and 2000/01), MSP practitioner fi le; primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01; CPSBC 1996/07 and 2000/01. 9AUGUST 2006PHC Physicians in Community-Based Practices Th e number of PHC physicians in community-based group practice settings increased from 2,294 to 2,422 between 1996/97 and 2000/01, representing 55 and 58 per cent of the total PHC physician workforce in each period. Figure 3 illustrates the net gain in the number of PHC physicians in community-based practices, according to the size of the group practice. Th ese gains seem to refl ect a slight reduction in the number of PHC physicians in small group practices and an increase in the number in mid-size and large group practices. In 1996/97, the proportion of PHC physicians in com-munity-based group practice settings varied across health authorities (See Appendix III, Table 1 and Maps††††). Th is variation ranged from a low of 42 per cent in Vancouver Coastal Health Authority, to a high of 66 per cent in Inte-rior Health Authority. Th e proportions in Fraser Health, Vancouver Island and Northern health authorities were 65, 59 and 53 per cent, respectively.In 2000/01 the proportion of PHC physicians in com-munity-based group practice settings ranged from 49 per cent in Vancouver Coastal Health Authority to 64 per cent in Fraser and Interior health authorities. Th e proportion in Vancouver Island Health Authority was 61 per cent. By comparison, the proportion of PHC physicians in commu-nity-based group practices in the Northern Health Author-ity was 52 per cent.†††† Th e maps in Appendix III illustrate both the proportion of PHC physicians in community-based groups by local health area (LHA) as well as the number of PHC physicians by town. Th e proportion of PHC physicians by practice type and setting is also illustrated for cities/towns.1996/97 2000/016-9 physician group10+ physician group4-5 physician group2-3 physician groupNumber of physicians05001,0001,5002,0002,5003,0001,207(53%)1,158(48%)490(21%)558(23%)360(16%)440(18%)237 (10%)266 (11%)Total: 2,294 Total: 2,422Physician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), hospital separations file, primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01.Figure 3: PHC Physicians in British Columbia, by Size of Community-Based PracticeSource: Physician counts: MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (BC Linked Health Database 1996/97 and 2000/01), MSP practitioner fi le; primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01; CPSBC 1996/07 and 2000/01.S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 10Canada has made substantive investments in PHC renewal, funded through the Health Transition Fund (1997-2000) and the PHCTF (2001-2006). Th ese investments and associ-ated activities in British Columbia were designed, in part, to encourage the establishment of PHC group practices. Th e analyses presented here describe the degree to which PHC physicians in British Columbia practice in groups, the characteristics of those practice settings, and temporal shift s in the organization of practice.Th is report provides a pioneering glimpse into the structure and distribution of single-physician and group practice settings among PHC physicians for two fi scal periods that predate the Health Transition Fund and PHCTF—1996/97 and 2000/01 respectively. Our analyses suggest that PHC physicians were far less likely to be located in single-phy-sician, community-based practice settings, and far more likely to practice in hospitals and large organizations over this time period. At the same time, there was only modest growth in the number PHC physicians likely to be located in community-based group practice settings. Over the study period, the proportion of PHC physicians in these settings increased from 55 to 58 per cent of the workforce. Further-more, there was only a net gain of ten community-based group practices of PHC physicians—a gain primarily among mid-size group practices (4 to 9 physicians). Th e proportion of PHC physicians working in group practice settings varied across health authorities.Our ability to assign PHC physicians to practice settings is limited by the completeness and accuracy of address information. Th e CPSBC Address fi le contains up to six possible