UBC Faculty Research and Publications

Issues in physician resources planning in B. C. : key determinants of supply and distribution, 1991-96… Kazanjian, Arminée, 1947-; Reid, Robert J.; Apland, Lars E.; Wood, Laura Christine, 1955-; Pagliccia, Nino; Wood, Laura Christine, 1955- Jun 30, 2000

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A Research Unit Funded by the Ministry of Health, British Columbia THE UNIVERSITY OF BRITISH COLUMBIA      Health Human Resources Unit Centre for Health Services and Policy Research 429 – 2194 Health Sciences Mall Vancouver, B.C. Canada  V6T 1Z3 Tel:  (604) 822-4810 Fax: (604) 822-5690   March 20, 2001       Dear Reader:   We have recently become aware that computing errors were made during the production of Tables 3.5, 4.1, 4.2, 4.3, 4.5, 4.6, 4.8, 4.9, 4.12, 4.16, 4.17, 4.18, and 4.22 in the report Issues in Physician Resources Planning in B.C.: Key Determinants of Supply and Distribution, 1991-96. A Report to the Post-Graduate Medical Education Advisory Committee.  Attached are the corrected tables.  Please insert them in the appropriate sections of the report.      Health Human Resources Unit   Centre for Health Services and Policy Research - 26 - Table 3.5 Distribution of Ministry of Health Payments for Physician Services by Payment Mechanism, 1996/971Payment MechanismsSpecialty No.Total Payments   FY 1996/972Fee-For-Service (%)Salary & Sessional (%)Service Agreements (%) Contractors3General / Family Practice 4,335 638,901,798          96.0 3.1 0.9 12 AgenciesAnesthesiology 329 56,027,709            99.9 0.1Cardiology 57 23,436,740            98.4 0.5 1.0 Nanaimo General HospitalCommunity Medicine 40 493,085                 43.4 57Dermatology 62 15,290,151            98.4 1.6Endocrinology & Metabolism 14 2,515,038              93.8 6.2Emergency Medicine 71 13,718,800            59.9 0.4 39.6 Vancouver General, St. Paul's & B.C. Women's HospitalGastroenterology 28 9,080,362              100Haematology 18 2,411,532              83.8 16.2Internal Medicine 358 67,327,316            89.9 5.3 4.8 Greater Victoria Hospital Society, Vancouver General Hospital & St. Paul's Hospital5Medical Biochemistry 12 7,472,848              100Medical Microbiology 25 5,885,350              99.6 0.4 B.C. Children's, St. Paul's Hospital, U.B.C. Medical Microbiology & Greater Victoria Hosp. SocietyMedical Oncology 16 17,518,337            7.3 92.7 B.C. Cancer AgencyNephrology 11 3,716,090              96.2 3.8Neurology 69 14,891,509            96.4 3.6Nuclear Medicine 19 17,511,482            100Pediatrics 225 36,584,621            69.4 11.1 19.5 B.C. Children's Hospital, Sunny Hill Children's HealthPathology - General 103 108,875,406          100 0.0  Centre & Queen Alexandra Children's Health CentrePathology - Anatomical 70 55,093,083            100Physical Medicine 37 5,035,181              67.8 32.2Psychiatry 488 76,474,980            67.5 31.0 1.6 Juan de Fuca Hospital Society, St. Joseph's Gen. Hosp.,Trail Regional Hosp. & West Coast General Hosp.Radiology - Diagnostic4 291 97,436,764            99.8 0.2Respiratory Medicine 44 11,025,355            94.7 5.3Rheumatology 27 4,833,618              91.0 9.0Cardiovascular and Thoracic Surgery 33 10,301,299            100General Surgery 189 40,198,514            98.0 0.0 2.0 Prince George Regional HospialNeurosurgery 32 8,163,795              99.3 0.7Obstetrics & Gynecology 182 39,143,784            93.1 1.5 5.4 Greater Victoria Hosp. Society & B.C. Women's Hosp.6Ophthalmology 182 58,660,936            99.4 0.6Orthopedic Surgery 148 30,183,249            99.3 0.7Otolaryngology 69 17,339,056            100 0.0Plastic Surgery 55 11,924,217            99.4 0.6Urology 68 20,349,066            99.5 0.5Vascular Surgery 25 7,502,115              99.8 0.2All Physicians 7,732 $1,535,323,185 93.5 3.7 2.81 Includes physicians on the 'active' registers of the CPSBC in 1996. 2 Excludes service agreement for transplantation services.3 Refers to organizations specified under service agreements for physician services in FY 1996/97. Agreements are specified by 'service type' not RCPSC specialty.  Payments for service agreementsare allocated to RCPSC specialty that best matches service type specified.4 Includes 32 Radiation Oncology Specialists.5 Agreements specified for intensive care services & geriatric home assessment.6 Agreements specified for maternal & newborn care.Health Human Resources Unit   Centre for Health Services and Policy Research - 31 -  Table 4.1:  Supply of Physicians in B.C. by Specialty, Number, FTEs, and FTE per 10,000 Population - 1991/92 and 1996/9711991 - 1992 1996 - 1997Specialty No. FTEsFTEs/10,000 Pop'n2 No. FTEsFTEs/10,000 Pop'n2Average Annual % Change3 in FTEs/10,000 Pop'n2General / Family Practice 3,847 3,299.36 9.78 4,335 3,809.92 9.81 0.07Anesthesiology 301 260.44 0.77 329 287.13 0.74 -0.85Cardiology 47 46.86 0.14 57 53.80 0.14 -0.05Community Medicine4 33 33.00 0.10 40 40.00 0.10 1.04Dermatology 57 51.12 0.15 62 56.42 0.15 -0.83Endocrinology & Metabolism 6 7.37 0.02 14 13.66 0.04 10.00Emergency Medicine4 59 59.00 0.17 71 71.00 0.18 0.90Gastroenterology 22 21.29 0.06 28 27.35 0.07 2.23Hematology 20 17.80 0.05 18 15.63 0.04 -5.27Internal Medicine 339 266.64 0.79 358 319.71 0.82 0.82Medical Biochemistry4 12 12.00 0.04 12 12.00 0.03 -2.77Medical Microbiology4 23 23.00 0.07 25 25.00 0.06 -1.13Medical Oncology4 10 10.00 0.03 16 16.00 0.04 6.81Nephrology 11 10.66 0.03 11 11.26 0.03 -1.70Neurology 64 60.69 0.18 69 63.08 0.16 -2.02Nuclear Medicine4 11 11.00 0.03 19 19.00 0.05 8.46Pediatrics 192 183.58 0.54 225 207.14 0.53 -0.39Pathology - General4 97 97.00 0.29 103 103.00 0.27 -1.60Pathology - Anatomical4 64 64.00 0.19 70 70.00 0.18 -1.01Physical Medicine 31 28.14 0.08 37 34.80 0.09 1.45Psychiatry 382 344.40 1.02 488 448.10 1.15 2.49Radiation Oncology4 28 28.00 0.08 32 32.00 0.08 -0.14Radiology - Diagnostic4 240 240.00 0.71 259 259.00 0.67 -1.28Respiratory Medicine 35 33.33 0.10 44 38.93 0.10 0.30Rheumatology 26 23.65 0.07 27 25.21 0.06 -1.52Cardiovascular & Thoracic Surgery 31 29.10 0.09 33 29.23 0.08 -2.68General Surgery 213 162.55 0.48 189 154.07 0.40 -3.81Neurosurgery 29 23.33 0.07 32 27.97 0.07 0.82Obstetrics & Gynecology 167 141.51 0.42 182 163.42 0.42 0.07Ophthalmology 165 157.50 0.47 182 170.47 0.44 -1.22Orthopedic Surgery 149 124.10 0.37 148 124.45 0.32 -2.71Otolaryngology 76 67.66 0.20 69 64.47 0.17 -3.70Plastic Surgery 49 42.99 0.13 55 50.46 0.13 0.40Urology 63 58.52 0.17 68 63.70 0.16 -1.11Vascular Surgery 23 22.06 0.07 25 23.04 0.06 -1.92Total Physicians 6,922 6,061.65 17.97 7,732 6,930.41 17.85 -0.131 For 1996, FTEs are based on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British Columbia   Cancer Agency. For 1991, FTEs are based on Fee for Service and Salaried and Sessional payments.  2 Based on 1991 BC Population = 3,373,399 and 1996 BC Population = 3,882,043.   Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24. All figures are as of July 1 of the year stated. 3 Average annual percent change in FTEs/10,000 population is calculated as follows: [(FTE 96-97/pop/FTE 91-92/pop)12/60 - 1]*100.4 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.   Health Human Resources Unit   Centre for Health Services and Policy Research - 36 - Table 4.2:  Age Distribution of B.C. Physicians by RCPSC Specialty - 1996/971Under 40 yrs 40 thru 49 yrs 50 thru 59 yrs 60 thru 69 yrs 70 yrs and older TotalsSpecialty No FTEs % No FTEs % No FTEs % No FTEs % No FTEs % No FTEsGeneral Practice 1588 1338.09 35.5 1442 1378.92 36.6 797 751.99 19.9 375 259.20 6.9 133 44.33 1.2 4335 3772.53Anaesthesiology 75 71.11 24.8 123 120.23 41.9 83 72.21 25.1 39 22.68 7.9 9 0.90 0.3 329 287.13Cardiology 15 12.43 23.4 25 24.95 46.9 16 14.85 27.9 1 1.00 1.9 57 53.23Community Medicine2 4 4.00 10.0 13 13.00 32.5 12 12.00 30.0 9 9.00 22.5 2 2.00 5.0 40 40.00Dermatology 8 6.10 10.8 22 23.39 41.5 16 15.05 26.7 11 10.84 19.2 5 1.04 1.8 62 56.42Endocrinology and Metabolism 6 6.00 43.9 6 6.25 45.8 1 0.58 4.2 1 0.83 6.1 14 13.66Emergency Medicine2 23 23.00 32.4 33 33.00 46.5 14 14.00 19.7 1 1.00 1.4 71 71.00Gastroenterology 8 6.76 24.7 15 15.35 56.1 5 5.24 19.2 28 27.35Haematology 3 2.59 16.6 10 7.86 50.3 5 5.18 33.1 18 15.63Internal Medicine 57 45.62 15.2 110 104.88 34.9 95 92.23 30.7 62 47.66 15.9 34 9.70 3.2 358 300.09Medical Biochemistry2 2 2.00 16.7 3 3.00 25.0 6 6.00 50.0 1 1.00 8.3 12 12.00Medical Microbiology2 3 3.00 12.0 9 9.00 36.0 8 8.00 32.0 5 5.00 20.0 25 25.00Medical Oncology2 5 5.00 31.3 6 6.00 37.5 5 5.00 31.3 16 16.00Nephrology 5 4.61 40.9 4 4.35 38.6 2 2.30 20.4 11 11.26Neurology 11 10.18 16.1 24 23.80 37.7 18 17.50 27.7 14 11.30 17.9 2 0.30 0.5 69 63.08Nuclear Medicine2 6 6.00 31.6 5 5.00 26.3 3 3.00 15.8 4 4.00 21.1 1 1.00 5.3 19 19.00Paediatrics 46 40.38 21.5 79 79.43 42.3 56 45.39 24.2 31 18.43 9.8 13 4.04 2.2 225 187.67Pathology - General2 15 15.00 14.6 29 29.00 28.2 31 31.00 30.1 22 22.00 21.4 6 6.00 5.8 103 103.00Pathology - Anatomical2 17 17.00 24.3 33 33.00 47.1 18 18.00 25.7 2 2.00 2.9 70 70.00Physical Medicine 5 3.57 10.3 15 16.06 46.1 12 11.78 33.9 4 3.37 9.7 1 0.02 0.1 37 34.80Psychiatry 76 70.03 15.9 167 159.63 36.2 123 118.17 26.8 87 72.49 16.4 35 20.35 4.6 488 440.67Radiation Oncology2 12 12.00 37.5 15 15.00 46.9 5 5.00 15.6 32 32.00Radiology - Diagnostic2 60 60.00 23.2 70 70.00 27.0 75 75.00 29.0 39 39.00 15.1 15 15.00 5.8 259 259.00Respiratory Medicine 8 6.98 17.9 25 22.91 58.8 10 8.04 20.7 1 1.00 2.6 44 38.93Rheumatology 3 2.59 10.3 14 12.34 48.9 10 10.28 40.8 27 25.21Cardiovascular and Thoracic Surg 4 4.06 13.9 12 10.85 37.1 11 10.76 36.8 5 2.29 7.8 1 1.27 4.3 33 29.23General Surgery 23 23.81 15.8 42 41.78 27.7 51 52.60 34.9 47 30.78 20.4 26 1.90 1.3 189 150.87Neurosurgery 8 7.45 26.6 6 7.01 25.1 9 9.16 32.7 6 4.28 15.3 3 0.07 0.3 32 27.97Obstetrics and Gynaecology 41 36.36 23.6 50 45.10 29.3 43 43.79 28.5 31 24.14 15.7 17 4.50 2.9 182 153.89Ophthalmology 37 33.06 19.4 56 65.09 38.2 52 53.76 31.5 23 14.19 8.3 14 4.37 2.6 182 170.47Orthopaedic Surgery 25 21.39 17.2 52 55.10 44.3 38 31.33 25.2 26 15.41 12.4 7 1.22 1.0 148 124.45Otolaryngology 11 10.05 15.6 23 24.56 38.1 23 21.70 33.7 10 7.44 11.5 2 0.72 1.1 69 64.47Plastic Surgery 13 11.94 23.7 22 23.33 46.2 17 14.04 27.8 2 1.03 2.0 1 0.12 0.2 55 50.46Urology 15 14.53 22.8 17 19.26 30.2 16 18.09 28.4 12 10.84 17.0 8 0.98 1.5 68 63.70Vascular Surgery 1 1.01 4.4 13 12.48 54.2 6 5.93 25.7 4 3.24 14.1 1 0.38 1.6 25 23.04Totals 2239 1937.70 28.4 2590 2520.91 36.9 1692 1608.95 23.5 875 645.44 9.4 336 120.21 1.8 7732 6833.211 FTE calculations are based on Fee for Service and Salaried and Sessional payments.2 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.Health Human Resources Unit   Centre for Health Services and Policy Research - 38 -  Table 4.3:  Sex Distribution of Physician FTEs in B.C. by Age and Specialty - 1996/971Specialty FTEs % Female FTEs % Female FTEs % Female FTEs % FemaleGeneral Practice 3772.5 24.3 1338.1 36.1 2130.9 19.2 303.5 6.7Anaesthesiology 287.1 13.4 71.1 14.0 192.4 13.9 23.6 8.3Cardiology 53.2 9.2 12.4 18.7 39.8 3.3 1.0 100.0Community Medicine2 40.0 23.3 4.0 25.0 25.0 28.0 11.0Dermatology 56.4 16.1 6.1 25.7 38.4 17.0 11.9 8.2Endocrinology and Metabolism 13.7 22.0 6.0 33.3 6.8 0.8Emergency Medicine2 71.0 12.2 23.0 26.1 47.0 6.4 1.0Gastroenterology 27.4 14.0 6.8 31.7 20.6 10.6Haematology 15.6 21.3 2.6 0.0 13.0 27.4Internal Medicine 300.1 9.2 45.6 25.9 197.1 12.9 57.4 3.1Medical Biochemistry2 12.0 41.7 2.0 100.0 9.0 33.3 1.0Medical Microbiology2 25.0 50.0 3.0 33.3 17.0 58.8 5.0Medical Oncology2 16.0 37.5 5.0 80.0 11.0 27.3Nephrology 11.3 8.6 4.6 21.7 6.7Neurology 63.1 5.9 10.2 10.1 41.3 4.7 11.6 0.6Nuclear Medicine2 19.0 20.0 6.0 16.7 8.0 25.0 5.0Paediatrics 187.7 24.5 40.4 41.9 124.8 20.6 22.5 21.4Pathology - General2 103.0 21.2 15.0 40.0 60.0 20.0 28.0 10.7Pathology - Anatomical2 70.0 28.2 17.0 35.3 51.0 25.5 2.0 50.0Physical Medicine 34.8 12.6 3.6 28.3 27.8 12.0 3.4Psychiatry 440.7 27.3 70.0 38.5 277.8 28.8 92.8 13.5Radiation Oncology2 32.0 22.0 12.0 25.0 20.0 25.0Radiology - Diagnostic2 259.0 19.4 60.0 26.7 145.0 21.4 54.0 5.6Respiratory Medicine 38.9 19.0 7.0 68.1 31.0 2.0 1.0Rheumatology 25.2 22.1 2.6 24.7 22.6 21.8Cardiovascular and Thoracic 29.2 4.6 4.1 0.0 21.6 6.2 3.6General Surgery 150.9 3.9 23.8 8.6 94.4 4.2 32.7Neurosurgery 28.0 0.0 7.5 0.0 16.2 0.0 4.4Obstetrics and Gynaecology 153.9 21.4 36.4 37.1 88.9 20.9 28.6 2.9Ophthalmology 170.5 10.5 33.1 23.5 118.9 8.5 18.6 0.2Orthopaedic Surgery 124.5 0.7 21.4 0.0 86.4 1.0 16.6Otolaryngology 64.5 6.9 10.1 9.7 46.3 7.8 8.2Plastic Surgery 50.5 8.2 11.9 25.5 37.4 3.1 1.2Urology 63.7 1.1 14.5 4.6 37.4 11.8Vascular Surgery 23.0 4.7 1.0 0.0 18.4 6.7 3.6Total 6833.2 20.7 1937.7 33.0 4129.9 17.5 765.7 6.71 FTE calculations are based on Fee for Service and Salaried and Sessional payments.2 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.Totals Under 40 40 thru 59 60 and olderHealth Human Resources Unit   Centre for Health Services and Policy Research - 42 -  Table 4.5:  Supply of Physicians by Place of Medical School Education - 19961 U.B.C. Other Canada Non-CanadaSpecialties Totals No. (%) No. (%) No. (%)General / Family Practice 4,335 1,392 (32.1) 1,903 (43.9) 1,040 (24.0)Anesthesiology 329 88 (26.7) 134 (40.7) 107 (32.5)Cardiology 57 16 (28.1) 23 (40.4) 18 (31.6)Community Medicine 40 9 (22.5) 22 (55.0) 9 (22.5)Dermatology 62 16 (25.8) 34 (54.8) 12 (19.4)Endocrinology & Metabolism 14 3 (21.4) 6 (42.9) 5 (35.7)Emergency Medicine 71 12 (16.9) 53 (74.6) 6 (8.5)Gastroenterology 28 6 (21.4) 19 (67.9) 3 (10.7)Hematology 18 5 (27.8) 8 (44.4) 5 (27.8)Internal Medicine 358 51 (14.2) 186 (52.0) 121 (33.8)Medical Biochemistry 12 3 (25.0) 6 (50.0) 3 (25.0)Medical Microbiology 25 2 (8.0) 11 (44.0) 12 (48.0)Medical Oncology 16 4 (25.0) 8 (50.0) 4 (25.0)Nephrology 11 3 (27.3) 3 (27.3) 5 (45.5)Neurology 69 13 (18.8) 35 (50.7) 21 (30.4)Nuclear Medicine 19 1 (5.3) 14 (73.7) 4 (21.1)Pediatrics 225 20 (8.9) 80 (35.6) 125 (55.6)Pathology - General 103 24 (23.3) 41 (39.8) 38 (36.9)Pathology - Anatomical 70 19 (27.1) 26 (37.1) 25 (35.7)Physical Medicine 37 6 (16.2) 16 (43.2) 15 (40.5)Psychiatry 488 71 (14.5) 200 (41.0) 217 (44.5)Radiation Oncology 32 8 (25.0) 5 (15.6) 19 (59.4)Radiology - Diagnostic 259 37 (14.3) 152 (58.7) 70 (27.0)Respiratory Medicine 44 7 (15.9) 19 (43.2) 18 (40.9)Rheumatology 27 6 (22.2) 10 (37.0) 11 (40.7)Cardiovascular & Thoracic Surgery 33 6 (18.2) 21 (63.6) 6 (18.2)General Surgery 189 24 (12.7) 100 (52.9) 65 (34.4)Neurosurgery 32 4 (12.5) 20 (62.5) 8 (25.0)Obstetrics & Gynecology 182 31 (17.0) 72 (39.6) 79 (43.4)Ophthalmology 182 30 (16.5) 105 (57.7) 47 (25.8)Orthopedic Surgery 148 28 (18.9) 77 (52.0) 43 (29.1)Otolaryngology 69 7 (10.1) 37 (53.6) 25 (36.2)Plastic Surgery 55 24 (43.6) 24 (43.6) 7 (12.7)Urology 68 18 (26.5) 36 (52.9) 14 (20.6)Vascular Surgery 25 7 (28.0) 10 (40.0) 8 (32.0)Total Specialists 3,397 609 (17.9) 1,613 (47.5) 1,175 (34.6)Total BC 7,732 2,001 (25.9) 3,516 (45.5) 2,215 (28.6)1 Includes physicians on the 'active' registers of the CPSBC in 1996. Health Human Resources Unit   Centre for Health Services and Policy Research - 44 -  Table 4.6:  Place of Medical School Education (%) by Specialty & GP/FP - 1991, 1996, and % Change U.B.C. Other Canada Non-CanadaSpecialties 1991 1996 % Change 1991 1996 % Change 1991 1996 % ChangeGeneral / Family Practice 31.1 32.1 1.0 43.0 43.9 0.9 25.9 24.0 -1.9Anesthesiology 26.2 26.7 0.5 41.2 40.7 -0.5 32.6 32.5 0.0Cardiology 21.3 28.1 6.8 42.6 40.4 -2.2 36.2 31.6 -4.6Community Medicine 18.2 22.5 4.3 36.4 55.0 18.6 45.5 22.5 -23.0Dermatology 24.6 25.8 1.2 52.6 54.8 2.2 22.8 19.4 -3.5Endocrinology & Metabolism 0.0 21.4 21.4 50.0 42.9 -7.1 50.0 35.7 -14.3Emergency Medicine 16.9 16.9 0.0 71.2 74.6 3.5 11.9 8.5 -3.4Gastroenterology 18.2 21.4 3.2 72.7 67.9 -4.9 9.1 10.7 1.6Hematology 25.0 27.8 2.8 45.0 44.4 -0.6 30.0 27.8 -2.2Internal Medicine 14.2 14.2 0.1 52.2 52.0 -0.3 33.6 33.8 0.2Medical Biochemistry 16.7 25.0 8.3 50.0 50.0 0.0 33.3 25.0 -8.3Medical Microbiology 4.3 8.0 3.7 39.1 44.0 4.9 56.5 48.0 -8.5Medical Oncology 20.0 25.0 5.0 30.0 50.0 20.0 50.0 25.0 -25.0Nephrology 27.3 27.3 0.0 27.3 27.3 0.0 45.5 45.5 0.0Neurology 20.3 18.8 -1.5 45.3 50.7 5.4 34.4 30.4 -3.9Nuclear Medicine 0.0 5.3 5.3 72.7 73.7 1.0 27.3 21.1 -6.2Pediatrics 8.9 8.9 0.0 33.9 35.6 1.7 57.3 55.6 -1.7Pathology - General 20.6 23.3 2.7 41.2 39.8 -1.4 38.1 36.9 -1.3Pathology - Anatomical 25.0 27.1 2.1 43.8 37.1 -6.6 31.3 35.7 4.5Physical Medicine 9.7 16.2 6.5 45.2 43.2 -1.9 45.2 40.5 -4.6Psychiatry 14.4 14.5 0.2 42.4 41.0 -1.4 43.2 44.5 1.3Radiation Oncology 17.9 25.0 7.1 32.1 15.6 -16.5 50.0 59.4 9.4Radiology - Diagnostic 13.1 14.3 1.2 56.3 58.7 2.3 30.6 27.0 -3.6Respiratory Medicine 14.3 15.9 1.6 42.9 43.2 0.3 42.9 40.9 -1.9Rheumatology 19.2 22.2 3.0 34.6 37.0 2.4 46.2 40.7 -5.4Cardiovascular & Thoracic Surgery 16.1 18.2 2.1 64.5 63.6 -0.9 19.4 18.2 -1.2General Surgery 10.3 12.7 2.4 56.8 52.9 -3.9 32.9 34.4 1.5Neurosurgery 13.8 12.5 -1.3 58.6 62.5 3.9 27.6 25.0 -2.6Obstetrics & Gynecology 16.2 17.0 0.9 36.5 39.6 3.0 47.3 43.4 -3.9Ophthalmology 13.9 16.5 2.5 57.0 57.7 0.7 29.1 25.8 -3.3Orthopedic Surgery 17.4 18.9 1.5 51.0 52.0 1.0 31.5 29.1 -2.5Otolaryngology 13.2 10.1 -3.0 53.9 53.6 -0.3 32.9 36.2 3.3Plastic Surgery 32.7 43.6 11.0 53.1 43.6 -9.4 14.3 12.7 -1.6Urology 27.0 26.5 -0.5 47.6 52.9 5.3 25.4 20.6 -4.8Vascular Surgery 26.1 28.0 1.9 39.1 40.0 0.9 34.8 32.0 -2.8Total Specialists 16.6 17.9 1.4 47.8 47.5 -0.3 35.6 34.6 -1.1Total Physicians 24.7 25.9 1.2 45.1 45.5 0.3 30.2 28.6 -1.6Note: 1991 figures for Radiation Oncology were taken from Report Table 4.4.   Table 4.8:  Geographic Distribution of Physician in B.C. by HHRU Region and Grouped Specialty, 1996/971General / Family Practice General Internal Medicine Medical Subspecialties General Surgery Surgical Subspecialties PediatricsHHRU Region Population2 No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. RatioVancouver & District 1,910,331 2,215 1,899.1 99.41 232 177.5 9.29 258 234.5 12.28 86 71.6 3.75 373 331.7 17.36 161 147.4 7.71Capital 331,761 491 376.1 113.37 34 24.7 7.44 45 55.3 16.68 20 13.2 3.98 70 63.2 19.05 15 17.4 5.26Fraser Valley 231,345 197 199.7 86.32 9 9.8 4.23 6 5.5 2.36 7 7.4 3.20 22 22.9 9.89 5 6.1 2.64Okanagan 334,743 343 321.7 96.10 19 18.5 5.53 29 32.6 9.72 19 14.1 4.20 51 48.2 14.39 14 10.4 3.09South East 160,708 184 157.8 98.21 10 9.1 5.67 3 2.6 1.61 12 9.0 5.58 10 10.1 6.29 4 4.6 2.87Island Coast 425,368 444 403.5 94.87 21 21.2 4.99 9 8.2 1.92 21 19.0 4.46 47 43.4 10.21 11 8.7 2.04Central 203,742 189 182.0 89.31 8 7.9 3.89 8 9.2 4.52 12 8.8 4.33 21 19.4 9.52 6 6.0 2.95North Central 219,324 221 218.6 99.65 11 14.0 6.40 5 5.4 2.45 9 8.0 3.67 17 14.7 6.71 5 6.6 3.00North 64,721 51 51.4 79.43 1 0.9 1.38 0 0.0 0.00 3 3.0 4.60 1 0.2 0.36 0 0.0 0.00Unknown - - - - - - - - - - - - - - - - - - -Total BC 3,882,043 4,335 3,809.9 98.14 345 283.6 7.31 363 353.2 9.10 189 154.1 3.97 612 553.8 14.27 221 207.2 5.34Psychiatry Obstetrics & Gynecology Laboratory/Radiology3 Anesthesiology Other4 All SpecialistsHHRU Region Population2 No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. RatioVancouver & District 1,910,331 339 321.8 16.85 107 102.1 5.34 335 335.0 17.54 200 171.7 8.99 100 97.7 5.12 2,191 1,991 104.23Capital 331,761 65 48.3 14.55 15 10.9 3.27 55 55.0 16.58 42 35.7 10.75 29 27.9 8.40 390 352 105.96Fraser Valley 231,345 12 10.1 4.35 6 6.2 2.66 19 19.0 8.21 10 9.9 4.30 0 0.0 0.00 96 97 41.83Okanagan 334,743 22 21.6 6.46 14 11.5 3.42 27 27.0 8.07 24 23.2 6.94 7 8.4 2.51 226 215 64.33South East 160,708 11 9.9 6.17 4 2.6 1.62 16 16.0 9.96 5 3.8 2.35 1 1.0 0.62 76 69 42.74Island Coast 425,368 25 22.6 5.32 20 14.7 3.46 29 29.0 6.82 29 24.7 5.80 4 4.0 0.94 216 196 45.97Central 203,742 7 6.9 3.39 7 7.0 3.42 17 17.0 8.34 10 10.1 4.98 4 3.8 1.86 100 96 47.20North Central 219,324 7 6.9 3.12 8 7.6 3.45 19 19.0 8.66 9 8.0 3.65 3 3.0 1.37 93 93 42.47North 64,721 0 0.0 0.00 1 1.0 1.55 3 3.0 4.64 0 0.0 0.00 0 0.0 0.00 9 8 12.52Unknown - - - - - - - - - - - - - - - -Total BC 3,882,043 488 448.1 11.54 182 163.4 4.21 520 520.0 13.40 329 287.1 7.40 148 145.8 3.76 3,397 3116.3 80.281 FTE calculations are based on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British Columbia Cancer Agency. FTE/Population Ratios are number of FTEs per 100,000.2 Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24.  All population estimates are as of July 1, 1996.3 As a more accurate representation of personnel in this specialty, 1 person=1FTE.4 "Other" category includes:  Community Medicine, Emergency Medicine, Occupational Medicine, Physical Medicine, and Public Health.Health Human Resources Unit   Centre for Health Services and Policy Research - 49 -    Health Human Resources Unit   Centre for Health Services and Policy Research - 50 - Table 4.9:  Geographic Distribution of Physicians in B.C. by HHRU Region and Grouped Specialty, 1991/92 1General / Family Practice General Internal Medicine Medical Subspecialties General Surgery Surgical Subspecialties PediatricsHHRU Region Population 2 No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.RatioVancouver & District 1,647,358 1,968 1,634.4 99.21 233 156.8 9.52 223 212.1 12.88 99 77.2 4.68 355 318.7 19.35 145 129.4 7.85Capital 307,644 443 333.9 108.53 31 23.5 7.65 34 35.6 11.58 22 13.1 4.26 75 64.3 20.91 11 13.5 4.38Fraser Valley 191,031 169 172.3 90.21 8 8.7 4.55 5 5.2 2.71 8 8.3 4.34 24 23.7 12.41 3 3.9 2.04Okanagan 279,790 275 264.5 94.52 18 17.9 6.41 18 19.9 7.09 19 13.4 4.80 45 40.3 14.41 11 11.8 4.22South East 145,167 179 156.8 108.00 10 9.0 6.22 2 2.5 1.75 8 7.0 4.83 8 6.9 4.77 4 4.6 3.19Island Coast 361,145 372 341.2 94.48 15 15.9 4.39 8 7.7 2.13 20 18.4 5.09 35 33.7 9.32 8 9.4 2.60Central 178,944 160 156.9 87.66 8 8.3 4.62 7 8.5 4.73 16 10.2 5.68 19 19.4 10.83 5 5.3 2.96North Central 202,571 184 174.4 86.08 7 9.7 4.77 4 4.6 2.29 13 9.4 4.65 16 14.5 7.18 4 5.7 2.83North 59,749 39 39.1 65.44 0 0.0 0.00 0 0.0 0.00 4 4.3 7.15 2 0.5 0.77 1 0.0 0.00Unknown - 58 26.0 - 4 1.6 - 2 2.0 - 4 1.3 - 6 3.2 - - - -Total BC 3,373,399 3,847 3,299.4 97.81 334 251.3 7.45 303 298.1 8.84 213 162.6 4.82 585 525.3 15.57 192 183.6 5.44Psychiatry Obstetrics & Gynecology Laboratory/Radiology 3 Anesthesiology Other 4 All SpecialistsHHRU Region Population 2 No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.RatioVancouver & District 1,647,358 289 264.4 16.05 100 85.6 5.20 305 305.0 18.51 192 162.8 9.88 87 83.5 5.07 2,028 1,796 108.99Capital 307,644 46 33.6 10.91 18 13.0 4.24 54 54.0 17.55 41 35.8 11.64 19 18.8 6.10 351 305 99.23Fraser Valley 191,031 8 8.7 4.57 4 4.2 2.19 16 16.0 8.38 10 10.6 5.53 0 0.0 0.00 86 89 46.72Okanagan 279,790 16 17.4 6.21 14 11.8 4.23 24 24.0 8.58 18 17.1 6.12 7 8.2 2.92 190 182 64.99South East 145,167 4 2.7 1.88 2 2.0 1.38 15 15.0 10.33 2 0.9 0.62 0 0.0 0.00 55 51 34.97Island Coast 361,145 14 12.0 3.31 15 11.3 3.13 26 26.0 7.20 19 15.8 4.38 7 7.0 1.94 167 157 43.48Central 178,944 3 3.8 2.10 7 6.7 3.74 17 17.0 9.50 10 9.6 5.35 3 2.7 1.49 95 91 51.00North Central 202,571 2 1.9 0.93 5 5.5 2.71 13 13.0 6.42 5 4.7 2.30 0 0.0 0.00 69 69 34.06North 59,749 0 0.0 0.00 1 1.0 1.59 3 3.0 5.02 0 0.0 0.00 0 0.0 0.00 11 9 14.53Unknown - - - - 1 0.4 - 2 2.0 - 4 3.2 - - - - 23 13.3 -Total BC 3,373,399 382 344.4 10.21 167 141.5 4.19 475 475.0 14.08 301 260.4 7.72 123 120.1 3.56 3,075 2762.3 81.881 FTE calculations are based on Fee for Service and Salaried and Sessional payments.  FTE/Population Ratios are number of  FTEs per 100,000.2 Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24.  All population estimates are as of July 1, 1991.3 As a more accurate representation of personnel in this specialty, 1 person=1FTE.4 "Other" category includes:  Community Medicine, Emergency Medicine, Occupational Medicine, Physical Medicine, and Public Health.   Table 4.12:   Regional Distribution of BC Physicians by Age Group, Sex, and Place of Medical School Training, 1996General / Family MedicineVancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 43 (16.0) 45 (14.0) 46 (16.0) 43 (15.0) 43 (15.0) 43 (13.0) 42 (14.0) 41 (13.5) 43 (15.0)Age Group n (%)< 40 859 (38.8) 136 (27.7) 66 (33.5) 121 (35.3) 66 (35.9) 153 (34.5) 77 (40.7) 110 (40.4) 1,588 (36.6)40 to 64 1,208 (54.5) 315 (64.2) 109 (55.3) 206 (60.1) 106 (57.6) 265 (59.7) 107 (56.6) 151 (55.5) 2,467 (56.9)65+ 148 (6.7) 40 (8.1) 22 (11.2) 16 (4.7) 12 (6.5) 26 (5.9) 5 (2.6) 11 (4.0) 280 (6.5)Sex n (%)Male 1,466 (66.2) 343 (69.9) 163 (82.7) 262 (76.4) 130 (70.7) 337 (75.9) 145 (76.7) 213 (78.3) 3,059 (70.6)Female 749 (33.8) 148 (30.1) 34 (17.3) 81 (23.6) 54 (29.3) 107 (24.1) 44 (23.3) 59 (21.7) 1,276 (29.4)Medical  School n (%)U.B.C. 791 (35.7) 137 (27.9) 65 (33.0) 100 (29.2) 37 (20.1) 143 (32.2) 60 (31.7) 59 (21.7) 1,392 (32.1)Other Canada 931 (42.0) 251 (51.1) 73 (37.1) 179 (52.2) 105 (57.1) 187 (42.1) 79 (41.8) 99 (36.4) 1,903 (43.9)Non-Canada 493 (22.3) 103 (21.0) 59 (29.9) 64 (18.7) 42 (22.8) 114 (25.7) 50 (26.5) 114 (41.9) 1,040 (24.0)Totals 2,215 - 491 - 197 - 343 - 184 - 444 - 189 - 272 - 4,335 - 'General' Specialties (General Internal Medicine; General Surgery; Psychiatry; Pediatrics; Obstetrics & Gynecology)Vancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 50 (17.0) 57 (15.0) 46 (17.0) 50 (23.0) 48 (17.0) 53 (18.0) 49 (19.0) 45 (19.0) 50 (18.0)Age Group n (%)< 40 159 (17.4) 11 (7.4) 8 (21.1) 16 (18.4) 6 (14.6) 14 (14.3) 9 (22.5) 15 (34.1) 238 (16.9)40 to 64 608 (66.5) 103 (69.1) 27 (71.1) 52 (59.8) 32 (78.0) 64 (65.3) 27 (67.5) 23 (52.3) 936 (66.3)65+ 147 (16.1) 35 (23.5) 3 (7.9) 19 (21.8) 3 (7.3) 20 (20.4) 4 (10.0) 6 (13.6) 237 (16.8)Sex n (%)Male 677 (74.1) 124 (83.2) 32 (84.2) 72 (82.8) 38 (92.7) 88 (89.8) 35 (87.5) 36 (81.8) 1,102 (78.1)Female 237 (25.9) 25 (16.8) 6 (15.8) 15 (17.2) 3 (7.3) 10 (10.2) 5 (12.5) 8 (18.2) 309 (21.9)Medical  School n (%)U.B.C. 141 (15.4) 12 (8.1) 8 (21.1) 12 (13.8) 4 (9.8) 5 (5.1) 2 (5.0) 5 (11.4) 189 (13.4)Other Canada 384 (42.0) 73 (49.0) 11 (28.9) 50 (57.5) 19 (46.3) 54 (55.1) 21 (52.5) 16 (36.4) 628 (44.5)Non-Canada 389 (42.6) 64 (43.0) 19 (50.0) 25 (28.7) 18 (43.9) 39 (39.8) 17 (42.5) 23 (52.3) 594 (42.1)Totals 914 - 149 - 38 - 87 - 41 - 98 - 40 - 44 - 1,411 -All Other Specialties (Medical Subspecialties; Surgical Subspecialties; Laboratory & Radiology; Anesthesiology)Vancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 47 (15.0) 50 (14.0) 49 (12.0) 45 (14.0) 42 (11.0) 47 (16.0) 47 (14.5) 45 (16.0) 47 (14.0)Age Group n (%)< 40 245 (20.8) 25 (11.8) 9 (15.5) 43 (32.6) 13 (38.2) 23 (20.2) 9 (16.1) 14 (25.5) 381 (20.7)40 to 64 834 (70.9) 157 (74.1) 43 (74.1) 79 (59.8) 20 (58.8) 80 (70.2) 44 (78.6) 36 (65.5) 1,293 (70.3)65+ 98 (8.3) 30 (14.2) 6 (10.3) 10 (7.6) 1 (2.9) 11 (9.6) 3 (5.4) 5 (9.1) 164 (8.9)Sex n (%)Male 958 (81.4) 193 (91.0) 52 (89.7) 122 (92.4) 29 (85.3) 101 (88.6) 54 (96.4) 49 (89.1) 1,558 (84.8)Female 219 (18.6) 19 (9.0) 6 (10.3) 10 (7.6) 5 (14.7) 13 (11.4) 2 (3.6) 6 (10.9) 280 (15.2)Medical  School n (%)U.B.C. 287 (24.4) 24 (11.3) 12 (20.7) 25 (18.9) 4 (11.8) 22 (19.3) 8 (14.3) 11 (20.0) 393 (21.4)Other Canada 529 (44.9) 124 (58.5) 29 (50.0) 77 (58.3) 21 (61.8) 60 (52.6) 33 (58.9) 24 (43.6) 897 (48.8)Non-Canada 361 (30.7) 64 (30.2) 17 (29.3) 30 (22.7) 9 (26.5) 32 (28.1) 15 (26.8) 20 (36.4) 548 (29.8)Totals 1,177 - 212 - 58 - 132 - 34 - 114 - 56 - 55 - 1,838 -Note: The 'North' and 'North Central' regions have been grouped. Physicians in emergency medicine, community medicine, physical medicine and public health are excluded from the analyses. Includes only physicians on the 'active' register of the CPSBC. IQR refers to 'inter-quartile range'.Health Human Resources Unit   Centre for Health Services and Policy Research - 56 -    Table 4.16:   General Practitioners / Family Physicians by Health Region, Age, Sex, and Place of Medical School Education, 1996Characteristic East KootenayWest Kootenay - BoundaryNorth OkanaganSouth Okanagan - Similkameen Thompson Fraser ValleySouth Fraser Valley Simon Fraser Coast GaribaldiAge    median (IQR) 42.5 (17.0) 43 (13.0) 44 (18.0) 43 (13.0) 44 (16.0) 46 (16.0) 44 (16.0) 43 (15.0) 42 (14.0)Age Group   n (%)< 40 32 (37.2) 34 (34.7) 47 (37.3) 74 (34.1) 46 (37.4) 66 (33.5) 160 (37.0) 103 (37.5) 29 (35.8)40 to 64 47 (54.7) 59 (60.2) 73 (57.9) 133 (61.3) 73 (59.3) 109 (55.3) 237 (54.9) 157 (57.1) 49 (60.5)65+ 7 (8.1) 5 (5.1) 6 (4.8) 10 (4.6) 4 (3.3) 22 (11.2) 35 (8.1) 15 (5.5) 3 (3.7)Sex   n (%)Male 65 (75.6) 65 (66.3) 97 (77.0) 165 (76.0) 92 (74.8) 163 (82.7) 302 (69.9) 204 (74.2) 58 (71.6)Female 21 (24.4) 33 (33.7) 29 (23.0) 52 (24.0) 31 (25.2) 34 (17.3) 130 (30.1) 71 (25.8) 23 (28.4)Medical School   n (%)U.B.C. 15 (17.4) 22 (22.4) 45 (35.7) 55 (25.3) 36 (29.3) 65 (33.0) 138 (31.9) 96 (34.9) 25 (30.9)Other Canada 53 (61.6) 52 (53.1) 61 (48.4) 118 (54.4) 59 (48.0) 73 (37.1) 185 (42.8) 118 (42.9) 41 (50.6)Non-Canada 18 (20.9) 24 (24.5) 20 (15.9) 44 (20.3) 28 (22.8) 59 (29.9) 109 (25.2) 61 (22.2) 15 (18.5)Totals 86 - 98 - 126 - 217 - 123 - 197 - 432 - 275 - 81 -Characteristic Cariboo North West Peace LiardNorthern Interior Vancouver Burnaby North Shore Richmond CapitalAge    median (IQR) 41 (11.0) 42 (16.0) 39 (10.0) 42 (15.0) 43 (16.0) 42 (15.5) 45 (18.0) 43 (15.0) 45 (14.0)Age Group   n (%)< 40 31 (47.0) 39 (38.2) 27 (52.9) 44 (37.0) 387 (39.7) 69 (43.1) 76 (35.8) 64 (39.5) 136 (27.7)40 to 64 34 (51.5) 60 (58.8) 22 (43.1) 69 (58.0) 527 (54.1) 81 (50.6) 116 (54.7) 90 (55.6) 315 (64.2)65+ 1 (1.5) 3 (2.9) 2 (3.9) 6 (5.0) 60 (6.2) 10 (6.3) 20 (9.4) 8 (4.9) 40 (8.1)Sex   n (%)Male 53 (80.3) 77 (75.5) 42 (82.4) 94 (79.0) 608 (62.4) 103 (64.4) 132 (62.3) 117 (72.2) 343 (69.9)Female 13 (19.7) 25 (24.5) 9 (17.6) 25 (21.0) 366 (37.6) 57 (35.6) 80 (37.7) 45 (27.8) 148 (30.1)Medical School   n (%)U.B.C. 24 (36.4) 25 (24.5) 8 (15.7) 26 (21.8) 345 (35.4) 61 (38.1) 88 (41.5) 63 (38.9) 137 (27.9)Other Canada 20 (30.3) 48 (47.1) 12 (23.5) 39 (32.8) 416 (42.7) 67 (41.9) 87 (41.0) 58 (35.8) 251 (51.1)Non-Canada 22 (33.3) 29 (28.4) 31 (60.8) 54 (45.4) 213 (21.9) 32 (20.0) 37 (17.5) 41 (25.3) 103 (21.0)Totals 66 - 102 - 51 - 119 - 974 - 160 - 212 - 162 - 491 -Cent Vanc IslandUpper Island/ Central Coast44 (41.5) 42 (14.0)75 (31.3) 49 (39.8)148 (61.7) 68 (55.3)17 (7.1) 6 (4.9)189 (78.8) 90 (73.2)51 (21.3) 33 (26.8)77 (32.1) 41 (33.3)96 (40.0) 50 (40.7)67 (27.9) 32 (26.0)240 - 123 -All Regions43 (15.0)1,588 (36.6)2,467 (56.9)280 (6.5)3,059 (70.6)1,276 (29.4)1,392 (32.1)1,904 (43.9)1,039 (24.0)4,335 -Health Human Resources Unit   Centre for Health Services and Policy Research - 69 - Health Human Resources Unit   Centre for Health Services and Policy Research - 78 -  Table 4.17: Distribution of Herfindahl Index for GP/FPs & Specialists by HHRU Regions, 1996-971,2,3General / Family Practice SpecialistsHHRU Region n Mean Median SD n Mean Median SDVancouver & District 1,839 0.77 0.78 0.14 1,071 0.89 0.96 0.15Capital 403 0.75 0.76 0.13 181 0.88 0.93 0.15Fraser Valley 177 0.74 0.75 0.14 55 0.92 0.95 0.10Okanagan 315 0.73 0.75 0.13 142 0.87 0.92 0.13South-East 155 0.74 0.77 0.15 38 0.88 0.94 0.14Island Coast 398 0.73 0.75 0.13 129 0.90 0.95 0.12Central 170 0.73 0.76 0.14 58 0.88 0.93 0.13North Central 187 0.71 0.73 0.14 52 0.89 0.95 0.12North 47 0.68 0.69 0.15 6 0.83 0.81 0.09Total Physicians 3,691 0.75 0.76 0.14 1,732 0.90 0.95 0.141 Includes physicians on the 'active' CPSBC registers in 1996 except for pediatrics, rehabilitation medicine, community medicine/  public health, psychiatry, laboratory medicine and radiology, medical oncology and radiation oncology (N=1,377).   Also, excludes 644 GP/FPs and 288 specialists with FTE < 0.2 in 1996/97 or who had no FFS billings.2 Note: The footnote on Page 77 of the PGME Report should read (n=1,377) specialties excluded.3 Section 4.2.2.1 on Page 75 should also read (n=1,377) for specialties excluded and (n=932) for other physicians excluded.   Table 4.18: Distribution of Herfindahl Index for GP/FPs1 by Age, Sex, Place of Training and FTE Status, 1996-97 All Regions Urban Semi-Urban Ruraln Mean SD Statistic2 P-value n Mean SD n Mean SD n Mean SD Statistic3 P-valueAge Group<30 122 0.73 0.13 37.7 <0.0001 65 0.73 0.13 42 0.70 0.13 15 0.74 0.12 0.50 0.60531-40 1,248 0.72 0.14 536 0.73 0.13 583 0.70 0.14 129 0.74 0.12 6.0 0.00341-50 1,284 0.74 0.14 548 0.76 0.14 631 0.73 0.13 105 0.68 0.15 29.4 <0.000151-60 688 0.79 0.13 290 0.80 0.14 347 0.77 0.13 51 0.78 0.12 5.7 0.00361-70 286 0.81 0.14 133 0.81 0.14 135 0.80 0.13 18 0.82 0.08 0.36 0.69870+ 63 0.82 0.16 27 0.86 0.13 33 0.80 0.16 3 0.75 0.20 0.97 0.327SexFemale 1,057 0.69 0.13 309.8 <0.0001 556 0.70 0.14 432 0.69 0.13 69 0.70 0.13 1.03 0.272Male 2,634 0.77 0.13 1,043 0.80 0.13 1339 0.75 0.14 252 0.74 0.13 57.2 <0.0001Medical SchoolU.B.C. 1,250 0.73 0.14 21.4 <0.0001 615 0.74 0.14 579 0.71 0.13 56 0.73 0.11 6.08 0.002In Canada 1,556 0.75 0.14 648 0.76 0.14 776 0.74 0.14 132 0.74 0.13 4.53 0.011Non-Canada 885 0.77 0.14 336 0.80 0.14 416 0.76 0.14 133 0.72 0.15 14.3 <0.0001Full-Time-Equivalency0.2-0.5 309 0.78 0.14 9.38 <0.0001 162 0.78 0.15 123 0.78 0.14 24 0.79 0.12 0.13 0.8790.5-1.2 2,509 0.74 0.14 1,166 0.76 0.14 1112 0.73 0.14 231 0.73 0.13 7.4 0.001>1.2 873 0.75 0.14 271 0.79 0.14 536 0.73 0.13 66 0.73 0.14 13.2 <0.0001Totals 3,691 1,599 1,771 3211 Includes GP/FPs on the 'active' CPSBC registers in 1996. Excludes 644 GP/FPs with FTE < 0.2 in FY 1996/97 or who had no FFS billings.2 F-statistic from analysis of variance to test for differences in log HI between levels of the covariate of interest.3 F-statistic from one-way analysis of variance testing for differences in log HI among urban, semi-urban and rural levels, stratified by age, sex, medical school, FTE or PGME location.Health Human Resources Unit   Centre for Health Services and Policy Research - 80 -    Table 4.22: Demographic and Training Characteristics of GP/FP 'Specialists' in Obstetrics & Gynecology, Anesthesiology, and Surgery, 1996/97GP/FP 'Specialists2All GP/FPs1 Obstetrics & Gynecology Anesthesiology SurgeryStatistic3 P-value Statistic3 P-value Statistic3 P-valueAge    median (IQR) 43 (24.0) 39 (11.0) 29.7 <0.001 43 (14.0) 0.13 0.717 45 (18.0) 14.5 <0.001Age Group   n (%)<40 1,373 (37.2) 96 (54.9) 37.6 <0.001 25 (31.6) 2.10 0.555 68 (34.7) 30.2 <0.00140-49 1,283 (34.8) 62 (35.4) 33 (41.8) 61 (31.1)50-59 687 (18.6) 11 (6.3) 15 (19.0) 27 (13.8)60+ 348 (9.4) 6 (3.4) 6 (7.6) 40 (20.4)Sex    n (%) Male 2,634 (71.4) 24 (13.7) 298.8 <0.001 70 (88.6) 11.7 <0.001 169 (86.2) 22.3 <0.001Female 1,057 (28.6) 151 (86.3) 9 (11.4) 27 (13.8)Medical School   n (%)U.B.C. 1,250 (33.9) 74 (42.3) 8.70 0.013 19 (24.1) 16.2 0.001 56 (28.6) 2.59 0.273In Canada 1,556 (42.2) 73 (41.7) 26 (32.9) 89 (45.4)Non-Canada 885 (24.0) 28 (16.0) 34 (43.0) 51 (26.0)Geographic Location   n (%)Urban 1,599 (43.3) 93 (53.1) 7.83 0.020 9 (11.4) 98.5 0.001 88 (44.9) 0.473 0.789Semi-urban 1,771 (48.0) 72 (41.1) 40 (50.6) 93 (47.4)Rural 321 (8.7) 10 (5.7) 30 (38.0) 15 (7.7)Totals 3,691 - 175 - 79 - 196 -1 Includes all GP/FPs on the 'active' registers of the College of Physicians and Surgeons of B.C., excluding GP/FPs with FTE<0.2 or who had no FFS billings in 1996/97 (n=644). 2 GP/FP 'specialists' were defined by the proportion of billings within the respective specialty 'domains'. GP/FP 'anesthesiologists' and 'surgeons' were defined as GP/FPs with >10% of total billings in the respective domain.  GP/FP 'obstetrician/gynecologists' were defined as GP/FPswith >20% of total billings in the obstetrics & gynecology fee-item domain. Percents given are relative to all GP/FPs.3 For categorical variables, chi-square test for homogeneity is presented.  For age (as a continuous variable), the F-statistic relating to one-way analysis of variance is presented.Health Human Resources Unit   Centre for Health Services and Policy Research - 92 -  A Research Unit Funded by the Ministry of Health, British Columbia THE UNIVERSITY OF BRITISH COLUMBIA      Health Human Resources Unit Centre for Health Services and Policy Research 429 – 2194 Health Sciences Mall Vancouver, B.C. Canada  V6T 1Z3 Tel:  (604) 822-4810 Fax: (604) 822-5690   March 20, 2001       Dear Reader:   We have recently become aware that computing errors were made during the production of Tables 3.5, 4.1, 4.2, 4.3, 4.5, 4.6, 4.8, 4.9, 4.12, 4.16, 4.17, 4.18, and 4.22 in the report Issues in Physician Resources Planning in B.C.: Key Determinants of Supply and Distribution, 1991-96. A Report to the Post-Graduate Medical Education Advisory Committee.  Attached are the corrected tables.  Please insert them in the appropriate sections of the report.      