addresses, each accompanied by an eff ective date. In cases where physicians had multiple work addresses, the address with the most recent eff ective date was selected. However, the address with the most recent date may not be the only address at which a PHC physician practices. In other words, we may have undercounted the number of PHC physicians in a group practice. Nor can we assume that physicians who had a hospital-based practice location are actually hospitalists. Analyses of services fi les would enable this determination. DiscussionWe are also limited in our ability to identify PHC physicians in active practice due to the incompleteness of physician service and billing data. Specifi cally, physicians who receive payment only through Alternative Payments Program (APP) Service Agreements cannot be identifi ed. APP Service Agreements are contracts between the Ministry of Health and an organization, rather than an individual physi-cian. We can only identify the organizations that receive funding through APP Service Agreements, not the indi-vidual physicians who may supply services on behalf of that organization.We are unable to explain why a signifi cant number of physi-cians (n=472) in 2001 provided only a home address to the College of Physicians and Surgeons (a potential cause of the large drop in single-physician practices). Our decision to as-sign some of these physicians to an alternate address (either the MSP Practitioner fi le or to a hospital) may have artifi -cially infl ated our count of PHC physicians practicing in a hospital. Th ese physicians may be locum physicians, may practice part time, or may work in an academic setting and provide services on rare occasions. Only further investiga-tion will shed light on this issue.We also assume that PHC physicians must collocate to be considered a group practice. While shared practice settings may support more eff ective communications or delivery of services, these benefi ts may also accrue when PHC physi-cians practice as part of a virtual team or network.    Th ough PHC policy makers and administrators expect to attain health and health system benefi ts from interdisci-plinary collaboration among PHC teams, physicians have their own personal, professional and economic reasons for collocating or networking with other providers. Th e purpose of this initiative was to develop population-based data infrastructure to identify group practices where physicians are likely to practice in teams and to build the capacity to evaluate the impact of temporal shift s toward team-based PHC in British Columbia. Th is work forms the building block for identifying interdisciplinary teams of health care professionals in PHC. 11AUGUST 2006ConclusionPHC renewal in Canada has an array of goals: increas-ing the number of people with a regular source of care, improving access to care, and enhancing the degree to which care is coordinated and integrated across the health system. Interdisciplinary teams have been identi-fied by the policy community as one method through which these goals may be achieved, and the collocation of PHC physicians is the first step in the development of team-based care. However, providing continuity of care takes more than sharing an offi  ce location. Th e results of a study designed to understand the degree of continuity of care in family practice settings in British Columbia in 1996/9727 indicate about 25 per cent of family physicians practiced in large community-based groups (4 or more physicians) and that these practice arrangements were predominant in rural and suburban areas of the province. For the most part, family physicians in these practices did not share patients.So more investigation is required, and could involve: (1) measuring the extent to which these collocated physicians work collaboratively; (2) identifying other health profes-sionals located at these sites; and (3) assessing the extent to which these interdisciplinary teams collaborate.Group practices of collocated PHC physicians can poten-tially off er improved continuity of, and access to, care, but other ingredients may be necessary. For example, informa-tion systems might better enable providers (collocated or not) to share information about a patient. Relationship, management and information continuity are important to patients—patients are willing to see another physi-cian at the same or a diff erent practice setting if they can get quicker access.28 Continuity might be better achieved through increases in the proportion of community-based physicians that collocate. And while no single-physician practitioner can provide PHC services 24/7, group prac-tices could allow physicians to pool resources and provide out-of-offi  ce-hours care.29 Perhaps the most important contribution of this proj-ect are the legacy information systems now available to identify and locate PHC group practice settings in British Columbia at two points of time of high relevance to policy-makers, planners and evaluators. By the end of 2006, we hope to have completed work to replicate this methodol-ogy using data from a more recent period. New research that relies on this legacy information system will help answer vital questions:1. What types of patients visit diff erent practice settings?2. Do group or single-physician practice settings provide better continuity of care?3. Does practice setting infl uence the use of pharmaceuti-cals, specialists or hospitals?4. Who delivers services within diff erent types of practice settings?5. What is the nature of patient sharing within diff erent group practice settings?Th ere is still much to learn about team-based PHC, and much work to be done to improve the administrative data infrastructure in British Columbia (particularly in relation to alternative funding) in order to fully support PHC plan-ning and evaluation. Researchers at the Centre for Health Services and Policy Research are committed to this agenda and look forward to developing a comprehensive picture of the attributes and qualities of physician group practice in British Columbia as we progress through our PHC research program. S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 121 Pollara Research, Health Care in Canada Survey: Retrospec-tive 1998–2003. (Toronto: Pollara Research, 2003). Available at: www.mediresource.com/e/pages/hcc_survey/pdf/HCiC_1998-2003_retro.pdf.2 Judith Maxwell, Karen Jackson, Barbara Legowski, Steven Rosell, Daniel Yankelovich, Pierre-Gerlier Forest and Lar-issa Lozowchuk, Report on Citizens’ Dialogue on the Future of Health Care in Canada (Saskatoon: Commission on the Future of Health Care in Canada, 2002), p. 32 and 37.3 Ibid., p. 32 and 37.4 Ibid., p. 37.5 Pollara Research, Health Care in Canada Survey: Retrospec-tive 1998–2003 (Toronto: Pollara Research, 2003). Available at: www.mediresource.com/e/pages/hcc_survey/pdf/HCiC_1998-2003_retro.pdf.6 Watson D and Krueger H. Primary health care experi-ences and preferences: Research highlights. May 2005. Centre for Health Services and Policy Research.7 Berger E, Price Waterhouse. Canada Health Monitor. Survey 13. December 1995-96, page 18. Toronto.8 Watson D and Krueger H. Primary health care experi-ences and preferences: Research highlights. May 2005. Centre for Health Services and Policy Research.9 College of Family Physicians of Canada, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada, Initial Data Release of the 2004 National Physician Survey: A Collaborative Project (To-ronto: Authors, 2004).  10 Canadian Institute for Health Information, Health Care in Canada (Ottawa: CIHI, 2003).  11 National Forum on Health, Canada Health Action: Build-ing on the Legacy—Final Report of the National Forum on Health (Ottawa: Government of Canada, 1997).12 Watson D and Wong S. Canadian Policy Context: Interdisci-plinary collaboration in primary health care. February 2005. Th e Enhancing Interdisciplinary Collaboration in Primary Health Care (EICP). Available at: www.eicp-acis.ca/en/resourc-es/research.asp.13 Government of Canada, Primary Health Care Transition Fund (Ottawa, Health Canada, 2004). Available at: www.hc-sc.gc.ca/phctf-fassp/english/index.html.14 Government of Canada, 2003 First Ministers’ Accord on Health Care Renewal (Ottawa: Health Canada, 2003). 