Health Human Resources Unit   Centre for Health Services and Policy Research - 26 - Table 3.5 Distribution of Ministry of Health Payments for Physician Services by Payment Mechanism, 1996/971Payment MechanismsSpecialty No.Total Payments   FY 1996/972Fee-For-Service (%)Salary & Sessional (%)Service Agreements (%) Contractors3General / Family Practice 4,335 638,901,798          96.0 3.1 0.9 12 AgenciesAnesthesiology 329 56,027,709            99.9 0.1Cardiology 57 23,436,740            98.4 0.5 1.0 Nanaimo General HospitalCommunity Medicine 40 493,085                 43.4 57Dermatology 62 15,290,151            98.4 1.6Endocrinology & Metabolism 14 2,515,038              93.8 6.2Emergency Medicine 71 13,718,800            59.9 0.4 39.6 Vancouver General, St. Paul's & B.C. Women's HospitalGastroenterology 28 9,080,362              100Haematology 18 2,411,532              83.8 16.2Internal Medicine 358 67,327,316            89.9 5.3 4.8 Greater Victoria Hospital Society, Vancouver General Hospital & St. Paul's Hospital5Medical Biochemistry 12 7,472,848              100Medical Microbiology 25 5,885,350              99.6 0.4 B.C. Children's, St. Paul's Hospital, U.B.C. Medical Microbiology & Greater Victoria Hosp. SocietyMedical Oncology 16 17,518,337            7.3 92.7 B.C. Cancer AgencyNephrology 11 3,716,090              96.2 3.8Neurology 69 14,891,509            96.4 3.6Nuclear Medicine 19 17,511,482            100Pediatrics 225 36,584,621            69.4 11.1 19.5 B.C. Children's Hospital, Sunny Hill Children's HealthPathology - General 103 108,875,406          100 0.0  Centre & Queen Alexandra Children's Health CentrePathology - Anatomical 70 55,093,083            100Physical Medicine 37 5,035,181              67.8 32.2Psychiatry 488 76,474,980            67.5 31.0 1.6 Juan de Fuca Hospital Society, St. Joseph's Gen. Hosp.,Trail Regional Hosp. & West Coast General Hosp.Radiology - Diagnostic4 291 97,436,764            99.8 0.2Respiratory Medicine 44 11,025,355            94.7 5.3Rheumatology 27 4,833,618              91.0 9.0Cardiovascular and Thoracic Surgery 33 10,301,299            100General Surgery 189 40,198,514            98.0 0.0 2.0 Prince George Regional HospialNeurosurgery 32 8,163,795              99.3 0.7Obstetrics & Gynecology 182 39,143,784            93.1 1.5 5.4 Greater Victoria Hosp. Society & B.C. Women's Hosp.6Ophthalmology 182 58,660,936            99.4 0.6Orthopedic Surgery 148 30,183,249            99.3 0.7Otolaryngology 69 17,339,056            100 0.0Plastic Surgery 55 11,924,217            99.4 0.6Urology 68 20,349,066            99.5 0.5Vascular Surgery 25 7,502,115              99.8 0.2All Physicians 7,732 $1,535,323,185 93.5 3.7 2.81 Includes physicians on the 'active' registers of the CPSBC in 1996. 2 Excludes service agreement for transplantation services.3 Refers to organizations specified under service agreements for physician services in FY 1996/97. Agreements are specified by 'service type' not RCPSC specialty.  Payments for service agreementsare allocated to RCPSC specialty that best matches service type specified.4 Includes 32 Radiation Oncology Specialists.5 Agreements specified for intensive care services & geriatric home assessment.6 Agreements specified for maternal & newborn care.Health Human Resources Unit   Centre for Health Services and Policy Research - 31 -  Table 4.1:  Supply of Physicians in B.C. by Specialty, Number, FTEs, and FTE per 10,000 Population - 1991/92 and 1996/9711991 - 1992 1996 - 1997Specialty No. FTEsFTEs/10,000 Pop'n2 No. FTEsFTEs/10,000 Pop'n2Average Annual % Change3 in FTEs/10,000 Pop'n2General / Family Practice 3,847 3,299.36 9.78 4,335 3,809.92 9.81 0.07Anesthesiology 301 260.44 0.77 329 287.13 0.74 -0.85Cardiology 47 46.86 0.14 57 53.80 0.14 -0.05Community Medicine4 33 33.00 0.10 40 40.00 0.10 1.04Dermatology 57 51.12 0.15 62 56.42 0.15 -0.83Endocrinology & Metabolism 6 7.37 0.02 14 13.66 0.04 10.00Emergency Medicine4 59 59.00 0.17 71 71.00 0.18 0.90Gastroenterology 22 21.29 0.06 28 27.35 0.07 2.23Hematology 20 17.80 0.05 18 15.63 0.04 -5.27Internal Medicine 339 266.64 0.79 358 319.71 0.82 0.82Medical Biochemistry4 12 12.00 0.04 12 12.00 0.03 -2.77Medical Microbiology4 23 23.00 0.07 25 25.00 0.06 -1.13Medical Oncology4 10 10.00 0.03 16 16.00 0.04 6.81Nephrology 11 10.66 0.03 11 11.26 0.03 -1.70Neurology 64 60.69 0.18 69 63.08 0.16 -2.02Nuclear Medicine4 11 11.00 0.03 19 19.00 0.05 8.46Pediatrics 192 183.58 0.54 225 207.14 0.53 -0.39Pathology - General4 97 97.00 0.29 103 103.00 0.27 -1.60Pathology - Anatomical4 64 64.00 0.19 70 70.00 0.18 -1.01Physical Medicine 31 28.14 0.08 37 34.80 0.09 1.45Psychiatry 382 344.40 1.02 488 448.10 1.15 2.49Radiation Oncology4 28 28.00 0.08 32 32.00 0.08 -0.14Radiology - Diagnostic4 240 240.00 0.71 259 259.00 0.67 -1.28Respiratory Medicine 35 33.33 0.10 44 38.93 0.10 0.30Rheumatology 26 23.65 0.07 27 25.21 0.06 -1.52Cardiovascular & Thoracic Surgery 31 29.10 0.09 33 29.23 0.08 -2.68General Surgery 213 162.55 0.48 189 154.07 0.40 -3.81Neurosurgery 29 23.33 0.07 32 27.97 0.07 0.82Obstetrics & Gynecology 167 141.51 0.42 182 163.42 0.42 0.07Ophthalmology 165 157.50 0.47 182 170.47 0.44 -1.22Orthopedic Surgery 149 124.10 0.37 148 124.45 0.32 -2.71Otolaryngology 76 67.66 0.20 69 64.47 0.17 -3.70Plastic Surgery 49 42.99 0.13 55 50.46 0.13 0.40Urology 63 58.52 0.17 68 63.70 0.16 -1.11Vascular Surgery 23 22.06 0.07 25 23.04 0.06 -1.92Total Physicians 6,922 6,061.65 17.97 7,732 6,930.41 17.85 -0.131 For 1996, FTEs are based on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British Columbia   Cancer Agency. For 1991, FTEs are based on Fee for Service and Salaried and Sessional payments.  2 Based on 1991 BC Population = 3,373,399 and 1996 BC Population = 3,882,043.   Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24. All figures are as of July 1 of the year stated. 3 Average annual percent change in FTEs/10,000 population is calculated as follows: [(FTE 96-97/pop/FTE 91-92/pop)12/60 - 1]*100.4 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.   Health Human Resources Unit   Centre for Health Services and Policy Research - 36 - Table 4.2:  Age Distribution of B.C. Physicians by RCPSC Specialty - 1996/971Under 40 yrs 40 thru 49 yrs 50 thru 59 yrs 60 thru 69 yrs 70 yrs and older TotalsSpecialty No FTEs % No FTEs % No FTEs % No FTEs % No FTEs % No FTEsGeneral Practice 1588 1338.09 35.5 1442 1378.92 36.6 797 751.99 19.9 375 259.20 6.9 133 44.33 1.2 4335 3772.53Anaesthesiology 75 71.11 24.8 123 120.23 41.9 83 72.21 25.1 39 22.68 7.9 9 0.90 0.3 329 287.13Cardiology 15 12.43 23.4 25 24.95 46.9 16 14.85 27.9 1 1.00 1.9 57 53.23Community Medicine2 4 4.00 10.0 13 13.00 32.5 12 12.00 30.0 9 9.00 22.5 2 2.00 5.0 40 40.00Dermatology 8 6.10 10.8 22 23.39 41.5 16 15.05 26.7 11 10.84 19.2 5 1.04 1.8 62 56.42Endocrinology and Metabolism 6 6.00 43.9 6 6.25 45.8 1 0.58 4.2 1 0.83 6.1 14 13.66Emergency Medicine2 23 23.00 32.4 33 33.00 46.5 14 14.00 19.7 1 1.00 1.4 71 71.00Gastroenterology 8 6.76 24.7 15 15.35 56.1 5 5.24 19.2 28 27.35Haematology 3 2.59 16.6 10 7.86 50.3 5 5.18 33.1 18 15.63Internal Medicine 57 45.62 15.2 110 104.88 34.9 95 92.23 30.7 62 47.66 15.9 34 9.70 3.2 358 300.09Medical Biochemistry2 2 2.00 16.7 3 3.00 25.0 6 6.00 50.0 1 1.00 8.3 12 12.00Medical Microbiology2 3 3.00 12.0 9 9.00 36.0 8 8.00 32.0 5 5.00 20.0 25 25.00Medical Oncology2 5 5.00 31.3 6 6.00 37.5 5 5.00 31.3 16 16.00Nephrology 5 4.61 40.9 4 4.35 38.6 2 2.30 20.4 11 11.26Neurology 11 10.18 16.1 24 23.80 37.7 18 17.50 27.7 14 11.30 17.9 2 0.30 0.5 69 63.08Nuclear Medicine2 6 6.00 31.6 5 5.00 26.3 3 3.00 15.8 4 4.00 21.1 1 1.00 5.3 19 19.00Paediatrics 46 40.38 21.5 79 79.43 42.3 56 45.39 24.2 31 18.43 9.8 13 4.04 2.2 225 187.67Pathology - General2 15 15.00 14.6 29 29.00 28.2 31 31.00 30.1 22 22.00 21.4 6 6.00 5.8 103 103.00Pathology - Anatomical2 17 17.00 24.3 33 33.00 47.1 18 18.00 25.7 2 2.00 2.9 70 70.00Physical Medicine 5 3.57 10.3 15 16.06 46.1 12 11.78 33.9 4 3.37 9.7 1 0.02 0.1 37 34.80Psychiatry 76 70.03 15.9 167 159.63 36.2 123 118.17 26.8 87 72.49 16.4 35 20.35 4.6 488 440.67Radiation Oncology2 12 12.00 37.5 15 15.00 46.9 5 5.00 15.6 32 32.00Radiology - Diagnostic2 60 60.00 23.2 70 70.00 27.0 75 75.00 29.0 39 39.00 15.1 15 15.00 5.8 259 259.00Respiratory Medicine 8 6.98 17.9 25 22.91 58.8 10 8.04 20.7 1 1.00 2.6 44 38.93Rheumatology 3 2.59 10.3 14 12.34 48.9 10 10.28 40.8 27 25.21Cardiovascular and Thoracic Surg 4 4.06 13.9 12 10.85 37.1 11 10.76 36.8 5 2.29 7.8 1 1.27 4.3 33 29.23General Surgery 23 23.81 15.8 42 41.78 27.7 51 52.60 34.9 47 30.78 20.4 26 1.90 1.3 189 150.87Neurosurgery 8 7.45 26.6 6 7.01 25.1 9 9.16 32.7 6 4.28 15.3 3 0.07 0.3 32 27.97Obstetrics and Gynaecology 41 36.36 23.6 50 45.10 29.3 43 43.79 28.5 31 24.14 15.7 17 4.50 2.9 182 153.89Ophthalmology 37 33.06 19.4 56 65.09 38.2 52 53.76 31.5 23 14.19 8.3 14 4.37 2.6 182 170.47Orthopaedic Surgery 25 21.39 17.2 52 55.10 44.3 38 31.33 25.2 26 15.41 12.4 7 1.22 1.0 148 124.45Otolaryngology 11 10.05 15.6 23 24.56 38.1 23 21.70 33.7 10 7.44 11.5 2 0.72 1.1 69 64.47Plastic Surgery 13 11.94 23.7 22 23.33 46.2 17 14.04 27.8 2 1.03 2.0 1 0.12 0.2 55 50.46Urology 15 14.53 22.8 17 19.26 30.2 16 18.09 28.4 12 10.84 17.0 8 0.98 1.5 68 63.70Vascular Surgery 1 1.01 4.4 13 12.48 54.2 6 5.93 25.7 4 3.24 14.1 1 0.38 1.6 25 23.04Totals 2239 1937.70 28.4 2590 2520.91 36.9 1692 1608.95 23.5 875 645.44 9.4 336 120.21 1.8 7732 6833.211 FTE calculations are based on Fee for Service and Salaried and Sessional payments.2 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.Health Human Resources Unit   Centre for Health Services and Policy Research - 38 -  Table 4.3:  Sex Distribution of Physician FTEs in B.C. by Age and Specialty - 1996/971Specialty FTEs % Female FTEs % Female FTEs % Female FTEs % FemaleGeneral Practice 3772.5 24.3 1338.1 36.1 2130.9 19.2 303.5 6.7Anaesthesiology 287.1 13.4 71.1 14.0 192.4 13.9 23.6 8.3Cardiology 53.2 9.2 12.4 18.7 39.8 3.3 1.0 100.0Community Medicine2 40.0 23.3 4.0 25.0 25.0 28.0 11.0Dermatology 56.4 16.1 6.1 25.7 38.4 17.0 11.9 8.2Endocrinology and Metabolism 13.7 22.0 6.0 33.3 6.8 0.8Emergency Medicine2 71.0 12.2 23.0 26.1 47.0 6.4 1.0Gastroenterology 27.4 14.0 6.8 31.7 20.6 10.6Haematology 15.6 21.3 2.6 0.0 13.0 27.4Internal Medicine 300.1 9.2 45.6 25.9 197.1 12.9 57.4 3.1Medical Biochemistry2 12.0 41.7 2.0 100.0 9.0 33.3 1.0Medical Microbiology2 25.0 50.0 3.0 33.3 17.0 58.8 5.0Medical Oncology2 16.0 37.5 5.0 80.0 11.0 27.3Nephrology 11.3 8.6 4.6 21.7 6.7Neurology 63.1 5.9 10.2 10.1 41.3 4.7 11.6 0.6Nuclear Medicine2 19.0 20.0 6.0 16.7 8.0 25.0 5.0Paediatrics 187.7 24.5 40.4 41.9 124.8 20.6 22.5 21.4Pathology - General2 103.0 21.2 15.0 40.0 60.0 20.0 28.0 10.7Pathology - Anatomical2 70.0 28.2 17.0 35.3 51.0 25.5 2.0 50.0Physical Medicine 34.8 12.6 3.6 28.3 27.8 12.0 3.4Psychiatry 440.7 27.3 70.0 38.5 277.8 28.8 92.8 13.5Radiation Oncology2 32.0 22.0 12.0 25.0 20.0 25.0Radiology - Diagnostic2 259.0 19.4 60.0 26.7 145.0 21.4 54.0 5.6Respiratory Medicine 38.9 19.0 7.0 68.1 31.0 2.0 1.0Rheumatology 25.2 22.1 2.6 24.7 22.6 21.8Cardiovascular and Thoracic 29.2 4.6 4.1 0.0 21.6 6.2 3.6General Surgery 150.9 3.9 23.8 8.6 94.4 4.2 32.7Neurosurgery 28.0 0.0 7.5 0.0 16.2 0.0 4.4Obstetrics and Gynaecology 153.9 21.4 36.4 37.1 88.9 20.9 28.6 2.9Ophthalmology 170.5 10.5 33.1 23.5 118.9 8.5 18.6 0.2Orthopaedic Surgery 124.5 0.7 21.4 0.0 86.4 1.0 16.6Otolaryngology 64.5 6.9 10.1 9.7 46.3 7.8 8.2Plastic Surgery 50.5 8.2 11.9 25.5 37.4 3.1 1.2Urology 63.7 1.1 14.5 4.6 37.4 11.8Vascular Surgery 23.0 4.7 1.0 0.0 18.4 6.7 3.6Total 6833.2 20.7 1937.7 33.0 4129.9 17.5 765.7 6.71 FTE calculations are based on Fee for Service and Salaried and Sessional payments.2 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.Totals Under 40 40 thru 59 60 and olderHealth Human Resources Unit   Centre for Health Services and Policy Research - 42 -  Table 4.5:  Supply of Physicians by Place of Medical School Education - 19961 U.B.C. Other Canada Non-CanadaSpecialties Totals No. (%) No. (%) No. (%)General / Family Practice 4,335 1,392 (32.1) 1,903 (43.9) 1,040 (24.0)Anesthesiology 329 88 (26.7) 134 (40.7) 107 (32.5)Cardiology 57 16 (28.1) 23 (40.4) 18 (31.6)Community Medicine 40 9 (22.5) 22 (55.0) 9 (22.5)Dermatology 62 16 (25.8) 34 (54.8) 12 (19.4)Endocrinology & Metabolism 14 3 (21.4) 6 (42.9) 5 (35.7)Emergency Medicine 71 12 (16.9) 53 (74.6) 6 (8.5)Gastroenterology 28 6 (21.4) 19 (67.9) 3 (10.7)Hematology 18 5 (27.8) 8 (44.4) 5 (27.8)Internal Medicine 358 51 (14.2) 186 (52.0) 121 (33.8)Medical Biochemistry 12 3 (25.0) 6 (50.0) 3 (25.0)Medical Microbiology 25 2 (8.0) 11 (44.0) 12 (48.0)Medical Oncology 16 4 (25.0) 8 (50.0) 4 (25.0)Nephrology 11 3 (27.3) 3 (27.3) 5 (45.5)Neurology 69 13 (18.8) 35 (50.7) 21 (30.4)Nuclear Medicine 19 1 (5.3) 14 (73.7) 4 (21.1)Pediatrics 225 20 (8.9) 80 (35.6) 125 (55.6)Pathology - General 103 24 (23.3) 41 (39.8) 38 (36.9)Pathology - Anatomical 70 19 (27.1) 26 (37.1) 25 (35.7)Physical Medicine 37 6 (16.2) 16 (43.2) 15 (40.5)Psychiatry 488 71 (14.5) 200 (41.0) 217 (44.5)Radiation Oncology 32 8 (25.0) 5 (15.6) 19 (59.4)Radiology - Diagnostic 259 37 (14.3) 152 (58.7) 70 (27.0)Respiratory Medicine 44 7 (15.9) 19 (43.2) 18 (40.9)Rheumatology 27 6 (22.2) 10 (37.0) 11 (40.7)Cardiovascular & Thoracic Surgery 33 6 (18.2) 21 (63.6) 6 (18.2)General Surgery 189 24 (12.7) 100 (52.9) 65 (34.4)Neurosurgery 32 4 (12.5) 20 (62.5) 8 (25.0)Obstetrics & Gynecology 182 31 (17.0) 72 (39.6) 79 (43.4)Ophthalmology 182 30 (16.5) 105 (57.7) 47 (25.8)Orthopedic Surgery 148 28 (18.9) 77 (52.0) 43 (29.1)Otolaryngology 69 7 (10.1) 37 (53.6) 25 (36.2)Plastic Surgery 55 24 (43.6) 24 (43.6) 7 (12.7)Urology 68 18 (26.5) 36 (52.9) 14 (20.6)Vascular Surgery 25 7 (28.0) 10 (40.0) 8 (32.0)Total Specialists 3,397 609 (17.9) 1,613 (47.5) 1,175 (34.6)Total BC 7,732 2,001 (25.9) 3,516 (45.5) 2,215 (28.6)1 Includes physicians on the 'active' registers of the CPSBC in 1996. Health Human Resources Unit   Centre for Health Services and Policy Research - 44 -  Table 4.6:  Place of Medical School Education (%) by Specialty & GP/FP - 1991, 1996, and % Change U.B.C. Other Canada Non-CanadaSpecialties 1991 1996 % Change 1991 1996 % Change 1991 1996 % ChangeGeneral / Family Practice 31.1 32.1 1.0 43.0 43.9 0.9 25.9 24.0 -1.9Anesthesiology 26.2 26.7 0.5 41.2 40.7 -0.5 32.6 32.5 0.0Cardiology 21.3 28.1 6.8 42.6 40.4 -2.2 36.2 31.6 -4.6Community Medicine 18.2 22.5 4.3 36.4 55.0 18.6 45.5 22.5 -23.0Dermatology 24.6 25.8 1.2 52.6 54.8 2.2 22.8 19.4 -3.5Endocrinology & Metabolism 0.0 21.4 21.4 50.0 42.9 -7.1 50.0 35.7 -14.3Emergency Medicine 16.9 16.9 0.0 71.2 74.6 3.5 11.9 8.5 -3.4Gastroenterology 18.2 21.4 3.2 72.7 67.9 -4.9 9.1 10.7 1.6Hematology 25.0 27.8 2.8 45.0 44.4 -0.6 30.0 27.8 -2.2Internal Medicine 14.2 14.2 0.1 52.2 52.0 -0.3 33.6 33.8 0.2Medical Biochemistry 16.7 25.0 8.3 50.0 50.0 0.0 33.3 25.0 -8.3Medical Microbiology 4.3 8.0 3.7 39.1 44.0 4.9 56.5 48.0 -8.5Medical Oncology 20.0 25.0 5.0 30.0 50.0 20.0 50.0 25.0 -25.0Nephrology 27.3 27.3 0.0 27.3 27.3 0.0 45.5 45.5 0.0Neurology 20.3 18.8 -1.5 45.3 50.7 5.4 34.4 30.4 -3.9Nuclear Medicine 0.0 5.3 5.3 72.7 73.7 1.0 27.3 21.1 -6.2Pediatrics 8.9 8.9 0.0 33.9 35.6 1.7 57.3 55.6 -1.7Pathology - General 20.6 23.3 2.7 41.2 39.8 -1.4 38.1 36.9 -1.3Pathology - Anatomical 25.0 27.1 2.1 43.8 37.1 -6.6 31.3 35.7 4.5Physical Medicine 9.7 16.2 6.5 45.2 43.2 -1.9 45.2 40.5 -4.6Psychiatry 14.4 14.5 0.2 42.4 41.0 -1.4 43.2 44.5 1.3Radiation Oncology 17.9 25.0 7.1 32.1 15.6 -16.5 50.0 59.4 9.4Radiology - Diagnostic 13.1 14.3 1.2 56.3 58.7 2.3 30.6 27.0 -3.6Respiratory Medicine 14.3 15.9 1.6 42.9 43.2 0.3 42.9 40.9 -1.9Rheumatology 19.2 22.2 3.0 34.6 37.0 2.4 46.2 40.7 -5.4Cardiovascular & Thoracic Surgery 16.1 18.2 2.1 64.5 63.6 -0.9 19.4 18.2 -1.2General Surgery 10.3 12.7 2.4 56.8 52.9 -3.9 32.9 34.4 1.5Neurosurgery 13.8 12.5 -1.3 58.6 62.5 3.9 27.6 25.0 -2.6Obstetrics & Gynecology 16.2 17.0 0.9 36.5 39.6 3.0 47.3 43.4 -3.9Ophthalmology 13.9 16.5 2.5 57.0 57.7 0.7 29.1 25.8 -3.3Orthopedic Surgery 17.4 18.9 1.5 51.0 52.0 1.0 31.5 29.1 -2.5Otolaryngology 13.2 10.1 -3.0 53.9 53.6 -0.3 32.9 36.2 3.3Plastic Surgery 32.7 43.6 11.0 53.1 43.6 -9.4 14.3 12.7 -1.6Urology 27.0 26.5 -0.5 47.6 52.9 5.3 25.4 20.6 -4.8Vascular Surgery 26.1 28.0 1.9 39.1 40.0 0.9 34.8 32.0 -2.8Total Specialists 16.6 17.9 1.4 47.8 47.5 -0.3 35.6 34.6 -1.1Total Physicians 24.7 25.9 1.2 45.1 45.5 0.3 30.2 28.6 -1.6Note: 1991 figures for Radiation Oncology were taken from Report Table 4.4.   Table 4.8:  Geographic Distribution of Physician in B.C. by HHRU Region and Grouped Specialty, 1996/971General / Family Practice General Internal Medicine Medical Subspecialties General Surgery Surgical Subspecialties PediatricsHHRU Region Population2 No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. RatioVancouver & District 1,910,331 2,215 1,899.1 99.41 232 177.5 9.29 258 234.5 12.28 86 71.6 3.75 373 331.7 17.36 161 147.4 7.71Capital 331,761 491 376.1 113.37 34 24.7 7.44 45 55.3 16.68 20 13.2 3.98 70 63.2 19.05 15 17.4 5.26Fraser Valley 231,345 197 199.7 86.32 9 9.8 4.23 6 5.5 2.36 7 7.4 3.20 22 22.9 9.89 5 6.1 2.64Okanagan 334,743 343 321.7 96.10 19 18.5 5.53 29 32.6 9.72 19 14.1 4.20 51 48.2 14.39 14 10.4 3.09South East 160,708 184 157.8 98.21 10 9.1 5.67 3 2.6 1.61 12 9.0 5.58 10 10.1 6.29 4 4.6 2.87Island Coast 425,368 444 403.5 94.87 21 21.2 4.99 9 8.2 1.92 21 19.0 4.46 47 43.4 10.21 11 8.7 2.04Central 203,742 189 182.0 89.31 8 7.9 3.89 8 9.2 4.52 12 8.8 4.33 21 19.4 9.52 6 6.0 2.95North Central 219,324 221 218.6 99.65 11 14.0 6.40 5 5.4 2.45 9 8.0 3.67 17 14.7 6.71 5 6.6 3.00North 64,721 51 51.4 79.43 1 0.9 1.38 0 0.0 0.00 3 3.0 4.60 1 0.2 0.36 0 0.0 0.00Unknown - - - - - - - - - - - - - - - - - - -Total BC 3,882,043 4,335 3,809.9 98.14 345 283.6 7.31 363 353.2 9.10 189 154.1 3.97 612 553.8 14.27 221 207.2 5.34Psychiatry Obstetrics & Gynecology Laboratory/Radiology3 Anesthesiology Other4 All SpecialistsHHRU Region Population2 No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. RatioVancouver & District 1,910,331 339 321.8 16.85 107 102.1 5.34 335 335.0 17.54 200 171.7 8.99 100 97.7 5.12 2,191 1,991 104.23Capital 331,761 65 48.3 14.55 15 10.9 3.27 55 55.0 16.58 42 35.7 10.75 29 27.9 8.40 390 352 105.96Fraser Valley 231,345 12 10.1 4.35 6 6.2 2.66 19 19.0 8.21 10 9.9 4.30 0 0.0 0.00 96 97 41.83Okanagan 334,743 22 21.6 6.46 14 11.5 3.42 27 27.0 8.07 24 23.2 6.94 7 8.4 2.51 226 215 64.33South East 160,708 11 9.9 6.17 4 2.6 1.62 16 16.0 9.96 5 3.8 2.35 1 1.0 0.62 76 69 42.74Island Coast 425,368 25 22.6 5.32 20 14.7 3.46 29 29.0 6.82 29 24.7 5.80 4 4.0 0.94 216 196 45.97Central 203,742 7 6.9 3.39 7 7.0 3.42 17 17.0 8.34 10 10.1 4.98 4 3.8 1.86 100 96 47.20North Central 219,324 7 6.9 3.12 8 7.6 3.45 19 19.0 8.66 9 8.0 3.65 3 3.0 1.37 93 93 42.47North 64,721 0 0.0 0.00 1 1.0 1.55 3 3.0 4.64 0 0.0 0.00 0 0.0 0.00 9 8 12.52Unknown - - - - - - - - - - - - - - - -Total BC 3,882,043 488 448.1 11.54 182 163.4 4.21 520 520.0 13.40 329 287.1 7.40 148 145.8 3.76 3,397 3116.3 80.281 FTE calculations are based on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British Columbia Cancer Agency. FTE/Population Ratios are number of FTEs per 100,000.2 Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24.  All population estimates are as of July 1, 1996.3 As a more accurate representation of personnel in this specialty, 1 person=1FTE.4 "Other" category includes:  Community Medicine, Emergency Medicine, Occupational Medicine, Physical Medicine, and Public Health.Health Human Resources Unit   Centre for Health Services and Policy Research - 49 -    Health Human Resources Unit   Centre for Health Services and Policy Research - 50 - Table 4.9:  Geographic Distribution of Physicians in B.C. by HHRU Region and Grouped Specialty, 1991/92 1General / Family Practice General Internal Medicine Medical Subspecialties General Surgery Surgical Subspecialties PediatricsHHRU Region Population 2 No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.RatioVancouver & District 1,647,358 1,968 1,634.4 99.21 233 156.8 9.52 223 212.1 12.88 99 77.2 4.68 355 318.7 19.35 145 129.4 7.85Capital 307,644 443 333.9 108.53 31 23.5 7.65 34 35.6 11.58 22 13.1 4.26 75 64.3 20.91 11 13.5 4.38Fraser Valley 191,031 169 172.3 90.21 8 8.7 4.55 5 5.2 2.71 8 8.3 4.34 24 23.7 12.41 3 3.9 2.04Okanagan 279,790 275 264.5 94.52 18 17.9 6.41 18 19.9 7.09 19 13.4 4.80 45 40.3 14.41 11 11.8 4.22South East 145,167 179 156.8 108.00 10 9.0 6.22 2 2.5 1.75 8 7.0 4.83 8 6.9 4.77 4 4.6 3.19Island Coast 361,145 372 341.2 94.48 15 15.9 4.39 8 7.7 2.13 20 18.4 5.09 35 33.7 9.32 8 9.4 2.60Central 178,944 160 156.9 87.66 8 8.3 4.62 7 8.5 4.73 16 10.2 5.68 19 19.4 10.83 5 5.3 2.96North Central 202,571 184 174.4 86.08 7 9.7 4.77 4 4.6 2.29 13 9.4 4.65 16 14.5 7.18 4 5.7 2.83North 59,749 39 39.1 65.44 0 0.0 0.00 0 0.0 0.00 4 4.3 7.15 2 0.5 0.77 1 0.0 0.00Unknown - 58 26.0 - 4 1.6 - 2 2.0 - 4 1.3 - 6 3.2 - - - -Total BC 3,373,399 3,847 3,299.4 97.81 334 251.3 7.45 303 298.1 8.84 213 162.6 4.82 585 525.3 15.57 192 183.6 5.44Psychiatry Obstetrics & Gynecology Laboratory/Radiology 3 Anesthesiology Other 4 All SpecialistsHHRU Region Population 2 No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.RatioVancouver & District 1,647,358 289 264.4 16.05 100 85.6 5.20 305 305.0 18.51 192 162.8 9.88 87 83.5 5.07 2,028 1,796 108.99Capital 307,644 46 33.6 10.91 18 13.0 4.24 54 54.0 17.55 41 35.8 11.64 19 18.8 6.10 351 305 99.23Fraser Valley 191,031 8 8.7 4.57 4 4.2 2.19 16 16.0 8.38 10 10.6 5.53 0 0.0 0.00 86 89 46.72Okanagan 279,790 16 17.4 6.21 14 11.8 4.23 24 24.0 8.58 18 17.1 6.12 7 8.2 2.92 190 182 64.99South East 145,167 4 2.7 1.88 2 2.0 1.38 15 15.0 10.33 2 0.9 0.62 0 0.0 0.00 55 51 34.97Island Coast 361,145 14 12.0 3.31 15 11.3 3.13 26 26.0 7.20 19 15.8 4.38 7 7.0 1.94 167 157 43.48Central 178,944 3 3.8 2.10 7 6.7 3.74 17 17.0 9.50 10 9.6 5.35 3 2.7 1.49 95 91 51.00North Central 202,571 2 1.9 0.93 5 5.5 2.71 13 13.0 6.42 5 4.7 2.30 0 0.0 0.00 69 69 34.06North 59,749 0 0.0 0.00 1 1.0 1.59 3 3.0 5.02 0 0.0 0.00 0 0.0 0.00 11 9 14.53Unknown - - - - 1 0.4 - 2 2.0 - 4 3.2 - - - - 23 13.3 -Total BC 3,373,399 382 344.4 10.21 167 141.5 4.19 475 475.0 14.08 301 260.4 7.72 123 120.1 3.56 3,075 2762.3 81.881 FTE calculations are based on Fee for Service and Salaried and Sessional payments.  FTE/Population Ratios are number of  FTEs per 100,000.2 Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24.  All population estimates are as of July 1, 1991.3 As a more accurate representation of personnel in this specialty, 1 person=1FTE.4 "Other" category includes:  Community Medicine, Emergency Medicine, Occupational Medicine, Physical Medicine, and Public Health.   Table 4.12:   Regional Distribution of BC Physicians by Age Group, Sex, and Place of Medical School Training, 1996General / Family MedicineVancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 43 (16.0) 45 (14.0) 46 (16.0) 43 (15.0) 43 (15.0) 43 (13.0) 42 (14.0) 41 (13.5) 43 (15.0)Age Group n (%)< 40 859 (38.8) 136 (27.7) 66 (33.5) 121 (35.3) 66 (35.9) 153 (34.5) 77 (40.7) 110 (40.4) 1,588 (36.6)40 to 64 1,208 (54.5) 315 (64.2) 109 (55.3) 206 (60.1) 106 (57.6) 265 (59.7) 107 (56.6) 151 (55.5) 2,467 (56.9)65+ 148 (6.7) 40 (8.1) 22 (11.2) 16 (4.7) 12 (6.5) 26 (5.9) 5 (2.6) 11 (4.0) 280 (6.5)Sex n (%)Male 1,466 (66.2) 343 (69.9) 163 (82.7) 262 (76.4) 130 (70.7) 337 (75.9) 145 (76.7) 213 (78.3) 3,059 (70.6)Female 749 (33.8) 148 (30.1) 34 (17.3) 81 (23.6) 54 (29.3) 107 (24.1) 44 (23.3) 59 (21.7) 1,276 (29.4)Medical  School n (%)U.B.C. 791 (35.7) 137 (27.9) 65 (33.0) 100 (29.2) 37 (20.1) 143 (32.2) 60 (31.7) 59 (21.7) 1,392 (32.1)Other Canada 931 (42.0) 251 (51.1) 73 (37.1) 179 (52.2) 105 (57.1) 187 (42.1) 79 (41.8) 99 (36.4) 1,903 (43.9)Non-Canada 493 (22.3) 103 (21.0) 59 (29.9) 64 (18.7) 42 (22.8) 114 (25.7) 50 (26.5) 114 (41.9) 1,040 (24.0)Totals 2,215 - 491 - 197 - 343 - 184 - 444 - 189 - 272 - 4,335 - 'General' Specialties (General Internal Medicine; General Surgery; Psychiatry; Pediatrics; Obstetrics & Gynecology)Vancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 50 (17.0) 57 (15.0) 46 (17.0) 50 (23.0) 48 (17.0) 53 (18.0) 49 (19.0) 45 (19.0) 50 (18.0)Age Group n (%)< 40 159 (17.4) 11 (7.4) 8 (21.1) 16 (18.4) 6 (14.6) 14 (14.3) 9 (22.5) 15 (34.1) 238 (16.9)40 to 64 608 (66.5) 103 (69.1) 27 (71.1) 52 (59.8) 32 (78.0) 64 (65.3) 27 (67.5) 23 (52.3) 936 (66.3)65+ 147 (16.1) 35 (23.5) 3 (7.9) 19 (21.8) 3 (7.3) 20 (20.4) 4 (10.0) 6 (13.6) 237 (16.8)Sex n (%)Male 677 (74.1) 124 (83.2) 32 (84.2) 72 (82.8) 38 (92.7) 88 (89.8) 35 (87.5) 36 (81.8) 1,102 (78.1)Female 237 (25.9) 25 (16.8) 6 (15.8) 15 (17.2) 3 (7.3) 10 (10.2) 5 (12.5) 8 (18.2) 309 (21.9)Medical  School n (%)U.B.C. 141 (15.4) 12 (8.1) 8 (21.1) 12 (13.8) 4 (9.8) 5 (5.1) 2 (5.0) 5 (11.4) 189 (13.4)Other Canada 384 (42.0) 73 (49.0) 11 (28.9) 50 (57.5) 19 (46.3) 54 (55.1) 21 (52.5) 16 (36.4) 628 (44.5)Non-Canada 389 (42.6) 64 (43.0) 19 (50.0) 25 (28.7) 18 (43.9) 39 (39.8) 17 (42.5) 23 (52.3) 594 (42.1)Totals 914 - 149 - 38 - 87 - 41 - 98 - 40 - 44 - 1,411 -All Other Specialties (Medical Subspecialties; Surgical Subspecialties; Laboratory & Radiology; Anesthesiology)Vancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 47 (15.0) 50 (14.0) 49 (12.0) 45 (14.0) 42 (11.0) 47 (16.0) 47 (14.5) 45 (16.0) 47 (14.0)Age Group n (%)< 40 245 (20.8) 25 (11.8) 9 (15.5) 43 (32.6) 13 (38.2) 23 (20.2) 9 (16.1) 14 (25.5) 381 (20.7)40 to 64 834 (70.9) 157 (74.1) 43 (74.1) 79 (59.8) 20 (58.8) 80 (70.2) 44 (78.6) 36 (65.5) 1,293 (70.3)65+ 98 (8.3) 30 (14.2) 6 (10.3) 10 (7.6) 1 (2.9) 11 (9.6) 3 (5.4) 5 (9.1) 164 (8.9)Sex n (%)Male 958 (81.4) 193 (91.0) 52 (89.7) 122 (92.4) 29 (85.3) 101 (88.6) 54 (96.4) 49 (89.1) 1,558 (84.8)Female 219 (18.6) 19 (9.0) 6 (10.3) 10 (7.6) 5 (14.7) 13 (11.4) 2 (3.6) 6 (10.9) 280 (15.2)Medical  School n (%)U.B.C. 287 (24.4) 24 (11.3) 12 (20.7) 25 (18.9) 4 (11.8) 22 (19.3) 8 (14.3) 11 (20.0) 393 (21.4)Other Canada 529 (44.9) 124 (58.5) 29 (50.0) 77 (58.3) 21 (61.8) 60 (52.6) 33 (58.9) 24 (43.6) 897 (48.8)Non-Canada 361 (30.7) 64 (30.2) 17 (29.3) 30 (22.7) 9 (26.5) 32 (28.1) 15 (26.8) 20 (36.4) 548 (29.8)Totals 1,177 - 212 - 58 - 132 - 34 - 114 - 56 - 55 - 1,838 -Note: The 'North' and 'North Central' regions have been grouped. Physicians in emergency medicine, community medicine, physical medicine and public health are excluded from the analyses. Includes only physicians on the 'active' register of the CPSBC. IQR refers to 'inter-quartile range'.Health Human Resources Unit   Centre for Health Services and Policy Research - 56 -    Table 4.16:   General Practitioners / Family Physicians by Health Region, Age, Sex, and Place of Medical School Education, 1996Characteristic East KootenayWest Kootenay - BoundaryNorth OkanaganSouth Okanagan - Similkameen Thompson Fraser ValleySouth Fraser Valley Simon Fraser Coast GaribaldiAge    median (IQR) 42.5 (17.0) 43 (13.0) 44 (18.0) 43 (13.0) 44 (16.0) 46 (16.0) 44 (16.0) 43 (15.0) 42 (14.0)Age Group   n (%)< 40 32 (37.2) 34 (34.7) 47 (37.3) 74 (34.1) 46 (37.4) 66 (33.5) 160 (37.0) 103 (37.5) 29 (35.8)40 to 64 47 (54.7) 59 (60.2) 73 (57.9) 133 (61.3) 73 (59.3) 109 (55.3) 237 (54.9) 157 (57.1) 49 (60.5)65+ 7 (8.1) 5 (5.1) 6 (4.8) 10 (4.6) 4 (3.3) 22 (11.2) 35 (8.1) 15 (5.5) 3 (3.7)Sex   n (%)Male 65 (75.6) 65 (66.3) 97 (77.0) 165 (76.0) 92 (74.8) 163 (82.7) 302 (69.9) 204 (74.2) 58 (71.6)Female 21 (24.4) 33 (33.7) 29 (23.0) 52 (24.0) 31 (25.2) 34 (17.3) 130 (30.1) 71 (25.8) 23 (28.4)Medical School   n (%)U.B.C. 15 (17.4) 22 (22.4) 45 (35.7) 55 (25.3) 36 (29.3) 65 (33.0) 138 (31.9) 96 (34.9) 25 (30.9)Other Canada 53 (61.6) 52 (53.1) 61 (48.4) 118 (54.4) 59 (48.0) 73 (37.1) 185 (42.8) 118 (42.9) 41 (50.6)Non-Canada 18 (20.9) 24 (24.5) 20 (15.9) 44 (20.3) 28 (22.8) 59 (29.9) 109 (25.2) 61 (22.2) 15 (18.5)Totals 86 - 98 - 126 - 217 - 123 - 197 - 432 - 275 - 81 -Characteristic Cariboo North West Peace LiardNorthern Interior Vancouver Burnaby North Shore Richmond CapitalAge    median (IQR) 41 (11.0) 42 (16.0) 39 (10.0) 42 (15.0) 43 (16.0) 42 (15.5) 45 (18.0) 43 (15.0) 45 (14.0)Age Group   n (%)< 40 31 (47.0) 39 (38.2) 27 (52.9) 44 (37.0) 387 (39.7) 69 (43.1) 76 (35.8) 64 (39.5) 136 (27.7)40 to 64 34 (51.5) 60 (58.8) 22 (43.1) 69 (58.0) 527 (54.1) 81 (50.6) 116 (54.7) 90 (55.6) 315 (64.2)65+ 1 (1.5) 3 (2.9) 2 (3.9) 6 (5.0) 60 (6.2) 10 (6.3) 20 (9.4) 8 (4.9) 40 (8.1)Sex   n (%)Male 53 (80.3) 77 (75.5) 42 (82.4) 94 (79.0) 608 (62.4) 103 (64.4) 132 (62.3) 117 (72.2) 343 (69.9)Female 13 (19.7) 25 (24.5) 9 (17.6) 25 (21.0) 366 (37.6) 57 (35.6) 80 (37.7) 45 (27.8) 148 (30.1)Medical School   n (%)U.B.C. 24 (36.4) 25 (24.5) 8 (15.7) 26 (21.8) 345 (35.4) 61 (38.1) 88 (41.5) 63 (38.9) 137 (27.9)Other Canada 20 (30.3) 48 (47.1) 12 (23.5) 39 (32.8) 416 (42.7) 67 (41.9) 87 (41.0) 58 (35.8) 251 (51.1)Non-Canada 22 (33.3) 29 (28.4) 31 (60.8) 54 (45.4) 213 (21.9) 32 (20.0) 37 (17.5) 41 (25.3) 103 (21.0)Totals 66 - 102 - 51 - 119 - 974 - 160 - 212 - 162 - 491 -Cent Vanc IslandUpper Island/ Central Coast44 (41.5) 42 (14.0)75 (31.3) 49 (39.8)148 (61.7) 68 (55.3)17 (7.1) 6 (4.9)189 (78.8) 90 (73.2)51 (21.3) 33 (26.8)77 (32.1) 41 (33.3)96 (40.0) 50 (40.7)67 (27.9) 32 (26.0)240 - 123 -All Regions43 (15.0)1,588 (36.6)2,467 (56.9)280 (6.5)3,059 (70.6)1,276 (29.4)1,392 (32.1)1,904 (43.9)1,039 (24.0)4,335 -Health Human Resources Unit   Centre for Health Services and Policy Research - 69 - Health Human Resources Unit   Centre for Health Services and Policy Research - 78 -  Table 4.17: Distribution of Herfindahl Index for GP/FPs & Specialists by HHRU Regions, 1996-971,2,3General / Family Practice SpecialistsHHRU Region n Mean Median SD n Mean Median SDVancouver & District 1,839 0.77 0.78 0.14 1,071 0.89 0.96 0.15Capital 403 0.75 0.76 0.13 181 0.88 0.93 0.15Fraser Valley 177 0.74 0.75 0.14 55 0.92 0.95 0.10Okanagan 315 0.73 0.75 0.13 142 0.87 0.92 0.13South-East 155 0.74 0.77 0.15 38 0.88 0.94 0.14Island Coast 398 0.73 0.75 0.13 129 0.90 0.95 0.12Central 170 0.73 0.76 0.14 58 0.88 0.93 0.13North Central 187 0.71 0.73 0.14 52 0.89 0.95 0.12North 47 0.68 0.69 0.15 6 0.83 0.81 0.09Total Physicians 3,691 0.75 0.76 0.14 1,732 0.90 0.95 0.141 Includes physicians on the 'active' CPSBC registers in 1996 except for pediatrics, rehabilitation medicine, community medicine/  public health, psychiatry, laboratory medicine and radiology, medical oncology and radiation oncology (N=1,377).   Also, excludes 644 GP/FPs and 288 specialists with FTE < 0.2 in 1996/97 or who had no FFS billings.2 Note: The footnote on Page 77 of the PGME Report should read (n=1,377) specialties excluded.3 Section 4.2.2.1 on Page 75 should also read (n=1,377) for specialties excluded and (n=932) for other physicians excluded.   Table 4.18: Distribution of Herfindahl Index for GP/FPs1 by Age, Sex, Place of Training and FTE Status, 1996-97 All Regions Urban Semi-Urban Ruraln Mean SD Statistic2 P-value n Mean SD n Mean SD n Mean SD Statistic3 P-valueAge Group<30 122 0.73 0.13 37.7 <0.0001 65 0.73 0.13 42 0.70 0.13 15 0.74 0.12 0.50 0.60531-40 1,248 0.72 0.14 536 0.73 0.13 583 0.70 0.14 129 0.74 0.12 6.0 0.00341-50 1,284 0.74 0.14 548 0.76 0.14 631 0.73 0.13 105 0.68 0.15 29.4 <0.000151-60 688 0.79 0.13 290 0.80 0.14 347 0.77 0.13 51 0.78 0.12 5.7 0.00361-70 286 0.81 0.14 133 0.81 0.14 135 0.80 0.13 18 0.82 0.08 0.36 0.69870+ 63 0.82 0.16 27 0.86 0.13 33 0.80 0.16 3 0.75 0.20 0.97 0.327SexFemale 1,057 0.69 0.13 309.8 <0.0001 556 0.70 0.14 432 0.69 0.13 69 0.70 0.13 1.03 0.272Male 2,634 0.77 0.13 1,043 0.80 0.13 1339 0.75 0.14 252 0.74 0.13 57.2 <0.0001Medical SchoolU.B.C. 1,250 0.73 0.14 21.4 <0.0001 615 0.74 0.14 579 0.71 0.13 56 0.73 0.11 6.08 0.002In Canada 1,556 0.75 0.14 648 0.76 0.14 776 0.74 0.14 132 0.74 0.13 4.53 0.011Non-Canada 885 0.77 0.14 336 0.80 0.14 416 0.76 0.14 133 0.72 0.15 14.3 <0.0001Full-Time-Equivalency0.2-0.5 309 0.78 0.14 9.38 <0.0001 162 0.78 0.15 123 0.78 0.14 24 0.79 0.12 0.13 0.8790.5-1.2 2,509 0.74 0.14 1,166 0.76 0.14 1112 0.73 0.14 231 0.73 0.13 7.4 0.001>1.2 873 0.75 0.14 271 0.79 0.14 536 0.73 0.13 66 0.73 0.14 13.2 <0.0001Totals 3,691 1,599 1,771 3211 Includes GP/FPs on the 'active' CPSBC registers in 1996. Excludes 644 GP/FPs with FTE < 0.2 in FY 1996/97 or who had no FFS billings.2 F-statistic from analysis of variance to test for differences in log HI between levels of the covariate of interest.3 F-statistic from one-way analysis of variance testing for differences in log HI among urban, semi-urban and rural levels, stratified by age, sex, medical school, FTE or PGME location.Health Human Resources Unit   Centre for Health Services and Policy Research - 80 -    Table 4.22: Demographic and Training Characteristics of GP/FP 'Specialists' in Obstetrics & Gynecology, Anesthesiology, and Surgery, 1996/97GP/FP 'Specialists2All GP/FPs1 Obstetrics & Gynecology Anesthesiology SurgeryStatistic3 P-value Statistic3 P-value Statistic3 P-valueAge    median (IQR) 43 (24.0) 39 (11.0) 29.7 <0.001 43 (14.0) 0.13 0.717 45 (18.0) 14.5 <0.001Age Group   n (%)<40 1,373 (37.2) 96 (54.9) 37.6 <0.001 25 (31.6) 2.10 0.555 68 (34.7) 30.2 <0.00140-49 1,283 (34.8) 62 (35.4) 33 (41.8) 61 (31.1)50-59 687 (18.6) 11 (6.3) 15 (19.0) 27 (13.8)60+ 348 (9.4) 6 (3.4) 6 (7.6) 40 (20.4)Sex    n (%) Male 2,634 (71.4) 24 (13.7) 298.8 <0.001 70 (88.6) 11.7 <0.001 169 (86.2) 22.3 <0.001Female 1,057 (28.6) 151 (86.3) 9 (11.4) 27 (13.8)Medical School   n (%)U.B.C. 1,250 (33.9) 74 (42.3) 8.70 0.013 19 (24.1) 16.2 0.001 56 (28.6) 2.59 0.273In Canada 1,556 (42.2) 73 (41.7) 26 (32.9) 89 (45.4)Non-Canada 885 (24.0) 28 (16.0) 34 (43.0) 51 (26.0)Geographic Location   n (%)Urban 1,599 (43.3) 93 (53.1) 7.83 0.020 9 (11.4) 98.5 0.001 88 (44.9) 0.473 0.789Semi-urban 1,771 (48.0) 72 (41.1) 40 (50.6) 93 (47.4)Rural 321 (8.7) 10 (5.7) 30 (38.0) 15 (7.7)Totals 3,691 - 175 - 79 - 196 -1 Includes all GP/FPs on the 'active' registers of the College of Physicians and Surgeons of B.C., excluding GP/FPs with FTE<0.2 or who had no FFS billings in 1996/97 (n=644). 2 GP/FP 'specialists' were defined by the proportion of billings within the respective specialty 'domains'. GP/FP 'anesthesiologists' and 'surgeons' were defined as GP/FPs with >10% of total billings in the respective domain.  GP/FP 'obstetrician/gynecologists' were defined as GP/FPswith >20% of total billings in the obstetrics & gynecology fee-item domain. Percents given are relative to all GP/FPs.3 For categorical variables, chi-square test for homogeneity is presented.  For age (as a continuous variable), the F-statistic relating to one-way analysis of variance is presented.Health Human Resources Unit   Centre for Health Services and Policy Research - 92 -  A Research Unit Funded by the Ministry of Health, British Columbia THE UNIVERSITY OF BRITISH COLUMBIA      Health Human Resources Unit Centre for Health Services and Policy Research 429 – 2194 Health Sciences Mall Vancouver, B.C. Canada  V6T 1Z3 Tel:  (604) 822-4810 Fax: (604) 822-5690   December 20, 2001       Dear Reader:   We have recently become aware that computing errors were made during the production of Table 4.11 in the report Issues in Physician Resources Planning in B.C.: Key Determinants of Supply and Distribution, 1991-96. A Report to the Post-Graduate Medical Education Advisory Committee.  Attached is the corrected table.  Please insert the table in the appropriate section of the report.      Health Human Resources Unit   Centre for Health Services and Policy Research - 54 - Table 4.11: Change in Population, Physicians, and FTE/Population Ratios by HHRU Region, 1991/92-1996/97*Vancouver Capital Fraser Valley Okanagan South East Island Coast CentralPopulation Growth 91-96  (%) 16.0 7.8 21.1 19.6 10.7 17.8 13.9Change in No. Physicians  n (%)**General Internal Medicine -1 -(0.4) 3 (9.7) 1 (12.5) 1 (5.6) 0 (0.0) 6 (40.0) 0 (0.0)Medical Subspecialties 35 (15.7) 11 (32.4) 1 (20.0) 11 (61.1) 1 (50.0) 1 (12.5) 1 (14.3)General Surgery -13 -(13.1) -2 -(9.1) -1 -(12.5) 0 (0.0) 4 (50.0) 1 (5.0) -4 -(25.0)Surgical Subspecialties 18 (5.1) -5 (16.0) -2 -(8.3) 6 (13.3) 2 (25.0) 12 (34.3) 2 (10.5)Pediatrics 16 (11.0) 4 (36.4) 2 (66.7) 3 (27.3) 0 (0.0) 3 (37.5) 1 (20.0)Psychiatry 50 (17.3) 19 (41.3) 4 (50.0) 6 (37.5) 7 (175.0) 11 (78.6) 4 (133.3)Obstetrics & Gynecology 7 (7.0) -3 -(16.7) 2 (50.0) 0 (0.0) 2 (100.0) 5 (33.3) 0 (0.0)Laboratory & Radiology 30 (9.8) 1 (1.9) 3 (18.8) 3 (12.5) 1 (6.7) 3 (11.5) 0 (0.0)Anesthesiology 8 (4.2) 1 (2.4) 0 (0.0) 6 (33.3) 3 (150.0) 10 (52.6) 0 (0.0)Change in FTE / Population Ratios (FTEs per 100,000)General Internal Medicine -0.23 -0.22 -0.33 -0.88 -0.55 0.60 -0.73Medical Subspecialties -0.60 5.10 -0.35 2.63 -0.14 -0.21 -0.21General Surgery -0.93 -0.28 -1.15 -0.60 0.75 -0.62 -1.35Surgical Subspecialties -1.99 -1.86 -2.52 -0.01 1.52 0.89 -1.31Pediatrics -0.14 0.88 0.60 -1.12 -0.32 -0.56 -0.01Psychiatry 0.80 3.64 -0.22 0.24 4.28 2.01 1.29Obstetrics & Gynecology 0.15 -0.97 0.47 -0.81 0.25 0.34 -0.33Laboratory & Radiology -0.98 -0.97 -0.16 -0.51 -0.38 -0.38 -1.16Anesthesiology -0.89 -0.89 -1.24 0.82 1.73 1.42 -0.38* Includes only physicians on the 'active' registers of the CPSBC. ** Percent change is calcualted (no. 1996/97 - no. 1991/92) / (no. 1991/92) *100N. Central North8.3 8.34 (57.1) 1 -1 (25.0) 0 --4 -(30.8) -1 -(25.0)1 (6.3) -1 -(50.0)1 (25.0) -1 -(100)5 (250.0) 0 -3 (60.0) 0 (0.0)6 (46.2) 0 (0.0)4 (80.0) 0 -1.63 1.380.16 0.00-0.98 -2.54-0.47 -0.410.17 0.002.20 0.000.74 -0.042.25 -0.391.35 0.00 A Research Unit Funded by the Ministry of Health, British Columbia THE UNIVERSITY OF BRITISH COLUMBIA      Health Human Resources Unit Centre for Health Services and Policy Research 429 – 2194 Health Sciences Mall Vancouver, B.C. Canada  V6T 1Z3 Tel:  (604) 822-4810 Fax: (604) 822-5690   March 20, 2001       Dear Reader:   We have recently become aware that computing errors were made during the production of Tables 3.5, 4.1, 4.2, 4.3, 4.5, 4.6, 4.8, 4.9, 4.12, 4.16, 4.17, 4.18, and 4.22 in the report Issues in Physician Resources Planning in B.C.: Key Determinants of Supply and Distribution, 1991-96. A Report to the Post-Graduate Medical Education Advisory Committee.  