15 Health Canada, First Ministers’ Meeting on the Future of Health Care: A 10-year Plan to Strengthen Health Care (Otta-wa: Government of Canada, 2004). Available at: www.hc-sc.gc.ca/english/hca2003/fmm/index.html.16 Starr D and Verhulst L. A Guide to the Interpretation of the Medical Services Plan Practitioner Profi les. May 31, 2003. Minis-try of Health and Ministry Responsible for Seniors.17 Reid RJ, Barer ML, McKendry R, McGrail K, Prosser B, Green B, Evans RC, Goldner E, Hertzman C, Sheps SB. Pa-tient-focused care over time: Issues related to measurement, prevalence, and strategies for improvement among patent populations. Canadian Health Services Research Foundation RC2-0276-10 July 2003.18 College of Family Physicians of Canada. National Family Physician Survey – Regional Report (British Columbia). Available at: www.cfpc.ca/english/cfpc/research/janus%20project/nfps/regional/bc.19 College of Family Physicians of Canada. National Family Physician Survey: Summary Report. Available at: www.cfpc.ca/english/cfpc/research/janus%20project/nfps/summary/2.20 College of Family Physicians of Canada, Canadian Medical As-sociation, Royal College of Physicians and Surgeons of Canada. (October 2004). National Physician Survey (NPS): Workforce, satisfaction and demographic statistics concerning current and future physicians in Canada. Available at: www.cfpc.ca/nps.References 13AUGUST 2006Appendix I: Data Sources for Physician LocationsMedical Services Plan (MSP) Practitioner Th e MSP practitioner fi le is a Ministry of Health registration data fi le that includes one mailing address per practitioner. Practitioners supply the Ministry with this billing address. Addresses contain a name, one address (clinic name if sup-plied, street or post offi  ce box number, town or city, postal code, and if applicable, suite number) and a unique identifi er. Th is single address, however, may be a home, offi  ce or pos-sibly an accountant’s offi  ce. In previous work, we relied solely on physicians’ billing addresses (from the MSP Payee fi le) to identify group practices. Th e result was estimates that were lower than expected, most likely because in many cases the billing address was not the practice location (e.g. when a third party billing address is used).College of Physicians and Surgeons of British Columbia (CPSBC) Files CPSBC collects information from all physicians as they reg-ister to work in the province. An annual survey is conducted to update personal information. Completion of the survey is mandatory, and response rates are approximately 90 per cent. Physicians can also update their address by mailing or faxing a signed letter to the College. Th e CPSBC Address fi le con-tains up to six addresses for each physician, and each address is accompanied by an ‘eff ective date’ and a variable indicating whether the address is a work or home address. Th ere can be several addresses for each physician, each with the same or diff erent eff ective dates. Physicians can also designate a future ‘eff ective date’, though they are encouraged not to assign one too far into the future.‡‡‡‡ ‡‡‡‡ Reid RJ, Barer ML, McKendry R, McGrail K, Prosser B, Green B, Evans RC, Goldner E, Hertzman C, Sheps SB. Patient-focused care over time: Issues related to measure-ment, prevalence, and strategies for improvement among patent populations. Canadian Health Services Research Foundation RC2-0276-10 July 200321 College of Family Physicians of Canada. National Family Physician Survey – Summary Report (October 1998). Available at: www.cfpc.ca/english/cfpc/research/janus%20project/nfps/summary/default.asp?s=1.22 College of Family Physicians of Canada, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada. (October 2004). National Physician Survey (NPS): Workforce, satisfaction and demographic statistics concern-ing current and future physicians in Canada. Available at: www.cfpc.ca/nps/English/home.asp.23 Canadian Medical Association. 1998 Physician Resource Questionnaire Results. Available at: www.cmaj.ca/cgi/content/full/159/5/525/DC1/3.24  Canadian Medical Association. 2001 Physician Resource Questionnaire Results. Available at: www.cmaj.ca/cgi/data/165/5/626/DC1/26.25 Canadian Medical Association. 2003 Physician Resource Questionnaire Results. Available at: www.cmaj.ca/cgi/data/169/7/701/DC1/23.26 Canadian Medical Association. 1998 Physician Resource Questionnaire Results. Available at: www.cmaj.ca/cgi/content/full/159/5/525/DC1/3.27 Reid RJ, Barer ML, McKendry R, McGrail K, Prosser B, Green B, Evans RC, Goldner E, Hertzman C, Sheps SB. Patient-focused care over time: Issues related to mea-surement, prevalence, and strategies for improvement among patent populations. Canadian Health Services Research Foundation RC2-0276-10 July 2003.28 Freeman GK, Richards SC. Is personal continuity of care compatible with free choice of doctor? Patients’ views on seeing the same doctor. British Journal of General Practice 1993; 43:493-497.29 Deber R. Rationales for primary health care reform: Why are we doing this? In, Implementing primary care reform Wilson R, Shortt SED, Dorland, eds. McGill-Queen’s University Press: Montreal, 2004.S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 14British Columbia1996/1997 2000/2001Practice Setting PhysiciansCommunity-Based 3,817 3,409          In Group Practice 2,294 2,422          In Single Practice 1,523 987Hospital 278 529Large Organization 57 71Home Address 0 174Total 4,152 4,183Vancouver Island Health1996/1997 2000/2001Practice Setting PhysiciansCommunity-Based 736 684          In Group Practice 454 502          In Single Practice 282 182Hospital 36 93Large Organization 1 3Home Address 0 39Total 773 819Interior Health1996/1997 2000/2001Practice Setting PhysiciansCommunity-Based 620 599          In Group Practice 423 451          In Single Practice 197 148Hospital 21 83Large Organization 3 7Home Address 0 16Total 644 705Fraser Health1996/1997 2000/2001Practice Setting PhysiciansCommunity-Based 978 880          In Group Practice 654 648          In Single Practice 324 232Hospital 13 68Large Organization 17 25Home Address 0 41Total 1,008 1,014Vancouver Coastal Health1996/1997 2000/2001Practice Setting PhysiciansCommunity-Based 1,241 1,023          In Group Practice 606 662          In Single Practice 635 361Hospital 158 205Large Organization 34 34Home Address 0 77Total 1,433 1,339Northern Health1996/1997 2000/2001Practice Setting PhysiciansCommunity-Based 242 223          In Group Practice 157 159          In Single Practice 85 64Hospital 50 80Large Organization 2 2Home Address 0 1Total 294 306Table 1: PHC Physicians by Practice Setting and Type in British ColumbiaAppendix II: PHC Physicians by PracticeSize and SettingSource: Physician counts: MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (BC Linked Health Database 1996/97 and 2000/01), MSP practitioner fi le; primary health care organizations and alternative pay-ments to physicians data, all BC Ministry of Health 1996/97 and 2000/01; CPSBC 1996/07 and 2000/01.Totals exclude the number of physicians in group and single-physician practices. Th ese numbers are a subset of the number of physicians in community-based practices. 15AUGUST 2006British Columbia1996/1997 2000/2001Practice Size Physicians Groups Physicians Groups2-3 Physicians 1,207 516 1,158 4974-5 Physicians 490 112 558 1296-9 Physicians 360 53 440 6310+ Physicians 237 19 266 21Total 2,294 700 2,422 710Interior Health1996/1997 2000/2001Practice Size Physicians Groups Physicians Groups2-3 Physicians 165 69 176 744-5 Physicians 84 19 73 176-9 Physicians 111 16 108 1510+ Physicians 63 5 94 8Total 423 109 451 114Fraser Health1996/1997 2000/2001Practice Size Physicians Groups Physicians Groups2-3 Physicians 362 156 339 1444-5 Physicians 169 39 190 456-9 Physicians 90 13 97 1410+ Physicians 33 3 22 2Total 654 211 648 205Vancouver Coastal Health1996/1997 2000/2001Practice Size Physicians Groups Physicians Groups2-3 Physicians 392 170 373 1624-5 Physicians 131 30 139 326-9 Physicians 40 6 83 1210+ Physicians 43 3 67 5Total 606 209 662 211Vancouver Island Health1996/1997 2000/2001Practice Size Physicians Groups Physicians Groups2-3 Physicians 212 88 203 874-5 Physicians 78 18 122 276-9 Physicians 86 13 118 1710+ Physicians 78 6 59 4Total 454 125 502 135Northern Health1996/1997 2000/2001Practice Size Physicians Groups Physicians Groups2-3 Physicians 76 33 67 304-5 Physicians 28 6 34 86-9 Physicians 33 5 34 510+ Physicians 20 2 24 2Total 157 46 159 45Table 2: Community-Based Group Practices by Practice Size in British ColumbiaSource: Physician counts: MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (BC Linked Health Database 1996/97 and 2000/01), MSP practitioner fi le; primary health care organizations and alternative pay-ments to physicians data, all BC Ministry of Health 1996/97 and 2000/01; CPSBC 1996/07 and 