Attached are the corrected tables.  Please insert them in the appropriate sections of the report.      Health Human Resources Unit   Centre for Health Services and Policy Research - 26 - Table 3.5 Distribution of Ministry of Health Payments for Physician Services by Payment Mechanism, 1996/971Payment MechanismsSpecialty No.Total Payments   FY 1996/972Fee-For-Service (%)Salary & Sessional (%)Service Agreements (%) Contractors3General / Family Practice 4,335 638,901,798          96.0 3.1 0.9 12 AgenciesAnesthesiology 329 56,027,709            99.9 0.1Cardiology 57 23,436,740            98.4 0.5 1.0 Nanaimo General HospitalCommunity Medicine 40 493,085                 43.4 57Dermatology 62 15,290,151            98.4 1.6Endocrinology & Metabolism 14 2,515,038              93.8 6.2Emergency Medicine 71 13,718,800            59.9 0.4 39.6 Vancouver General, St. Paul's & B.C. Women's HospitalGastroenterology 28 9,080,362              100Haematology 18 2,411,532              83.8 16.2Internal Medicine 358 67,327,316            89.9 5.3 4.8 Greater Victoria Hospital Society, Vancouver General Hospital & St. Paul's Hospital5Medical Biochemistry 12 7,472,848              100Medical Microbiology 25 5,885,350              99.6 0.4 B.C. Children's, St. Paul's Hospital, U.B.C. Medical Microbiology & Greater Victoria Hosp. SocietyMedical Oncology 16 17,518,337            7.3 92.7 B.C. Cancer AgencyNephrology 11 3,716,090              96.2 3.8Neurology 69 14,891,509            96.4 3.6Nuclear Medicine 19 17,511,482            100Pediatrics 225 36,584,621            69.4 11.1 19.5 B.C. Children's Hospital, Sunny Hill Children's HealthPathology - General 103 108,875,406          100 0.0  Centre & Queen Alexandra Children's Health CentrePathology - Anatomical 70 55,093,083            100Physical Medicine 37 5,035,181              67.8 32.2Psychiatry 488 76,474,980            67.5 31.0 1.6 Juan de Fuca Hospital Society, St. Joseph's Gen. Hosp.,Trail Regional Hosp. & West Coast General Hosp.Radiology - Diagnostic4 291 97,436,764            99.8 0.2Respiratory Medicine 44 11,025,355            94.7 5.3Rheumatology 27 4,833,618              91.0 9.0Cardiovascular and Thoracic Surgery 33 10,301,299            100General Surgery 189 40,198,514            98.0 0.0 2.0 Prince George Regional HospialNeurosurgery 32 8,163,795              99.3 0.7Obstetrics & Gynecology 182 39,143,784            93.1 1.5 5.4 Greater Victoria Hosp. Society & B.C. Women's Hosp.6Ophthalmology 182 58,660,936            99.4 0.6Orthopedic Surgery 148 30,183,249            99.3 0.7Otolaryngology 69 17,339,056            100 0.0Plastic Surgery 55 11,924,217            99.4 0.6Urology 68 20,349,066            99.5 0.5Vascular Surgery 25 7,502,115              99.8 0.2All Physicians 7,732 $1,535,323,185 93.5 3.7 2.81 Includes physicians on the 'active' registers of the CPSBC in 1996. 2 Excludes service agreement for transplantation services.3 Refers to organizations specified under service agreements for physician services in FY 1996/97. Agreements are specified by 'service type' not RCPSC specialty.  Payments for service agreementsare allocated to RCPSC specialty that best matches service type specified.4 Includes 32 Radiation Oncology Specialists.5 Agreements specified for intensive care services & geriatric home assessment.6 Agreements specified for maternal & newborn care.Health Human Resources Unit   Centre for Health Services and Policy Research - 31 -  Table 4.1:  Supply of Physicians in B.C. by Specialty, Number, FTEs, and FTE per 10,000 Population - 1991/92 and 1996/9711991 - 1992 1996 - 1997Specialty No. FTEsFTEs/10,000 Pop'n2 No. FTEsFTEs/10,000 Pop'n2Average Annual % Change3 in FTEs/10,000 Pop'n2General / Family Practice 3,847 3,299.36 9.78 4,335 3,809.92 9.81 0.07Anesthesiology 301 260.44 0.77 329 287.13 0.74 -0.85Cardiology 47 46.86 0.14 57 53.80 0.14 -0.05Community Medicine4 33 33.00 0.10 40 40.00 0.10 1.04Dermatology 57 51.12 0.15 62 56.42 0.15 -0.83Endocrinology & Metabolism 6 7.37 0.02 14 13.66 0.04 10.00Emergency Medicine4 59 59.00 0.17 71 71.00 0.18 0.90Gastroenterology 22 21.29 0.06 28 27.35 0.07 2.23Hematology 20 17.80 0.05 18 15.63 0.04 -5.27Internal Medicine 339 266.64 0.79 358 319.71 0.82 0.82Medical Biochemistry4 12 12.00 0.04 12 12.00 0.03 -2.77Medical Microbiology4 23 23.00 0.07 25 25.00 0.06 -1.13Medical Oncology4 10 10.00 0.03 16 16.00 0.04 6.81Nephrology 11 10.66 0.03 11 11.26 0.03 -1.70Neurology 64 60.69 0.18 69 63.08 0.16 -2.02Nuclear Medicine4 11 11.00 0.03 19 19.00 0.05 8.46Pediatrics 192 183.58 0.54 225 207.14 0.53 -0.39Pathology - General4 97 97.00 0.29 103 103.00 0.27 -1.60Pathology - Anatomical4 64 64.00 0.19 70 70.00 0.18 -1.01Physical Medicine 31 28.14 0.08 37 34.80 0.09 1.45Psychiatry 382 344.40 1.02 488 448.10 1.15 2.49Radiation Oncology4 28 28.00 0.08 32 32.00 0.08 -0.14Radiology - Diagnostic4 240 240.00 0.71 259 259.00 0.67 -1.28Respiratory Medicine 35 33.33 0.10 44 38.93 0.10 0.30Rheumatology 26 23.65 0.07 27 25.21 0.06 -1.52Cardiovascular & Thoracic Surgery 31 29.10 0.09 33 29.23 0.08 -2.68General Surgery 213 162.55 0.48 189 154.07 0.40 -3.81Neurosurgery 29 23.33 0.07 32 27.97 0.07 0.82Obstetrics & Gynecology 167 141.51 0.42 182 163.42 0.42 0.07Ophthalmology 165 157.50 0.47 182 170.47 0.44 -1.22Orthopedic Surgery 149 124.10 0.37 148 124.45 0.32 -2.71Otolaryngology 76 67.66 0.20 69 64.47 0.17 -3.70Plastic Surgery 49 42.99 0.13 55 50.46 0.13 0.40Urology 63 58.52 0.17 68 63.70 0.16 -1.11Vascular Surgery 23 22.06 0.07 25 23.04 0.06 -1.92Total Physicians 6,922 6,061.65 17.97 7,732 6,930.41 17.85 -0.131 For 1996, FTEs are based on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British Columbia   Cancer Agency. For 1991, FTEs are based on Fee for Service and Salaried and Sessional payments.  2 Based on 1991 BC Population = 3,373,399 and 1996 BC Population = 3,882,043.   Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24. All figures are as of July 1 of the year stated. 3 Average annual percent change in FTEs/10,000 population is calculated as follows: [(FTE 96-97/pop/FTE 91-92/pop)12/60 - 1]*100.4 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.   Health Human Resources Unit   Centre for Health Services and Policy Research - 36 - Table 4.2:  Age Distribution of B.C. Physicians by RCPSC Specialty - 1996/971Under 40 yrs 40 thru 49 yrs 50 thru 59 yrs 60 thru 69 yrs 70 yrs and older TotalsSpecialty No FTEs % No FTEs % No FTEs % No FTEs % No FTEs % No FTEsGeneral Practice 1588 1338.09 35.5 1442 1378.92 36.6 797 751.99 19.9 375 259.20 6.9 133 44.33 1.2 4335 3772.53Anaesthesiology 75 71.11 24.8 123 120.23 41.9 83 72.21 25.1 39 22.68 7.9 9 0.90 0.3 329 287.13Cardiology 15 12.43 23.4 25 24.95 46.9 16 14.85 27.9 1 1.00 1.9 57 53.23Community Medicine2 4 4.00 10.0 13 13.00 32.5 12 12.00 30.0 9 9.00 22.5 2 2.00 5.0 40 40.00Dermatology 8 6.10 10.8 22 23.39 41.5 16 15.05 26.7 11 10.84 19.2 5 1.04 1.8 62 56.42Endocrinology and Metabolism 6 6.00 43.9 6 6.25 45.8 1 0.58 4.2 1 0.83 6.1 14 13.66Emergency Medicine2 23 23.00 32.4 33 33.00 46.5 14 14.00 19.7 1 1.00 1.4 71 71.00Gastroenterology 8 6.76 24.7 15 15.35 56.1 5 5.24 19.2 28 27.35Haematology 3 2.59 16.6 10 7.86 50.3 5 5.18 33.1 18 15.63Internal Medicine 57 45.62 15.2 110 104.88 34.9 95 92.23 30.7 62 47.66 15.9 34 9.70 3.2 358 300.09Medical Biochemistry2 2 2.00 16.7 3 3.00 25.0 6 6.00 50.0 1 1.00 8.3 12 12.00Medical Microbiology2 3 3.00 12.0 9 9.00 36.0 8 8.00 32.0 5 5.00 20.0 25 25.00Medical Oncology2 5 5.00 31.3 6 6.00 37.5 5 5.00 31.3 16 16.00Nephrology 5 4.61 40.9 4 4.35 38.6 2 2.30 20.4 11 11.26Neurology 11 10.18 16.1 24 23.80 37.7 18 17.50 27.7 14 11.30 17.9 2 0.30 0.5 69 63.08Nuclear Medicine2 6 6.00 31.6 5 5.00 26.3 3 3.00 15.8 4 4.00 21.1 1 1.00 5.3 19 19.00Paediatrics 46 40.38 21.5 79 79.43 42.3 56 45.39 24.2 31 18.43 9.8 13 4.04 2.2 225 187.67Pathology - General2 15 15.00 14.6 29 29.00 28.2 31 31.00 30.1 22 22.00 21.4 6 6.00 5.8 103 103.00Pathology - Anatomical2 17 17.00 24.3 33 33.00 47.1 18 18.00 25.7 2 2.00 2.9 70 70.00Physical Medicine 5 3.57 10.3 15 16.06 46.1 12 11.78 33.9 4 3.37 9.7 1 0.02 0.1 37 34.80Psychiatry 76 70.03 15.9 167 159.63 36.2 123 118.17 26.8 87 72.49 16.4 35 20.35 4.6 488 440.67Radiation Oncology2 12 12.00 37.5 15 15.00 46.9 5 5.00 15.6 32 32.00Radiology - Diagnostic2 60 60.00 23.2 70 70.00 27.0 75 75.00 29.0 39 39.00 15.1 15 15.00 5.8 259 259.00Respiratory Medicine 8 6.98 17.9 25 22.91 58.8 10 8.04 20.7 1 1.00 2.6 44 38.93Rheumatology 3 2.59 10.3 14 12.34 48.9 10 10.28 40.8 27 25.21Cardiovascular and Thoracic Surg 4 4.06 13.9 12 10.85 37.1 11 10.76 36.8 5 2.29 7.8 1 1.27 4.3 33 29.23General Surgery 23 23.81 15.8 42 41.78 27.7 51 52.60 34.9 47 30.78 20.4 26 1.90 1.3 189 150.87Neurosurgery 8 7.45 26.6 6 7.01 25.1 9 9.16 32.7 6 4.28 15.3 3 0.07 0.3 32 27.97Obstetrics and Gynaecology 41 36.36 23.6 50 45.10 29.3 43 43.79 28.5 31 24.14 15.7 17 4.50 2.9 182 153.89Ophthalmology 37 33.06 19.4 56 65.09 38.2 52 53.76 31.5 23 14.19 8.3 14 4.37 2.6 182 170.47Orthopaedic Surgery 25 21.39 17.2 52 55.10 44.3 38 31.33 25.2 26 15.41 12.4 7 1.22 1.0 148 124.45Otolaryngology 11 10.05 15.6 23 24.56 38.1 23 21.70 33.7 10 7.44 11.5 2 0.72 1.1 69 64.47Plastic Surgery 13 11.94 23.7 22 23.33 46.2 17 14.04 27.8 2 1.03 2.0 1 0.12 0.2 55 50.46Urology 15 14.53 22.8 17 19.26 30.2 16 18.09 28.4 12 10.84 17.0 8 0.98 1.5 68 63.70Vascular Surgery 1 1.01 4.4 13 12.48 54.2 6 5.93 25.7 4 3.24 14.1 1 0.38 1.6 25 23.04Totals 2239 1937.70 28.4 2590 2520.91 36.9 1692 1608.95 23.5 875 645.44 9.4 336 120.21 1.8 7732 6833.211 FTE calculations are based on Fee for Service and Salaried and Sessional payments.2 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.Health Human Resources Unit   Centre for Health Services and Policy Research - 38 -  Table 4.3:  Sex Distribution of Physician FTEs in B.C. by Age and Specialty - 1996/971Specialty FTEs % Female FTEs % Female FTEs % Female FTEs % FemaleGeneral Practice 3772.5 24.3 1338.1 36.1 2130.9 19.2 303.5 6.7Anaesthesiology 287.1 13.4 71.1 14.0 192.4 13.9 23.6 8.3Cardiology 53.2 9.2 12.4 18.7 39.8 3.3 1.0 100.0Community Medicine2 40.0 23.3 4.0 25.0 25.0 28.0 11.0Dermatology 56.4 16.1 6.1 25.7 38.4 17.0 11.9 8.2Endocrinology and Metabolism 13.7 22.0 6.0 33.3 6.8 0.8Emergency Medicine2 71.0 12.2 23.0 26.1 47.0 6.4 1.0Gastroenterology 27.4 14.0 6.8 31.7 20.6 10.6Haematology 15.6 21.3 2.6 0.0 13.0 27.4Internal Medicine 300.1 9.2 45.6 25.9 197.1 12.9 57.4 3.1Medical Biochemistry2 12.0 41.7 2.0 100.0 9.0 33.3 1.0Medical Microbiology2 25.0 50.0 3.0 33.3 17.0 58.8 5.0Medical Oncology2 16.0 37.5 5.0 80.0 11.0 27.3Nephrology 11.3 8.6 4.6 21.7 6.7Neurology 63.1 5.9 10.2 10.1 41.3 4.7 11.6 0.6Nuclear Medicine2 19.0 20.0 6.0 16.7 8.0 25.0 5.0Paediatrics 187.7 24.5 40.4 41.9 124.8 20.6 22.5 21.4Pathology - General2 103.0 21.2 15.0 40.0 60.0 20.0 28.0 10.7Pathology - Anatomical2 70.0 28.2 17.0 35.3 51.0 25.5 2.0 50.0Physical Medicine 34.8 12.6 3.6 28.3 27.8 12.0 3.4Psychiatry 440.7 27.3 70.0 38.5 277.8 28.8 92.8 13.5Radiation Oncology2 32.0 22.0 12.0 25.0 20.0 25.0Radiology - Diagnostic2 259.0 19.4 60.0 26.7 145.0 21.4 54.0 5.6Respiratory Medicine 38.9 19.0 7.0 68.1 31.0 2.0 1.0Rheumatology 25.2 22.1 2.6 24.7 22.6 21.8Cardiovascular and Thoracic 29.2 4.6 4.1 0.0 21.6 6.2 3.6General Surgery 150.9 3.9 23.8 8.6 94.4 4.2 32.7Neurosurgery 28.0 0.0 7.5 0.0 16.2 0.0 4.4Obstetrics and Gynaecology 153.9 21.4 36.4 37.1 88.9 20.9 28.6 2.9Ophthalmology 170.5 10.5 33.1 23.5 118.9 8.5 18.6 0.2Orthopaedic Surgery 124.5 0.7 21.4 0.0 86.4 1.0 16.6Otolaryngology 64.5 6.9 10.1 9.7 46.3 7.8 8.2Plastic Surgery 50.5 8.2 11.9 25.5 37.4 3.1 1.2Urology 63.7 1.1 14.5 4.6 37.4 11.8Vascular Surgery 23.0 4.7 1.0 0.0 18.4 6.7 3.6Total 6833.2 20.7 1937.7 33.0 4129.9 17.5 765.7 6.71 FTE calculations are based on Fee for Service and Salaried and Sessional payments.2 As a more accurate representation of personnel in this specialty, 1 person=1 FTE.Totals Under 40 40 thru 59 60 and olderHealth Human Resources Unit   Centre for Health Services and Policy Research - 42 -  Table 4.5:  Supply of Physicians by Place of Medical School Education - 19961 U.B.C. Other Canada Non-CanadaSpecialties Totals No. (%) No. (%) No. (%)General / Family Practice 4,335 1,392 (32.1) 1,903 (43.9) 1,040 (24.0)Anesthesiology 329 88 (26.7) 134 (40.7) 107 (32.5)Cardiology 57 16 (28.1) 23 (40.4) 18 (31.6)Community Medicine 40 9 (22.5) 22 (55.0) 9 (22.5)Dermatology 62 16 (25.8) 34 (54.8) 12 (19.4)Endocrinology & Metabolism 14 3 (21.4) 6 (42.9) 5 (35.7)Emergency Medicine 71 12 (16.9) 53 (74.6) 6 (8.5)Gastroenterology 28 6 (21.4) 19 (67.9) 3 (10.7)Hematology 18 5 (27.8) 8 (44.4) 5 (27.8)Internal Medicine 358 51 (14.2) 186 (52.0) 121 (33.8)Medical Biochemistry 12 3 (25.0) 6 (50.0) 3 (25.0)Medical Microbiology 25 2 (8.0) 11 (44.0) 12 (48.0)Medical Oncology 16 4 (25.0) 8 (50.0) 4 (25.0)Nephrology 11 3 (27.3) 3 (27.3) 5 (45.5)Neurology 69 13 (18.8) 35 (50.7) 21 (30.4)Nuclear Medicine 19 1 (5.3) 14 (73.7) 4 (21.1)Pediatrics 225 20 (8.9) 80 (35.6) 125 (55.6)Pathology - General 103 24 (23.3) 41 (39.8) 38 (36.9)Pathology - Anatomical 70 19 (27.1) 26 (37.1) 25 (35.7)Physical Medicine 37 6 (16.2) 16 (43.2) 15 (40.5)Psychiatry 488 71 (14.5) 200 (41.0) 217 (44.5)Radiation Oncology 32 8 (25.0) 5 (15.6) 19 (59.4)Radiology - Diagnostic 259 37 (14.3) 152 (58.7) 70 (27.0)Respiratory Medicine 44 7 (15.9) 19 (43.2) 18 (40.9)Rheumatology 27 6 (22.2) 10 (37.0) 11 (40.7)Cardiovascular & Thoracic Surgery 33 6 (18.2) 21 (63.6) 6 (18.2)General Surgery 189 24 (12.7) 100 (52.9) 65 (34.4)Neurosurgery 32 4 (12.5) 20 (62.5) 8 (25.0)Obstetrics & Gynecology 182 31 (17.0) 72 (39.6) 79 (43.4)Ophthalmology 182 30 (16.5) 105 (57.7) 47 (25.8)Orthopedic Surgery 148 28 (18.9) 77 (52.0) 43 (29.1)Otolaryngology 69 7 (10.1) 37 (53.6) 25 (36.2)Plastic Surgery 55 24 (43.6) 24 (43.6) 7 (12.7)Urology 68 18 (26.5) 36 (52.9) 14 (20.6)Vascular Surgery 25 7 (28.0) 10 (40.0) 8 (32.0)Total Specialists 3,397 609 (17.9) 1,613 (47.5) 1,175 (34.6)Total BC 7,732 2,001 (25.9) 3,516 (45.5) 2,215 (28.6)1 Includes physicians on the 'active' registers of the CPSBC in 1996. Health Human Resources Unit   Centre for Health Services and Policy Research - 44 -  Table 4.6:  Place of Medical School Education (%) by Specialty & GP/FP - 1991, 1996, and % Change U.B.C. Other Canada Non-CanadaSpecialties 1991 1996 % Change 1991 1996 % Change 1991 1996 % ChangeGeneral / Family Practice 31.1 32.1 1.0 43.0 43.9 0.9 25.9 24.0 -1.9Anesthesiology 26.2 26.7 0.5 41.2 40.7 -0.5 32.6 32.5 0.0Cardiology 21.3 28.1 6.8 42.6 40.4 -2.2 36.2 31.6 -4.6Community Medicine 18.2 22.5 4.3 36.4 55.0 18.6 45.5 22.5 -23.0Dermatology 24.6 25.8 1.2 52.6 54.8 2.2 22.8 19.4 -3.5Endocrinology & Metabolism 0.0 21.4 21.4 50.0 42.9 -7.1 50.0 35.7 -14.3Emergency Medicine 16.9 16.9 0.0 71.2 74.6 3.5 11.9 8.5 -3.4Gastroenterology 18.2 21.4 3.2 72.7 67.9 -4.9 9.1 10.7 1.6Hematology 25.0 27.8 2.8 45.0 44.4 -0.6 30.0 27.8 -2.2Internal Medicine 14.2 14.2 0.1 52.2 52.0 -0.3 33.6 33.8 0.2Medical Biochemistry 16.7 25.0 8.3 50.0 50.0 0.0 33.3 25.0 -8.3Medical Microbiology 4.3 8.0 3.7 39.1 44.0 4.9 56.5 48.0 -8.5Medical Oncology 20.0 25.0 5.0 30.0 50.0 20.0 50.0 25.0 -25.0Nephrology 27.3 27.3 0.0 27.3 27.3 0.0 45.5 45.5 0.0Neurology 20.3 18.8 -1.5 45.3 50.7 5.4 34.4 30.4 -3.9Nuclear Medicine 0.0 5.3 5.3 72.7 73.7 1.0 27.3 21.1 -6.2Pediatrics 8.9 8.9 0.0 33.9 35.6 1.7 57.3 55.6 -1.7Pathology - General 20.6 23.3 2.7 41.2 39.8 -1.4 38.1 36.9 -1.3Pathology - Anatomical 25.0 27.1 2.1 43.8 37.1 -6.6 31.3 35.7 4.5Physical Medicine 9.7 16.2 6.5 45.2 43.2 -1.9 45.2 40.5 -4.6Psychiatry 14.4 14.5 0.2 42.4 41.0 -1.4 43.2 44.5 1.3Radiation Oncology 17.9 25.0 7.1 32.1 15.6 -16.5 50.0 59.4 9.4Radiology - Diagnostic 13.1 14.3 1.2 56.3 58.7 2.3 30.6 27.0 -3.6Respiratory Medicine 14.3 15.9 1.6 42.9 43.2 0.3 42.9 40.9 -1.9Rheumatology 19.2 22.2 3.0 34.6 37.0 2.4 46.2 40.7 -5.4Cardiovascular & Thoracic Surgery 16.1 18.2 2.1 64.5 63.6 -0.9 19.4 18.2 -1.2General Surgery 10.3 12.7 2.4 56.8 52.9 -3.9 32.9 34.4 1.5Neurosurgery 13.8 12.5 -1.3 58.6 62.5 3.9 27.6 25.0 -2.6Obstetrics & Gynecology 16.2 17.0 0.9 36.5 39.6 3.0 47.3 43.4 -3.9Ophthalmology 13.9 16.5 2.5 57.0 57.7 0.7 29.1 25.8 -3.3Orthopedic Surgery 17.4 18.9 1.5 51.0 52.0 1.0 31.5 29.1 -2.5Otolaryngology 13.2 10.1 -3.0 53.9 53.6 -0.3 32.9 36.2 3.3Plastic Surgery 32.7 43.6 11.0 53.1 43.6 -9.4 14.3 12.7 -1.6Urology 27.0 26.5 -0.5 47.6 52.9 5.3 25.4 20.6 -4.8Vascular Surgery 26.1 28.0 1.9 39.1 40.0 0.9 34.8 32.0 -2.8Total Specialists 16.6 17.9 1.4 47.8 47.5 -0.3 35.6 34.6 -1.1Total Physicians 24.7 25.9 1.2 45.1 45.5 0.3 30.2 28.6 -1.6Note: 1991 figures for Radiation Oncology were taken from Report Table 4.4.   Table 4.8:  Geographic Distribution of Physician in B.C. by HHRU Region and Grouped Specialty, 1996/971General / Family Practice General Internal Medicine Medical Subspecialties General Surgery Surgical Subspecialties PediatricsHHRU Region Population2 No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. RatioVancouver & District 1,910,331 2,215 1,899.1 99.41 232 177.5 9.29 258 234.5 12.28 86 71.6 3.75 373 331.7 17.36 161 147.4 7.71Capital 331,761 491 376.1 113.37 34 24.7 7.44 45 55.3 16.68 20 13.2 3.98 70 63.2 19.05 15 17.4 5.26Fraser Valley 231,345 197 199.7 86.32 9 9.8 4.23 6 5.5 2.36 7 7.4 3.20 22 22.9 9.89 5 6.1 2.64Okanagan 334,743 343 321.7 96.10 19 18.5 5.53 29 32.6 9.72 19 14.1 4.20 51 48.2 14.39 14 10.4 3.09South East 160,708 184 157.8 98.21 10 9.1 5.67 3 2.6 1.61 12 9.0 5.58 10 10.1 6.29 4 4.6 2.87Island Coast 425,368 444 403.5 94.87 21 21.2 4.99 9 8.2 1.92 21 19.0 4.46 47 43.4 10.21 11 8.7 2.04Central 203,742 189 182.0 89.31 8 7.9 3.89 8 9.2 4.52 12 8.8 4.33 21 19.4 9.52 6 6.0 2.95North Central 219,324 221 218.6 99.65 11 14.0 6.40 5 5.4 2.45 9 8.0 3.67 17 14.7 6.71 5 6.6 3.00North 64,721 51 51.4 79.43 1 0.9 1.38 0 0.0 0.00 3 3.0 4.60 1 0.2 0.36 0 0.0 0.00Unknown - - - - - - - - - - - - - - - - - - -Total BC 3,882,043 4,335 3,809.9 98.14 345 283.6 7.31 363 353.2 9.10 189 154.1 3.97 612 553.8 14.27 221 207.2 5.34Psychiatry Obstetrics & Gynecology Laboratory/Radiology3 Anesthesiology Other4 All SpecialistsHHRU Region Population2 No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. Ratio No. FTEsFTE / Pop. RatioVancouver & District 1,910,331 339 321.8 16.85 107 102.1 5.34 335 335.0 17.54 200 171.7 8.99 100 97.7 5.12 2,191 1,991 104.23Capital 331,761 65 48.3 14.55 15 10.9 3.27 55 55.0 16.58 42 35.7 10.75 29 27.9 8.40 390 352 105.96Fraser Valley 231,345 12 10.1 4.35 6 6.2 2.66 19 19.0 8.21 10 9.9 4.30 0 0.0 0.00 96 97 41.83Okanagan 334,743 22 21.6 6.46 14 11.5 3.42 27 27.0 8.07 24 23.2 6.94 7 8.4 2.51 226 215 64.33South East 160,708 11 9.9 6.17 4 2.6 1.62 16 16.0 9.96 5 3.8 2.35 1 1.0 0.62 76 69 42.74Island Coast 425,368 25 22.6 5.32 20 14.7 3.46 29 29.0 6.82 29 24.7 5.80 4 4.0 0.94 216 196 45.97Central 203,742 7 6.9 3.39 7 7.0 3.42 17 17.0 8.34 10 10.1 4.98 4 3.8 1.86 100 96 47.20North Central 219,324 7 6.9 3.12 8 7.6 3.45 19 19.0 8.66 9 8.0 3.65 3 3.0 1.37 93 93 42.47North 64,721 0 0.0 0.00 1 1.0 1.55 3 3.0 4.64 0 0.0 0.00 0 0.0 0.00 9 8 12.52Unknown - - - - - - - - - - - - - - - -Total BC 3,882,043 488 448.1 11.54 182 163.4 4.21 520 520.0 13.40 329 287.1 7.40 148 145.8 3.76 3,397 3116.3 80.281 FTE calculations are based on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British Columbia Cancer Agency. FTE/Population Ratios are number of FTEs per 100,000.2 Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24.  All population estimates are as of July 1, 1996.3 As a more accurate representation of personnel in this specialty, 1 person=1FTE.4 "Other" category includes:  Community Medicine, Emergency Medicine, Occupational Medicine, Physical Medicine, and Public Health.Health Human Resources Unit   Centre for Health Services and Policy Research - 49 -    Health Human Resources Unit   Centre for Health Services and Policy Research - 50 - Table 4.9:  Geographic Distribution of Physicians in B.C. by HHRU Region and Grouped Specialty, 1991/92 1General / Family Practice General Internal Medicine Medical Subspecialties General Surgery Surgical Subspecialties PediatricsHHRU Region Population 2 No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.RatioVancouver & District 1,647,358 1,968 1,634.4 99.21 233 156.8 9.52 223 212.1 12.88 99 77.2 4.68 355 318.7 19.35 145 129.4 7.85Capital 307,644 443 333.9 108.53 31 23.5 7.65 34 35.6 11.58 22 13.1 4.26 75 64.3 20.91 11 13.5 4.38Fraser Valley 191,031 169 172.3 90.21 8 8.7 4.55 5 5.2 2.71 8 8.3 4.34 24 23.7 12.41 3 3.9 2.04Okanagan 279,790 275 264.5 94.52 18 17.9 6.41 18 19.9 7.09 19 13.4 4.80 45 40.3 14.41 11 11.8 4.22South East 145,167 179 156.8 108.00 10 9.0 6.22 2 2.5 1.75 8 7.0 4.83 8 6.9 4.77 4 4.6 3.19Island Coast 361,145 372 341.2 94.48 15 15.9 4.39 8 7.7 2.13 20 18.4 5.09 35 33.7 9.32 8 9.4 2.60Central 178,944 160 156.9 87.66 8 8.3 4.62 7 8.5 4.73 16 10.2 5.68 19 19.4 10.83 5 5.3 2.96North Central 202,571 184 174.4 86.08 7 9.7 4.77 4 4.6 2.29 13 9.4 4.65 16 14.5 7.18 4 5.7 2.83North 59,749 39 39.1 65.44 0 0.0 0.00 0 0.0 0.00 4 4.3 7.15 2 0.5 0.77 1 0.0 0.00Unknown - 58 26.0 - 4 1.6 - 2 2.0 - 4 1.3 - 6 3.2 - - - -Total BC 3,373,399 3,847 3,299.4 97.81 334 251.3 7.45 303 298.1 8.84 213 162.6 4.82 585 525.3 15.57 192 183.6 5.44Psychiatry Obstetrics & Gynecology Laboratory/Radiology 3 Anesthesiology Other 4 All SpecialistsHHRU Region Population 2 No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.Ratio No. FTEsFTE /Pop.RatioVancouver & District 1,647,358 289 264.4 16.05 100 85.6 5.20 305 305.0 18.51 192 162.8 9.88 87 83.5 5.07 2,028 1,796 108.99Capital 307,644 46 33.6 10.91 18 13.0 4.24 54 54.0 17.55 41 35.8 11.64 19 18.8 6.10 351 305 99.23Fraser Valley 191,031 8 8.7 4.57 4 4.2 2.19 16 16.0 8.38 10 10.6 5.53 0 0.0 0.00 86 89 46.72Okanagan 279,790 16 17.4 6.21 14 11.8 4.23 24 24.0 8.58 18 17.1 6.12 7 8.2 2.92 190 182 64.99South East 145,167 4 2.7 1.88 2 2.0 1.38 15 15.0 10.33 2 0.9 0.62 0 0.0 0.00 55 51 34.97Island Coast 361,145 14 12.0 3.31 15 11.3 3.13 26 26.0 7.20 19 15.8 4.38 7 7.0 1.94 167 157 43.48Central 178,944 3 3.8 2.10 7 6.7 3.74 17 17.0 9.50 10 9.6 5.35 3 2.7 1.49 95 91 51.00North Central 202,571 2 1.9 0.93 5 5.5 2.71 13 13.0 6.42 5 4.7 2.30 0 0.0 0.00 69 69 34.06North 59,749 0 0.0 0.00 1 1.0 1.59 3 3.0 5.02 0 0.0 0.00 0 0.0 0.00 11 9 14.53Unknown - - - - 1 0.4 - 2 2.0 - 4 3.2 - - - - 23 13.3 -Total BC 3,373,399 382 344.4 10.21 167 141.5 4.19 475 475.0 14.08 301 260.4 7.72 123 120.1 3.56 3,075 2762.3 81.881 FTE calculations are based on Fee for Service and Salaried and Sessional payments.  FTE/Population Ratios are number of  FTEs per 100,000.2 Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model - #24.  All population estimates are as of July 1, 1991.3 As a more accurate representation of personnel in this specialty, 1 person=1FTE.4 "Other" category includes:  Community Medicine, Emergency Medicine, Occupational Medicine, Physical Medicine, and Public Health.   Table 4.12:   Regional Distribution of BC Physicians by Age Group, Sex, and Place of Medical School Training, 1996General / Family MedicineVancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 43 (16.0) 45 (14.0) 46 (16.0) 43 (15.0) 43 (15.0) 43 (13.0) 42 (14.0) 41 (13.5) 43 (15.0)Age Group n (%)< 40 859 (38.8) 136 (27.7) 66 (33.5) 121 (35.3) 66 (35.9) 153 (34.5) 77 (40.7) 110 (40.4) 1,588 (36.6)40 to 64 1,208 (54.5) 315 (64.2) 109 (55.3) 206 (60.1) 106 (57.6) 265 (59.7) 107 (56.6) 151 (55.5) 2,467 (56.9)65+ 148 (6.7) 40 (8.1) 22 (11.2) 16 (4.7) 12 (6.5) 26 (5.9) 5 (2.6) 11 (4.0) 280 (6.5)Sex n (%)Male 1,466 (66.2) 343 (69.9) 163 (82.7) 262 (76.4) 130 (70.7) 337 (75.9) 145 (76.7) 213 (78.3) 3,059 (70.6)Female 749 (33.8) 148 (30.1) 34 (17.3) 81 (23.6) 54 (29.3) 107 (24.1) 44 (23.3) 59 (21.7) 1,276 (29.4)Medical  School n (%)U.B.C. 791 (35.7) 137 (27.9) 65 (33.0) 100 (29.2) 37 (20.1) 143 (32.2) 60 (31.7) 59 (21.7) 1,392 (32.1)Other Canada 931 (42.0) 251 (51.1) 73 (37.1) 179 (52.2) 105 (57.1) 187 (42.1) 79 (41.8) 99 (36.4) 1,903 (43.9)Non-Canada 493 (22.3) 103 (21.0) 59 (29.9) 64 (18.7) 42 (22.8) 114 (25.7) 50 (26.5) 114 (41.9) 1,040 (24.0)Totals 2,215 - 491 - 197 - 343 - 184 - 444 - 189 - 272 - 4,335 - 'General' Specialties (General Internal Medicine; General Surgery; Psychiatry; Pediatrics; Obstetrics & Gynecology)Vancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 50 (17.0) 57 (15.0) 46 (17.0) 50 (23.0) 48 (17.0) 53 (18.0) 49 (19.0) 45 (19.0) 50 (18.0)Age Group n (%)< 40 159 (17.4) 11 (7.4) 8 (21.1) 16 (18.4) 6 (14.6) 14 (14.3) 9 (22.5) 15 (34.1) 238 (16.9)40 to 64 608 (66.5) 103 (69.1) 27 (71.1) 52 (59.8) 32 (78.0) 64 (65.3) 27 (67.5) 23 (52.3) 936 (66.3)65+ 147 (16.1) 35 (23.5) 3 (7.9) 19 (21.8) 3 (7.3) 20 (20.4) 4 (10.0) 6 (13.6) 237 (16.8)Sex n (%)Male 677 (74.1) 124 (83.2) 32 (84.2) 72 (82.8) 38 (92.7) 88 (89.8) 35 (87.5) 36 (81.8) 1,102 (78.1)Female 237 (25.9) 25 (16.8) 6 (15.8) 15 (17.2) 3 (7.3) 10 (10.2) 5 (12.5) 8 (18.2) 309 (21.9)Medical  School n (%)U.B.C. 141 (15.4) 12 (8.1) 8 (21.1) 12 (13.8) 4 (9.8) 5 (5.1) 2 (5.0) 5 (11.4) 189 (13.4)Other Canada 384 (42.0) 73 (49.0) 11 (28.9) 50 (57.5) 19 (46.3) 54 (55.1) 21 (52.5) 16 (36.4) 628 (44.5)Non-Canada 389 (42.6) 64 (43.0) 19 (50.0) 25 (28.7) 18 (43.9) 39 (39.8) 17 (42.5) 23 (52.3) 594 (42.1)Totals 914 - 149 - 38 - 87 - 41 - 98 - 40 - 44 - 1,411 -All Other Specialties (Medical Subspecialties; Surgical Subspecialties; Laboratory & Radiology; Anesthesiology)Vancouver Capital Fraser Vall Okanagan South East Isl Coast Central N & N Cent TotalsAge  median (IQR) 47 (15.0) 50 (14.0) 49 (12.0) 45 (14.0) 42 (11.0) 47 (16.0) 47 (14.5) 45 (16.0) 47 (14.0)Age Group n (%)< 40 245 (20.8) 25 (11.8) 9 (15.5) 43 (32.6) 13 (38.2) 23 (20.2) 9 (16.1) 14 (25.5) 381 (20.7)40 to 64 834 (70.9) 157 (74.1) 43 (74.1) 79 (59.8) 20 (58.8) 80 (70.2) 44 (78.6) 36 (65.5) 1,293 (70.3)65+ 98 (8.3) 30 (14.2) 6 (10.3) 10 (7.6) 1 (2.9) 11 (9.6) 3 (5.4) 5 (9.1) 164 (8.9)Sex n (%)Male 958 (81.4) 193 (91.0) 52 (89.7) 122 (92.4) 29 (85.3) 101 (88.6) 54 (96.4) 49 (89.1) 1,558 (84.8)Female 219 (18.6) 19 (9.0) 6 (10.3) 10 (7.6) 5 (14.7) 13 (11.4) 2 (3.6) 6 (10.9) 280 (15.2)Medical  School n (%)U.B.C. 287 (24.4) 24 (11.3) 12 (20.7) 25 (18.9) 4 (11.8) 22 (19.3) 8 (14.3) 11 (20.0) 393 (21.4)Other Canada 529 (44.9) 124 (58.5) 29 (50.0) 77 (58.3) 21 (61.8) 60 (52.6) 33 (58.9) 24 (43.6) 897 (48.8)Non-Canada 361 (30.7) 64 (30.2) 17 (29.3) 30 (22.7) 9 (26.5) 32 (28.1) 15 (26.8) 20 (36.4) 548 (29.8)Totals 1,177 - 212 - 58 - 132 - 34 - 114 - 56 - 55 - 1,838 -Note: The 'North' and 'North Central' regions have been grouped. Physicians in emergency medicine, community medicine, physical medicine and public health are excluded from the analyses. Includes only physicians on the 'active' register of the CPSBC. IQR refers to 'inter-quartile range'.Health Human Resources Unit   Centre for Health Services and Policy Research - 56 -    Table 4.16:   General Practitioners / Family Physicians by Health Region, Age, Sex, and Place of Medical School Education, 1996Characteristic East KootenayWest Kootenay - BoundaryNorth OkanaganSouth Okanagan - Similkameen Thompson Fraser ValleySouth Fraser Valley Simon Fraser Coast GaribaldiAge    median (IQR) 42.5 (17.0) 43 (13.0) 44 (18.0) 43 (13.0) 44 (16.0) 46 (16.0) 44 (16.0) 43 (15.0) 42 (14.0)Age Group   n (%)< 40 32 (37.2) 34 (34.7) 47 (37.3) 74 (34.1) 46 (37.4) 66 (33.5) 160 (37.0) 103 (37.5) 29 (35.8)40 to 64 47 (54.7) 59 (60.2) 73 (57.9) 133 (61.3) 73 (59.3) 109 (55.3) 237 (54.9) 157 (57.1) 49 (60.5)65+ 7 (8.1) 5 (5.1) 6 (4.8) 10 (4.6) 4 (3.3) 22 (11.2) 35 (8.1) 15 (5.5) 3 (3.7)Sex   n (%)Male 65 (75.6) 65 (66.3) 97 (77.0) 165 (76.0) 92 (74.8) 163 (82.7) 302 (69.9) 204 (74.2) 58 (71.6)Female 21 (24.4) 33 (33.7) 29 (23.0) 52 (24.0) 31 (25.2) 34 (17.3) 130 (30.1) 71 (25.8) 23 (28.4)Medical School   n (%)U.B.C. 15 (17.4) 22 (22.4) 45 (35.7) 55 (25.3) 36 (29.3) 65 (33.0) 138 (31.9) 96 (34.9) 25 (30.9)Other Canada 53 (61.6) 52 (53.1) 61 (48.4) 118 (54.4) 59 (48.0) 73 (37.1) 185 (42.8) 118 (42.9) 41 (50.6)Non-Canada 18 (20.9) 24 (24.5) 20 (15.9) 44 (20.3) 28 (22.8) 59 (29.9) 109 (25.2) 61 (22.2) 15 (18.5)Totals 86 - 98 - 126 - 217 - 123 - 197 - 432 - 275 - 81 -Characteristic Cariboo North West Peace LiardNorthern Interior Vancouver Burnaby North Shore Richmond CapitalAge    median (IQR) 41 (11.0) 42 (16.0) 39 (10.0) 42 (15.0) 43 (16.0) 42 (15.5) 45 (18.0) 43 (15.0) 45 (14.0)Age Group   n (%)< 40 31 (47.0) 39 (38.2) 27 (52.9) 44 (37.0) 387 (39.7) 69 (43.1) 76 (35.8) 64 (39.5) 136 (27.7)40 to 64 34 (51.5) 60 (58.8) 22 (43.1) 69 (58.0) 527 (54.1) 81 (50.6) 116 (54.7) 90 (55.6) 315 (64.2)65+ 1 (1.5) 3 (2.9) 2 (3.9) 6 (5.0) 60 (6.2) 10 (6.3) 20 (9.4) 8 (4.9) 40 (8.1)Sex   n (%)Male 53 (80.3) 77 (75.5) 42 (82.4) 94 (79.0) 608 (62.4) 103 (64.4) 132 (62.3) 117 (72.2) 343 (69.9)Female 13 (19.7) 25 (24.5) 9 (17.6) 25 (21.0) 366 (37.6) 57 (35.6) 80 (37.7) 45 (27.8) 148 (30.1)Medical School   n (%)U.B.C. 24 (36.4) 25 (24.5) 8 (15.7) 26 (21.8) 345 (35.4) 61 (38.1) 88 (41.5) 63 (38.9) 137 (27.9)Other Canada 20 (30.3) 48 (47.1) 12 (23.5) 39 (32.8) 416 (42.7) 67 (41.9) 87 (41.0) 58 (35.8) 251 (51.1)Non-Canada 22 (33.3) 29 (28.4) 31 (60.8) 54 (45.4) 213 (21.9) 32 (20.0) 37 (17.5) 41 (25.3) 103 (21.0)Totals 66 - 102 - 51 - 119 - 974 - 160 - 212 - 162 - 491 -Cent Vanc IslandUpper Island/ Central Coast44 (41.5) 42 (14.0)75 (31.3) 49 (39.8)148 (61.7) 68 (55.3)17 (7.1) 6 (4.9)189 (78.8) 90 (73.2)51 (21.3) 33 (26.8)77 (32.1) 41 (33.3)96 (40.0) 50 (40.7)67 (27.9) 32 (26.0)240 - 123 -All Regions43 (15.0)1,588 (36.6)2,467 (56.9)280 (6.5)3,059 (70.6)1,276 (29.4)1,392 (32.1)1,904 (43.9)1,039 (24.0)4,335 -Health Human Resources Unit   Centre for Health Services and Policy Research - 69 - Health Human Resources Unit   Centre for Health Services and Policy Research - 78 -  Table 4.17: Distribution of Herfindahl Index for GP/FPs & Specialists by HHRU Regions, 1996-971,2,3General / Family Practice SpecialistsHHRU Region n Mean Median SD n Mean Median SDVancouver & District 1,839 0.77 0.78 0.14 1,071 0.89 0.96 0.15Capital 403 0.75 0.76 0.13 181 0.88 0.93 0.15Fraser Valley 177 0.74 0.75 0.14 55 0.92 0.95 0.10Okanagan 315 0.73 0.75 0.13 142 0.87 0.92 0.13South-East 155 0.74 0.77 0.15 38 0.88 0.94 0.14Island Coast 398 0.73 0.75 0.13 129 0.90 0.95 0.12Central 170 0.73 0.76 0.14 58 0.88 0.93 0.13North Central 187 0.71 0.73 0.14 52 0.89 0.95 0.12North 47 0.68 0.69 0.15 6 0.83 0.81 0.09Total Physicians 3,691 0.75 0.76 0.14 1,732 0.90 0.95 0.141 Includes physicians on the 'active' CPSBC registers in 1996 except for pediatrics, rehabilitation medicine, community medicine/  public health, psychiatry, laboratory medicine and radiology, medical oncology and radiation oncology (N=1,377).   Also, excludes 644 GP/FPs and 288 specialists with FTE < 0.2 in 1996/97 or who had no FFS billings.2 Note: The footnote on Page 77 of the PGME Report should read (n=1,377) specialties excluded.3 Section 4.2.2.1 on Page 75 should also read (n=1,377) for specialties excluded and (n=932) for other physicians excluded.   Table 4.18: Distribution of Herfindahl Index for GP/FPs1 by Age, Sex, Place of Training and FTE Status, 1996-97 All Regions Urban Semi-Urban Ruraln Mean SD Statistic2 P-value n Mean SD n Mean SD n Mean SD Statistic3 P-valueAge Group<30 122 0.73 0.13 37.7 <0.0001 65 0.73 0.13 42 0.70 0.13 15 0.74 0.12 0.50 0.60531-40 1,248 0.72 0.14 536 0.73 0.13 583 0.70 0.14 129 0.74 0.12 6.0 0.00341-50 1,284 0.74 0.14 548 0.76 0.14 631 0.73 0.13 105 0.68 0.15 29.4 <0.000151-60 688 0.79 0.13 290 0.80 0.14 347 0.77 0.13 51 0.78 0.12 5.7 0.00361-70 286 0.81 0.14 133 0.81 0.14 135 0.80 0.13 18 0.82 0.08 0.36 0.69870+ 63 0.82 0.16 27 0.86 0.13 33 0.80 0.16 3 0.75 0.20 0.97 0.327SexFemale 1,057 0.69 0.13 309.8 <0.0001 556 0.70 0.14 432 0.69 0.13 69 0.70 0.13 1.03 0.272Male 2,634 0.77 0.13 1,043 0.80 0.13 1339 0.75 0.14 252 0.74 0.13 57.2 <0.0001Medical SchoolU.B.C. 1,250 0.73 0.14 21.4 <0.0001 615 0.74 0.14 579 0.71 0.13 56 0.73 0.11 6.08 0.002In Canada 1,556 0.75 0.14 648 0.76 0.14 776 0.74 0.14 132 0.74 0.13 4.53 0.011Non-Canada 885 0.77 0.14 336 0.80 0.14 416 0.76 0.14 133 0.72 0.15 14.3 <0.0001Full-Time-Equivalency0.2-0.5 309 0.78 0.14 9.38 <0.0001 162 0.78 0.15 123 0.78 0.14 24 0.79 0.12 0.13 0.8790.5-1.2 2,509 0.74 0.14 1,166 0.76 0.14 1112 0.73 0.14 231 0.73 0.13 7.4 0.001>1.2 873 0.75 0.14 271 0.79 0.14 536 0.73 0.13 66 0.73 0.14 13.2 <0.0001Totals 3,691 1,599 1,771 3211 Includes GP/FPs on the 'active' CPSBC registers in 1996. Excludes 644 GP/FPs with FTE < 0.2 in FY 1996/97 or who had no FFS billings.2 F-statistic from analysis of variance to test for differences in log HI between levels of the covariate of interest.3 F-statistic from one-way analysis of variance testing for differences in log HI among urban, semi-urban and rural levels, stratified by age, sex, medical school, FTE or PGME location.Health Human Resources Unit   Centre for Health Services and Policy Research - 80 -    Table 4.22: Demographic and Training Characteristics of GP/FP 'Specialists' in Obstetrics & Gynecology, Anesthesiology, and Surgery, 1996/97GP/FP 'Specialists2All GP/FPs1 Obstetrics & Gynecology Anesthesiology SurgeryStatistic3 P-value Statistic3 P-value Statistic3 P-valueAge    median (IQR) 43 (24.0) 39 (11.0) 29.7 <0.001 43 (14.0) 0.13 0.717 45 (18.0) 14.5 <0.001Age Group   n (%)<40 1,373 (37.2) 96 (54.9) 37.6 <0.001 25 (31.6) 2.10 0.555 68 (34.7) 30.2 <0.00140-49 1,283 (34.8) 62 (35.4) 33 (41.8) 61 (31.1)50-59 687 (18.6) 11 (6.3) 15 (19.0) 27 (13.8)60+ 348 (9.4) 6 (3.4) 6 (7.6) 40 (20.4)Sex    n (%) Male 2,634 (71.4) 24 (13.7) 298.8 <0.001 70 (88.6) 11.7 <0.001 169 (86.2) 22.3 <0.001Female 1,057 (28.6) 151 (86.3) 9 (11.4) 27 (13.8)Medical School   n (%)U.B.C. 1,250 (33.9) 74 (42.3) 8.70 0.013 19 (24.1) 16.2 0.001 56 (28.6) 2.59 0.273In Canada 1,556 (42.2) 73 (41.7) 26 (32.9) 89 (45.4)Non-Canada 885 (24.0) 28 (16.0) 34 (43.0) 51 (26.0)Geographic Location   n (%)Urban 1,599 (43.3) 93 (53.1) 7.83 0.020 9 (11.4) 98.5 0.001 88 (44.9) 0.473 0.789Semi-urban 1,771 (48.0) 72 (41.1) 40 (50.6) 93 (47.4)Rural 321 (8.7) 10 (5.7) 30 (38.0) 15 (7.7)Totals 3,691 - 175 - 79 - 196 -1 Includes all GP/FPs on the 'active' registers of the College of Physicians and Surgeons of B.C., excluding GP/FPs with FTE<0.2 or who had no FFS billings in 1996/97 (n=644). 2 GP/FP 'specialists' were defined by the proportion of billings within the respective specialty 'domains'. GP/FP 'anesthesiologists' and 'surgeons' were defined as GP/FPs with >10% of total billings in the respective domain.  GP/FP 'obstetrician/gynecologists' were defined as GP/FPswith >20% of total billings in the obstetrics & gynecology fee-item domain. Percents given are relative to all GP/FPs.3 For categorical variables, chi-square test for homogeneity is presented.  For age (as a continuous variable), the F-statistic relating to one-way analysis of variance is presented.Health Human Resources Unit   Centre for Health Services and Policy Research - 92 -  A Research Unit Funded by the Ministry of Health, British Columbia THE UNIVERSITY OF BRITISH COLUMBIA      Health Human Resources Unit Centre for Health Services and Policy Research 429 – 2194 Health Sciences Mall Vancouver, B.C. Canada  V6T 1Z3 Tel:  (604) 822-4810 Fax: (604) 822-5690   December 20, 2001       Dear Reader:   We have recently become aware that computing errors were made during the production of Table 4.11 in the report Issues in Physician Resources Planning in B.C.: Key Determinants of Supply and Distribution, 1991-96. A Report to the Post-Graduate Medical Education Advisory Committee.  Attached is the corrected table.  Please insert the table in the appropriate section of the report.      Health Human Resources Unit   Centre for Health Services and Policy Research - 54 - Table 4.11: Change in Population, Physicians, and FTE/Population Ratios by HHRU Region, 1991/92-1996/97*Vancouver Capital Fraser Valley Okanagan South East Island Coast CentralPopulation Growth 91-96  (%) 16.0 7.8 21.1 19.6 10.7 17.8 13.9Change in No. Physicians  n (%)**General Internal Medicine -1 -(0.4) 3 (9.7) 1 (12.5) 1 (5.6) 0 (0.0) 6 (40.0) 0 (0.0)Medical Subspecialties 35 (15.7) 11 (32.4) 1 (20.0) 11 (61.1) 1 (50.0) 1 (12.5) 1 (14.3)General Surgery -13 -(13.1) -2 -(9.1) -1 -(12.5) 0 (0.0) 4 (50.0) 1 (5.0) -4 -(25.0)Surgical Subspecialties 18 (5.1) -5 (16.0) -2 -(8.3) 6 (13.3) 2 (25.0) 12 (34.3) 2 (10.5)Pediatrics 16 (11.0) 4 (36.4) 2 (66.7) 3 (27.3) 0 (0.0) 3 (37.5) 1 (20.0)Psychiatry 50 (17.3) 19 (41.3) 4 (50.0) 6 (37.5) 7 (175.0) 11 (78.6) 4 (133.3)Obstetrics & Gynecology 7 (7.0) -3 -(16.7) 2 (50.0) 0 (0.0) 2 (100.0) 5 (33.3) 0 (0.0)Laboratory & Radiology 30 (9.8) 1 (1.9) 3 (18.8) 3 (12.5) 1 (6.7) 3 (11.5) 0 (0.0)Anesthesiology 8 (4.2) 1 (2.4) 0 (0.0) 6 (33.3) 3 (150.0) 10 (52.6) 0 (0.0)Change in FTE / Population Ratios (FTEs per 100,000)General Internal Medicine -0.23 -0.22 -0.33 -0.88 -0.55 0.60 -0.73Medical Subspecialties -0.60 5.10 -0.35 2.63 -0.14 -0.21 -0.21General Surgery -0.93 -0.28 -1.15 -0.60 0.75 -0.62 -1.35Surgical Subspecialties -1.99 -1.86 -2.52 -0.01 1.52 0.89 -1.31Pediatrics -0.14 0.88 0.60 -1.12 -0.32 -0.56 -0.01Psychiatry 0.80 3.64 -0.22 0.24 4.28 2.01 1.29Obstetrics & Gynecology 0.15 -0.97 0.47 -0.81 0.25 0.34 -0.33Laboratory & Radiology -0.98 -0.97 -0.16 -0.51 -0.38 -0.38 -1.16Anesthesiology -0.89 -0.89 -1.24 0.82 1.73 1.42 -0.38* Includes only physicians on the 'active' registers of the CPSBC. ** Percent change is calcualted (no. 1996/97 - no. 1991/92) / (no. 1991/92) *100N. Central North8.3 8.34 (57.1) 1 -1 (25.0) 0 --4 -(30.8) -1 -(25.0)1 (6.3) -1 -(50.0)1 (25.0) -1 -(100)5 (250.0) 0 -3 (60.0) 0 (0.0)6 (46.2) 0 (0.0)4 (80.0) 0 -1.63 1.380.16 0.00-0.98 -2.54-0.47 -0.410.17 0.002.20 0.000.74 -0.042.25 -0.391.35 0.00 Issues in Physician ResourcesPlanning in B.C.: Key Determinantsof Supply and Distribution,t99I-96A Report to the Post-Graduate MedicalEducation Advisory CommitteeA. Kazarfiaq Robert J. ReidNino Paglicciq Lars Apland, Lar¡ra WoodHHRU 00:2 June 2000Issues in Physician Resources Planningin B.C.: Key Determinants ofSuppty and Distribution, 199l-96A Report to the Post-Graduate Medical EducationAdvisory CommitteeHHRU 00:2Health Human Resources UnitCentre for Health Services and Policy ResearchThe John F. McCreary Health Sciences CentreUniversity of British ColumbiaVancouver, British Columbia V6T lZ3A. KazanjianR.J. ReidN. PaglicciaL. AplandL. WoodJune 2000Can¡di¡n Cat¡logdng in Publtc¡üon lht¡Ikzanjiaa, Arminée, 1 947-Issues in Ph¡æician Ræorrræs Planning in B.C.:Key Deûerminants of Supply and DisFibution, 199l-96ßesÊarch rceortsÆIølth Ht¡man Resouroes ltrri! HHRU 00:2)rsBN 1-894066-91-XA cotalogue reoud for this publicatior is ava¡lable from the Natimal Libmry of CanadaHEALTH HUMAI\ RESOT'RCES I'NITThe Health Human Resources Unit (HHRU) was established as a demonstration project by the British ColumbiaMinistry of Health in 1973. Since that time, the Unit has continued to be funded on an ongoing basis (subject toannual review) as part of the Centre for Health Services and Policy Research. The Unit undertakes a series ofresearch studies that are relevant to health human resources management and to public policy decisions.The HHRU's research agenda is determined through discussion of key current issues and available resources withthe senior staff on the Ministry of Health. Various health care provider gfoups participate indirectly, through on-going formal and informal communications with Ministry of Health ofücials and the HHRU researchers. ArminéeKazanjian is the Associate Director and Principal Investigator for the Unit.Three tlpes of research are included in the Unit's research agenda. In conjunction with professional licensingbodies or associations, the HHRU maintains the Cooperative Health Human Resources Database. The Unit usesthese data to produce regular status reports that provide a basis for in-depth studies and for health human resourcesplanning. The Unit undertakes more detailed anaþes bearing on particular health human resources policy issuesand assesses the impact of specific policy measures, using secondary analyses of data from the CooperativeDatabase, data from the adminishative databases maintained under the HIDU, or primary data collected throughsurveys. The HHRU also conducts specific projects pertaining to the management of health human resources atlocal, regional and provincial levels.Copies of studies and reports produced by the HHRU are available at no charge.(See final pages of this document for a listing of HHRU studies and reports)Health Human Resources UnitCentre for Health Services and Policy Research#429-2194 Health Sciences MallVancouver, BC V6T lZ3Phone: (604)822-4810Fax: (604) 822-5690e-mail: hhru@chspr.ubc.caURL: www.chspr.ubc.caHealth Human Resources Unit Centre for Health Services and Policy ResearchTABLE OF CONTENTSEXECUTIVE SI]MMARYl. INTRODUCTION..........2. STI]DY AIMS:3. METHODOLOGY l0j.1. 1 College of Physicians and Surgeons of British Columbia Registration Data............ ....... 103.L2 Ministry of Heahh Pþsician Payment Data............ ............... I I3.1.2.1 Medical Services Plan Fee-For-Service Payments.................... ........................ I I3.1.2,2 Ntemative Payment Branch (APB) Salary and Sessional Payments....... .......,.. 123.1.2.3 'Service Agreements' with Health Care Facilities and Other Organizations. ........................... 123.1.3 Royal College of Pþsícians and Surgeons of Canada CertiJìcation Data and the CanadianPostgrqduate Medícal Education Regßtry....... ...................... /33.1.4 Population Estimates ..................... 143.2 V¡ru¡sL¡s nwo MpesuREs ............ ........ 143.2.1 Physician-speci/ìc Yariables .......... 163.2.1.3 Place of Medical School Education and Years Since Graduation.... .................. 173.2. 1.6 Physicians''Scope of Practice'.............,.................... 203.2.2 Pþsician Supply Varìables...... ...... 2I3,2.2.2Physician Counts and Full-Time-Equivalenrs (FTEs) .......... .......223.2.2.3 Physícian to Population Ratios.......4. RESI]LTS4.1 A¡rrr I: Suppr,v aNn Drsrrununox op Psvslcr.lNs rN B.C. ................ ................... 284.1.1 Pþsician Supply from the Provincial Perspective, I99I/92 and 1996/97 ....................... 294.l.l.l Physician Counts, Full-Time-Equivalents (FTEs), and FTE/Population Ratios .......................294.1.1.2 Age and Scx Characteristics of B.C. Physicians..... ....................352728-i-Hgalth Human Resources Unit C-entre for Health Services and Policy Research4.1.1.3 L¡cation of Undergraduate Medical Education...... .....................394.1.2 Distribution of B.C. Pþsicians by Health Human Resource Unit (HHRU) Regions and GroupedSpecialty Categories, 1991/92 and 1996/97 ....... 484. I .2.1 Physician Counts, Full-Time-Equivalents (FTEs), and FTE/Population Ratios ....................... 484.1.2.2 Variation in Specialist Demographics and Medical Schools ofTraining across HHRU Regions....................554.1.j Pltysician Supply in B.C.'s 20 Health Regions, 1991/92 and 1996/97. ........ 584.1.3.1 Physician Counts, Full-Time-Equivalents (FTEs), and FTE/ Population Ratios........... ...........584,1.3.2 Regional Variation in the Age, Sex, and Training Characteristics of GP/FPs...... ....................674.2 AIv.II: Vanlnrlo¡¡ u.¡ PHysrcru Scope orPn¡crrc8............. ........714.2.1 Measuring Scope of Praclice: Grouping Fee-items into Clinical Domains...... .............. 744.2.2 Variation in Physicians' 'Scope of Practice'. ..... 754.2.2.1 Distributional Properties of the Herfindahl Index............. ..........754.2.2.2 Physician and Practice Correlates of GP/FP Practice Scope............. ..............,..794.2.2.3 Understanding Differences in GP/FPs' Practice Scope using Multivariate Models ................ 8l4.2.3 Specialty Care Delivered by GP/FPs in 8.C.......... ................. 8i4.2.3.1 ldentification of GP/FP 'Anesthesiologists', 'Surgeons', and 'Obstetrician/ Gynecologists'.......................... 864.2.3.2 Gengraphic Distribution of GP/FP 'Specialists' ......................... 894.2.3.3 Demographic and Training Characteristics of GPÆP 'specialists'... .................904.3 At¡vr III: SrasrI-n'y oF B.C. Psysrcnrus l99l - 1996 ......................924.3.1 'Inflow'and'Outflow'of Physicians to B.C. 1991-1996 by Specialty. ........944,3.2 Geographic Distt'ibutions of 'Stable', 'Inflow', and 'Outflow' Physicians ...................... 964.3.2.1 'Inflow' of Physicians by HHRU and Grouped Specialty........ ........................,. 974.3.2.2 'Outflow' of Physicians by HHRU Region and Grouped Specialty ...................974.3.3 Stability Status by Physician Demographic and Training Characteristics................... .......................1034.3.3.1 Characteristics of 'lnflow' Physicians..... ........... 1034.3.3.2 Charcc,tsristics of 'Outflow' Physicians ................... ................ 1074.4 A¡rvr IV: THe 'LlrE CycL¡' oF A PHysrcrAN's PRAcrrcE, lggl/92 ro 1996197 .. .....................1085. DISCUSSION t176. REFERENCES............7. APPENDICES-tl-Health Human Resources Unit Centre for Health Services and Policy ResearchExecutive SummaryAt the request of the Post Graduate Medical Education (PGME) Advisory Committee of BritishColumbia, this project was undertaken to describe the supply and distribution of physicians inBritish Columbia, including that of general practitioners/family physicians and specialists certifiedby the Royal College of Physicians and Surgeons of Canada (RCPSC). To meet this objective,the study had four specific aims: (1) to describe the supply and distribution of physicians in B.C.n l99l/92 and 1996197 by region, sex, age, specialty and place of medical education; (2) toexamine differences in the 'scope of practiceo among B.C. physicians in relation to their specialty,geographic location, demographics, practice intensity, and place of medical education; (3) toexamine the stability of the physician workforce in B.C. between l99l/92 and 1996197 by socio-demographics, speciaþ and place of medical education; and (a) to examine how physicians'intensity of practice relates to the professional life cycle. The study did not examine issuesrelating to the appropriateness of the physician supply in relation to population health needs ordemand for care. The following outlines the study's methodology and rnajor findings.MethodologyThis study used administrative data from four sources: (a) the physician licensing database of theCollege of Physicians and Surgeons of British Columbia (CPSBC); (b) physician payment recordsfrom the British Columbia Ministry of Health; (c) physician certification records from the RoyalCollege of Physicians and Surgeons of Canada (RCPSC); and (d) the Canadian PostgraduateMedical Education Registry (CAPER) databases. These data were supplemented with populationestimates for British Columbia's 83 Local Health Areas (LHAs) and 20 Health Regions (HRs)based on the 1996 Canada census. No primary data collection was used.To create a cross-sectional anaþic file for each study year, B.C. Ministry of Health Fee-for-Service and Salary and Sessional payment data, were linked to the CPSBC licensing data, usingdeterministic linkage. For the longitudinal anaþis, deterministic linkage was used to merge thethree study years. The RCPSC/CAPER certificational data were linked to these from CPSBCusing probabilistic data linkage procedures.Two types of variables, and related appropriate measures, were developed for the analyses:Physician-Specific variables which pertain to individual physicians; and physician supply variablespertaining to the region in which physicians work.Changes in the Supply of Physicians in 8.C., 1991192-1996197There werc 7,732 physicians on the 'active' registers n 1996197, accounting for approximately6,930 physician ñrll-time-equivalents (FTEs), or approximately 18 physician FTEs per 10,000B.C. residents (560 residents per physician FTE).Between |99ll92 and 1996197,Ihe B.C. physician population grew by about 511 GP/FP and 358specialist FTEs. Over this period, this growth in physician FTEs was closely matched by the-l-Health Human Resources Unit Centre for Health Services and Policy Researchpopulation growth, yielding similar per capita supply (18 per 10,000) for the two study years. Inaddition, there was little change in the per capita supply of both GP/FPs and specialists, yielding aconsistent primary care/specialist ratio of about 55:45.Despite the negligible change in the overall per capita supply of GP/FPs and specialists, therewere important differences in the patterns of growth among specialties. Most Royal College ofPhysicians and Surgeons of Canada (RCPSC) specialties reported a net increase in numbersexcept for four specialties (general surgery, otolaryngology, hematolog¡ and orthopedic surgery)which reported a net decline. However, when specialist supply relative to the population growthwas examinedo more than half the specialties reported a net decline in FTE to population ratiosover the study period. The appropriateness of these changes in the context of changingpopulation health needs was not examined in this report.Age, Sex, and Place of Medical Education of B.C.'s Physician PopulationOver the study period, the average age of physicians increased by about I yeæ from a mean ageof 45.4 years in l99ll92 to 46.2 n 1996/97. Specialists were considerably older than their GPcolleagues (15% vs 8% aged 61+ years) but there was considerable variability in age amongspecialty groups. RCPSC speciaþ groups with more than 20% of their physician supply aged60+ years lrl.1996197 included: community medicine, dermatolog¡ medical microbiology, nuclearmedicine, psychiatry; and general surgery. Women physicians comprised 2l% of the totalphysician population but comprised a larger proportion of GP/FPs Qa%) than specialists (18%).The sex distribution appears to be equilibrating over time: the female:male ratio for youngerphysicians (aged < 40 yrs) was 34:66, consistent with the increasing representation of women inCanadian medical schools. However, ¿rmong RCPSC specialties, the variation by sex wassubstantial (range: 0 to 44%).Of the total 1996197 physician population, 26Yo were graduates of the University of BritishColumbia, 46Yo came from other Canadian medical faculties, and 29o/o originated from non-Canadian schools. GP/FPs were almost twice as likely to have obtained their medical degrees atU.B.C. than were specialist physicians. Over the period 1991192-1996197, there was a modest netincrease in the proportion of physicians who completed their medical education at U.B.C. (24.7%to 25.9o/o) but this varied considerably by speciaþ. The proportion graduating ûom U.B.C. overtime has increased substantially. For physicians graduating in or before 1970, 16% originatedûom U.B.C. compared to 2lo/o and 35% of those physicians graduating between 1971-1980 andpost- 1 980, respectively.Geographic Distribution of GP/FP and Specialist Physicians, 1991192-1996197During the S-year period under study, the absolute number of GP/FPs increased in all regionsexcept one. However, when examined in the context of population growth, the per capita supplyof GP/FPs grew in 13 regions and declined in seven others. The regions with smaller GP/FPbaseline per capita supplies (1991/92) tended to grow faster than did regions with greatersupplies. While significant differences in the per capita supply by region continued to exist, thisdifferential growth helped mitigate the regional disparities in GP/FP supply.Health Human Resources Unit Centre for Health Services and Policy ResearchOver the study period, about two thirds of the health regions saw a net increase in their per capitasupply of specialists. Parallel to the findings for GPÆPs, regions with smaller supplies :rl.l99l/92tended to grow faster than those with larger supplies. Further analysis is required to examinewhich (if any) of the physician workforce policies in place during this time period resulted inattenuating disparities in the supply of both GP/FPs and specialists among regions.While differences in the regional distribution for specialists overall decreased over the studyperiod, the disparities increased for some specialty groups (including internal medicine, themedical subspecialties, general surgery, and pediatrics) and decreased for others (the surgicalsubspecialties, psychiatry, obstetrics and gynecology, laboratory medicine, radiology, andanesthesiology). The number of FTEs increased in most regions over the range of specialties, yetthe increases in many HHRU regions did not keep pace with population growth. General surgeryshowed the most consistent reductions in supply across regions; the FTE to population ratiodeclined in eight of nine HHRU regions. Conversely, psychiatry saw the most consistentincreases across regions (in all but one).Variation in the 'Scope of Practice' of B.C. PhysiciansThe boundaries of practice between different types of generalist and specialist physicians are fluidwith little information on when one starts and another leaves off To measure a physician's oscopeof practice', lve assessed the proportion of the physician's billings that fell within each of theclinical odomains' that make up the Medical Services Plan (MSP) fee schedule. The degree thatGP/FP and specialists limited their practices to items within their 'own' domain was markedlydifferent, reflecting important differences in their roles within B.C.'s health system. Most RCPSCspecialists billed services almost entirely \¡vithin their own clinical domain, suggesting that thesephysicians were almost uniformly highly specialized. However, we did identify a minority ofRCPSC-trained specialists whose practices were comprised of services across the range ofdomains, resembling the practices of generalist physicians.While the largest segment of most GP/FPs' practices was in the GP/FP domain, they also billedservices in a range of other clinical domains. There was, however, considerable variability in the'breadth' and 'balance' of GP/FPs billings across the other domains. On the whole, GP/FPspracticing in rural or semi-urban areas billed services in a wider variety of domains than did thosein urban areas. The provision of a wider range of services by GP/FPs was related to lowersupplies of both specialists and other GPlFPs.GPÆPs at the beginnings of their careers (i.e., those aged <40 years) generally delivered abroader array of services than did GPÆPs who were nearing retirement (i.e., aged 60+ years).Female GPÆPs also delivered a wider array of services than did their male counterparts, but thisfinding was almost entirely related to the delivery of a greater share of services in obstetrics andgynecology. GP/FPs who graduated ûom U.B.C. delivered services across a wider array ofclinical domains than did those trained at other schools. Finall¡ part-time GPiFPs (i.e., FTE< 1.0) appeared to have naffower practices than did full-time physicians and generally limitedtheir practices to services that were within the GP/FP domain.-3-Health Human Resources Unit Centre for Health Services and Policy ResearchGP/FP 'Specialists' and the Delivery of Specialized Services in B.C.We also examined how GPÆPs contributed to three areas of speciaþ practice (anesthesiology,surgery and obstetrics and gynecology) n 1996/97. We examined the proportion of eachGPiFP's practice in these areas and identified those physicians who appeared to deliver a greaterproportion of these types of care than their peers. Most GP/FPs delivered no services in theanesthesiology fee item domain. We identified 79 GPÆPs, however, who concentrated more thanl0% their practices in this area, functioning under our definition as GPiFP 'anesthesiologists'.These GP/FP 'specialists'were predominantly located in rural HHRU regions, complementing thegeographic distribution of RCPSC-certified anesthesiologists (who were located largely in urbansettings). GP/FP 'anesthesiologists' \¡/ere more likely to be male and trained at non-8.C. medicalschools, but were no more likely to be older or younger compared with other GP/FPs.For surgery, most GP/FPs provided some services within the range of surgical domains, butrelatively few (196) concentrated more thanl}Yo of their practice in these areas. We identifiedthese physicians as GP/FP osurgeons'. They were no more likely to be located in rural HIIRUregions than were other GP/FPs, complementing the more even geographic distribution ofRCPSC-certified general surgeons. GPÆP 'surgeons' were significantly older than other GPÆPs(i.e.,2ÙYo were aged 60+ years) but no more or less likely to come from medical schools in otherlocales.The vast majority of all GP/FPs (91%) delivered a significant proportion of their servicçs in theobstetrics and gynecology 'domain'. Based on the delivery of 20o/o services in obstetrics andgynecology, we identified 175 GP/FPs who functioned as GP/FP 'obstetrician/gynecologists'.These GPÆPs appeared more likely to be located in urban locales than were other GP/FPs,minoring the uneven distribution of RCPSC-certified obstetrician and gynecologists. GP/FP'obstetrician/gynecologists' were overwhetningly female (86%) and most were aged <40 years(55o/o). They were also more likely to be trained at U.B.C. than were other GP/FPs.Stability of BC's Physician Supply 199l-1996Only about two thirds of the physician workforce were 'actively' registered to practice medicineduring the entire study period (1991-1996). Of the remainder, about 20Yo ganed registrationduring the period and about l1% exited the registration rolls. While there were few differencesin these proportions between GP/FPs and specialists overall, there were significant differencesamong RCPSC specialties. Specialties with particularly high in-migration included psychiatry,community medicine, nuclear medicine, and endocrinology and metabolism. Specialties with highout-migration included neurosurgery, general pathology, community medicine, general surgery,and otolaryngology.The report also found large and important differences in physician stability by geographic region.The North and North Central HIIRU regions had the highest proportion of new registrant GP/FPswith more than one third gaining registration during the study period. For specialists, in-migrantscomprised more than one third of the North Central and South East physician pools. Mostregions saw about l0-l5o/o of their GP/FPs and specialist population move off the oactive'-4-Health Human Resources Unit _ Centre for Health Services and Policy Researchregisters during the study period. For GPÆPs the highest rates of out-migration (>15%) wereseen in the South East and North regions. For specialists, 4 HHRU regions had >20o/o out-migration including the Capital, South East, North Central and North regions.As expectedo 'inflow' physicians were significantly younger and ooutflow' physicians significantlyolder than those in ostable' practiceo reflecting the natural lifecycle in physicians' practices.Mirroring the increased proportion of women in Canadian medical schools over the last severaldecades, oinflow'physicians were more likely and outflow physicians less likely to be female thanthose in 'stable' practice. Overall, the proportions of in-coming and 'stable' physicians whoreceived their medical degrees at U.B.C. were not statistically different. Thus, the increasedrepresentation of U.B.C.-trained physicians over the study period (discussed above) was largelydue to the'outflow' ofphysicians.The Professional 'Life cycle' of a Physician's PracticeTo examine how physician productivity changes in relation to the professional 'life cycle' of aphysician's practice, we examined how gross income changed over the 5 year study period forthose physicians in 'stable' practice for the entire period. In general, there were important age-related differences in physician income and changes in income over the study period. Overall,incomes were highest for physicians aged 40-54; incomes progressively increased with age before40 years and progressively decreased with age after age 54.Over the 5-year study period, the practices of physicians aged <40 years tended to grow inintensity (i.e., increased gross income), were relatively stable for physicians between 40-49 years,and then graduaþ declined after age 50 (with the largest declines occurring after age 60). Theseage-related changes in practice intensity were generally consistent regardless of sexo geographiclocation, place of medical school graduation, and full-time-equivalency (although there were somedifferences in what ages the peaks occuned). These findings suggest that current age of thephysician pool in specific regions and/or for specialty groups can have important implications forfuture supply.DiscussionWhile this descriptive study provides a comprehensive 'snapshot' of physician supply over theperiod l99ll92 - 1996197, it does not consider issues related to population oneed' nor the extentto which such needs may be met with the current complement of physicians. The data andanalyses provided in the study are framed from a policy perspective, to help policy makersunderstand the physician supply 'landscape' in B.C. However the report is only a small slice ofthe information required for comprehensive and integrated planning of the provincial physicianworkforce. The report highlights the degree to which planning for physicians in B.C. isconstrained by the unrestricted migration patterns of physicians from other provinces, and theneed for on-going national coordination.-5-Health Human Resources Unit Centre for Health Services and Policy ResearchL lntroductionThe supply, speciaþ mix, practise patterns and distribution of physicians in B.C. are topics ofcontinuing interest and study (Kazanjian, A., Wong F*g, P., Wood, L. 1993; Kazanjian, A.,Paglicci4 N. 1996; Hanvelt, R.A. ef a|2000); recent studies at the national (Barer, M.L., Wood,L., Schneider, D.G. 1999; Evans, R.G. 1998) and international levels (Maynard, A. and Walker,A. 1997:' Rivo, M.L. and Kindig, D.A. 1996) are also of interest to planners and policy makersseeking to develop national approaches to learn from other jurisdictions that which may bepertinent to them.This study examines key factors affecting the current supply and distribution of physicians in B.C.from the longitudinal perspective of the last decade. An analysis of current supply by age and sex,both in number and full-time-equivalence, to explore issues of productivity across the professionallife-cycle provides a demographic and practice profile of generaVfamily practitioners and specialistphysicians. The cross-sectional analyses compare the B.C. medical workforce n l99l/92 and1996197, delineating major changes in the mix and distribution of physicians by region andspecialt¡ and describing the flows into and out of this workforce, including interprovincial andinternational migration.The study also examines changes in physician supply relative to the B.C. population through thepresentation of physician/population ratios. It should be noted that we have examined these ratiosto better understand issues in physician supply and clearly not to allude to medical workforcerequirements, which are often expressed simply (and misleadingÐ as physician/population ratioswithout any due attention to the important details on physician practice style, setting and mode ofremuneration.Frequently, studies on the medical workforce use modeling and/or forecasting approaches toestablish the current and future supply of physicians. We have not followed that path for tworeasons: simple forecasting models are misleading, at best, and more complex models require aclear understanding of factors which affect supply and the quantification and measurement of suchfactors. We have, therefore, opted to deepen our understanding of the key determinants ofphysician supply, mix and distributior¡ rather than undertake projections of future supply, toidentify where gaps exist in our knowledge pertaining to such determinants. We have paidparticular attention to differences in practice intensity and in scope of practice (including that offamily practice) and to regional variations. These analyses present our unique contribution to theknowledge base on post graduate medical education training, geographic location and scope ofpractice throughout the professional life-cycle.This study was commissioned by the Post Graduate Medical Education Advisory Committee ofB.C. The Committee is chaired by the B.C. Ministry of Health; the membership represent variousstakeholders including the U.B.C. Faculty of Medicine, the College of Physicians and Surgeons of8.C., the B.C. Medical Association, the Professional Association of Interns and Residents of8.C., Regional Health Boards, and medical student representatives. Findings from the study will-6-HealthHuman Resources Unit Centre for Health Services and Policy Researchassist in the discussions, deliberations, and decisions the Committee may make regarding therelative numbers and mix ofresidency seats at U.B.C.The main focus of our study is to better understand the salient features of current supply withregard to the training and production of future supply in the province. Thereforeo we haveendeavoured to undertake as much analysis as possible by location of training. Data limitationsregarding location of post graduate medical education have seriousþ hampered our attempt toproduce timely analyses (see discussion in methods section).-7 -Health Human Resources Unit _ Centre for Health Services and Policy Research2. Study Aims:As discussed above, this project was undertaken at the request of the Post Graduate MedicalEducation (PGME) Advisory Committee, who were seeking information about the supply anddistribution of physicians in British Columbia. More specificaþ, information was sought aboutthe supply of general practitioners and Royal College of Physicians and Surgeons of Canada(RCPSC)-certified specialists in B.C. and its semi-autonomous health regions. The principal goalof this study was to examine the 'landscapeo of B.C. physician supply in order to better informdecision-making about the allotment of positions across U.B.C.'s post-graduate trainingprograms. The questions of concern to the committee included how many specialists there were,what specialties were represented, where they were located, what were their demographic andpractice characteristics, and where the current stock of physicians had been educated. To addressthese general questions, four specific aims were identified for the project. A series of anaþeswere completed for each aim and these are presented in Section 4.0.The study's specific aims were:Aim I: Describe the Supply and Distribution of Physicians in B.C. by Specialty.This aim was intended to inform policy makers about the current status of the B.C.physician workforce and the recent trends in supply for each physician specialty.The specialties were amlyzed with respect to the numbers of physicians on theactive rolls ratios n 1991,192 and 1996/97, estimates of the numbers of full-time-equivalents (FTEs) and FTE/population ratios. The changes in the geographicdistribution of physicians within the province were also explored. The supply ofphysicians in each specialty category was analyzed in relation to age, sexo and theplaces of medical education.Aim II: Describe the Variation in the 'Scope of Practicen Among Physicians in B.C.Understanding differences in the range of services provided by physicians is anessential but often overlooked component of physician workforce planning. Thereare little data regarding variation in where the practice boundaries are set betweenand among specialties. This study aim was designed to examine differences in thescope of practice of B.C. physicians, particularly general practitioners and familyphysicians. We explored the variability in the range of services in relation togeographic location, age, sex, practice intensity, and place of medical education.We also focused on identifying and characterizing the provision of three t¡pes ofservices by general practitioners/family physicians: anesthesiology, surgery andobstetrics and gynecology services.-8-Healtlr Human Resources Unit Centre for Health Services and Policy ResearchAim III:- Analyse the'Stability'of Physician Human Resources in B.C.This study aim concentrated on describing how 'stable' the B.C. physician supplyhas been and explored the patterns of migration both into and out of the province.Special attention was paid to characterizng the physicians who entered and exitedthe province with respect to a variety of demographic and practice characteristics.In addition to examining those who came and left practice in 8.C., we alsoexamined how physicians migrated between different geographic locales.Aim IV: Examine the Age-Related Effects on Physician 'Output'In addition to forecasting the number of physicians entering and leaving practice,medical human resource planning should also account for expected changes in thevolume of physicians' practices over time. The analyses for this study aimdescribed the typical 'life-cycle' of a physician's practice in B.C., spanning the timefrom when he or she entered practice afrer completing post-graduate training untilretirement. The purpose of this section was to provide insight into how thepractice intensity of physicians currently in practice might change as they age.-9-3.tHealth Human Resources Unit Centre for Health Services and Poli Research3. MethodologyData SourcesThis study used administrative data from four sources: (a) the physician licensing database of theCollege of Physicians and Surgeons of British Columbia (CPSBC); (b) physician payment recordsfrom the British Columbia Ministry of Health; (c) physician certification records from the RoyalCollege of Physicians and Surgeons of Canada (RCPSC); and (d) the Canadian PostgraduateMedical Education Registry (CAPER) databases. These data were supplemented with populationestimates for British Columbia's 83 Local Health Areas (LHAs) and 20 Health Regions (HRs)based on the P.E.O.P.L.E Project 24. No primary data collection was used. The followingsection includes a brief description of each data source.3.1.1 College of Physicians and Surgeons of British Columbia Registration DataPursuant to the Medical Practitioners Act of British Columbia (RSBC 1996, Chapter 285), theCPSBC is responsible for establishing, monitoring, ffid enforcing standards of education andpractice for all physicians in British Columbia. As such, registration with the CPSBC is requiredof any physician delivering clinical services in the province. The registration data collected by theCollege detail the demographic characteristics and educational qualifications of all physicians.Since our interest is in physicians actively practicing medicine, we concentrated on three Collegeregisters: the 'full' (i.e., unrestricted) registero the 'special' registerr, and the 'temporary' (inpractice) register. For the remainder of this report, we refer to these three CPSBC registersjointly as the 'active' registers.2 This definition is consistent with other research reports from theHealth Human Resources Unit (HHRI-I).3 Registration data relating to physicians not resident inB.C., non-practicing B.C. resident physicians, physicians-in-training, and honorary members werenot included.The CPSBC collects licensing data from each physician on his or her initial registration andupdates this information annually upon renewal. Moreover, the database is continuaþ updatedfor additions and deletions, physician address changes (i.e., physicians are required to promptlyreport address changes to maintain registration) and specialty status as certified by the RCPSCand the Canadian College of Family Physicians (CCFP).The data used in this study comprise the College registration files for 1991, 1993, and 1996.These data contain one record for every physician on the 'activeo register on the following dates:December 3l,l99l; March 31,1993:' and September 15, 1996. The data therefore represent aI The'special' register is similar to the 'full' register with the exception that these physicians are subject to conditions^ imposed on their practice (e.g., limited to a particular field of medicine).' The one physician with registration on the 'osteopathic' register was not included in this study.3 ttHRU 99:2 ROLLCALL UPDATE 98. A Status Report of Selected Health Personnel in the province of British Columbia.May 99. ISBN l-894066-97-9. ISSN 0828-9360.