2000/01.S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 16Appendix III: Proportion of PHC Physicians in Community-Based Group PracticesTable 1: Proportion of PHC Physicians in Community-Based Group Practices in British ColumbiaBritish Columbia1996/1997 2000/2001PHC Physicians in Community-Based Group Practices2,294 2,422Total PHC Physicians 4,152 4,183Proportion in Groups 55% 58%Interior Health1996/1997 2000/2001PHC Physicians in Community-Based Group Practices423 451Total PHC Physicians 644 705Proportion in Groups 66% 64%Fraser Health1996/1997 2000/2001PHC Physicians in Community-Based Group Practices654 648Total PHC Physicians 1,008 1,014Proportion in Groups 65% 64%Vancouver Coastal Health1996/1997 2000/2001PHC Physicians in Community-Based Group Practices606 662Total PHC Physicians 1,433 1,339Proportion in Groups 42% 49%Vancouver Island Health1996/1997 2000/2001PHC Physicians in Community-Based Group Practices454 502Total PHC Physicians 773 819Proportion in Groups 59% 61%Northern Health1996/1997 2000/2001PHC Physicians in Community-Based Group Practices157 159Total PHC Physicians 294 306Proportion in Groups 53% 52%Source: Physician counts: MSP payment information masterfi le (for fee for service data), Hospital Discharge Abstracts Database (BC Linked Health Database 1996/97 and 2000/01), MSP practitioner fi le; primary health care organizations and alternative pay-ments to physicians data, all BC Ministry of Health 1996/97 and 2000/01; CPSBC 1996/07 and 2000/01. 17AUGUST 2006The proportion of total PHC physicians practicing in a community-based group practice setting was calculated by dividing the number of these physicians by the total number of PHC physi-cians in each local health area.See the five health authority-specific maps on the following pages for local health area names. Only their numbers are shown on this map.42201202373843414045 4416416616516216187*81*946059575651*54538892505280 552883 49*272526293024181946*10357111213*14152322207821317716*1776*75424346697062 6163646566*67687147728584* 4833343532921163NorthernInteriorVancouver         IslandVancouverCoastalFraserFraserPart ofVancouverCoastalVancouverCoastalLocal health areaHealth authorityPhysician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 1996/97 and 2000/2001); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01. Population counts: PEOPLE 28 (2001), BC Stats.* The values for LHAs 6, 13, 16, 49, 51, 66, 76,81, 84 and 87 should be interpreted with caution as they are based on a small number of physicians.Data classified by natural breaks (Jenks optimization algorithm)100.0%81.0%64.3%44.0%16.0%0.0%No PHC physiciansProportion of total PHC physicians practicing in a community-based group practice setting, by local health area, 2000/01 Each circle represents one local health area (LHA)Map 1: British Columbia—Proportion of PHC Physicians in Community-Based Group Practices (2000/2001)  18Map 2: Interior Health—Proportion of PHC Physicians in Community-Based Group Practices (2000/2001) S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH27Cariboo-Chilcotin25100 Mile House26North Thompson29Lillooet30South Cariboo24Kamloops18Golden19Revelstoke4Windermere6KootenayLake*10Arrow Lakes3Kimberley5Creston7Nelson11 Trail12GrandForks13Kettle Valley*   14SouthernOkanagan15 Penticton21 Armstrong-Spallumcheen23 Central Okanagan77 Summerland152322Vernon20SalmonArm 78Enderby31Merritt772116Keremeos*17Princeton9Castlegar2Cranbrook1FernieThompson CaribooEastKootenayKootenayBoundaryOkanaganSorrento (1)Slocan Park (1)Rock Creek (1)Riondel (1)Peachland (1)Lone Butte (1)Lac Le Jeune (1)Kaslo (1)Greenwood (1)Argenta (1)108 Mile Ranch (1)Winlaw (1)Sicamous (2)Salmo (2)Lytton (2)Keremeos (2)Barriere (2)Okanagan Falls (2)New Denver (3)Elkford (3)Christina Lake (3)Osoyoos (4)Lumby (4)Nakusp (5)Grand Forks (5)Fruitvale (5)Princeton (6)Lillooet (6)Clearwater (6)Chase (6)Ashcroft (6)Armstrong (7)Merritt (8)Creston (15)Enderby (8)Oliver (9)Invermere (10)Revelstoke (13)Kimberley (13)Westbank (17)Summerland (19)Salmon Arm (33)Penticton (45)Vernon (61)Kamloops (78)Kelowna (112)Fernie (13)Castlegar (13)Trail (18)Nelson (28)Cranbrook (29)100 Mile House (15)Williams Lake (27)Sparwood (7)Rossland (7)Golden (7)Naramata (1)Winfield (6)Proportion of total PHC physicians practicing in acommunity-based group practice, by local health area, 2000/01 81.4 - 100.0%64.6 - 80.8%45.0 - 64.1%16.6 - 42.5%0.0%Data categorized by natural breaks (Jenks optimization algorithm).Not all categories are represented in this health authority.