-10-Health Human Resources Unit Centre for Health Services and Policy Researchpoint prevalence of physician supply on these dates. Since the College data are continuouslyupdated, the data represent the most recent data as of the date extracted. The College data werelinked to the other data from the B.C. Ministry of Health using the CPSBC unique identificationnumber assigned to each physician. The data extracted from the CPSBC licensing data includedage, sex, RCPSC specialty(ies), postal code, and date(s) and place of medical school graduation.Anonymity was maintained by grouping physician age into intervals and postal codes into regions.Unique identifiers were strþed after linking with other data sets, but before the data were madeavailable to the research team.3,1.2 Ministry of Health Physician Payment DataTo estimate the number ofphysician full-time-equivalents (FTEs) during the study years and othervariables relating to physician practice style, we employed three sets of administrative data fromthe B.C. Ministry of Health for the study years. These databases included: (1) fee-for-service(FFS) payments from the B.C. Medical Services Plan (MSP); (2) salary and sessional paymentdata from the Ministry of Health's Alternative Payments Branch (APB); and, (3) 'seryiceagreement' data describing payments for physician services made under contract with a variety ofhealth care facilities and other organizationsa. In sun¡ these data represent the totality ofpayments made by the Ministry of Health to physicians for insured clinical services. To match thedate of record for these payment data to the CPSBC data as closely as possible, the data wereextracted for the fiscal years (April l't through March 3l$) of 1991192, 1993/94 and 1996/97.Because the data pertain only to services covered by the B.C. Ministry of Health's programs, datarelated to non-insured services (e.g., cosmetic surgery) and services insured by third parties (e.g.,'Workers' Compensation Board, Insurance Corporation of British Columbia) were not available.Payments made for non-B.C. residents were also excluded. The following provides a moredetailed descrþion of the Ministry of Health physician payment databases.3.1.2.1 Medical Services Plan Fee-For-service PaymentsThe Medical Services Plan (MSP) physician payments databases contain one record for eachservice paid under this mechanism. These data are housed for research purposes at the Centre forHealth Services and Polþ Research, as part of the B.C. Linked Health Data set (BCLHD)(Chamberlayne et al 1996). All physician payments (relating to patient consultations,examinations, clinical procedures, ambulatory laboratory services, and diagnostic imagingservices) were extracted for the study years, regardless of setting (i.e., physicians' offices, clinics,hospitals, long term care facilities, patient homes, and others). For each year, the services andtariffs specified by these data reflect the negotiated schedule of benefits in effect at that time.Interest payments and other fees for non-clinical services (e.g., tray fees) were excluded. Sincethe submission of claims is vital to physician reimbursement, fee-for-service payments databasesare generally thought to capture the vast majority of services paid through this mechanism (Rooset ol 1983). Furthermore, those data fields critical to payment (e.g., physician and patienta Payments for physician services through such contracts commenced in 1995.- lt -Health Human Resources Unit Centre for Health Services and Policy Researchidentifiers, service itenr, and fee tariff) are generally regarded to be the most valid (Wener et al1990). The data fields extracted from the claims records included physician identifiers (i.e., theMSC and CPSBC identification numbers), service code, tariff amount, date paid and fee-itemcategory. The physician identifier was used to aggregate all payments to each physician and tolink with the other data sources. All identifiers were scrambled before data were released to theresearch team to maintain anonymity and confidentiality.3.1.2.2 Alternative Payment Branch (APB) Salary and Sessional PaymentsIn addition to fee-for-service (FFS) payments, the British Columbia government paysapproximately 8% of physician services by non-FFS methods (MOH Annual Report 1997). Theinclusion of data for services provided through these mechanisrns was vital to providing acomplete picture of physician supply in the province. This was especially the case for certainphysician specialties (e.g., emergency medicine, pediatrics and psychiatry) where non-FFSreimbursement comprises a large part of total payments. For physicians paid through salary andsessional arrangements with the Ministry of Health, the APB collects records of all paymentsmade to enrolled physicians. Unlike the claims database, however, these data do not characterizethe quantity or nature of the services provided. Thuso for this subset of physician services, wewere precluded from examining the types of services provided to B.C. residents. For physicianspaid solely under these mechanistns, \¡/e were able to characterize their gross income but not theirpatterns of practice. However, since many physicians who received these alternative paymentsalso had FFS billings, we were able to characterize the FFS portion oftheir practices.3.1.2.3 'Service Agreements' with Health Care Facilities and Other OrganizationsBeginning in fiscal year 1995/96, the Ministry of Health began contracting directly with healthcare facilities, health regions, and other organizations to provide a defined set of physicianservices. The services specified under these contracts were varied and included primary,specialt¡ and sub-specialty care in both urban and rural locales. The contracting organizations inturn employed, or contracted with, individual physicians or physician groups to provide thespecified services. In fiscal year 1996197, these contract payments represented approximately 3%of the total physician services budget (excluding transplantation services). In contrast to thesalary and sessional dat4 the Ministry collects payment information for the service agreementsonly as it relates to the contracting organization. The service agreement data specifr neitherwhich physicians were employed nor the services provided. For these agreements, therefore, wewere only able to specify the contractor, the general nature of the services specified (e.g., primarycare, intensive care), the total payments made for the study year, the locale (i.e., LHA) where theservices were provided, and the number of full-time physician equivalents (FTEs) under contractto the Ministry. Since we could not attribute these payments to individual physicians, theseservices were aggregated at the Health Region level and used to supplement the cross-sectionalphysician supply analyses that follow. Table 3.1 outlines the key attributes and differences amongthe three Ministry of Health payment databases described above.-t2-Health Human Resources Unit Centre for Health Services and Poli Research3.1.3 Royal College of PhysÍcians and Surgeons of Canada Certification Dataand the Canadian Postgnduate üedìcal Education Registrt'Data from the registration files of the Royal College of Physicians and Surgeons of Canada(RCPSC) and Canadian Postgraduate Medical Education Registry (CAPER) were used tosupplement the licensing data extracted from the CPSBC files. More specificall¡ these datarelated to the location and dates of postgraduate medical education training for physiciansregistered in the province n 1996/97. The RCPSC is responsible for accrediting all Canadianspecialist training programs and for certifying all specialist physicians. In 8.C., the CPSBC grants'full' registration for physicians to practice as specialists only if they have obtained certification bythe RCPSC.6 CAPER was established in 1986 through the co-operation of a variety of nationalmedical organizations with the mandate to provide accurate information for national medicalworkforce planning. To accomplish this task, an individual longitudinal file is maintainedcontaining socio-demographic data and training details of each interru resident or fellow under thesupervision of the Canadian faculties of medicine.For those physicians who obtained their RCPSC specialty certification in 1985 or later, data wereextracted on speciaþ and post-graduate medical education using CAPER's electronic registrationdat{. The variables extracted for analysis included RCPSC certified speciaþ (or specialties),certification dates, and place of the post-graduate training program where the final year of trainingleading to certification was completed. For physicians who obtained their RCPSC specialtycertification before 1985, these data were manually extracted from the physician's certificationrecords at the RCPSC, since they were not available in electronic form.Since these data were unavailable for the release of this report, the analyses using these data will be released in asupplement on the post-gaduate medical education characteristics of B.C. physicians.Subject to terms and conditions set by its Executive Committee, the CPSBC may grant 'special' or 'temporary' (in-practice)registration to specialists who have not received RCPSC certification.Electronicdatawere available from CAPER for 1985 and subsequentyears.567Table 3.1 Key Features of the Ministry of Health Physician Payment DatabaseFiscal YearcDatabase 91192 93194 96197 Anaþsis unit service DataMSP Claims DatabaseSalary & Sessional Data tT{{{rr{PhysicianPhysician-13-Health Human Resources Unit Centre for Health Services and Policy Research3.1.4 Population EstimatesMid-year population estimates for 1991, 1993, and 1996 were obtained from P.E.O.P.L.E.Projection #248 and used to calculate physician to population ratios for the study years. Thepopulation estimates were calculated for British Columbia's 83 Local Health Areas (LHAs) andthen were aggregated for the province's 20 Health Regions, nine Health Human Resource Unit(HHRU) regions (see Table 3.2), and the provincial total. Since the LHA boundaries underwentchanges, beginning in 1995, all analyses are standardized to the post-1995 boundaries (see Section3.2.2.1).3.1.5 Data LinkageThe analytic data set on which all analyses were based was constructed at the level of thephysician by linking the CPSBC licensing data, the Ministry of Health FFS, salary and sessionalpayments data, and the RCPSCiCAPER certification data for each study year. Since CPSBCregistration is required to practice medicine in British Columbia, we used CPSBC data to definethe universe of physicians. All other data were matched to this database to create a cross-sectional analytic file for each study year. In order to study trends over time, a longitudinal filewas also created by merging the data from the three study years. Deterministic linkage was usedto link the CPSBC data to the Ministry of Health data using the CPSBC unique physicianidentifier. The data from the RCPSC and CAPER were linked to those from the CPSBC using aprobabilistic procedure involving the physician's first name, last name, birth date, and sex. Tomaintain anonymity and confidentiality, the linkage was performed and identifiers strþed bycomputer analysts at CHSPR before the data were released to the research team.3.2 Variables and lì,leasuresThe following section outlines the variables and measures used in one or more of the analyses.Each is specified as to the data sources used and the methods for variable construction. Becausethe analyses relate to different aspects of physician supply, the variables are grouped as those thatrelate to individual physicians (i.e., physician-specific variables) and those that relate to theregions in which physicians work (i.e., physician supply variables).8 Population Section, BC STATS, B.C. Minìstry of Finance and Corporate Relations.-t4-Health Human Resources Unit Centre for Health Services and Policy Researchtable 5.2: lreltn¡t¡on ot Heatth Human Resource Unit (HHRU) Regionstttlt(u Reg¡on Health Region (HR)I Vancouver & District 7 South Fraser Valley8 Simon Fraser16 Vancouver17 Burnaby18 North Shore19 Richmond2 Capital 20 Capital3 Fraser Vallev 6 Fraser Valley4 Okanagan J4North OkanaganSouth Okanasan - Similkameen5 SoutþEast I East Kootenay2 West Kootenav - Boundarv6 Island Coast 9 Coast Garibaldil0 Central Vancouver Islandl l Upper Island/Central Coast7 Central 5 Thompson12 CaribooI North Central 35North WestNorthern Interior9 North 4 Peace LiardSource: Health Human Resources Unit, Centre for Health Services and Policy Research-15-Health Human Resources Unit Centre for Health Services and3.2.1 PhysÍcian-speclfic Variables3.2.1.1 PhysicianSpecialtyThe categoruation of physicians used in this report is based on the generaVfamily practice andRCPSC speciaþ designations reported by the CPSBC for physici¿rns on the full, special, andtemporary (in practice) registers. General practitioners and family physicians are eligible for fullregistration only if they have graduated fiom a recognized medical school, completed an approvedperiod of recognized post-graduate medical education, obtained certification by the MedicalCouncil of Canada" and have shown a satisfactory record from all other locales in which theyworked prior to licensure in B.C. (CPSBC Policy Manual 1999). The CPSBC may also grantspecial or temporary registration, on a case-by-case basiso to general or family physicians notmeeting these requirements but who agree to practice in a specified area of need. To be licensedas a specialist on the CPSBC's 'full' register, a physician must have graduated from a recognizedmedical school, be certified by the RCPSC, and have demonstrated a satisfactory record ofmedical conduct. As of June 1998, only physicians trained at recognized speciaþ trainingprogr¿ìms in Canada and the U.S. are eligible for RCPSC certification and certification is onlygranted after the successful completion of prescribed specialist examinations. Prior to 1998,physicians who trained at other locations (chiefly Commonwealth countries) may also havequalified for certification. As discussed above, when RCPSC specialty certification has not beenattained or when the physician does not meet all other requirements for full registration, theCPSBC may grant 'special' or otemporary' registration in special circumstances, if the physician'squalifications are deemed suitable.With some exceptions, the most recently obtained specialt¡ as reported on the CPSBCregistration record for the study years, was used for all analyses in this study. This speciaþ waschosen on the assumption that it most accurately reflected thç current field of practice for themajority of physicians. In most instances, the most recent speciaþ also reflected the most'specialized' specialty, where two or more specialties were recorded. In some cases, however,the most recent and most specialized RCPSC specialties were not congruent. For somephysicians, for example, the most recent specialty of the CPSBC was 'general internal medicine'while earlier specialties included 'cardiology', 'gastroenterology'o or ohematology'. For thesephysicians, the most 'specialized' speciaþ was used in the analysis (n=238). Furthermore, toprovide a consistent point of reference, dates of record were chosen to match those used in otherHHRU publications. Accordingly, the specialty data were extracted as of the following dates:December 31, l99l; March 31,1993; and September 15,1996. Because of their small numbers,some RCPSC specialty categories rilere grouped within larger categories. These specialtiesincluded: pediatric cardiology grouped with ca¡diology; occupational medicine grouped withcommunity medicine; dermatology/syphilology grouped with dermatology; clinicalimmunology/allergy, geriatric medicine, and infectious disease grouped with internal medicine;bacteriology grouped with medical microbiology; neuropathology and hematological pathologygrouped with pathology; medical genetics grouped with pediatrics; therapeutic radiology groupedwith radiation oncology; and pediatric general surgery with general surgery.-t6-Health Human Resources Unit Centre for Health Services and Policy ResearchAll HHRU publications before 1996 used Medical Services Commission (MSC) specialtydesignations derived from physician billings instead of RCPSC specialties. Accordingly, the datapresented in previous HHRU publications with respect to specialty numbers differ from thosepresented in this report. Because designations in previous HHRU reports are derived fromphysician billings, the number of physicians in general practice, for instance, is slightly inflated inthese publications (by 50 in l99l and 83 in 1996) due to RCPSC-certified specialists havingbilling patterns similar to those of general practitioners (i.e. in effect practicing as generaVfamilypractitioners).For the purposes of this stud¡ the specialties have been grouped at various levels of aggregation.The first level of aggregation includes eleven main specialty groups: general practice and familypractice (GP/FPs); general internal medicine; medical subspecialties; general surgery; surgicalsubspecialties; pediatrics; psychiatry; obstetrics and gynecology; radiology and laboratorymedicine; anesthesiology; and 'other' specialties. In other anaþes, physicians are grouped into abinary grouping: GP/FPs and specialists.3.2.1.2 Age and SexEach physician's age was calculated from the date of birth recorded on the CPSBC registrationrecord. For each study year, age was calculated as of April 1 to be consistent with thecommencement of the Medical Services Plan billing periods (see above). For the cross-sectionalanalyses, age was calculated at the time the data were extracted. For the longitudinal analyses,age was as of the end of the interval. The only exception to this rule is in the examination of 'but-flow'' physicians (Section 4.3) where age was specified at the beginning of the interval. For allanaþses, physician age was grouped into five basic intervals: ages <40,40-49, 50-59, 60-69, and70+ years. In some cases, some of these categories were combined (e.g., ages 60+) because ofsmall cell sizes.Physician sex was ascertained from the CPSBC registration file.3.2.1.3 Place of Medical School Education and Years Since GraduationPlace ofmedical school education was derived from the name of the medical school first recordedon the CPSBC registration file. The graduating institutions were categorized as the University ofBritish Columbia (U.B.C.), other Canadian medical schools, and all non-Canadian medicalschools.Similarly, time since graduation estimated from year of graduation is from the CPSBC files.-17-Health Human Resources Unit Centre for Health Services and Polic.y ResearchIable 3.3: Aggregated Specialties{ggregated Spec¡alty GP/FPs & RCPSC Specialties3eneral Practice / Family Medicine ieneral PracticeFamily MedicineSeneral Internal Medicine lnternal MedicineMedical Subspecialties Jardrologyllinical Immunology & AllergySritical Care MedicineDermatologyBndocrinology and Metabolism3astroenterology3eriatric MedicineFlematology[nfectious DiseaseMedical Microbiology / BacteriologyVedical Oncology!{ephrology!leurologyPediatric CardiologyRespiratory MedicineRheumatoloevGeneral Surscrv Seneral SurgerySurgical Subspecialties Cardiothoracic SurgeryCardiovascular SurgeryColorectal SurgeryNeurosurgeryOphthalmologyOrthopedic SurgeryOûolaryngologyPediatric General SurgeryPlastic SurgeryThoracic SurgeryUrologyVascular SurservCbstetics and Gynecology ObsteFics and GynecologyGynecologic OncologyReproductive Endocrinology and FertilityMaternal and Feal MedicinePerinatolosyPediatrics PedratncsMedical GeneticsPsychiatry PsychiatryLaboratory Medicine, Radiologyand Radiation OncologyBacteriologyMedical BiochemistryNeuropathologyNuclear MedicinePathologyPathology - AnatomicPathology - HematologicRadiologyRadiation OncologyTherapeutic Radiolosy{nesthesiolosv Anesthesioloey)ther Specialties :lommunity Medicine / Public HealthEmergency Medicine)ccupational MedicinePhysical Medicine-18-Health Human Resources Unit Centre for Health Services and Policy Research3.2.1.4 Geographic LocationThe physician's geographic location was derived from the postal code specified on the physician'sCPSBC registration file. The postal code served to locate each physician's practice within one ofB.C.'s 83 LHAs, which were in turn aggregated into the 20 Health Regions and nine HHRUregions. The postal codes recorded by the CPSBC relate to the addresses published annually inthe CPSBC Medical Directory. In most cases, this address specifies the physician's principaloffice address but in some cases may be a home address. Because physicians may specify eithertheir office or home address on the College's registration file, these data may misclassi$ somephysicians as to their practice address. Furthermore, address information on administrative filescan quickly become outdated. However, the accuracy of CPSBC addresses is enhanced because,as mentioned earlier, physicians are required to immediately report address changes to maintainlicensure and the CPSBC requests address updates as part of the annual registration process. Itwas beyond the scope of this project to validate the physician addresses at each of the intervalsunder study.For some of the analyseso physicians were grouped into 'urban', 'semi-urban'o ffid 'rural' practicelocales based on population density in 1996. Population densþ was calculated by dividing theestimated 1996 population, as obtained from the P.E.O.P.L.E. #24 Projections, by the number ofsquare kilometers in each LHA. The thresholds for constructing these units were determined bylooking for natural'break-points' in the observed frequency distribution. The LIIA groupings areprovided in Appendix A. Some LHAs may include areas with differing urban/rural make-up and,thus, some physicians may be misclassified. However, these misclassifications are infrequent andunlikely to affect aggregate-level analyses.3.2.1.5 Patterns of Geographic'Stability'The longitudinal nature of the CPSBC ûles permitted the construction of variables specifying thegeographic 'stability' of the study population of B.C. physicians. Using the location of practicespecified by the CPSBC in 1991, 1993, and 1996, we were able to classify each physician ashaving a'stable', oinflow' or ooutflow' stability pattern. Physicians were classified with a 'stable'stability pattern if they were registered on the oactive' CPSBC registers in the three study years.Physicians were classified with an oinflow' pattern if they were registered in 1996 but not in 1991,and with an'outflow' pattern if they were registered in 1991 but not in 1996. An'other' categorywas created for physicians who were: (a) on the active register in both 1991 and 1996 but not in1993; or (b) on the active register in 1993 but not in 1991 and 1996. This latter pattern reflectedthose who both gained registration and dropped it during the study period. (See figure 3.1.)For'inflow' physicians, entry onto the 'active'CPSBC registry may indicate recent completion ofpostgraduate training, relocation from other provinces or other countries, or reactivation from aprevious inactive status. For'outflow' physicians, the reasons underlying their departure from theCPSBC registries may include relocation out of the province, re-entry into training programs,- t9-Health Human Resources Unit Centre for Health Services and Policy Researchretirement from clinical practice, death, or other extended absence. It was beyond the scope ofthis study to examine the reasons for entry or exit.For 'stable' physicians, we also created a variable reflecting their regional mobility during thistime. Physicians were classified as having an ointer-regional' move if their Health Region was notthe same in l99l and 1996. For these physicians, we tracked the regions of entry and exit.Figure 3.1: Physician Stability PatternsCPSBC Reg¡strationSl¡b¡lity Psttcm 91192 93194 96197''"'o---l *-li Þ]3.2.1.6 Physicians' 'Scope of Practice'Understanding differences in physician 'scope of practice' is an important, but often overlooked,component of workforce planning. To examine this issue (Section 4.2), two approaches weretaken. First, we examined the range of services provided by each physician over the course of oneyear and constructed a measr¡re (the 'Herfindahl index') to reflect both the 'breadth' and 'balance'ofthe physician's practice across the range of clinical services. Second, we focused on describingthe practice characteristics of GP/FP 'specialists' who concentrated a significant portion of theirpractice in obstetrics and gynecology, anesthesiology, or general surgery. These measures aredescribed briefly below.Herfindahl IndexUsing the methods developed by Baumgardner and Marder (1991), we used the Herfindahl indexto measure a physician's 'specialization' in one or more areas of clinical practice.I-20 -Health Human Resources Unit Centre for Health Services and Policy ResearchOrigina[y developed in the business literature to help identify violations of anti-trust statutes,Baumgardner arrd Marder adapted the index to npasure the degree to which obstetricians andgynecologists 'concentrate' their practices in relation to certain diagnoses. We chose to modifrthis technique by looking at the range of services provided instead of the diagnoses encountered,To do this, we used the clinical 'domains' which form the basis of the MSP fee schedule. Ingeneral, a service (or 'fee-item') is grouped into a speciaþ 'domain' based on that specialtythought to be omost responsible' for delivering the service. It was beyond the scope of this studyto independently assign fee-items to speciaþ categories using rigorous scientific methods.Instead, we used these administrative groupings, validated them for our pu{poses, and madeadjustments when warranted. The domains were validated by exarnining the proportion of olaimsfor each fee-item rnade by physicians considered to 'owno that code (see Appendix B).The Herfindatrl index was used to measure the dispersion of the services provided by an individualphysician þ one year ¿¡cross the MSP fee-item domains. This index can be expressed as follows:HI : >(Sl), where S¡ is the share of the number of services billed in fee-item cluster i comparedwith the total number of services billed across all fee-item clusters by the physician. In otherwords, the Herfindahl index is equal to the sum of the squared share of each fee-item cluster ûomwhich a physician bills. We also used the decornposition of the Herfindahl index proposed byAdelman (1969) which examines both the obalance' of the fee-items billed across domains and the'breadth' in the number of domains where services are provided. This decomposition can bespecified as follows: ¡¡:[(cv)2+1] / N, where ocv' referi to the coefficient of variation of thesha¡e of each dornain within a physician's practice and oN' refers to the total number of possibledomains. We did not examine the specific types of services provided by physicians.GP/FP 'Specialists'One dimension of physician deployment not often analyzed is the contribution of GP/FPs tospecialty practice. We used MSP service claims to identify GPÆPs who deliver significantly moreservices than their peers in the fields of obstetrics and gynecology, anesthesiology, and surgery.More specificall¡ a physician's billings in these areas were calculated as a proportion of his or hertotal billings and the frequency distribution of this proportion was used to identiS GP/FPospecialists'. The ûequency distribution and.the threshold proportions used are presented inSection 4.2.3.3.2.2 PhysÍcian Supply VariablesThe physician supply variables in this study are specified on both a provincial and a regional basis.The following section describes the small areas used, the methods utilized for counting physiciansand full-time-equivalents (FTEs), and the construction ofphysician to population ratios.-21 -Health Human Resources Unit Centre for Health Services and Policy Research3.2.2.1 GeographicSmallAreasThe physician supply statistics generated in this report (Section 4.1) are presented for threegeographic aggregations: (a) the province as a whole; (b) the nine Health Human Resource Unit(HHRU) regions; and, (c) B.C.'s 20 Health Regions. For the provincial analyses, the supply ofGP/FPs and each RCPSC specialty was examined in Fiscal Year (FY) l99ll92 and 1996197.Since specialists are heaviþ concentrated in urban centres, physician supply at the Health Regionlevel was specified for GP/FPs and for all RCPSC specialists combined. As an intermediate step,physician supply was also examined for the larger HIIRU regions which permits a finer analysis ofspecialist supply at the regional level. These nine regions represent contiguous groupings of the20 Health Regions based on regional patterns of health service use. (See Table 3.2 for definitionsof the HIIRU regions.) At this level, physician supply was examined for GPÆPs and for theRCPSC grouped specialty categories (see above). As the geographic boundaries of the healthregions were redefined after 1995, all analyses were conducted using the post-1995 boundarydefinitions (see Section 3.1.4).3.2.2.2 Physician Counts and Full-Time-Equivalents (FTEs)For each of the geographic breakdowns (province, HIIRU region, Health Region), two methodswere used to count the physician populationn l99ll92 and 1996/97:. (1) a simple count of thephysicians on the 'active' CPSBC registers; and, (2) an estimation of the number of physicianFTEs. Counts were generated from the number of physicians on the CPSBC oactive' registers ineach study year whose postal code was located in the geographic area of interest. The use ofsimple head counts implies that all physicians carry similar workloads and are equal in theircapacþ to provide services to patients. This is clearly not the case since some physicians maynot be engaged in active medical practice (e.g., physicians involved in full-time administration orresearch), may work opart-time,' or are 'semi-retired'. At the other end of the scale, somephysicians provide services more than 'ftill-time'. In order to account for these differences, weestimated the number of fr¡ll-time-equivalent (FTE) physicians.To permit inter-specialty and time-series comparisons, we estimated physician FTEs based on the'Health Canada method' - the recommendations of a working group from Health Canada,provincial health ministries, and academic consultants (Canadian Institute for Health Information1998). This method uses specialty-specific percentile levels of earnings to define which physiciansare 'full-time' and makes adjustments either up or down for physicians with greater or lesserearnings. Gross income was chosen to measure physician output since it is implicitly weighted bythe service intensity and/or value. Furthermore, the use of percentiles is preferable to thresholdsbecause it adjusts for price changes over time. The Health Canada method also has the advantagethat it recognizes differences in income and workload among specialties. Accordingly, itfacilitates the longitudinal comparison of FTE totals for particular specialties over time. Whilegenerally accepted, this method of calculating full-time-equivalence results in specialty-specificFTEs. As a result, the comparison of FTE totals between specialties, or the addition of FTEsacross different specialties, is somewhat arbitrary in an absolute sense. In a relative sense,-22-Health Human Resources Unit, Centre for Health Services and Policy Researchhowever, where comparisons are made over time intervals, FTEs calculated in this nnnner arequite instructive.The Health Canada method uses 40th and 60'h percentiles of specialt¡specific incomes asbenchmark ranges within which to measure full-time-equivalence. Physicians with paymentswithin this range are counted as one FTE, those below the 40th percentile are counted as fractionsof an FTE, and those above the 60th percentile are counted as more than one FTE. For physicianswith incomes below the 40th percentile, the FTE is calculated in direct proportion to théir billingsbelow this level. For instance, if the physician bills 50% of the 401h percentile billings, he or she isassigned an FTE of 0.5. For physicians with payments above the 60th percentile, the HealthCanada method uses the logarithm of the ratio of the physician's billings to the 60th percentilebillings to prevent very high incomes fromtranslating into unrealistic numbers of FTEs. The stepsin calculating the FTE are outlined in Table 3.4.Several important modifications were made to the Health Canada formula because of limitationsin the available B.C. physician payment data. We assigned physicians with the RCPSC specialtiesof pathology, medical microbiology, diagnostic radiology, and nuclear medicine an FTE:Ibecause billings associated with an MSP billing number do not necessarily reflect the servicesprovided by a single physician. In 8.C., services provided by several laboratory or radiologyspecialists may be billed through a single physician's billing number.We also modified the calculation of FTEs to account for the use of oservice agreements' inFY 1996197 in addition to FFS and Salary/Sessional payments. Estimates of physician 'output'would be biased downward without inclusion of FTE estimates from this form of payment. Thisis particularly the case in specialties where a substantial portion of payments \ryas in the form ofoservice agreements'. As discussed above, unlike the FFS or Salary/Sessional data, the oserviceagreement' data did not permit the assignment of this income to particular physicians. Thus, weare limited in our ability to capture some (or all) of the income for specific physicians coveredunder these agreements. In addition, the service agreements only specify the types of physicianservices provided and not the specialties of those physicians contracted.Table 3.4: Used to Calculate Physician FTEsl. Group physicians into RCPSC categories (based on most recent recorded specialty onCPSBC files.)2. Sum FFS and Salary/Sessional payments for each physician for each year (based on date ofpayment).Only payments for B.C. residents included. Isolation payments and interest paymentsexcluded.3. Determine 40th and 60th percentiles of total payments for each specialty group.4. Assign FTE:I for physicians with total payments between 40th and 60th percentiles.5. Assign FTE<I for physicians with total payments below the 40th percentile. The FTEvalue is calculated as: FTE : (physician's total payments) I (40th percentile of totalpayments.)6. Assign FTE>I for physicians with total payments over the 60th percentile. The FTE value*is calculated as: FTE: 1 + ln (lphysician's total paymentsl I l60th percentile of pavmentsl).-23 -Health Human Resources Unit Centre for Health Services and Policy ResearchTo assign these 'service agreements' to particular specialties, we assumed that the oservice types'specified under the contract were provided by physicians in the corresponding speciaþ. Forinstance, contracts for 'primary cæe' services were assigned to GPlFPs, omaternaVnewborn care'to obstetricians and gynecologists, ogeneral surgery' to general surgeons, and 'pediatric care' topediatricians. We are cognizant of the fact some of the income relating to the service agreementsmay be mis-assigned in this nnnner since the contracting agencies may have contracted withphysicians outside these speciaþ groups. However, it was beyond the scope of this study tovalidate (and adjust ifnecessary) these assignments.Table 3.5 shows the proportion of payments in FY 1996197 for each payment mechanism byspecialty. In 1996197, service agreements accounted for 2.9Yo of all payments for physicianservices (excluding transplantation services). These payments were matched to l0 of the 35specialty groups. In six specialty groups, including generaVfamily medicine, cardiology, internalmedicine, psychiatry, general surgery, and obstetrics and gynecology, the agreements accountedfor a small minorþ of total expenditures (0.9-5.5%). For these specialties, the number of FTEscovered under the service agreements was estimated by dividing the amount paid under theagreements by the median FFS and Salary/Sessional payment for physicians in those specialties.The FTEs were then assigned to the LHA where the contracting agency was located. To gaugethe sensitivity of these estimates, we also used the 40th and 60th percentile billings to generate arange of FTE estimates. The validity of these estimates was also examined by comparing themwith the number of FTEs specified under the service agreements (see Appendix C). While theestimates may be biased upwards (if physicians received payments under the service agreementsand other mechanisms), we believe that this bias is minimal because of the relatively small size ofthe contracts in relation to the other income.For pediatricians,2l.T%o of paymentsn1996197 were made through agreements with the threeVancouver-area hospitals for pediatric services, including critical care, special care nursery,oncology and other services. We modified the above method to estimate full-time-equivalence forpediatricians because of the relatively large contribution of these service agreements. Withoutexcluding physicians covered under these agreements from the calculation of the percentiles (sincemany also had some FFS billings), the number of pediatrician FTEs would be significantlyoverestimated. To account for this problen¡ we identified 8l physicians who were based at theB.C. Children's Hospital and were on faculty of U.B.C.'s Department of Pediatrics (Dr. JudithHall, personal communication). These physicians were excluded from the pediatrician percentilecalculations. While this adjustment is clearly not ideal (since we estimated the ousual' physicianoutput for less than 60Yo of pediatricians), we believe that it provides a reasonable estimate ofpediatrician full-time equivalence.Because of the relatively large service agreements with the B.C. Cancer Agency, VancouverGeneral Hospital, and St. Paul's Hospital for the provision of oncology and emergency services(relative to the FFS/Salary/Sessional earnings), we assigned FTE:I for emergency medicinespecialists, medical oncologists, and radiation oncologists in both study years.e9 Physicians in specialties other than those specified are also paid under these arrangements (e.g., other physicians arecontracted by the B.C. Cancer Agency [8. Sealy, personal communication]). Because of this fact, the full-time equivalence ofother physicians may be underestimated.-24 -Health Human Resources Unit Centre for Health Services and Policy ResearchSince the 40th and 60th percentile cutpoints are relative to the billing patterns of all physicianswithin the specialty groups in each study year, there were differences between years in theabsolute payments that these percentiles represented. Thus, there is the potential that anydifferences or similarities in the estimated full-time-equivalence between the study years may bebiased by the choice of relative cutpoint. To analyze this potential bias, we examined our FTEestimates for physicians who were the most likely to be in ostable' practice over this time, that isphysicians at the mid-point of their 'professional life cycle' who were actively practicing FFSmedicine during both study years. We hypothesized that for this cohort of physicians the FTEestimates at the beginning and end of the study period should be similar. Thus, we compared theFTE estimates in 1991192 and 1996197 for those in 'stable' practice (i.e., registered in 1991,1993, and 1996), between the ages of 45 and 55 years, and in specialties where fewer than l0% ofservices were provided by'service agreements' n1996197.We found that overall the corelafion between the two FTE estimates was substantial (r=0.87).Moreover, there were few differences in this finding among speciaþ groups. When wecateogorized FTEs into <1, l, and >1 categories, we found no consistent pattern in whether theshifts were up or down. These findings suggest that comparing the FTE calculations betweenyears is reasonable for the specialty types studied. Unfortunatel¡ we are not able to generalizethese findings with certainty to specialites with >l0yo of total payments n 1996197 accounted forby'service agreements'.3.2.2.3 Physician to Population RatiosFor each geographic breakdown, physician to population ratios were calculated by dividing theestimated number of physician FTEs by the population estimates. These estimates are presentedas either FTEs per 10,000 population (for GP/FPs and all specialists combined) or FTEs per100,000 (for individual or grouped RCSPC specialties). Careful attention was paid to using thesame geographic boundaries to estimate both physician and population estimates. In some cases,the ratio ofthe ntrmber of physicians to population is also presented.It is important to state that by using FTE to population ratios, we are in no way implying theappropriateness ofthe ratios presented. Appropriateness of these ratios must be considered in theface of population health needs and changes in the practice in medicine. For this study, ratios arepresented only to compare changes in supply over time.-25,table 3.5: D¡stributi,on of M¡nistry of Heålth Paym€nb for Physici¡n Serv¡ces by Psymebt Mechrnis¡n, 1996197,toecialtv NoIotslPayments FY1996197**Fee.For-Senice(o/ol¡vmem ûlecDâusmsS¡l¡ry& | ServiceSession¡l (o/o ) I .lsrcements (ø ) Contn¡ctine Ors¡rizetions***eneral / fâmilv Prachce 4-335 5ió19_ t 59-553 95.9 3.2 u-y I z Asenctes\nesthesiology)ardiolorylommunity Medicine>rmatologySndocrinology & Metabolismimergency Medicineiastroenterolory{emalologyntemal Medicinevledical Biochemistryvledical Microbiologyvledical / Radiation Oncology###rlephrologyileurology,luclear Medicine)ediatrics)athology - General)athology - Anatomical)hysical Medicine)sychiatryladiology - Diagnosticlespiratory Medicinelheumatolorylardiovascular and Thoracic Surgeryieneral Surgery,ieurosurgery)bletrics & Gynecolog¡r)phthalmology)rthopedic Surgery)tolaryngolog¡r)lastic SurgeryJrology'lqcnl¡r S¡rrcpru122549l1329574062147l28l835869l92251037037488238442733189?.)18218214869))6825ss',994,727s23,309,0749278,996$l 5,04s,137s2,359,459$13,661,717$9,080,362s2922,050s63,7s3,274s7,472,848s6,932,s I 8s17,817,58693,s7s,842$14,359,964s17,5 I 1,482s32,904,588$108,873,978$5s,093,083$3,412,606ssz,790,703s96,973940sr0,440,124$4,399,473s10,301,299s40,193,747s8,109,02ós38,566,609ssg,324,949s29,963238$17,333,6s0$1 1,854,346s20,237,6?ts7-48892998.493.459.810080.789.399.998.4r0084.27.29ó. I96.310066.0100100s2.552.999.894.490.110098.099.393.099.499.310099.499.s99-83.93.70.25.6,.:0.71.50.60.10.00.60.60.20.10.5r001.66.60.4r9.35.60.4t2-.347.544.939.8s.l15.592.7¿.t2.01.0 Nanaimo General HospitalVancouver General, St. Paul's & B.C. Women's HospitalGreater Victoria Hospilål Society, VancouverGeneral Hospital & St. Paul's Hospital #B.C. Childrens, St. Pau¡'s Hospital, U.B.C.Medical Microbiology & Greæer Victoria Hosp. SocietyB.C. Cancer AgencyB.C. Children s Hospital, Sunny Hill Childrens HealthCentre & Queen Alexandra Children's Health CentreJuan de Fuca Hospit¿l Society, St. Joæph's Gen. Hosp.,Trail Regional Hosp. & rgfest Coast General Hosp.Prince George Regional HoçialGreater Victoria Hosp. Society & B.C. Women's Hosp.21.7t:t\ll Phvsicians 7.712 st-479-596-541 93.2 t.9 2.9onIl.Jo\I** Excludæ service agre€ineot 6r trasplant¿tion services ($ó29,?72).æ Ellocated to RCPSC speciElty tha¡ b€st natches søvice t¡'pe speciûed.# Medic¡l and Radiæion oncologr RCPSBC spocialties combined for this aalysis. B.C. Cancer Agency paynens aributed to these spociålties.##Agreerænts spociñed ôr intensile c€re services & geritic hon¡e assesstnent.l¡##Agre€íHrts speciûed for saernal & newbom cae.tDo)é=Þ(Du)o()(Dlt¿co()tst(Do'(DÞ(t)(DFIc)(DU'ÞÈFgoC)F(Dv)oFt(>Health Human Resources Unit Centre for Health Services and Policy Research-27 -Health Human Resources Unit Centre for Health Services and Policy Research4. Results4.1 Aim l: Supply and Distribution of Physicians in B.G.This section examines the supply of physicians (including general practitionerVfamily physiciansand specialists) in British Columbia at two points in time: n l99ll92 and five years later in1996197 (the most recent year available at the start of this study). We present statistics on thesupply of practicing physicians on the provincial rolls at these intervals and examine theirspecialty, age, sex, and place of medical school education.ro We also explore the geographicdistribution of physicians within the province and examine how this distribution changed over the5-year study period. Finall¡ we examine differences in the demographic and practicecharacteristics of B.C. physicians by the regions in which they practice.In order to provide a comprehensive examination of physician supply, th¡ee different levels ofanaþis are presented in this section of the report. At the most aggregate level, we present theoverall provincial supply of the various Royal College of Physicians and Surgeons of Canada(RCPSC) specialists and of general practitioners /family physicians (GP/FPs) (Section 4.1.1). Theprovincial perspective is vital since many specialist and subspecialist physicians act as 'provincialresources', providing refenal services to all B.C. residents. At the second level of disaggregation,we examine the distribution of 'grouped' specialties for B.C.'s nine Health Human Resource Unit(HHRU) regions (Section 4.1.2). These analyses are primarily intended to examine the regionaldistribution of important categories of specialty physicians within regional referral systems. Inparticular, the distribution of 'general' specialists across the HHRU regions (includingpediatricians, general internists, psychiatrists, and obstetricians/gynecologists) is examined. Forthe final level of analysis, the distribution of physicians (GPÆPs and all specialists combined) ispresented for B.C.'s 20 Health Regions (using the post-1995 boundary definitions)(Section 4.1.3). These analyses are intended to focus on the regional distribution of primary carephysicians in the province. This finer geographic breakdown was chosen because of thecommunity orientation of primary care, the more equitable distribution of GPIFPs across theprovince (compared with specialist and subspecialist physicians) and to assist medical servicesplanning at the regional level.rrr0 Charactcristics relating to post-graduate medical education will be examined in a future supplement to this report.rrThe 20 Health Regions used in this study represent the Ministry of Health's geographic analysis units. The boundaries forthese regions largely reflect those of B.C.'s Regional Health Boards (RHBs), Community Health Councils (CHCs), andCommunity Health Service Societies (CHSSs).-28 -Health Human Resources Unit Centre for Health Services and Policy Research4.1.1 Physician Supply from the ProvincÍal Percpective, 1991/92 and 1996/974.1.1.1 Physician Counts, Full-Time-Equivalents (FTEs), and FTE/Population Ratiosln1996, there were 7,732 physicians registered to practice medicine on the 'active' registers (fuII,special and temporary lin practice] registers) of the College of Physicians and Surgeons of B.C.(CPSBC). Basing physician supply anaþes solely on the numbers of licensed physicians is notadvisable, however, given the facts that many licensed physicians may not be active in clinicalpractice (e.g., physicians holding administrative, research or teaching positions) and, for those inpractice, may differ in their levels of practice intensity. For these reasons, we also calculatedphysician'fi.rll-time-equivalents' (FTEs) using the Health Canada formula based on Ministry ofHealth physician payment records (including FFS, Salary/Sessional, and Altemative Payments).(See Section 3.2 for a description of this methodology.) For 1996197, we estimated that 6,930physician FTEs were in practice in B.C.'2 It is important to recall that since FTEs are estimated indifferent ways for different types of physicians, it is difficult to interpret the summation of FTEsacross specialties in any absolute sense. This anaþis is solely intended to permit comparisons ofFTEs over time. We also found that 739 physicians on the oactive' CPSBC registers (9.6%) hadno payments for clinical services (including fee-for-service, salary or sessional payments) ûom theB.C. Ministry of Health." Using the P.E.O.P.L.E.24 mid-year population estimates ior l996ta,we estimate that there were approximately 17.9 physician FTEs per 10,000 B.C. residents (or 558persons per physician FTE) in this fiscal year.Using similar estimation methods for l99ll92 (based on 1991 CPSBC registration data andl99ll92 Ministry of Health payment datars)o 6,922 physicians, corresponding to 6,062 FTEs,were practicing in B.C during 1991192. In this year, 688 physicians on the oactive' registers(9.9o/o) had no FFS or Salary/Sessional payments from the Ministry of Health. Using the mid-yearl99l population estimates, we estimate that the FTE/population ratio was 18.0 physician FTEsper 10,000 (556 persons per physician FTE).12 Because of the difüculties in appllng payments for laboratory and diagnostic imaging services to calculate FTEs forphysicians with specialties in medical biochemistry, medical microbiolory, nuctear medicine, patholory, and radiolory, allphysicians of these types wero estimated at I FTE. Furthermore, specialists in emergency medicine, community medicine,medical oncolory and radiation oncolory were all specified as I FTE because of limitations in the physician-specific billingdata for FY 1996197, These adjustmçnts are departures from the Health Canada formula. See Section 3.2 for details. It isimportant to note that payments from third parly insurers (e.g., Workers' Compensation Board, Insurance Corporation ofBritish Columbia) and out-oÊpocket paymcnts for non-insured services (e.g., cosmetic surgery) were not used in thesecalculations. Theso limitations may result in some over-or under-estimate of physician FTEs.13 This figut" is likely an overestimate since no physician-specific identifiers were available on payments made through ServiceAgreements in 1996197 (see Section 3.2). Thus, physicians paid only under these agreements would be counted inconectly ashaving no Ministry of Health payments.ra Population estimates (P.E.O.P.L.E. #24) were supplied by the Population Section, BC STATS, Ministry of Finance andCorporate Relations, Government of British Columbia.15 The principal difference between the Ministry of Health's payment data for lggllg2 and 1996197 was the addition ofphysician 'Service Agreements' in the latter year (see Section 3.1). Thus, the 1996197 estimates include payments madethrough these agreements in addition to the fee-for-service and salary/sessional payments for the specialties of generalpractice, cardiolory, internal medicine, pediatrics, psychiatry, general surgery and obstetrics and gmecolory.-29 -Health Human Resources Unit Centre for Health Services and Policy ResearchThere was an approximate ll.7%o growth in the number of physicians on the 'active' CPSBCregisters over this five year period, corresponding to a growth in FTEs of about 14.3o/o (or about2.3% and 2.9%o pu year respectiveþ). Over the same intervalo B.C.'s population grew by about15.0% (or 3.0% growth per year). Thus, population growth out-paced the growth in the numbersof physicians (by about 0.7Yo per year), while closely matching the increase in physician FTEsover this period.Table a.l displays the numbers of physicians, FTEs, and FTEs/10,000 population for 35 specialtygroups (GP/FPs and 34 RCPSC specialties). For GP/FPs, the physician population grew by 488physicians from a baseline of 3,847 n 1991192. This increase corresponded to an addition of 511GP/TP FTEs over this interval. However, the growth in FTEs translated into only a very slightchange in the FTE/population ratio from 9.78 to 9.81 FTEs per 10,000 population (or less thanlYo change per year). For specialists, the overall physician population grew by 322 physicians.Their FTE/population ratio fell very slightly from 8.19 to 8.03 FTEs per 10,000 population.16In 1996197, the largest RCPSC specialties (with more than 200 physicians each) were psychiatry(488 physicians), general intemal medicine (358 physicians), anesthesiology (329 physicians),diagnostic radiology (253 physicians) and pediatrics (225 physicians). The specialty groups withthe fewest physicians included nuclear medicine (19 physicians), hematology (18 physicians),endocrinology and metabolism (14 physicians), medical biochemistry (12 physicians), andnephrology (11 physicians). When the specialties were ranked from most to least numerous inboth study years, the rankings remained remarkably consistent (Spearman correlation coefficient :0.98), suggesting no large differences in the patterns of growth rimong specialties.However, on closer inspection, some important differences were revealed. Over the 5 yearinterval, all but six specialties saw their numbers of physicians grow Ganging ftom a net gain of106 physicians in psychiatry to one physician in rheumatology). Two specialties (medicalbiochemistry and nephrology) had no net change in physician numbers and four specialties showeda net drop, including general surgery (24 physicians), otolaryngology (7 physicians), hematology(2 physicians) and orthopedics (l physician). In relative terms, the changes in the numbers ofactive physicians varied from a fall of ll.3% for general surgery to an increase of l33Yo forendocrinology and metabolism. The marked disparities in the growth patterns rimong specialtiesremain (although are somewhat diminished) when one considers changes in FTEs. The changes inthe FTEs varied from a drop of 6.7 FTEs for general surgery to an increase of 104 FTEs forpsychiatry; in relative tems, the changes ranged from a 12.2% drop in FTEs for hematology to an85% increase in FTEs for psychiatry. (See Figure 4.1.)16 Sensitivity analyses for thcse estimates using 40th and 60th percentile billings to calculate FTEs contributed by serviceagreements in 1996197 are presented in Appendix C.-30-Health Human Resor,uces Unit Centre for Health Services and Policy Research*For 1996, FTEs are baæd on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British ColumbiaCancer Agency. For 199 l, FTEs are based on Fee for Service and Salaried and Sessional payments. See discussion in Section 3.2.2.2.ttBasedonl99lBCPopulation=3,373,399and199óBCPopulation=3,882943. PopulationeslimatessuppliedbyPopulationSecrion,BC5TATS,Minisrry of Finance ând Corporate Relations, are !Ìom the P.E.O.P.L.E. Projection Model - #24. All figures are as ofJuly I of lhe year stated.**tAs a more accurate representation of personnel, Community Medicine, Emergency Medicine, Laboratory/Radiology, Radiation/Medical Oncology specialtieare included as I person=l FTE.table4.l: SupplyofPhysiciansinB.C.bySpecialty,Number,FTEs,andPopul¡tionperFTE-l99lD2andl996llt7*l99l - 1992 1996 - 1997lpeciâlty No. FTEsFTEs/10,000Ponrn*t No, FTEsFTEs/10,000Pontn*úAverageAnnu¡l o/oChrnge inFTEs/10,000PoDtn*rieneral / Family Praciice 3.84? 3.299.36 9.7Í 4,335 3,809.9' 9.8t 0.0';AnesthesiologyCardiologyOommunity Medicínet*rDermatologyEndocrinology & MetabolismEmergency Medicine*r*SaslroenterologyHematologylniernal MedicineMedical Biochemistryt**Medical Microbiology*t*Medical OncologyNephrologyNeurologyNuclear MedicinetrtPediatricsPathology - GeneralrtiPathology - Anatomicûlt*3?þsical MedicinePsychiatryRadiatíon Oncolog¡rtt*ladiology - Diagnostic**tlespiratory Medicinelheumatologylardiovascular & Thoracic Surgeryieneral Surgeryrleurosurgery)bstetrics & Gynecology)phthalmology)rlhopedic Surgery)tolaryngologyllastic SurgeryJrologyy'ascular Surserv30t4',1JJ576s9aa20339l223t0ll64llt9297643l382z824035263t2t329167t65t4976496323260.4446.8633.0051.127.3759.0021.2917.80266.6412.0023.00r0.0010.6660.69I 1.00I 83.s897.0064.0028.14344.4028.00240.0033.3323.6529.t0t62.5523.33l4l .51157.50124.t067.6642.9958.5222.060.770.140. l00.150.020.t'l0.0ó0.050.790.040.070.030.030.t80.030.540.290. t90.08l-020.080.710. l00.070.090.480.070.420.470.370.200. l30.170.07J 29574062l47t28t8358t225l6ll69l9225t03703748838253442733893282824869556825287.t353.8040.0056.4213.6ó71.0027.35ls.ó3319.7112.0025.00r6.00t1.26ó3.08t9.00207.14t03.0070.0034.80448. r038.002s3.0038.9325.2129.23154.0727.97t63.42170.47124.4s64.4750.4ó63.7023.040.7¿0. l¿0. l(0. t:0.0r0.rt0.010.0¿0.8,0.0:0.0(0.0r0.0:0. t(0.0i0.5:0.2i0.r{0.0t¡.li0. t(0.6r0. l(0.0(0.0t0.4(0.0,0.420.440.320. It0. l30. l(0.0(-0.854.05r.04-0.83t0.000.902.23-5.270.82-2.7?-l.t36.81-1.70-2.028.464.39-1.60-t.011.452.493.35-1.740.30-1.52-2.68-3.8 I0.820.07-t ,r)-2.71:3.700.40-l.l I-1.92total Physicians 6,922 ó,0ó l .65 17.9', ?.1ft ó.930.4 t t7.8 -0.1-31 -Health Hurnal Resources Unit Centre for Health Services and Policy ResearchFigure 4.1: Changes in Physician F fEs in B.C. 91192-96197by RCPSC SpeciaþPsychiatryMedicineAnesúesiologrPodiatricsGynæologyOphthalmology- DiagnoSicMcdicineOnoologrMedicinePlasic SurgeryModicineCardiologyMedicine& Met¡bolism-An¡tomicål- Ge¡reralOncoloryMedicineDermatoloryUroloryNeurosurgeryNeurologyMicrobiologyRheumaûolog¡rSurgeryNephrologrC¡rdiovascular &SurgerySu.gpryBioclrcmisty40 60Net Change ln tr'IEs gllln -961n-32 -Health Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.2 shows the changes in FTE/population ratios for GP/FPs and RCPSC specialists overthe S-year study interval. This analysis examines the dual dynamics of both changes in specialtysupply and population growth. In addition to the four specialties that declined in their absoluteFTEs (hematology, otolaryngology, orthopedic surgery and general surgery), the growth in FTEsfor 14 specialty categories did not keep pace with population growth. In other wordso a total ofl8 specialties saw declines in their FTE to population ratios over this interval, ranging from -4.0o/ofor dermatology to -23.7% for hematology. Conversel¡ 15 specialties saw an overall increase intheir FTE/population ratios ranging from 1.5% for respiratory medicine to 6l.10/o forendocrinolo gy and metabolism.In summary, some specialties grew faster and others slower than the provincial population. Theappropriateness of growth in either direction was not examined. Relative rates of growth are afi.mction of many factors such as training, migration, and retirement. More importantly, factorspertaining to the practice of medicine and the population health needs would have to be taken intoconsideration when estimating appropriate GP/FP or specialist to population ratios.Another critical (and often studied) aspect of physician supply is the 'balance' between GP/FPsand specialists. Based on the numbers of physicians on the active register in each of the two studyyears, the ratio of GPÆPs to specialists widened very slightly from 55.7:44.3 n l99ll92 to 56:44n 1996197. With respect to FTEs, there was also little change in the GPiFP to specialist ratiofrom 54.4:45.6 in 199 I 192 to 54.7 :45.3 n 1996197 .Principal Findings: Overall Physícían Supply 1991/92 ønd 1996/97o In 1996197, 7,732 physicians were on the 'active' registers of the CPSBC. Using availabledata, this corresponds to approximately 6,930 physician FTEs.o In 1996/97, there were approximately 18 physician FTEs per 10,000 B.C. residents (or about560 persons per physician FTE).r Between l99ll92 and 1996/97, there was a net increase of 511 GP/FP and 358 specialistFTEs. However, the per capita supply of physicians was relatively stable because of similarrates of population growth.o Important differences in the overall patterns of supply existed rimong specialty groups. Whilemost specialties saw a net increase in the numbers of physicians during this period, 4specialties (general surgery, otolaryngology, hematology, and orthopedic surgery) saw a netdecline.o More than half of the speciaþ groups saw a net decline in their per capita FTE supply overthe S-year study period.o The ratio of primary care physicians to specialist FTEs n 1996197 was 55:45. Little change inthis ratio was seen over the proceeding S-years.-33-Health Human Resources Unit Centre for Health Services and Policy ResearchFigurc 4.2: Percent Change in FTE/Population Ratiosby Speciaþ 91192-96197Endocrinolory MenabolismMedicineOncoloryPsychiatryMedicineMedicineMedicineMedicineNeurosurçrySurgeryModicineObsætrics Cynæolog/General / P¡acticeCardiologyt0 20 30 407o Change ln FTE/Populatton R¡ttos 91/9 - 96197-34-Health Human Resources Unit Centre for Health Services and Policy Researsh4.1.1.2 Age and Sex Characteristics of B.C. PhysiciansIn 1996/97, the mean age of all physicians on the 'active' CPSBC registries was 47.1 years(SD 11.5). When weighted by their FTE value, the average age was reduced marginaþ to 46.2years (SD 9.2 yearc). In 1991192, the unweighted mean age of all physicians on the oactive'registers was 46.3 years (SD 12.0) while the FTE-weighted mean age was 45.4 years (SD 9.44).Thus, the physician population showed an overall aging of about 0.8 years during this 5 yearperiod (in both the unweighted and FTE-weighted analyses) (F-statistic:17.2 P<0.0001'7).Table 4.2 and Figure 4.3 show the age composition n 1996197 of B.C physicians by theirspeciaþ classification. Overall, about 29o/o of the physician FTEs were aged <40 years, 60%were aged 40-59 years, about llolo were aged 60 years or older. This compares to data froml99ll92 where about 35% of physicians were aged <40 years, 55%o aged 40-60 years and about9o/o aged 60 years or more (data not shown). These analyses confirm the gradual upward shift inthe age distribution of physicians over this interval.There are also important differences in the physician age structure by speciaþ type. In comparingGP/FPs to all specialists (1996197), a larger proportion of GP/FP FTEs were aged<40 years(35.5o/o) than were specialist FTEs (19.5%) (p<0.0001). This is not surprising, given the longertraining requirements for specialist physicians. However, among RCPSC specialties, there werealso substantial differences in age structures. The proportion of the FTEs aged 40 years or lessranged from a maximum of 43.9% in endocrinology and metabolism to only 4.4% tn vascularsurgery. In addition to endocrinology, 3 specialties had a particularly high proportion of youngerFTEs: emergency medicine (32.4%), medical oncology (31.3%), and nephrology Ø0.9%).Physicians aged 60+ years represented 1,5.7% of specialists, almost twice the proportion ofGPIFPs (8.1%)(p<0.0001). Specialties with > 20o/o of their physician FTEs aged 60 years orolder included: community medicine (27.5%), dermatology (21.1%), medical microbiology(20%), nuclear medicine (26.3%), psychiatry (21.1%), general surgery (21.7o/o), generalpathology (27.2%) and radiology diagnostic (20.2%). Conversely, less than 5% of cardiolog¡emergency medicine, anatomic patholog¡ respiratory medicine and plastic surgery was aged 60+.Table 4.3 shows the distribution for the B.C. generalist and specialist physician FTE population bysex in 1996197. While female physicians represented 209% of the physician FTE workforceoverall they comprised a much larger proportion of FTEs <40 years (33.8%) compared with FTEsaged 40-59 years (l7.7Yo) or FTEs aged 60+ yearc (7.3o/o) (p<0.0001) This finding is notunexpected as it mirrors the changes in the sex composition of medical school enrollment over thelast several decades (ACMC, Canadian Medical Educator Statistics, 1998). For GPÆPs, womenrepresented approximately 30% of the workforce, but made up more than 35% of the physicianFTEs under 40 years of age and only 6.7% of the FTEs aged 60 years or older. Forl7 One-way analysis ofvariance (une4ual variancc assunption) to tesl for dilferencc in lM age between l99ll92 nd 1996197. Age weÅ$tted by F.ÍE in this analysis. Nornulityassunption tesed with Kolmogorov statistic (H. I ).-35-lsblc 4.2: Age Distributi,on of B.C. Püysicians by Sp€c¡¡lty - 196/97*ibæidteUnder,l0 yrs ¿10 thru 49 yrs 5{) thro 59vn 60tùro69w 70 m ud Olds lot¡lsNo. FTEs o/o No. FTEs o/o No. FTEs Vo No, FTEs 6/o No. FTEs o/o No. FTEsieneral / Familv Prac-tice 1,58t 1338.0S 35.i t,44t t,37E.9' 36.1 79i 751.9 19.! 375 2s9.2( 6.1 l3: 44.3i t.1 4.335 3.?72.5ilnesthesiolory)adiolorylom¡nity Medicine*r)emntoloryhdocrinolory & Metabolisûiærgency Medicinetr'iasÍoent€rolots/{errâtoloryntçnal Medicinevledicål Bioch€mistrJy''vledical Microbiologt tvledical Oncologlt{ephroloryrleurolorytlucles Medicinerr>ediaÍicsi ' 'latholory - Generalrrlatholory - Ana¡omical*'lhysical Medicinelsychiaryladiation OncologÉ'Ladiolog - Dagnostictrlespiratory Medicinelleumatologlladiorascular & Thoracic Surgery3aeral Surgery\¡eu¡osurgery)bsredcs & CynecologrþhthalnologrÌthopedic Surgety)tolaryngologr?lastic SurgeryJroloryVeulrSuruw75l52341l51157ét26C4234l25lll3l5I?l.l l12.434.006.106.0023.006.762.s945.622.003.005.004.6tt0. r86.00¡16.001s.0017.003.5770.0312.0060.006.982.s94.0623.817.4536.3633.062t.3910.05lt.9414.53l.0l24.873.4r0.010.843.932.424.1r6.6t5.216.1t2.Q31.340.9l6.l31.(20.4t4.ó24.3t0.315.934.323.7t7.9t0.313.9r5.826.623.ót9.4t7.2ls.623.122.84.4l2i')¿t:(3il:l(I r(a(2tj7t2lJJlil6;l:7(2:ltti41(5(5(5i2i2tl',t:t20.2324.9513.0023.396.2s33.0015.357.ú104.883.009.006.004.3523.805.0079.0029.0033.0016.06t59.ó315.0070.0022.9112.34t0.8541.787.0145. l065.0955. l024.56¿J.5tt9.2612.¿1841.946.532.:4t.l45.t46.:56.t50.334.52s.(36.t37.:38.(37."126.335.t28.147.16.136.242.527.158.t48.537.l27.125.18.338.i44.338.r46.230.254.283l6t2l6It45595685)l8J563ll8t2t2372t0l0lt5l94352382317l6672.2114.8512.0015.050.5814.005.245. l6ot t?6.008.005.002.3017.503.0056.0031.0018.00I 1.78I 18. l78.0072.008.0410.2810.7652.609.t643.7953.7631.3321.7014.04t8.095,9325.n.:30.(26;4.:19.'t9.:JJ.30.'50.(32.t3t.:20.,ta'l5.r24.130.25;JJ.:26.1))l28.:20.'40.t36.r34.132;28.r31.:25.:,JJ.27.128.'25;39I9llII0062I500l443t))1487237I054763t2326l02t2422.681.009.0010.840.831.000.000.0047.61.005.000.000.00r t.304.0031.0022.002-005.J I72.490.0037.001.000.002.Ð30.784.2824.t4r4.19t5.417.441.03t0.843.24?.sl.ç7)<t9.26.t1.40.(0.(15.98.320.(0.(0,(t7.s2l.ll3.t21.4t(9.116.40.c14.(2.Í0.c7.820.415.3t5.18.3t2.4I 1.52.Ct7.cr4.l25342Il3I35It4I26Jl7t4I0.900.002.N1.040.000.000.000.009.740.000.000.000.000.301.0013.006.000.000.0220.350.00i4.000.000.001.2?r.900.074.504.3?t))0.720. 120.980.380.:0.(5.(Lt0.(0.(0.(0.(0.(0.(0.(0.(0.15.:5.f5.f0.(0.1329574C62t47t28l8358t225lóll69l9)t<1037A31.188322s3442753189a')182182t4869556825287.1:s3.2:40.0(56.4it3.6(71.0{27.3:15.6:300.0J12.0{25.0(l6.dll.2(63.0{19.0(225.U103.c(70.0(34.8(440.6135.0(2s3.0(38.9:2s.2110 tit50.8i27.9i153.8Jt70.4i124.4:u.4150.4(63.7(23.U:otal Physicians 1 )?< 1943.32 28.3 2,5X 2,520.41 36; t,692 1,619.56 23.1 87s 656.01 9.( 33( t28.t7 I 7.732 ó.Eó7.5,I(¿)o\¡rrAs a ¡rpre accurate representation ofpersonnel, these specialties are included as I person = I FTE.counts haræ beeo subgituted for FTES. As a rsult, these rota¡s will not correspond with those in ea¡lier tables which include FTEs accounted for through Service Agreermts.(DÞ)btF(D(noÉ()ov)co(D(Do'F!(DÊD(A(Dô(DttÞtÊ.FUoC)F(ÐU)C!ÞãHealth Human Resources Unit Centre for Health Services and Policy ResearchGeneral /FamilyCommunityDermatologyEndocrinologyEmergencyHematologyIntemalMedical BiochemiMedicalMedicalNephrologyNeuroloryNuclear MediciPediatricsPathology - AnatPhysicalRespiratory MediciRheumatologyCV & ThoracicGeneral SurgeryNeurosurgeryFigure 4.3: fue Distribution of BC Physician FTEs by SpocÍalty, 1996197CardiologrPsychiatryRadiation Oncolog¡Diagnostic Radiolog-37 -Health Human Resources Unit Centre for Health Services and Policy Researchtable 43: Sex Distr¡bution of Pbysician FTEs in B.C. by Age end Specialty - 1996197,'pec¡altyTotds Under 40 40 thru 59 60 ¡nd OlderFTEs 7o Fem¡lo FTEs 7o Female FTEs o/o Fcm¡l¿ FTEs 7o Fem¡leiene¡al i Family Practice 3.712.5 24. I,338. I 36. r 2-130.s t9.1 303.: 6.',lAn€shesiologilcardiotosrIlConurumity Medicirre*rlDennatolog¡lBrdocrinolog & MeabdisnIEmergency Mediciner.tGasroerrtøoloryHemdologyIrÍeÍial MedicineMedical BiochernicryrrMedical Microbidos/ttMedical OrcologyatNephrologrNeurclog/Nwlear MedicirertPediatricsr.tPalholory - Gorer¿l*rPathologl - Anatomic¿FtPþsícal MedicinePsychiaryRadiatior OrrcdoryttRadiology - Díagnostict.Respiratory MedicineRhcunntologrCardiovascular & Thoracic SurgcryGøeral SurgeryNeurosurçryOboarics& GyræcdogyOplthalrnlogrOrth@icSurgeryOtolaryngoloryPlastíc SurgeryUrolog¡rVâscular Sursery2gt.l53.240.056.413.'l7t.027.415.6300. It2.02s.016.0I 1.3ó3. I19.0225.0103.070.034.8440.738.0253.038.925.2toa150.928.0t53.9t?0.stu.s64.5s0.563.723.0t3.48.120.c16. It4.612.115.822.813.04t.744.A43.88.94.9t 5.832.920.428.6t2.527.t23,719.4t3.822.14.64.00.021.4l0.s0.77.t8.3l.l5.37t.l12.44.r6.16.C23.0ó.8)Á45.62.43.05.04.6t0.26.046.0t5.0t7.03.670.0t2.o60.07.02.64.t23.87.536.433. I21.4t0.tI 1.9r4.5t.0l4.c18.?25.425.133.326.t3t;l2s.9100.033.380.021.710. I16.756.540.03s.328.338.525.02().768. l24.78.637.123.59.725.54.6ty2.439.825.038.46.847.020.613.0tn.t9.0t7.0I 1.06.74t.38.0t35.060.05 t.027.82n.823.0ta.03 t.022.62t.694.416.288.9I r8.986.446.337.437.418.413.!3.:28.(17.(6.¿10.(27.4t2.s33.:58.t27.34.125.C27.420.025.5t2.a28.82t;l2 1.82.42t.86.24.220.98.51.07.83.16.723.61.0| 1.0I 1.90.81.057.41.05.0I1.65.044.028.02.03.492.83.05 1.0t.03.632.74.428.618.ó16.68.2t.2I 1.83.68.:t00.(830.(25.et0.150.013.533.33.92.90.2tcfal Physicians 6,870.s 20.e t',923.s 33.i 4,140.( 17.', 787.2 7'.'FTE calculalions arc based cn Fee fs Service, Salaried and Sessionat, and Service Agreem€nt paym€atq exctuding Service At"d;ipayrEr¡ts to lhe Brilish Cdumt)¡a Câncer Agency. See discusion in Sectiør 3.2.2.2.t*As a nrcrc accurate repres€fitûtion ofpersorure! these specialties are included as I pencr = I FTE.rrrA significant portion ofthese FIES was ac¡ounted for tkough Søvice Agreem€nts for wfiich age and sex treakdorns were unalailsble. To provide a nloreaccuralg rcpresentation ofpersonnel, actual personnel comts hÀve been sub6tituted for FTEs. As a res.rh, lhese lotals will no oonespad rvith thosein earliertables\f,lrich include FTEs accounted forlhrcugh Service r\greemerüs.-38-Health Human Resources Unit Centre for Health Services and Policy Researchspecialist FTEs, women represented 18.3% of the workforce n 1996197 ando as with GP/FPs,they were generally younger than their male counterparts (25% aged <40 years vs. 8.lo/o aged,SQ+ years). Among the RCPSC specialties, the contribution of female physicians to theworkforce varied widely from less ttøî l% of the FTEs in orthopedic surgery to 43.8% of theFTEs in medical oncology. For most specialties, the age group <40 years of age had the largestproportion of female FTEs.4.1.1.3 Location of Undergraduate Medical EducationIn 1996, 2,001 (25.9%) B.C. physicians were graduates of the Universþ of British Columbia(U.B.C.) Faculty of Medicine while 3,520 (45.5%) were graduates of other Canadian medicalschools, and2,2ll (28.6%) were from non-Canadian sites. (There were no significant diflerencesfrom these figures when the percentages were weighted by physician FTEs.) Of Canadian-trainedphysicians Qr 5,521), the 16 Canadian medical schools \ryere represented as follows in descendingorder: University of British Columbia (36.2%); Universþ of Alberta (11.2%); University ofToronto (8.0%); University of Manitoba(6.7%); University of Calgary (6.0%);McGill University(5.8%); University of Saskatchewan (5.S%); University of Western Ontario Ø.6%); Queen'sUniversþ Ø.2%); Dalhousie University (3.5%); McMaster University (3.0%); Universiry ofOttawa (2.6%); Memorial University (1.6%); Université de Montreal (0.2%); Université Laval(0.2o/o); and Université de Sherbrooke (0.1%). When the medical schools were grouped byprovince, their representation was as follows:Principal Findingsr Age and sex Dístribution of PhysícÍans by specíaltyo The mean age of all physicians in B.C. (weighted by their FTE values) was 45.4 years inl99ll92 and 46.2 years in 1996/97. Thus, there was an aging of the physician populationabout 0.8 years over this period.o In 1996197, specialists were, on the whole, substantially older than were their GP/FPcolleagues. Compared with GP/FPs, fewer specialist FTEs were aged <40 years (20%o vs.35%) andmore aged 60+ years (15.7% vs. 8.1%).o There were substantial age differentials in 1996197 among the RCPSC specialty groups.Specialties with > 20o/o of their physician FTEs in the oldest age group (60+ years) included:community medicine; dermatology; medical microbiology; nuclear medicine; psychiatry;general surgery, pathology-general and diagnostic radiology.r Female physicians comprised 20.9% of the 1996197 physician population overall. Thisproportion was greater for GP/FPsQa%) than specialists (18%).o Female physicians comprised a much larger proportion of physicians <40 years (33.5%)compared with physicians aged 40-59 years ( I 7.7o/o) or physicians aged 60+ years (7 .3Yo).o There was substantial variation in the contribution of female physicians to the specialistworkforce by specialty (range: 0 to 44%).