*The values for Kootenay Lake, Kettle Valley and Keremeos LHAs should be interpreted with caution as they are based on a small number of physicians.Number of PHC physicians by town, with practice type and setting, 2000/01Name (2**)Name (100)Com-munity-based group practiceCommunity-based single-physician practiceHome address only Hospital or large organization practice **Towns reporting fewer than three physicians are coloured grey and not divided by practice type and settingTown name (500 physicians total)Health service delivery areaLocal health areaHighwayInterior HealthPhysician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 1996/97 and 2000/2001); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01. Population counts: PEOPLE 28 (2001), BC Stats. 19Map 3: Fraser Health—Proportion of PHC Physicians in Community-Based Group Practices (2000/2001) APRIL 200633Chilliwack34Abbotsford35Langley201Surrey202S. Surrey/White Rock37Delta32Hope76Agassiz-Harrison*75Mission42Maple Ridge43Coquitlam41 Burnaby40 New WestminsterFraser EastFraser SouthFraser NorthHarrison Hot Springs (1)Agassiz (3)Pitt Meadows (6)Hope (10)Port Moody (13)White Rock (33)Mission (36)Maple Ridge (46)Port Coquitlam (60)Chilliwack (63)New Westminster (66)Coquitlam (68)Abbotsford (73)Langley (83)Delta (91)Burnaby (155)Surrey (206)Proportion of total PHC physicians practicing in a community-based group practice, by local health area, 2000/01 81.4 - 100.0%64.6 - 80.8%45.0 - 64.1%16.6 - 42.5%0.0%Data categorized by natural breaks (Jenks optimization algorithm).Not all categories are represented in this health authority.*The value for Agassiz-Harrison LHA should be interpreted with caution as it is  based on a small number of physicians.Number of PHC physicians by town, with practice type and setting, 2000/01Name (2**)Name (100)Com-munity-based group practiceCommunity-based single-physician practiceHome address only Hospital or large organization practice **Towns reporting fewer than three physicians are coloured grey and not divided by practice type and settingTown name (500 physicians total)Fraser HealthPhysician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 1996/97 and 2000/2001); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01. Population counts: PEOPLE 28 (2001), BC Stats.Health service delivery areaLocal health areaHighway 20Map 4: Vancouver Coastal Health—Proportion of PHC Physicians in Community-Based Group Practices (2000/2001) 46Sunshine Coast47Powell River48Howe Sound44NorthVancouver38Richmond164166165 16316216145WestVancouver161162163164165166City CentreDntn EastsideNortheastWestsideMidtownSouthNorth Shore -Coast Garibaldi83Central Coast49Bella Coola*Part of North Shore -Coast GaribaldiWhistler (16)Sechelt (22)Squamish (23)Powell River (25)West Vancouver (46)Richmond (130)North Vancouver (135)Vancouver (908)Garibaldi Highlands (1)Pemberton (4)Texada Island (1)Madeira Park (1)Halfmoon Bay (1)Bowen Island (2)Gibsons (15)Bella Coola (2)Waglisla (8)Health service delivery areaLocal health areaHighwayProportion of total PHC physicians practicing in acommunity-based group practice, by local health area, 2000/01 81.4 - 100.0%64.6 - 80.8%45.0 - 64.1%16.6 - 42.5%0.0%Data categorized by natural breaks (Jenks optimization algorithm).Not all categories are represented in this health authority.*The value for Bella Coola LHA should be interpreted with caution as it is based on a small number of physicians.Number of PHC physicians by town, with practice type and setting, 2000/01Name (2**)Name (100)Com-munity-based group practiceCommunity-based single-physician practiceHome address only Hospital or large organization practice **Towns reporting fewer than three physicians are coloured grey and not divided by practice type and settingTown name (500 physicians total)Vancouver Coastal HealthPhysician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 1996/97 and 2000/2001); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01. Population counts: PEOPLE 28 (2001), BC Stats.S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH 21Map 5: Vancouver Island Health—Proportion of PHC Physicians in Community-Based Group Practices (2000/2001) 69Qualicum70Alberni62Sooke64GulfIslands65Cowichan66Lake Cowichan*67Ladysmith68Nanaimo71Courtenay72Campbell River85Island North84Island West*     61 Greater Victoria63 SaanichNorth IslandCentral IslandSouthIslandSayward (1)Mayne I. (1)Mansons Landing (1)Lazo (1)Gold River (1)Errington (1)Denman Island (1)Saturna I. (1)North Saanich (1)Hornby Island (1)Ucluelet (2)Port Alice (2)Pender I. (2)Galiano I. (2)Alert Bay (2)Nanoose Bay (2)Heriot Bay (2)Gabriola Island (3)Lake Cowichan (4)Shawnigan Lake (4)Lantzville (5)Tofino (6)Port McNeill (6)Brentwood Bay (6)Chemainus (7)Mill Bay (8)Cumberland (8)Sooke (9)Port Hardy (10)Qualicum Beach (10)Ladysmith (11)Saanichton (16)Saltspring I. (17)Parksville (22)Courtenay (22)Sidney (24)Comox (28)Port Alberni (29)Campbell River (39)Duncan (44)Nanaimo (83)Victoria (374)Proportion of total PHC physicians practicing in a community-based group practice, by local health area, 2000/01 81.4 - 100.0%64.6 - 80.8%45.0 - 64.1%16.6 - 42.5%0.0%Data categorized by natural breaks (Jenks optimization algorithm).Not all categories are represented in this health authority.*The values for Island West and Lake Cowichan LHAs should be interpreted with caution as they are based on a small number of physicians.Number of PHC physicians by town, with practice type and setting, 2000/01Name (2**)Name (100)Com-munity-based group practiceCommunity-based single-physician practiceHome address only Hospital or large organization practice **Towns reporting fewer than three physicians are coloured grey and not divided by practice type and settingTown name (500 physicians total)Vancouver Island HealthPhysician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 1996/97 and 2000/2001); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01. Population counts: PEOPLE 28 (2001), BC Stats.Health service delivery areaLocal health areaHighwayAPRIL 2006 22Map 6: Northern Health—Proportion of PHC Physicians in Community-Based Group Practices (2000/2001) S I NG L E  AND  GROUP  P RACT I C E S  AMONG  P R I MARY  H EA LTH  C ARE  P H YS I C I ANS  I N  B CCENTRE FOR HEALTH SERVICES AND POLICY RESEARCH87Stikine*81Fort Nelson*94Telegraph Creek60Peace River North59Peace River South57Prince George56Nechako51Snow Country*54Smithers53Upper Skeena88Terrace92Nisga’a50Queen Charlotte52Prince Rupert80Kitimat55Burns Lake28QuesnelNorthernInteriorNortheastNorthwestSmithers (19)Fort St. John (20)Terrace (23)Quesnel (23)Prince Rupert (27) Prince George (86)Valemount (1)Stewart (1)Hudson's Hope (1)Tumbler Ridge (2)Dease Lake (2)McBride (3)Houston (3)Fraser Lake (3)Fort Nelson (3)Masset (5)Chetwynd (5)Fort St. James (6)Mackenzie (7)Burns Lake (7)Kitimat (9)Hazelton (9)Vanderhoof (10)Queen Charlotte City (13)Dawson Creek (18)Proportion of total PHC physicians practicing in acommunity-based group practice, by local health area, 2000/01 81.4 - 100.0%64.6 - 80.8%45.0 - 64.1%16.6 - 42.5%0.0%No PHC physiciansData categorized by natural breaks (Jenks optimization algorithm).Not all categories are represented in this health authority.*The values for Fort Nelson, Stikine and Snow Country LHAs should be interpreted with caution as they are based on a small number of physicians.Number of PHC physicians by town, with practice type and setting, 2000/01Name (2**)Name (100)Com-munity-based group practiceCommunity-based single-physician practiceHome address only Hospital or large organization practice **Towns reporting fewer than three physicians are coloured grey and not divided by practice type and settingTown name (500 physicians total)Northern HealthPhysician counts: MSP practitioner information file, MSP payment information masterfile (for fee for service data), Hospital Discharge Abstracts Database (all BC Linked Health Database 1996/97 and 2000/2001); primary health care organizations and alternative payments to physicians data, all BC Ministry of Health 1996/97 and 2000/01 data; CPSBC 1996/07 and 2000/01. Population counts: PEOPLE 28 (2001), BC Stats.Health service delivery areaLocal health areaHighwayCentre 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 CanadiansAUGUST 2006

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