-39-Health Human Resources Unit Centre for Health Services and Policy ResearchBritish Columbia 36.2% Ontario 22.3%Alberta 17.5% Quebec 6.4%Saskatchewan 5.8% Nova Scotia 35%Manitoba 6.7% Newfoundland 1.6%The remaining 2,211 'non-Canadian' graduates originated from 303 different institutionsworldwide. Institutions with more than 50 graduates included: the University of London (261physicians), University of Cape Town (168 physicians), the University of Glasgow (91physicians), University of Witwatersrand (73 physicians), Universþ of Northern lreland (72physicians), University of Edinburgh (65 physicians), University of Hong Kong (63 physicians),Queen's University (Belfast) (59 physicians) and University of Manchester (55 physicians).Tables 4.4 and 4.5 show the distribution of physicians by medical school of graduation byspecialty in 1991 and 1996 respectively. In 1996, GP/FPs in B.C. were almost twice as likely asRCPSC specialists to have obtained their medical degree from U.B.C. than elsewhere (32.1% vs.17.9%; p<0.0001). GP/FPs were also less likely than specialists to have obtained their degree atnon-Canadian institutions (24.0% vs. 34.5Yo) in 1996. Among the RCPSC specialties, thecontribution of the U.B.C. undergraduate medical training progrrim to the B.C. physicianworkforce ranged from43.6Yo in plastic surgery to 5.3% in nuclear medicine. (See Figure 4.4.)Table 4.6 and Figure 4.5 display how the proportion of physicians graduating from differentmedical school locales changed from l99l to 1996. Over this period, there was a modest netincrease (1.2%) in the proportion of B.C. physicians graduated from U.B.C. (24.7o/o vs.25.9%).The increase was more apparent for specialists (1.4%) than for GPÆPs (1.0%). Among RCPSCspecialists, relatively large net increases in the contribution of the U.B.C. medical school wereseen in cardiology (21.3% to 28.lYo), medical biochemistry (16.7% to 25.0Yo), plastic surgery(32.7% to 43.6%) and endocrinology and metabolism (0% to 21.4%). The overall increase inU.B.C.'s contribution to physician workforce in B.C. was largely at the expense of non-Canadiangraduates. The proportion of physicians in B.C. who had graduated ûom non-Canadian sitesdeclined from 30.2Yo to 28.6%. Not all RCPSC specialties, however, saw an increase in theproportion of physicians who obtained their medical degrees ûom U.B.C. Otolaryngology,neurology, neurosurgery, and urology actually saw net declines in the proportion of physiciansfrom U.B.C.A key observation or reminder regarding the changes in proportions of active physicians in B.C.who were trained elsewhere is that they cannot, on the whole, be planned or managed. Not onlydoes U.B.C. not control the proportion of its graduates who remain within the province, but alsothe inflow of physicians from other Canadian or foreign medical schools is not known in advance.At present, no restrictions are placed on licensure of physicians from other provinces, providedthat they meet licensing requirements.-40-Health Human Resources Unit Centre for Health Services and Policy ResearchI¡ble 4.4: Supply of Physicians by Place of Medical School Education - 1991*Jpecialties Totalsu.B.c.No. (YolOther CanadaNo. (o/o\Non-CanadaNo. P/olfeneral / Family Practice 3.84i r,r98 (31.1) t,6s4 (43.0) 99s (2s.9\{nesthesiologyJardiolorySommunity Medicine)ermatolorylndooinology & Metabolism3mergency Medicine3asüoenterologyïematology.ntemal Medicinevfedical Biochemiseyvledical MicrobiologyVledical Oncologyt{ephroloryt{eurologyt{uclear Medicinelediatrics?athology - General?athology - Anatomicallhysical Medicine?sychiatryladiation Oncologyladiology - Diagnosticlespiratory Medicineìheumatolog¡rlardiovascular & Thoracic SurgerySeneral Surgery{eurosurgery)bstetrics & Gynecology)phthahnology)rthopedic Surgery)tolaryngolory)lastic SurgeryJrologyy'ascular Surgerv30147335765922203391223l0ll64ll19297643l3822824035263l21329t67165r497649632379 (26.2)l0 (2t.3)6 (18.2)14 (24.6\0 (0.0)l0 (16.9)4 (r8.2)5 (25.0)48 (t4.2)2 (t6.7)r (4.3)2 (20.0)3 (27.3)13 (20.3)0 (0.0)t7 (8.e)20 (20.6)16 (25.0)3 (e.7)55 (14.4)s (17.9\30 (tz.s)5 (14.3)5 (re.2)5 (16.1)22 (10.3)4 (13.8)27 (t6.2)23 (r3.e)26 (t7.4)l0 (13.2)t6 (32.7)t7 (27.0\6 Q6.t\124 (41.2)20 (42.6)t2 (36.4)30 (s2.6)3 (50.0)42 (71.2)t6 (72.7)e (45.0)177 (s2.2)6 (50.0)9 (3e.r)3 (30.0)3 (27.3)2e (45.3)8 (72.7\6s (33.9)40 (4t.2)28 (43.8)t4 (45.2)162 (42.4)9 (32.t)t42 (59.2)15 (42.9)e (34.ó)20 (64.5)t2t (56.8)t7 (58.6)6t (3ó.5)94 (57.0)76 (5 r.0)4t (53.9)26 (53.1)30 (47.6)9 (39.1)e8 (32.6)t7 (36.2)15 (45.5)13 (22.8)3 (50.0)7 (l r.e)2 (e.t)6 (30.0)l 14 (33.6)4 (33.3)13 (56.5)5 (50.0)5 (45.5)22 (34.4)3 (27.3)r l0 (57.3)37 (38.r)20 (31.3)t4 (4s.2)165 (43.2)t4 (50.0)68 (28.3)15 (42.e)12 (46.2)6 (te.4)70 (32.e)8 (27.6)79 (47.3)48 (29.1)47 (3 l.5)25 (32.9)7 (14.3)16 (25.4)I (34.8)loøl Specialiss 3.07:, 509 û6.6) t-470 ø7.8\ 1.096 (35.6)loral BC 6,922 r,707 (24.7\ 3,124 (45.1) 2,09t (30.2)*Includes ohvsicians on the 'active'registers ofthe CPSBC in 199p y i i  'activ ' registers-4t-Health Human Resources Unit Centre for Health Services and Policy ResearchTable 4.5: Supply of Physicians by Place of Medical School Education - 1996*Specialties Totalsu.B.c.No. (o/olOther CanadaNo. (%lNon-CanadaNo. ("/olGeneral / Familv Practice 4,335 1.392 ß2.1 r.904 G3.91 r.039 Q4.0\AnesthesiologyCardiologyCommunþ MedicineDermatologyEndocrinology & MetabolismEmergency MedicineGastroenterologyHematologyIntemal MedicineMedícal BiochemistryMedical MicrobiologyMedical OncologyNephrologyNeurologyNuclear MedicincPediatricsPathology - GeneralPathology - AnatomicalPhysical MedicinePsychiaüyRadiation OncologyRadiology - DiagnosticRespiratory MedicineRheumatologyCardiovascular & Thoracic SurgeryGeneral SurgeryNeurosurgeryObstehics & GynecologyOphthalmologyOrthopedic SurgeryOtolaryngologyPlastic SurgeryUrologyVascular Surgerv329574062t47l28l83581225l6ll69l922510370374883825344273318932t82t821486955682588 (26.7)t6 (28.1)9 (22.s)r 6 (25.8)3 (21.4)t2 (16.9)6 (21.4)s (27.8)5 r (14.2)3 (25.0)2 (8.0)4 (2s.0)3 (27.3)l3 ( 18.8)l (5.3)20 (8.e)24 (23.3)t9 (27.1)6 (t6.2)7t (14.5)e (23.7)36 (t4.2)7 ( 15.9)6 (22.2)6 (r8.2)24 (r2.7)4 (t2.s)3l (17.0)30 ( r 6.5)28 (r 8.e)7 (10.1)24 (43.6)18 (26.s)7 (28.0\134 (40.7)23 (40.4)22 (55.0)34 (54.8)6 (42.e)53 (74.6)le (67.e)8 (44.4)186 (52.0)6 (50.0)l l (44.0)8 (50.0)3 (27.3)35 (50.7)t4 (73.7)8l (36.0)4t (3e.8)26 (37.r)16 (43.2)200 (4r.0)7 (r8.4)r 50 (59.3)t9 (43.2)l0 (37.0)2t (63.6)100 (sz.e)20 (62.s)73 (40.1)105 (57.7\78 (52.7)37 (53.6)24 (43.6)36 (s2.9)l0 t40.0)t07 (32.s)r8 (31.6)e (22.s)t2 (19.4)5 (35.7)6 (8.5)3 (r 0.7)s (27.8)t2t (33.8)3 (2s.0)t2 (48.0)4 (2s.0)5 (45.5)2t (30.4)4 (2r.1)t24 (55.r)38 (36.e)2s (3s.7)r 5 (40.5)217 (44.s)22 (s7.9)67 (26.s)18 (40.e)l l (40.7)6 (18.2)65 (34.4)8 (25.0)78 (42.9)47 (25.8)42 (28.4)2s (36.2)7 (r2.7)t4 (20.6)8 132.0tfotal Specialists 3,397 609 07.9\ 1.616 &7.6) 1,172 (34.5)Iotal BC 7,732 2,001 (25.g',) 3,520 (45.5) 2-2tl Q8.6\*Includes physicians on the 'active'registers of the CPSBC in 1996.-42-Health Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.4: Percent of B.C. Physicians Graduating from U.B.C.'s Faculty ofMedicine by Specialty, 1996197Plastic SurgeryGPs/FPsCardiologrVascular SurgeryHematologyNephrologyPathology - AnatomicalAnesthesiologyUroloryDermatologyMedical OrcoloryMedical BiochemistryRadiation OncoloryPathology - GeneralCommunity MedicineRheumatologyGastroenlerologyEndocrinoloryOrthopedic SurgeryNeuroloryCV &, Thoracic SurgeryObsteficVGyræcologyEmergency MedicineOph¡halmologyPhysical MedicineRespiratory MedicinePsychiatryIntemal MedicineRadiolory - DiagnosticGeneral SurgeryNeurosurgeryOtolaryngolog¡rPediatricsMedical MicrobiologyNuclear Medicine-43-Health Human Resources Unit Centre for Health Services and Policy ResearchI¡ble 4.6: Place of Mcdical School Ddr¡cetion (þ by Spccirlty & GP/IP - l9l, 1996, and o/o(}ørryeSpocialtiesU.Bc'l99l 1996 o/o(ltg,¡weOtherC¡n¡d¡l9l 1996 o/oOltaryeIr{olrGn¡dal99l 1996 o/oûa¡rrc3ercral / Fanilv Practioe t.032.13l.l 43.943.0 0.9 25.9 24.0 -1.9AræsthæioloryCadioloryConrrunityMedicineDermaologrEndooirclory & lvÊtaboli smFrrærgency lvbdiciræGærrøtøoloryFbnøoloryInternal lvßdicineNedical BiodrmisFylvbdiøl Miaobiolorylvßdical Onooloryl*flroloryl.leuoloryIfuclear ì¡bdicinePediaricsPdholo6/ - Gen€ralPdholog/ - AnatqnicalPtrpiøl lvbdicturPsyúiatryRadiaionOnoloryRadiolory- DagnæticRespiracy lvbdicircRhanøoloryCadiqæcrf a & Thmacic SrrgeryGercral S\rgøy|'buroougeryobsterics & G,yneoologrOphthalrxtloryOrth@ic$ngeryOtola'yngologrPlasticSurgøyúdoryVasofar Suroerr¡26.22r.3t8.224.60.0t6.918.225.014.216.74.320.0n.320.30.08.920.62s.09.714.417.912.5t4.3t9.216. Ir0.313.816.213.9I'1.4t3.232;r27.026.126.728.t22.525.821.4t6.921.4n.814.225.08.025.0n.318.85.38.923.3n.lt6.2t4.523.7t4.215.922.218.2t2.712.5t7.016.518.9l0.t43.626.528.00.56.84.31.221.40.03.22.80.r8.33.75.00.0-1.55.30.02.72.t6.50.25.8t.71.63.02.12.4-1.30.92.51.5-3.0l r.0{.51.94t.242.636.452.6s0.011.2n.745.052.250.039.t30.0n.345.3n.733.94t.243.845.242.432.1s9.242.934.6@.556.858.636.557.051.053.953. I47.639.140.7 4.540.4 -2.255.0 18.654.8 2.242.9 :l.l74.6 3.567.9 4944.4 4.69.0 4.3s0.0 0.044.0 4.950.0 20.027.3 0.050.7 5.473.7 1.036.0 2.t39.8 -1.437.1 4.643.2 -1.941.0 -t.418.4 -t3.7s9.3 0.143,2 0.337.0 2.463.6 4.952.9 :3.962.5 3.940,1 3.657.7 0.752.7 t.753.6 4.343.6 -9.452.9 5.3,m.0 0.932.6 32.5 0.036.2 31.ó 4.645.s 22.s -23.0?2.8 19.4 -3.550.0 35.7 -t4.3ll.9 8.5 :3.49.t 10.7 l.ó30.0 n.8 -2.233.6 33.8 0.233.3 25.0 -8.356.5 48.0 -8.550.0 25.0 25.045.5 45.5 0.0y.4 30.4 :J.9n3 2t.t 4.257.3 55.1 4.238.1 36.9 -1.331.3 35.7 4.545.2 40.5 4.643.2 4.5 1.350.0 s7.9 7.928.3 265 -1.9429 409 -1.946.2 40.7 -5.419.4 18.2 -t.232.9 34.4 1.5n.6 25.0 -2.647.3 429 4.429.t 25.8 -3.331.5 28.4 :3.232,9 36.2 3.314.3 t2.7 -1.625.4 20.6 4.834.8 32.0 A.8total Specialists t7.9t6.6 1.4 4'1.8 47.6 4.2 35.6 34.5 -l.ltotal Phaiciau 24.7 25.9 t.2 45.1 45.5 0.4 -1.628.630.2-44-Health Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.5: Change in Percent of Physicians Graduating from U.B.C.'sFaculty of Medicine by Specialty, 1991192 to 1996197EndocrinoloryPlastic SurgsryMedical BiochemistryCardioloryPhysical MedicineRadiation OncoloryNr¡clear MedicineMedical Otcolog/Co¡¡¡nurity MedicineMedícal MicrobiologrGasroenteroloryRheurmtolos¡Hematol06rPathology - GeneralOpthalnnlogrGeneral Surgery- Anatomical& Thoracic SurçryVascular Surgery- DiagnosticRespimtory MedicineOnhopaedic SugeryÞeûmtolog/GPs/FPsObatetrics/GynecoloryAnaesthesiaPsychiatryIntemal MedicinePaediatricsNephrologyEmergency Medicine-45-Health Human Resources Unit Centre for Health Services andAnother way to examine how the contribution of the U.B.C. medical school has changed overtime is to stratify the physician population by date of entry into practice (see Table 4.7). For thisanaþis, physicians who graduated in 1970 or before Qv2,975) were compared with those whograduated from l97l-1980 (n:2,456) and those who graduated in l98l or later (n:3,462). Thesegroupings were selected because they reflect major changes in the size of the entering medicalclass at U.B.C. For GP/FPs,20.7%o of the early cohort obtained their medical degree at U.B.C.whtle 25Vo and 39% of the middle and late cohorts graduated from U.B.C. respectively0<0.0001). For specialists, we found a similar increase over time with 123%, 15.60/0 and26.l%of the tltee cohorts graduating from U.B.C. respectively (p<0.0001). Conversely, there was adrop in the proportion of non-Canadian trained physicians over time. For GP/FPs, the proportionof foreign-trained physicians in the three cohorts was 43.20/0,27.8yo, and 14.2o/o, while forspecialists, the corresponding proportions were 45.1o/o, 36.4% and 16.10/o (see Figure 4.6).Additional analyses on U.B.C.'s contribution to the physician workforce in B.C. are presented inSection 4.3.4. (i.e., the place of medical school education for 'inflow', ooutflow', üd ostable'physicians).Principal Findings: Locatíon of Grøduatíng Medícøl Schoolo In 1996,26Vo of physicians on the oactive' CPSBC registers were graduates of the Universþof British Columbia's medical school. Graduates of other Canadian medical schoolscomprised 46Yo,wlnle29%o of the total came from non-Canadian-schools.o For all the Canadian graduates, 22.3% orþinated fiom Onta¡io and 17.5% fiom Alberta.Other than U.B.C., the Canadian medical school with the largest representation in the B.C.physician workforce was the Universþ ofAlberta (11.2%).o GPÆPs were almost twice as likely to have obtained their medical degrees at U.B.C. thanwere specialists.o There was wide variation in the contribution of the undergraduate U.B.C. medical schoolprogram among B.C.'s RCPSC specialties in 1996, ranging from1-44%o.o There was a modest net increase in the proportion ofB.C. physicians who had graduated fromthe U.B.C. medical schoolo from l99ll92 to 1996/97 (24.7% to 25.9yo). Some specialtiessaw much larger net increases in this proportion than did others. While the contribution oother Canadian sites remained relatively constant, there was some decline in the contributionof non-Canadian schools.o When stratified by their date of graduation, the proportion of B.C. physicians who graduatedfrom U.B.C. has increased substantially over time. Of practicing physicians who graduated inor before 1970, 16% originated from U.B.C. compared with 2lVo and 35o/o of thoseicians who between 1971-1 980 and post- I 980 respectively.-46-Health Human Resources Unit Centre for Health Services and Policy Researchlable 4.7: Place of Medical School Fducation by Year of Medical School Graduation,l99t-lÐ61'Year of Medical School GraduationBefore 1970 I tglulg I rgm & After I ¿¡t YearsGeneral / Famlly kactice n (%)U.B.C.Other CanadaNon-CanadaTotal2ss (20.7)446 (36.r)s33 (43.2)1.234 û00)334 (25.0)63t (47.2)371 (27.8)1.336 t100)e38 (3e.0)1,129 (46.9)341 (t4.2)2.408 1100)t,527 (30.7)2,206 (44.3)1,245 (25.0)4.978 fl00)Specialists n (7o)U.B.C.Other CanadaNon-CanadaTotal2t4 (12.3)742 (42.6)78s (4s.1)t.741 fi00)17s (1s.6)s37 (47.9)408 (36.4>1.120 fi00)27s (26.t)609 (57.8)170 (16.1)1.0s4 1100)664 (17.0)1,888 (48.2)1,363 (34.8)3.915 ( 100)Àll Physicians n (%)U.B.C.Other CanadaNon-CanadaTotal46e (15.8)1,188 (39.9)1,318 (44.3)2,975 (100)soe (20.7)1,168 (47.6)779 (31.7\2.456 t100)1,213 (35.0)1,738 (50.2)sl r (14.8)3,4.62 (100)2,191 (24.6)4,094 (46.0)2,608 (29.3)8,893 (100)* Includes all physicians on the 'active' registers ofthe CPSBC in l99l , 1993 and/or I 996.Figure 4.6: Place of Medical School Education by Year of Graduation,B.C. Physicians 1991-1996.oÊ 40%80%6Ù0/o20%0o/oBefore 1970 1970-79 1980&AfrerGeneral / Family PracticcBefore 1970 197G79 1980&AfterSpecialisfsYear of Medic¡l School Gradustion-47 -Health Human Resources Unit Centre for Health Services and Policy Research4.1.2 Distribution of B.C. Physicians by Health Human Resource Unit (HHRU)Regíons and Grouped Specialty Categories, 1991/92 and 1996/974.1.2.1 Physician Counts, Full-Time-Equivalents (FTEs), and FTE/Population RatiosTable 4.8 presents the geographic distribution of GPÆPs and RCPSC-certified specialists in B.Cn 1996197 and Table 4.9 presents similar data for 1991192. In this section, we examine thedistribution of I I speciaþ groups across B.C.'s 9 Health Human Resources Unit (HHRU)regions. The HHRU regions represent contiguous groupings of the 20 Health Regions (which arebased on the groupings of the 83 LHAs). The 35 physician specialties discussed in Section 4.1.1are clustered into the following groups: GP/FPs, general internal medicine, medical sub-specialties, general surgery surgical subspecialties, pediatrics, psychiatry, obstetrics andgynecologS laboratory and diagnostic imaging, anesthesiologS and other. Since many HIIRUregions have limited (or no) specialists in individual specialty categories, we felt that thisclustering of specialists provided a more informative picture of their geographic distribution. (Seemethods section for a complete specification of the groupings of health regions and physicians.)In the next section, we examine the physician supply characteristics of the 20 Health Regions,using larger units of speciaþ aggregation (two categories: GPÆPs and all specialists combined).Because GP/FPs are more equitably distributed across the province (and their supplyoverwhelmingly surpasses specialist supply in many rural Health Regions), discussion of thedistribution of GP/FPs is left to this level of geographic disaggregation (Section 4.1.3).From the perspective of each speciaþ group, Table 4.10 summarizes the data in Tables 4.8 and4.9 to highlight the variation in supply among the HHRU regions. For each study year, thehighest and lowest FTE/population ratios are presented (excluding the North region because of itscomparably small supply of most specialist types.) The'higlr/lod'ratio is presented as a measureof variation. We first examine the baseline (1991/1992) variation in specialist supply acrossregions and then inspect how this variation changed over the five-year study period.In l99l/92, we found substantial regional variation in supply for most specialty groups. Thespecialties with the smallest disparities were general surgery and general internal medicine(higt/low ratios of 2.17 and 1.33 respectiveþ which is consistent with the ogeneral'nature ofthese specialties. While the distribution was relatively equitable, general internists were somewhatmore concentrated in the Vancouver and District (hereafter shortened to 'Vancouver') andCapital HHRU regions (9.52 and 7.65 FTEs per 100,000t8). Among the other regions, supplieswere fairly similar (4.39-6.41per 100,000) except for the North HHRU region, with no FTEs.This pattern was reversed, however, for general surgeons. The Vancouver and Capital HHRUregions had among the fewest general surgeons per capita (4.68 and 4.26 FTEs per 100,000)while two of the more rural regions (North and Central) had the greatest supplies (7.1518 The supply ofgrouped specialists in this section is expressed as physician FTEs per 100,000 population.-48-Iable 4t: Geogrephic Dislributim ofPhysici¡ls iû B.C by HSRU Regiø ud Gropcd Sp€.irtty' 1996i97'Ga6å¡/FmilyPn liæ Goedlnrmd Mcdicine Mcdic¡l Subspeidtic Cacrd Suncrv Sur¡¡cd Subcoeci¡lt¡cs Pcdi¡tisilHRURcqior Populdior'I TbTPop.Nd F-fEs R¡tioFTE/Pop.Na FTEg RâfioFTE / Po¡Na FTEs R¡tioF-tSIPop'Nr FT& RitioFTE/Pop.Na FTÊs R¡rioFTE/Pop.Nc FfAs R¡r¡oy'amuw&Disr¡ictlapital:æValþ)}oaganiouth Eætsland Coõlle¡ùal{orü Cmtral,,lonhInltnow191033331,76?31,34:334J4.160,7û42536æ3J4,2r932/eJz2215 t,899.¡ 9.4i491 376.t 113.3:197 t9B.7 .3:.343 321.7 96.1(184 157.8 %.2.M q3.5 94.9lE9 læ.0 89,3r2t 2t8.6 9.e5l 51.4 79.41?32 rn.s 9.234 24.7 7.49 9.8 4.219 18.5 5.5:¡0 9.1 5.62t 21.2 4.98 7.9 3.8l¡ l4O 6.,st 09 l.3l258 æ,4.5 12.245 55.3 16.óó 5.5 2.?8 32.6 9.73 26 ¡.69 E.2 1.9E 9.2 4.t5 5.4 2.40 0.0 0.086 7t.6 3.71N t3.2 3.917 7.4 3.Át9 l4.l 4.Át2 9.0 5.5r21 19.0 4.4112 8.E 4.3':9 8.0 3.6,3 3.0 4.4373 331.7 t?.31m 8.2 l9.OÐ, 2.9 9.85t ß.2 t4.31r0 I0.r 6.2:47 43.4 t0.z2t r9.4 9.51t7 t4.7 6.7| 0.2 O3llól t47.4 1.7t5 17.4 5.25 6.1 2.614 10.4 3.q4 4.6 2.9I I E.7 2.O6 6.0 2.95 66 3.û0 0.0 0.ûtotat ItL: 3.8&¿04: 4.335 3.E09.9 98.1, 345 2E3.6 7.3 363 353.2 9.ll lE9 154.t 3.9 6tz 553.E t4.z 2l ml.zPsychiâtry où¡r¡rrie&Gmolø I¡bdâtñ/Rrdä@..i A!6th6iol@ (lû6r.r. AllSËidkrsFHRU T Poonl¡lid¡'FlE/PoP.Nc FTES R¡ioFTE/Pop.Nq F-tEs RtioFTE/ Po¡Na FTE¡ R¡úioFTE/PooNû FTEs RfioFTE/PopNô FTEs R¡tioF:TEIPç.Nc FTqs Rd¡oy'aæuvø&Dbt¡k*þiraliæValley)þn8grnìouh Eastsland Coætlotnl{orth Ccntr¿l{o¡rhInkmwlBr0¡333r36?3t,34.334J4l@,7û425361203,74:.2r932,4J2339 321.8 16.8:65 48.3 t45:12 10.¡ 4.31n 21.6 6.41ll 9.9 ó.1:25 n.6 s.317 6.9 3.317 6.9 3.tt0 0.0 0.ûrgl w2.l 5.115 ¡o9 3./6 6.2 2.4t4 ! t.5 3.414 2.6 r.6.20 14.7 3.4{7 't.0 3.4.8 7.6 3.4iI 1.0 t.5:335 335.055 55.0t9 19.0n n.016 16.0Ð 8.0t7 t7.0t9 19.03 3.0t7.t16.5iE.28.O9.96.&8.38.6r4.62@ t7t.1 E.942 35.7 lO7t0 9.9 4.3u 8.2 ó.95 3.8 2.3æ .7 5.8l0 l0.l 4.9,9 8.0 3.ó0 0_0 0.o100 gt.1 s.tt8 n9 4.4/0 0.0 0.û7 E.4 2.5r 1.0 0.6.4 4.0 0.94 3.8 1.83 3.0 r.3',0 0.0 0.û¿r9l l,99l tu.z390 352 105.q9ó yt 4t.&26 2t5 64.3i76 69 42.7t2t6 196 45.v.t(þ 96 47.493 93 424,9 8 t2.Sttot¡lBC 3.EE¿04: 48t 448.1 ¡l.t 182 t63.4 4.21 5n 5æ.0 13.4t 3Ð A7.l ?.4 l,l8 145.8 3.71 33n 3nó.3 t2.5tIè\oIr*¡As a morc æura¡e repmtation of permnnel, Emergency Medici¡g L¡boraory Medicinc, púdiolos/ ud Medic¿l Onælogr spæialties æ included æ I pc6on=l FIE..r.r'Otlær' qtegory ircludæ: Comuity Medici¡c, Emsggnsy Medicing OcÀparional Modicirc, Physicat Medicinc, md Pubtic Hø|th.oÊ)ÞF(DU)oÉ()(Drt)o(Dtsl(Dätsl(D$)(t)(DC)(D(t,9)Þ.FËot)F(Dvt(DÂ)Lfôlable,L9: Gograph¡c Distribüt¡d of PbFicius ir BC by HERU Rcgio Ðd Gropcd SpGc¡8tty' l99r/92rGosd / FuilvPracioc GoÈd Intcnsl Modicinê Medicd Subsmidtiæ GaedSunry Sunk¡l Subcoæi¡ltis Pdiûi6trgRUREioo Pooülatioo"FTE/Po9.ño fTEs R¡tioFIEIPopNc f'fEs R¡tioETEIPopNc FTBS R¡tioFTE/Pop.No. FTES R¡tio!lÁlPop.No. FTEs R¡tioFTPIPop.No FTEs R¡lioy'ææuvq&Dbtictþilå¡:æValþ)'kanaganiouth Eastsla¡d Coastlatnl,Ionh Cental.lorthlnknomt,&7,31ñt,er9t,03n9J9145,16361,14178,9¿lñzs1sg:t4l,%E r,634.4 99.243 333.9 l6.t169 172.3 *2n5 26/..5 *.tt79 156.8 I@.0(3'r2 34t.2 94.4160 t569 c13184 t74.4 86.039 39.r 65.458 26.0a3 156.8 9.513t 85 7.6i8 8.7 4.5i18 r7.9 6.4,,l0 9.0 6.215 15.9 4.318 8.3 4.6,7 9.7 4.7.0 0.0 0ü4 l.óø ztzt 12.&34 35ó lt.g5 5.2 2.718 19.9 7.ø.2 2.5 l.7lE 7.7 2.t:7 8.5 4.7.4 4.6 2.20 0.0 0û2 2.O9 7?.2 4.62. l3.l 4.2E E.3 4.119 13.4 4.88 ?.0 4.820 18.4 5.0ló to.2 5.6t3 9.4 4.64 4.3 7.14 1.3355 3l&7 19.3:75 64.3 20.924 8.7 t2.445 q3 ß.48 6.9 4.7',3s 31.1 9.3119 19.4 10.&16 14.5 7.lr2 0.5 0.76 3.2t45 tæ'4 7.8I I t3.5 4.33 3.9 ZAll il.8 4.24 4.6 3.1,8 9.4 2.65 5.3 2.94 5.7 ?.4r 0.0 0.otot¿tBC 3373,39 3-U7 3.æA 97.8 3y 251.3 7.4:. 303 æE.t E.& 213 162.6 4.8 585 525.3 15.5' rE3.6 s.4tE2PsEhify Obstclri{s & Gvûeco¡oqv I¡borrtodR¡dioloa/r'r A¡ethai¡lø oûrrrâr ÂllSË¡dLisHIRURe¡d PoDül¡tio¡'¡FTE/PopNq FTE' Rrt¡oFTE/Pop.Nd FTES R¡tioFTE/Pop.Nc FTES R¡ioFTE/Pop.Nq FTRs R¡tioFlE/Pop.Nc FTES R¡tioFTE/Pop.NG FTES Rtioy'uæuvc& Disuialapial:æValley)knag¡niouth Eastsbnd C6tlotralllo¡rh Centr¿l.Iorthlnknomt,Ø735n1,er91,03279,79t45,¡6361,14t?Eg4-ñ45759,74289 2ø.4 16.06 33.6 10.98 8.? 4.5t6 t7.4 6.24 2.7 t.&14 120 3.33 3.8 2.ll2 t.9 0.q0 0.o 0_û100 85.6 5.^¡8 13.0 4.2/4 4.2 z.tl¡4 ll.8 4.22 2.0 l.3r15 il.3 3.1:7 6.7 3.7t5 5.5 2.7:¡ r.0 1.5!l 0.4305 305.0 18.5y 540 17.5:16 tó.0 8.3r24 A.O 8.5115 r5.0 r0.3:26 26.0 ?.^l7 17.0 9.5113 13.0 6.4'.3 3.0 5.02 2.0t92 ló28 9.8r41 35.8 ¡t.ót0 10.ó 5.5:l8 t?.l 6.¡:2 0.9 0.619 15.8 4.31¡0 9.ó 5.315 4.7 /310 00 0.04 3.2E7 83.5 s.g19 18.8 6.1(o 0.0 0.û7 8.2 2.9.0 0.0 0.û7 7.0 !.93 L7 1.4!0 0.0 0.q0 0.0 0.s¿t?8 \7 1æ.935¡ 305 99.286 89 4.7r90 t82 &.955 5t 4.9167 t57 43.495 91 51.069 69 y.All 9 14.51lotal BC 337339 392 3/É-.4 r0.2 167 141.5 4.1! 475 4t5_O 14.0 301 2@.4 ?.7 IB læ.1 3.t 3,Cr5 n6Z3 tz.tI9lI.FIE ca¡elâtioß æ bæed on Fee for Swiæ ad Salary æd Sessional pãymmts. FTE/Popubion Raiæ æ the numbq ofFIEs ptr t00,000.r*.As a morc æunre rcpmtaion of pcrsmd Emcgørcy Medicinq l¡bordory Medicine, Radiolo¿y, ud Medi:l Onælogy spæialties æ included æ I pemn=l FTE.rrr.iotheri €tcgory insfuds: Comunity Medicing Emcrgpncy Medicinc Oc$pational Medicine, Physical Medici¡c ad Public Halth.(DÞÞF(Dv)oEC)(Dv>ô(DFl(Do'(DÊ)(t)oFtC)oaâÞÊ.FËoC)F(DU)og)ÊtC)f¡ble 4.lO: Summery of Reg¡on¡l Vrria[on ¡n Supply of Spcc¡¡¡ist r.TES, l99u:r2-1996197wtr.[LMedicinetuGorc¡tSubsoecirlistsucner¡lSurser"vsù¡urc¡lSubsoccidlsts Pediatrics Psrrchi¡tryub$emcs¿ftGynecoloeyI¡mn¡torydtR¡diolory Aresthcs¡oloav¡ tülropulanon áoos l:rvLlvz-HigbeslowesRatio Highat/LowesFTE/Popul¡tion R¡tios 1996197*HigltesLowesR¡tio Hieùrcso4.owes9.s24.392.179.293.892.3912.88t.757.3616.68t.6l10.35s.684.261.335.583.201.7420.914.774.3919.056.293.O37.8s2.M3.867.712.043.7816.050.9317.2916.853.t25.40s.201.383.775.341.623,29t8.516.422.88t7.546.822.57I1.640.6218.7810.752.354.57# IIHRU Region, c-*", :Ë;;ii;lt" j# Pl¡f¡sicianslFTE/Populæion RatioslChangesinFTE/Popul¡tionR¡tio*r* IHiehestll¡wesl6lzr.63-0.888J5.10-0.60)t0.75-2.546)1.524.52730.88-t.12874.284.22540.t44.977I2.2s-1.1ó641.73-1.24per 8¡01.F6.I!¡rI*r Represents the nu¡rùer ofHHRU rcgim (rac 9) with ¡æt i¡rcreases in tbe nurber of$rysiciars and FTBpopfaion raios.'f tlÍgh€st a¡d lou,€st na dwges in the nurbec ofFTEs per 100,000 anurg HHRU rcgions, l991ly2 1o 1996/97 .oÞ)ÞFCDU'oÉtì(Du)o(D,-t(Da'FI(DÞct)(Dc)(Drt)NDãFUoÕF(Da,(DÞ(?Health Human Resources Unit Centre for Health Services and Policy Researchand 5.68 FTEs per 100,000). This is as expected, since the former have greater availability ofsub-specialties. Laboratory medicine specialists/radiologists were also fairly evenly distributedacross HIIRU regions (higt/low ratio : 2.88). The highest concentrations were in the Vancouverand Capital HHRU regions (18.51 and 17.55 FTEs per 100,000), while supply in the other HHRUregions ranged from 5.02 (North) to 10.33 (South East) FTEs per 100,000.Compared with general surgery, internal medicine and laboratory medicine/radiology n 1991192,there was somewhat more variation in the supply of pediatricians and obstetrician/gynecologists(higt/low ratios of 3.86 and3.77 respectiveþ). Pediatricians were most highly concentrated inthe Vancouver HHRU region (7.85 FTEs per 100,000) which is consistent with the fact that thetertiary pediatric care is centralized at the B.C. Children's Hospital (Dr. Judith Hall, personalcommunication). Among the other regions, the supply of pediatricians ranged from2.04 (FraserValley) to 4.38 (Capital) FTEs per 100,0000 except for the North which had no FTEs.Obstetrician/gynecologists were also more concentrated in the Vancouver region (5.20 FTEs per100,000), but outside this region, there was still more than two-fold variation - ranging from 4.24(Capital) to 1.38 (South East) FTEs per 100,000.Not unexpectedly, the distribution of medical and surgical subspecialists showed greaterdisparities (higlr/low ratios of 7.36 and 4.39) than the specialties discussed above. The Vancouverand Capital HHRU regions had markedly higher concentrations of these subspecialists comparedwith any other region, which is consistent with the centralization of tertiary care in these sites.However, there was substantial variation in supply among the remaining regions, highlighting therole of regional secondary care centres and physician referral networks in the delivery ofsubspecialty care in the province.Anesthesiology and psychiatry showed the greatest variation in regional supply (higlr/low ratios of18.8 and 17.4). For anesthesiology, this large disparity was mainly due to the strikingly lowsupply in one region n l99l/92 (South East), at 0.62 FTEs per 100,000. The Vancouver andCapital HHRU regions had the greatest supply (again not surprisinglÐ with the remaining regionsranging from 2.3 (North Central) to 6.12 (Okanagan) FTEs per 100,000 - except for the North,with no RCPSC-certified anesthesiologists. For psychiatrists, the large disparities were morediffiise. Psychiatrists were overwhelming concentrated in the Vancouver HHRU region (16.0FTEs per 100,000) - more than71Vo of all psychiatrists. Except for the Capiøl HIIRU region(10.9 FTEs per 100,000), all other regions had substantially smaller supplies (ranging ûom zeroto 6.2 FTEs per 100,000).By 1996197,the regional disparities had increased for some specialty groups and had decreasedfor others. While general internal medicine and general surgery remained the most evenlydistributed, the gaps increased marginaþ over the study period. For obstetrics and gynecology,pediatrics and the laboratory/radiology specialties, the distribution across regions remainedintermediate among specialty groups and the disparities narrowed. For anesthesiology, thehigtr/low ratio declined markedly (fiom 18.8 to 4.57) n 1996197 due to the concurrent reductionin supply in the Vancouver and Capital regions and increased supply in most rural ones. Similarly,disparities for psychiatry were markedly reduced (from 17.3 to 5.4) owing to the significant netinflow of psychiatrists into many IIHRU regions. For medical and surgical subspecialists, the-52-Health Human Resources Unit Centre for Health Services and Policy Researchregional disparities appeared to increase and decrease respectively. We must be careful ininterpreting these changes since these fluctuations were the result of changes of only one or twophysicians in several ofthe more sparsely populated regions.Table 4.10 also presents the number of HHRU regions (nraximum 9) that increased both inphysician numbers and per capita FTE supply. (For these analyses the North HHRU region isincluded.) For most speciaþ groups, there were consistent increases in the number of specialistsacross HHRU regions. All specialties except general surgery and obstetrics and gynecologyincreased in at least two-thirds of regions. The most consistent growth was seen in psychiatrywhere gains were seen in all regions except one - the North region had no permanent psychiatristsin either study year. These gains across regions corresponded to a concerted recruitment driveduring this time (Dr. H.K. Sigmundson, personal communication). General surgery saw thefewest increases, with only the South East and Island Coast HHRU regions showing a net gain ingeneral surgeons.While most specialty groups increased in numbers across HHRUs, this growth often did not keeppace with population growth. Psychiatry was the only specialty group that saw gains in per capitasupply (FTE/population ratio) in a majority of HHRU regions (seven). In fact, six specialtygroups saw increases in per capita supply in one-third or fewer HHRU regions. For each ofgeneral surgery and the laboratory/radiology specialties, only one HHRU region witnessed percapita gains - the South East and North Central regions respectively.Table 4.11 summarizes data from Tables 4.8 and 4.9 from the HHRU perspective. For eachregion, the changes in population, physician numbers and FTE to population ratios over the studyperiod are presented. Seven regions saw relatively consistent gains in physician numbers acrossthe nine specialty groups (for this anaþis GP/FPs and other specialties are excluded). In theCentral and North regionso net gains were achieved in fewer than two-thirds of the specialtycategories. Conversely, the Island Coast HHRU region saw increases in physician numbers acrossall specialty categories. It is also apparent that the net changes in many HIIRU regions wererelatively small for the specialty categories - often three or fewer physicians. However, given therelatively small supply of many types of specialties across the regions, these small absolutechanges can be proportionally quite large. This finding highlights the fact that a loss ofjust one ortwo physicians can have relatively significant consequences for regional specialist supply.In addition to variations in regaining physicians, the HHRU regions witnessed an almost three-fold variation in population growth over this interval (ranging from7.8o/o in the Capital region to2l.l% in the Fraser ValtÐ. The marked differences in population growth resulted in someregions experiencing per capita growth for most specialties while some saw growth for only afew. The South East and North Central regions had the smallest population increases (1,0.7% and8.3% respectiveþ) and were among the regions with the most consistent per capita increases insupply across specialty groups (5 and 7 specialties). Conversel¡ regions with the greatestpopulation growth (Vancouvero Fraser Valþ, Okanagan) saw per capita increases in a minorityof specialties. These findings higtrtight the enormous impact that changes in population can haveon physician availability per capita.-53-Health Human Resources Unit Centre for Health Services and Policy ResearchooNaoOrNoqo¡.6þo6€o5odoouÊoEooÀ*ioeúoJ!o¡ÉoE,õ,ã¡oÉo9oo9'qid: 'qC 'S1'r oo-êîîîeoossür833s3-:ol?oo9??ââA-âqâôõû9eû3ssç-T-Êhó€ €9qìfiRÑRÑ.'jo9?oôioôioss$ssgaaoÈçNÈ$OoñÉh-^^óeó\cìdìcì=ãidì-dì9gîîo-içî9â6'aîq'qîôoN.:çF@6Ê99v911 Ð95€ÈÊdôÉhOO sSqsç8åãoo9o9ôi oqsaaõsgãsËOHSNOÈdÈóSlnsñsRË99o-:9sÕ9aîaôôîaôîegeSÐõegt aaoÈæ+FÉFee99qèoqn€çc.i999o9?9^^- ^h ê ql iq-t- O O æôioNd;çoo€ÉN--v9hhdvvY IÈÈ_dNÉNóOhhNñNN9È.'ìn-v?èitl+-+??îso9090c 11â 1ô 1aeù?383+3ó=î9ç99- fi8fr€süàìõ9ç?î.':di ç99ï'\ 11q dl â6'?3.Ç'Y)33s,oÉho€ootsor6ÉãÊhlõ€4s83ä&9?9îooo9?bã. - bn.€ç.9 .3 ã9* ã Ë.Ë ,åE'E Eé þÉ ;d8EÉ2ã Ë s sÈ ã'såËËåsãååç >-'õ ø - 9P6.ã.9 .9 È obä ä.å åËãEé Þé õÈEs2õøaÈ'etäEËËåËååå-54-Health Human Resources Unit Centre for Health Services and Poli Research4.1.2.2 Variation in Specialist Demograph¡cs and Medical Schools of Training acrossHHRU RegionsTable 4.12 outlines the age, sex, and medical schools of origin for B.C. physicians by HHRUregion in 1996. For the purposes of these analyses, we have further grouped the specialtycategories into 'general specialties' (general internal medicine, general surgery, psychiatry,pediatrics, and obstetrics and gynecology); and 'all other specialties' (the medical and surgicalsubspecialties, anesthesiology, laboratory specialties, and radiology). Furthermore, the NorthCentral and North HHRU regions have been grouped as the combined 'North and North Central'geographic area. These collapsed categories were necessary because of the small cell sizes.While included in this table for completeness, differences in the demographic and trainingcharacteristics of GPÆPs are discussed in relation to B.C.'s 20 Health Regions (seeSection 4.1.3).There was considerable variation in the population of 'general' specialists across the HHRUs.The median age of ogeneral' specialists ranged from 45 to 57 years (p<0.001).re Regions withle Kruskal-Wal lis Test (non-parametric chi-square approximation).Principal Findings: Dístrìbution of Specíølist Physicíans in B.C.'s HHRII Regíonso In 1991192, there was substantial variation across the HHRU regions in the supply ospecialists in all specialty groups. The speciaþ groups with the least variation across regions(between 0.3- and 3-fold, excluding the North HHRU region) included general surgery,general internal medicine, and laboratory medicine/radiology. The largest disparities existedfor psychiatry and the medical subspecialties.o Between l99l/92 and 1996197, the regional disparities in supply increased for some specialtygroups (internal medicine, medical subspecialties and general surgery) while decreasing forothers (surgical subspecialists, psychiatrists, obstetrics and gynecology, laboratory medicineand radiology, anesthesiology and pediatrics).o There were substantial differences in the patterns of change in specialist supply over the studyperiod. While most regional specialist populations witnessed a net increase in FTEs over thestudy period, the increases in many HHRU regions did not keep pace with population growth.General surgery showed the most consistent reductions: the FTE/population ratio declined ineight of nine regions. Conversely, psychiatry saw the most consistent increases across regions(in all but one).o While many regions experienced a loss (or gain) of only a few specialist FTEs during thisinterval, these small changes often had a relatively significant influence on overall regionalsupply. This finding underscores the relatively unstable supply of various types of specialiststhat is faced by many health-55-Health Human Resources Unit Centre,for Health Services and Policy ResearchcãI4çô4r!!-ããê3IÊÉ0'ãIté(-)5Ë2Ëã!Ëo7Ê.uoz'¡ÅEFafc.Eþ,eeúE(.)coùc)o6'&c-þ€Èo.E.AoÊo!t.5€e€ doi ôiÉiOnv ò-d óç€ro ôþ N$6€ç@ hF 6óóh"-{N o"q F}qc-N ó-o ôo@ -o\ çhæ €o\d qi..: Éi +d€- FN È+ø9r NO ô€ooó oo @dNOd Éó -6Çôa q'î q6'oor $6 ÈócrÞs 999 Crg-o+ ao ótsæ60 hó ôôodÈ hN 6øïnq dÌ\ \aqohs æÈ É€Èçhv rN Nó$Ç 9ñ= es 8ESNo Êo9 @N çSâ çciÉi -:ai JEi- onÉ €É È6 1ñ.= î6' âqhn^. oo oósrge 99e Stg.'f€n oþ Érdó ç Édrrh hs oôrO çr+ \Õtsõl ñG.G. Êâ Ê6'ç o Éi ñ Éi Éi ...: -.;i- çhv FN ó*q cl!?C vìn ân¡ dro tsN .^.Ni d þ Ê æ - :r_hî 19c 1o îô'¿ 3ge Ee tðO\$o çN @6çn6t hr6 O- NÈó +oiri øi+ ôiôi-_ óhv rd 6çonþ rF 6Fn\oN óo ç6HN ó-ô11 €'î :1çho qo .^.hOgCt !9o:-gçso oo hsÉ€d aF hîîa q'1 ô6:OO^' €- 6NsrÐe 99= egñoé Èó dod@- OÉ Noo€d oç Fh90F oh ñÔQâa Ça 6'A3gú öÞ sg lQa 1Ç qq€æ^i n\tObU @- dAOôr 6n ç-FN N db. A'1ñ î6' ñAn rios €ai oici-. oav rN Nh-þþ NÉ ÔôNO- 9€ otsÉN N:f @æ @N €hodoiJ ..its diF-hN æ- Èh\odo Nh NohÈh- rd ihdâ QQa 1e' ôôå öûÞ ðe 3ðhód ro oÉo6È Nr óronÈ æÉ óóÐ6d óç hóþoN 96 €Fq .:.: â ol.q -1 qF- ---. sh É€Nril aÉ Ndøf ó N9 æÊd6Êh-m f o Nohço 60 00ÉrÈ æÈ dhôñ€ d€ NoFç q ÈNFFdÊ 6È O\rF +oo' oio r-.:d9v 90 NhthÕ Oø FÊoÈr çT ohFÓ ñÉ _Nâ oîq' î€' râ3 sgû gg eegÊñh çh dóHOñ Nd Ére-cì câ en-*S-f H 6Y'- ÉhhFo óô t+Nnó 6Ê dN+o oó 6hv oó óôaæ 06hoç €$ 6óa ol- <ir F OlçnÊ -ô gOc-€€ +øi r;ñ-þÊ rN ÈgO€ts Fr Êçhêç F.o *ðd9É 9d ÊóQôa î'q' 1ôOOi Êø ççNf g €È Nçh+€ a6 r6S6O hÈ ædNø 6N Nh?Eå ËËcg: ri éÞa+EcÈã^esV-igåÉs c5eEg €eriË* ËEå!€ãå ñ E-E.B 9-56-Health Human Resources Unit Centre for Health Services and Policy Researchrelatively low median ages included the North/1.{orth Central regions (45 years; interquartile range(IQR) 19) and the Fraser Valley (46 years; IQR l7). Conversely, regions with relatively highmedian ages included the Capital (57 years; IQR 15) and Island Coast (53 years; IQR 18) regions.It is noteworthy that the Capital region had both the smallest proportion of younger 'general'specialists (aged <40 years) and the highest proportion of older ones (aged 65+ years). Theabove findings persist when physician age is weighted by FTE values calculated for 1996197. Forthe sake of simplicity, only the unweighted anaþes are presented here.For the remaining group of specialists, there was similar variation in median ages across regions(p<0.001) (range 42-50 years). Again, the Capital region had the highest median age (50 years;IQR 14.0) compared with all others. In this instance, however, the youngest median age was inthe South East (42 years; IQR I l) region.In relation to the sex distribution of specialists, the proportion of female 'general' specialistsvaried considerably from only 7.3% in the South East to 25.9% in Vancouver and District. Forall other types of specialists, the proportion of women ranged from 3.6 to l8.6Yo. Again, thehighest representation of women was in the Vancouver HHRU region. Since older physicians(particularly specialists) were largely male (see Section 4.1.1.2), these findings reflect differencesin the specialist distribution among HHRU regions.For 'general' specialists, it was also apparent that the contribution of U.B.C.'s undergraduatemedical program was unevenly distributed across the regions - ranging from only 5.0% ofspecialists trained at U.B.C. in the Central region to 2l.lo/o in the Fraser Valþ. In all regions,less than one quarter of the 'general' specialist supply was U.B.C trained. In contrast, thecontribution of foreign trained ogeneral' specialists was substantial in several regions. In theFraser Valley and North/l{orth Central HHRU regions more than 50% of physicians were foreigntrained. It is noteworthy that the Fraser Valley had high proportions of both U.B.C. and foreigntrained ogeneral' specialists. Interestingly, the U.B.C medical school was more heavilyrepresented among the 'all other specialist' group with less variation among HHRU regions.Conversely, the representation of foreign medical schools for this mix of specialists was lessprominent across all regions compared with'general' specialists.-57 -Health Human Resources Unit Centre for Health Services and Policy Research4.1.3 Physician Supply in B.C.'s 20 Health Regiong 1991/92 and 1996/97The following section outlines the distribution of GPIFPs and specialist physicians for a finer unitof geographic disaggregationo B.C.'s 20 Health Regions. Because there are many regions withrelatively few (or no) specialists in many ofthe specialty categories, we elected to report physiciansupply at the health region level for GP/FPs and all specialists combined. Thus, these anaþestrade more precision in geographic specification for less precision in specialty differentiation.A main purpose behind this anaþis is to understand the distribution of primary care physicians(GPÆPs) across the province. GP/FPs are the point of first contact with the health care systemfor most British Columbians and serve to respond to the majority of their health concerns. Whilespecialty care is directed at those individuals with specialized needs, primary care responds to awide range of problems and diagnoses. Thus, this finer geographic specification permits greaterprecision in understanding regional differences in access to physician services which most BritishColumbians use - either periodically or on a regular basis. Moreover, we see these analyses asparticulady helpful in understanding access to physician care in the rural and remote areas of theprovince.4.1.3.1 Physician Counts, Full-Time-Equivalents (FTEs), and FTE/ Population RatiosTables 4.13 and 4.14 present the distribution of GP/FPs, RCPSC specialists (combined), and allphysicians :n.1996/97 and l99l/92 respectively. For GP/FPs, there was an almost 2-foldvariationin the supply of physicians across regions. In 1996197, the region with the largest supply ofGP/FPs was Vancouver (13.4 FTEs per 10,000) compared with Peace Liard with the smallestsupply (7.9 FTEs per 10,000), about a 1.7 fold difference. The average FTE/population ratioPrincipal Findings: Regíonol Dílþrences ín Specínlßt Age, Sex, and Traíníngo There was substantial variation in the ages of 'general' specialists ¿ìmong regions, includinginternal medicine, general surgery, obstetrics and gynecology, pediatrics and psychiatry.Some regions had a much older supply of these specialists than did others. The Capital andIsland Coast regions had the largest proportion of older 'generalo specialists.o The distribution of female 'general' specialists was uneven across the HHRU regions. In allregions, however, women represented less than one quarter of the total 'general' specialistsupply.o oGeneral' specialists who were trained at U.B.C.'s medical school were unevenly distributedacross the province. In several regions, only SYo of 'general' specialists were U.B.C. trained.In no region was greater than one-quarter ofthese specialists U.B.C.-trained.o Foreign-trained 'general' specialists represented more than one-quarter of the supply in allHHRU regions. In several regions, physicians with medical training outside Canada made up50o/o or more of the 'seneral'-58-Health Human Resources Unit Centre for Health Services and Policy Researchamong regions (unweighted for population size) was 9.52 FTEs per 10,000 (SD 1.31). In1991192, the average ratio was slightly smaller (9.22) but there was more variation among regions(SD 1.58). In this earlier year, supply ranged from a high of 13.8 FTEs per 10,000 in Vancouverto a low of 6.54 per 10,000 in Peace Liard. These disparities in the regional supply of GP/FPs arenoteworthy as they suggest important differences in access to physician care tlroughout theprovince.While the overall supply of GPÆP FTEs changed little during this S-year period (9.78 to 9.81 per10,000), there were important differences in the patterns of change among regions. The numberof physicians on the 'active' registry of the CPSBC increased in all regions except one (WestKootenay-Boundary), as did the number of FTEs calculated using physician payment data.However, when combined with the differential patterns of regional population growth during thisperiod, the GP/FP FTE/population ratios increased in 13 of the 20 regions (see Table 4.15 andFigure 4.7). For regions gaining in per capita GP supply, the increases ranged from a relativelysmall net change of 0.3 FTEs per 10,000 in the South Fraser Valley to a high of 2.6 FTEs per10,000 in the North West region. For the seven regions where supply fell over this period, thereduction ranged ûom 0.9 (South Okanagan-Similkameen) to 1.8 FTEs per 10,000 (WestKootenay-Boundary). As discussed above, these analyses are purely descrþive and did notexamine the appropriateness of these changes in regional physician supply.Figure 4.8 shows the change in the supply over the five year study period (in FTEs per 10,000)compared to the baseline supply n 1991192. A weak inverse linear relationship appears to existbetween the regional GPÆP supply n l99ll92 and the rate of change in supply in the subsequent5 years (10.56; p<0.0001). In other words, health regions with lower baseline supply inl99l/92 tended to grow faster in the subsequent five years than did regions with greater supply.Thus, this analysis reveals that the disparity in the regional supply of GP/FPs was decreasingduring this period. The main outlier was the North West region which grew rapidly, ûom aregion with a smaller supply than average n l99ll92 (8.95 FTEs per 10,000) to one with arelatively rich supply n 1996/97 (11.5 per 10,000). While the growth in the supply of GP/FPs inrelation to the regional populations appears to have principally occurred in areas with smallerFTE/population ratios, it is clear, howevero that the disparities among regions, for the most part,persisted at the end ofthe period.In summary, although substantial regional disparities in GP/FP supply continued to exist in1996197, there was some reduction in these disparities over the preceding five years. We did notexamine the appropriateness of these shifts in regional physician supply. Optimally, GP/FP supplyshould 'match' population health needs and, given the substantial differences in health statusamong B.C. regions, some regions should arguably be served by a richer supply of GP/FPs thanothers. Further analyses are required to examine how these changes 'matched' the population'sneeds for primary care.-59-table 4.13: Distributio¡ ofGeneral Pr¡ctitioners/Family Physiciaos & Speci¡lists in B.C. by lleelth Region,1996197*Gc¡eral / F¡milv Pr¡ctice Sneci¡listc** AII Phvsici¡nsHc¡lth Reeion Population*** No FTEsFTE/Pop'nRetio No FTEsFTE/Poy'nR¡tio No. FTEsFTE/Poy'nR¡tiotsast KootenayWest Kootenay-Boundaryllortlr Okanaganlouth Okanagan - SimilkameenfhompsonFraser Valleyiouth Fraser Valleylimon Fraserloasr Garibaldilental Vancouver IslandiJpper Island/Central Coaslariboo:lorth WestPeace Liard$ortlrern lnteriorVancouverBurnaby!{orth ShoreRichmond3apitalilnknown79,08381,625I 14,080220,663r30,390231,345542,707302,s5073,323233As9I 18,58673,35290,2t264,72tt29,112546,211187,086176,772t55,00533t,7618698126217t23t974322758l24012366t025ll19974ró02t2r6249176;t81.2112.2209.51t4.4t99.7u4.6271.370.7220.4tt2.567.6104.051.41t4.6732.5t49;t170.8130.3376.19.699.9s9.E39.508.778.638.198.979.649.M9.49o ),tI 1.537.948.87t3.418.009.668.40I 1.344037396416284962342432tt55l629964I,3659lr5lt0739031.037.7s8.5156.882.096.8232.3239.015.4130.649.6r4.227.98.t65.31,190.690.7142.t93.63s0.73.914.625.137.tt6.294.184.287.902.r05.594.181.933.091.255.0621.804.858.046.0410.571231371903792072936665r8t02380t7882t3ló01832,33925t363269881107.6I r8.9170.7366.4196.4296.5676.9sr0.386.r350.9t62.t81.8131.959.5t79.8t,923.0240.4312.9223.9726.813.6114.57t4.9616.60t5.0612.8112.47r6.8711.7415.0313.67I l.l514.629.t9r 3.9335.2t12.8517.70t4.442t.9tfotal BC 3,882,043 4,335 3,809.9 9.81 3,397 3,t12.7 E.02 7,732 6,922.( t7.8ito\OI*FTE calculations are based on Fee for Service, Salary and Sæsional, and most Sen¡ice Agreement paymena, excluding paymena to the British Columbia Cancer Agency.FTE/Poprlation ratios re,present the number ofFTEs per 10,000. Includes only those physicians on the'activd registers ofthe CPSBC in 1996.*iAs a more accurate r€presentation of penonnel, Emergency Medicing Laboratory/Radiology, and Medical Oncologr specialties a¡e hcluded as I person=l FTE.*+*Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, are ûom the P.E.O.P.L.E. Projection Model #24.Populatitm estimates are as ofJuly I, 1996.(}ÞÂ)(Þv)oçtsl()o(t)Lrc)(D4(Dã,tsaoÞ(toFC)(DU)Ê0oC)F(Du)oÀ)()Ieble 4.14: Distribution of Gener¡l PractitionerlFamily Physicians & Spcci¡lists in B.C. by Health Region, l99ll92*General / F¡milv Pr¡ctice Soeci¡lists** All Phvsiciensllealth Region Ponul¡tion*** No. FTEsFTE/PoprnR¡tio No. FTEsFTE/Pop'nR¡tio No. FTEsFIE/Pop'nR¡tioEast KootenayWest Kootenay-BoundaryNorth OkanaganSouth Okanagan - SimilkameenThompsonFraser ValleySouth Fraser ValleySimon FraserCoast GaribaldiCental Vancouver IslandUpper Island/Cenhal CoastCaribooNorth WestPeace LiardNorthern InteriorVancouverBurnabyNorth ShoreRichmondCapiølUnknown7r,70573,46296,83?182,953r t3,136l9r,03l449A21250,20561,195198,88410r,0666s,80885,38059,749r l7,l9t49t,726t63409162,s36r30,061307,644751049lr841021693602256520899s8893995917t33t841494435870.s86.389.0175.4106.s172.3366.6214.857.1t92.491.8s0.476.439.r98.0677.t124.9t5t.l99.9333.926.09.8311.759.r99.s99.4t9.028.r68.589.329.679.087.6s8.956.548.3613.777.649.307.68t0.85272847r437886t73221t211738t7l7l0521,32176157803512423.327.542.5139.378.889.3177.5224.59.6I10.037.412.514.98.754.1I t05.18r.0135.771.8305.313.73.253.744.397.616.964.673.958.971.575.533.701.901.741.454.6222.474.958.3s5.529.9210213213832718025553344671325r3775106491472,2382093412297948293.8I13.8131.6314.7r 85.3261.6544.1439.266.7302.4129.262.991.347.8152.11782.2205.9286.8171.7639.239.7r3.0tts.4s13.5tl7.2(t6.3t13.65t2.tl17.5110.8915.2112.789.5510.698.0ct2.9836.2412.6C17.6413.2Q20.78foal BC 3,373,399 3,841 3299.4 9.78 3,075 2762.3 8.19 6,922 6061. 17.9',Io\I*FTE calculations are based on Fee for Service and Salary and Sessional payments.FTE/PopulationratiosrepresentthenumberofFTEsper10,000. Includesonlythosephysiciansonthe'active'registe¡softheCPSBCinl99l.**As a more accurate representation ofpersonnel, Emergency Medicine, Laboratory/Radiolog, and Medical Oncology specialties are included as I persolrl FTE.**+Population esÉimates supplied by Population Section, BC STATS, Ministy ofFinance and Corporate Relations, are from the P.E.O.P.L.E. Projection Model #24.Population estimates are as ofJuly I , I 99 I .(D!eçÞ)F(Dv,oc>(1r,r>ô(D(DäFt(}Ê)(n(!FtC)(}U)Þo-FUo()F(DU)(DÞ()He?lth Human Resources Unit - . Centre for Health Services and Policy,ResearchTable 4.15: Annual Rates of Change in Physician Supply by Health Region, l99ll92tot996l97*Health Resion l99l Ponulation*Average Annual o/oChange in FTE/Poprn RatiGP/F?s I Soecialists*** | ¡¡¡ PhvsiciansEast KootenayWest Kootenay-BoundaryNorth OkanaganSouth Okanagan - SimilkameenThompsonFraser ValleySouth Fraser ValleySimon FraserCoast GaribaldiCentral Vancouver IslandUpper Island/Central CoastCaribooNorth WestPeace LiardNorthern InteriorVancouverBurnabyNorth ShoreRichmondCanital71,70573,46296,831182,953lt3,l3(191,031449,421250,20561,195198,884101,06ó65,80885,38059,749ll7,l9l491,726163,409162,536130,061707 644-0.28-3.271.36-0.20-r.40-0.880.090.880.66-0.490.883.785.203.9st.20-0.530.920.771.810.883.824.323.15-1.374.02-2.191.62-2.526.020.212.470.37t2.144.941.83-0.6r-0.43-0.74t.821.270.80-1.221.95-0.71-1.66-r.320.60-0.80l.5l-0.231.353.146.462.831.42-0.580.400.07l.8l1.07Iotal BC 3.373.39\ 0.07 4.42 -0.1s*For 1996, FTEs are based on Fee for Service, Salary and Sessional, and most Service Agreement payments, excludingpayments to the British Columbia Cancer Agency. For 1991, FTEs are based on Fee for Service and Salaryand Sessional payments. Includes only those physicians on the'active'regisûers of the CPSBC.**Population estimates supplied by Population Section, BC STATS, Ministry of Finance and Corporate Relations, arefrom the P.E.O.P.L.E. Projection Model - #24. All figures are as of Juþ I, 1991.***As a more accurate representation of personnel, Emergency Medicine, Laboratory/Radiology, and Medical Oncoloryspecialties are included as I person=l FTE.-62-Health Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.7: Supply of GP/FP FTEs inl99ll92 & 1996197 bvHealth RegionW. Kootenay-NorthE.N. ShoreCoast GarUppcr Isl./Cent.Cent.VancouverCaribooSimonN. InteriorThornpsonFraser ValleyRichmondS. Fraser VBurnabyPeace Liard5.0 6.0 7.0 8.0 9.0 10.0 t 1.0 12.0 13.0 t4.0GP/IIP FTEs per 10,000 Population4.0-63-Health Human Resources Unit Centre for Health Services and Policy ResearchTables 4.13 and 4.14 also show the distribution of specialist FTEs by their region of registration.As is apparent from Section 4.1.2, the supply of specialists in the Vancouver and Capital regionsgreatly exceeds all other regions and is in line with the fact that specialized care in manyspecialties is concentrated in large urban facilities. ïVhat is also apparent is that within HHRUregions, there was considerable variation in the supply of specialists among the constituent HealthRegions. Figure 4.9 shows the distribution of specialist supply by Health Region, grouped intoHHRU regions. Thus, inasmuch as HHRU regions reflect common resource units for specialistcare, there also appears to be considerable regionalization of specialist supply outside the Capitaland Vancouver Health Regions.All regions (except Peace Liard) added specialist FTEs during the study period Ganging fiom 1.7in the Cariboo to 85.5 in Vancouver). However, population growth outpaced the growth inphysicians in many regions, resulting in declines in per capita supply in eight regions. (Theseresults are consistent with those presented in Section 4.1.2) At the extremes, the North tWestgained 1.4 specialists per 10,000 population (or a gain of 13.0 FTEs from a baseline of 17 inl99ll92) while the Simon Fraser region lost 0.88 per 10,000, in spite of the fact that SimonFraser gained 14.5 FTEs from a baseline of 224.5. Peace Liard was the only region to lose a netnumber of specialist FTEs during this period.As with GPlFPs, we found a weak negative correlation between the 5 year change in regionalspecialist supply and the baseline number of specialist FTEs n l99ll92 (r-0.70; p<0.0001). TheVancouver and Capital regions were excluded from this analysis because of the centralization oftertiary care specialists in these regions. In other wordso the regions with the smallest baselinesupply of specialists were more likely to gain in supply during the study period (see Figure 4.10).-64-oÞÉÞãIDtt)odHc)oCAÕt.DoEb(JFltDsPTâtD:FI(ã(DrÂq)ãEo()F(Drt)(ìÀthôF:¡o\(JrIFigure 4.8: Change in Suppþ of GP/trfP FTEs forBC's HealthRegions l99ll92tot996l97 by Baseline GP/FP Supply l99ll923.02.5€^2'0å$ r.s*dÈ:1.0\€)ËËn'.: È o.oå$ ".'6 t -r.o-1.54.0x Vanoower/Capital. Other Regions7.0 B.o gÐ 'lo.o ìy=-0.3157x+3.215Regtmal X'lD / Population Ratio in Ílt l99lly2 (per l0r0lX))Health Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.9: Supply of Specialist FTEs int99ll92 & 1996197by Health RegionHealth Region HHRU RegionVancouverSimonN. ShoreRichmondBurnabyS. F¡aserFraser ValþS. Okanagan - SimCent. VancouverUpper Isl./Cent.CoastThompsonCaribooN. I¡¡teriorNorth West4.0 8.0 12.0 16.0Specialist FTEs per 101000 Population-66-Principal Findings: Varíatíon ín Physicíøn Supply among B.C.'s Heolth Regíonso In 1996/97, there was approximately a 2-fold variation in the supply of GPÆPs among B.C.'s20 Health Regions.o Between l99ll92 and 1996197, the number of registered physicians increased in all HealthRegions as did the number of FTEs (except for one region). However, the GP/FP per capitasupply grew in 13 regions while it declined in seven others.o Health Regions with smaller GP/FP per capita supplies n l99ll92 tended to show greatersupply increases in the subsequent 5 years than did regions with greater supplies. Thisdifferential growth helped mitigate the regional disparities in GP/FP supply.o The supply of specialist FTEs per capita in the Vancouver and Capital region greatly exceededall others. However, within HHRU regions, there was considerable variation in the supplyamong their constituent Health Regions. This suggests considerable regionalizationspecialist services outside the Vancouver and Capital Health Regions.o Most Health Regions gained specialist FTEs dwing the study period. About two-thirds alsosaw a net increase in per capita supply.o As with GPÆPs, regions with fewer specialist FTEs n l99l/92 tended to grow faster in theirof soecialists than those with a ion ratio.Health Human Resources Unit Centre for Health Services and Policy Research4.1.3.2 Regional Variation in the Age, Sex, and Training Characteristics of GP/FPsThe demographic and training characteristics of GP/FPs by Health Region is given in Table 4.16.Among the 20 regions, significant differences in the age mix of the GP/FP workforce exist(p<0.0001), with median ages ranging from 39 to 46 years. The regions with the youngest supplyof GPIFPs on the 'active' CPSBC registers were the Cariboo and Peace Liard regiotrs, with 47o/oand 52.9% of physicians aged <40 years respectively. Conversely, the regions with the oldestGP/FP supply were the Fraser Valley, North Shore and Capital regions - with median ages of 46,45, and 45 years respectively. These high and low rankings persist when physician age isweighted by their FTEs (data not shown). In general, the regions with the youngest physicianswere located in the northern portions of the province. Few generalizations can be madeohowever, with regard to the types ofregions with an older mix ofphysicians (see Figure 4.11).In relation to sex differentials, there were significant differences in the percent of female GP/FPsamong Health Regions (p<0.001). Regions with greater than 30% female GP/FPs included theNorth Shore, Vancouver, Burnaby, Capital, West Kootenay-Boundary, and South Fraser Valleyregions. Less than 20%o of GP/FPs were female in the Peace Liard, Fraser Valþ, and Caribooregions (see Figure 4.12). There were also significant differences in the originating medicalschools for GP/FPs in different regions (p<0.001). Regions in the lower mainland (Vancouver,-67 -lOrooIFigure 4.L0: Change in Supply of Specialist FTEs for BCrs HeatthRegions l99ll92 to 1996197 by Baseline Specialist Supply l99ll92(excluding Vancouver & Capital Health Regions)E r.oùo^êå30.sÈ¡-o6)ô"4-v0-0I'l àÞ_' \oËo\'ã ä -o.tè0 FlEl €\ctõ -r.o-1.5Regional FTE / Population Ratio in FY l99ll92 (per 10,000). All Regions except Vancouver/Capital-Lineor (All Repiy: -0.1804x + 0.9791R2 = 0.4396(Ð$)gtF(Dtnoô(Drno(D(Dä(DÞ)u)(DhtC)(DutÊ)o.o()F(DU)(}À)HC)Io\\oIt¡ble 4.16: Genenl P¡actitioners / Fsmily Physicians by Heeltü Region, Age, Sex, and Place of Medicd School Educetion, 1996:h¡ncterfut¡c E¡st Kooten¡vWest KootenayRnr¡nrl¡ruNorthôl¡on¡o¡nwutnOlonegm-S¡ñ¡lkqmæú Thonnmn Frer V¡llcvSoutb FmserSinon F Co¡st G¡ñb¡ldiCent V¡rcIql¡ndUpper Islrnd/Cêntnl Côstrge nEüafi (rQK)lge Group n (7o)<4040 to 6465+42.532477(17.0)(37.2)(s4.7)t8. l)43 (13.0)v (34.7)se (60.2)5 (5.1)44 (18.0)47 (37.3)73 <s7.9)6 t4.8)4J (lj.u)74 Q4.t)133 (61.3)l0 14-6)# (ro,u,46 (37.4)73 (59.3)4 (3.3\€ (ro.u)66 (33.5)109 (55.3)22 lL1.2\# (ro,u)160 (37.0)237 (s4.9)?< /e rt4., (r).u)103 (37.s)rs7 (s7.r)t5 t5 5\4¿ \t4.U)æ (3s.8)49 (60.5)3 ß.n4 (41 .5)75 (31.3)r48 (61.Ð17 0.1\42 (14.0)4e (3e.8)68 (55.3)6 Q.9\)ex n('/o)6s Qs.6)2l Q4.4\65 (66.3)33 ßlnyt (77.0)29 (8.0\165 (76.0)52 Q4.0',E2 Q4.8)31 es.z\ß3 $2.7)34 07.3\3m (69.e)t30. l)130 2U Q4.2)71 0s.8\ s8 (7r.6))1 0Q i\ 189 (78.8)5',t l2l 3ìm Q3.2)33 (26.8)lledical Scbool n(7o)u.B.c.Othcr Canad¿Nn--ô¡-¡la15 (17.4)53 (61.6)l1 ttôo\n (n.4)52 (53.1)24 (245\4s (3s.7)61 (48.4)20 0s.9)5s (25.3)l18 (s4.4)4 QO.3\36 Qe.3)59 (48.0)28 Q2.8',165 (33.0)73 (37.1)59 (æ.9\¡38 (31.9)185 (42.8)t@ Qs.2\e6 (34.e)118 (42.9)6r (n.2\2s (30.9)4r (50.6)15 n8.51n Q2.t)% (40.0)67 07.9\4l (33.3)s0 (40.Ða) t)A^\[ot¡l! ¿t-t lzalhinct ristic Cùibm North WAt Psce Li¡rdNorahemIntcñor v Bum¡bv North Shorc Richnond C¡oiøl AllRæimsrgc rrDo n (rvK,\geGmp n(7o)<4040 to 6465+4r (r r.u,,3t (47.0)34 (5r.5)I û.5)4¿ (ro.u)39 (38.2)60 (s8.8)3 e.9\Jv (ru.u)27 (s2.e)22 (43.1)2 ß.9\4¿ \l>.v)44 (37.0)69 (58.0)6 t5.0)4J (rO.U)3C7 (39.7)sn ç4.1)60 (6.2\4.¿ (r).))69 (43.1)81 (s0.6)10 (6.3)45 (18.0)76 (35.8)t16 (s4.7)20 (9.4\43 (l5.0)64 (3e.s)90 (ss.ó)t t¿ol45 (r4.U)ß6 (n.7)3r5 (64.2)¿ô /e r\4J ( r J.U,l2,317 (s3.4)3,532 (81.Ð386 18 9lSer n(7o)lvlalrFsmlrs3 (80.3)tl /to1n Qs.s)25 (245\42 (n.4)9 (17.6)% (7e.0)25 01.0)ûe 62.4)ß ß7.6\ 103 (ó4.4)57 ß5.6\ 132 (62.3)æ (r7.7t t1745(n.2)(27.8't343 (69.e)148 t30.r)3,0s9 (70.6)I )'tÁ oa ^\MedicalSchool n(7o)u.B.c.Othc CanadaN^ñ-l'...,{.24 (36.4)20 (30.3)D. (33.3\2s (24.s)48 (47.t)D (28.4\8 (1s.Ð12 (23.s)31 160.8t26 Qr.8)39 (32.8)s, /¿{Ál345 (35.4)416 (42.7)213 01.9\61 (38.1)o (41.e)32 (20ô\88 (41.5)e7 (41.0)37 07.5\63 (38.9)58 (35.8)4l Q5.3\137 (27.9)2sr (51.r)t03 t21.0)ßn Qz.t)r,e04 (43.9)I O?S /t¿O\fotds 5t 974 t6{, 212 1fj7(DÞÞFov)oÉ()ou)éo(DFt(Do'Ft(DFD(t)(lÈlc)(D(t,ÞÊ.r.úoc>(!U)oÀ)H(lHealth Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.11: General Practitioners / Family Physicians by Healthand Age Group,1996D. KootenayW. KootenayN. OkanaganS. Okanagan'l'hompsonIrrascr VallcyS. Fraser ValleySimon F'raserCoast GaribaldiCcntral Van. IslandUpper I./ CoastCaribooNorth WestPeace LiardN. InteriorVancouverBurnabyNorth ShoreRichmondCapitalAllu.c.tD 6s. -lI ooo-uo I| ..oo I20o/o0% 40% 600/oPercent80Yo t00%54.7 8.160.2 5.t57.9 4.86t.3 4.(s9.3r 55.3 I r r,z54.9 Ll57.t 5.560.561.7 7.155.3 4.95r.558.8E58.0 s.0Is4.l 6.254.7 9.455.6 4.9&.2 8.1s6.9 6.5-70-Health Human Resources Unit Centre for Health Services and Policy ResearchRichmond, North Shore, and Burnaby) as well as Cariboo and North Okanagan had the greatestproportion of GP/FPs graduating from the U.B.C. medical school (35.4-41.5%). (SeeFigure 4.13.)4.2 Aim ll: Variation in Physician Scope of PracticeAs discussed in Section 2.1, understanding differences in physicians' scope of practice is anessential (but often overlooked) component of workforce planning. The boundaries betweenprimary and specialty medical care are fluid, with little data on where primary care ends andspecialized care begins. To provide their patients with access to a comprehensive array ofservices, primary care physicians can opt to provide the services directly (if they have adequatetraining, accreditation, and resources) or to refer to specialists when more advanced skills andtechnologies are required. Little is known, however, about variability in the scope of servicesprovided by primary care physicians and specialists. The anaþes that follow are intended to helpfill that gap.The anaþes are divided into three parts. First, we discuss our measurement of a physician's'scope of practice' and how we validated the administrative data used for this purpose (Section4.2.1). Second, we describe the variability in physician's practice scope across the spectrum ofclinical services that are paid by FFS in B.C. Given their differing roles within the health system,specialists and GPIFPs are considered separately. Multivariate models are also presented toidentify demographic and practice characteristics that are correlatcs of a physician's scope ofpractice. Third, we focus on describing the practice characteristics of GPIFP 'specialists' whofocus a significant proportion of their care on the fields of obstetrics and gynecology,anesthesiology, and general surgery.Principal Findings: Regíonal Differences Ín GP/FP Age, Sesc, and Trøíningo The median age of GPIFPs located in B.C.'s 20 Health Regions varied ûom 39 to 46 years in1996.o In general, the most northern regions had the greatest proportion of physicians aged <40years.o Health Regions differed significantly in the gender distribution of their GPÆP workforce.Generally, regions in the lower mainland or lower Vancouver Island had a higherrepresentation of female GP/FPs. Northern regions had the smallest representation.o Health regions in the lower mainland had the greatest proportion of U.B.C.-trained GP/FPs(35-42%). Regions in the B.C. interior and north generally had the smallest proportion oU.B.C. graduates (l 8-24o/o).-71 -Health Human Resources Unit Centre for Health Services and Policy ResearchE. KootenayW. KootenayN. OkanaganS. OkanaganThompsonFraser ValleyS. Fraser ValleySimon F¡aserCoast GaribaldiCenhal Van. IslandUpper L/ CoastCaribooNorth WestPeace LiardN. InteriorVancouverBumabyNorth ShoreRichmondCapitalTotalFigure 4.122 General Practitioners / Family Physicians by Health Regionand Sex, 199610o/o 20o/o 30o/o 40o/o 50o/o 600/o 70% 80o/o 90%percent l00o/o-72-Health Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.13: GP/FPs by Health Region and Place of Medical School Graduation,E. KootcnayW. KootenayN. OkanaganS. Okanagan'l'hompson|raser ValleyS. F'raser VallcySimon l"rascrCoast GatibaldiCcntral Van. IslandUpper I./ CoastCalibooNorth WcstPeacc I-iardN. IntcriorVancouverIlurnabyNorth ShorcI{ichmondCapital'lbtaló1.6 20.953.1 24.548.4 15.954.4 20.348.0 I 22.8E 37.t 29.942.8 25.2E ä.s 22.250.6 t 8.540.0 27.940.7 26.047.1 28.423.s 60.832.8 I qS.q42.7 21.941.9 20.041.0 I n.s35.8 25.35 t.l 21.043.9 24.080o/o0o/o 20o/o 40%Pprcenfl00o/"73-Health Human Resources Unit Centre for Health Services and Policy Resea¡ch4.2.1 Measuring Scope of Practice: Grouping Fe*items into Clinical DomainsAs discussed in Section3.2, our characterization of physicians' scope of practice is based on thedistribution of FFS billings that physicians submit across the clinical odomains' of the MedicalService Plan's FFS fee schedule (Medical Services Commission 1997). The fee-items(representing billable clinical services) are divided into 2l specialty 'domains'. The purposebehind separating fee-items on this basis is largely administrative in nature, assisting in theappropriate FFS reimbursement of physicians. In general, fee-items are assigned to specialtydomains based on which physician group(s) are considered 'most responsible' for the delivery ofthese services. Although most physicians principaþ bill within their 'own' domains, they are alsopermitted to bill across the range of domains. Many fee-items, however, are restricted to a subsetof eligible physicians (e.g., only specialists are permitted to bill specialist consultations).Furthermore, ffiffiy services are limited to those physicians who have appropriatetraining/certification and/or who have access to accredited facílities (e.g., inpatient invasiveprocedures). There are also a variety of fee-items where no specialty is considered to oown' thefee-item; these items are placed in an 'other' fee-item category. Fee-items may also be assignedtwo or more specialty domains when they are considered 'owned' by multiple specialties (e.g.,tonsillectomy is assigned to both the general surgery and otolaryngology domains). It was beyondthe scope of this study to independently assign fee codes to specialty categories using rigorousscientific methods. Instead, we used these administrative groupings, validated them for ourpu{poses, and made adjustments when warranted. Our underlying goal was to provide amechanism to group fee-items into clinically meaningful categories, spanning the spectrum ofclinical services.Since fee-items are placed into domains based on the specialty thought 'most responsible', ourapproach to validation of these groupings was to assess the proportion of claims made byphysicians assumed to 'ou¡n' that code. We paid particular attention to the oother' fee-items thatwere assigned to no specialty group. The results of this validation are presented in Appendix B.Overall, our findings suggest substantial validity of the MSP fee-item assignments. For over 85oloof the fee-items, more than four-fifths of the services were provided by 'in-domain' physicians,suggesting significant face validity. We decided not to reassign any fee-item (except for some'other' fee-items) domains because the items with the highest likelihood of domainmisspecification (i.e., items where >20o/o of services were provided by 'out-oÊdomain'physicians) were, on the whole, infrequently used. We reassigned 670/o of the oother' fee-items toanother speciaþ domain because they were overwhelmingly claimed by a single specialty group.The distribution of a physician's billings across the 2l fee-item domains (excluding the 'other'domain) served as the basis to gauge the 'breadth' of a physician's practice (i.e., number ofdifferent domains in which he or she submitted biflings) and the obalance' of those billings acrossdomains. As discussed in the methods section, we used the Herfindahl index (HI) to examinethese two aspects of a physicianos 'scope of care'. In other words, the HI was used to measurethe degree to which physicians 'concentrateo the range of services they provide. The HIrepresents the sum of the squared shares of the physician's total services that were billed withineach fee-item domain (HI=X, {sf }, where s¡ refers to the share of fee-item domain i in the total-74-Health Human Resources Unit Centre for Health Services and Policy Researchnumber of fee-item domains billed by the physician.) The measure ranges from I (mostconcentrated) when the physician bills all his or her services within a single domain to ll I (where1 is the total number of fee-item domains) when the physician provides an equal number ofservices across all domains. In other words, as the Herfindahl index moves towards one, thephysician can be said to be more 'specialized' (i.e., fewer billings in categories other than his orher'own').There are several important caveats, however, in our use of the fee-item domain approach togauge a physician's scope of practice. Our measurement of a scope of practice is limited to onlythose services specified by the fee-item schedule. Specific clinical services that are provided aspart of a larger 'global' fee-item (e.g., preventive counseling is often provided as part of a'limited' or 'comprehensive' office visit) are not captured with this method. Furthermore,because the MSP fee schedule is dominated by 'procedural' seryices (rather than purely cognitiveones), our measure of scope of practice is dominated by these types of services. Finally, theremay be a variety of other factors (e.g., tariffs) that influence a physician's choice of fee-item forwhich we could not control.For the 'scope of practice' analyses that follow, we did not examine the provision of specific typesof services by individual physicians.4.2.2 Variatíon in Physicians"Scope of PractÍce'4.2.2.1 Distributional Properties of the Herfindahl lndexFigures 4.14 and 4.15 show the distribution of the Herfindahl index for specialists and GP/TPsrespectively based on their 1996/97 MSP billings. V/e excluded those specialties where a largeproportion of billings occurred external to the FFS system (pediatrics, rehabilitation medicine,medical oncology, radiation oncology, community medicine/public healttu and psychiatry) orwhere physician-specific billings æe not known (laboratory medicine and radiology) (n:857).Physicians with less than <0.2 FTE were also excluded (n:864). These graphs show markedlydifferent distributions for specialists and GP/FPs. For specialists (n:1,732),the HI is for the mostpart very high (median 0.97; IQR 0.13) and approaches unity for the majorþ of specialists. Inother words, most specialists have relatively 'concentrated' practices and bill the vast majority oftheir services within a single fee-item domain. For 801 specialists, their Herfindahl index equalsone with all services billed within their own domain. This finding suggests substantial face validityin this use of the Herfindahl index, since one would expect specialists to largely limit theirpractices to their fields of training. There is a tail of specialists, however, who have relatively lowHerfindahl indices and appear to be practicing more as 'generalists' (minimum 0.26). Amongspecialty groups, the distribution of the HI is very consistent (data not shown). The mainexceptions are obstetricians and gynecologists who have lower overall HIs (median 0.S0).-75 -Health Hyrnan Resources Unit Centre {or Health Serviges and Policy ResearchFigure 4.14 Distribution of Herfindahl Index for Specialists, 1996/97 (n=1,732)0000000000000000000000000tùt¡¡¡¡¡¡¡¡ült¡¡ttt¡¡t¡tttùHerfnd¡hl Index lBared on FYIÐ6117 MSP BillingslFigure 4.15 Distribution of Herfindahl Index for GP/FPsr1996197 (n=3,691)00 000000000000000 00000000 Iù ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡'{l I t ¡ 0 t ¡ ¡ ¡ t I I I I ùHcrffndcbl Indcx [Basal on FYl96l97 MSP Billingslaf¡l sool¡.êter (Xl00.! ,.0cÁU)o ,ooãIË()aETlt*Í\o9llrêl.i zooârf¡üoàe, t00Eructc)f¡(-76-Hqalth Human Resources Unit Centre for.Health Services and Policy ResearchFor GP/FPs, the HI distribution appears quite different from that of specialists. Not only is themedian lower (0.77), but there is more variation (IQR 0.20) (F-statistic 1366.18; p<0.000120).These findings suggest that GPÆPs are much more likely to use domains other than their oown'than are specialists. In fact, 25Yo of GPs have a Herfindahl index of below 0.66.2t Thus, the HI isperforming as expected with specialists and GP/FPs differing in anticipated ways. At the otherend of the spectrum, 67 GP/FPs limited their practice to only one fee-item domain with no billingsin any other (i.e., HI:l). While the majority of these GP/FPs (78.1%) limited themselves to onlythe 55 GP/FP (or osteopathy) services, 16 GPÆPs were billing exclusively within another domain(including anesthesiology, obstetrics and gynecology or one of the surgical domains). Weconsider these GP/FP 'specialists' in section 4.2.3.Table 4.17 shows the regional differences in the HI by HHRU region for GP/FPs and specialists.22For specialists, although there appears to be variation among regions, the differences are notstatistically significant (F-statistic:0.84; p0.56). However, for GP/FPs there is significantvariability ¿ìmong their regions of practice (F-statistic 9.95; p<0.0001). The median HI rangesfrom a high of 0.78 in Vancouver (GPÆPs with the most concentrated practices) to a low of 0.69in the North (GP/FPs with the least concentrated practices). Both the North and North Centralregions have significantly lower HI than all other regions combined (p<0.0001).20 Be.ause of the skewed distribution, significance testing is based on a one-way analysis of variance of the logarithmic(natural) transformation of the Herfindahl index.2l The minimum HI for GPÆPs (0.33) is much higher than the theoretical minimum of 0.05 (l/21). This is because a largeproportion of billings for most GPÆPs relates to GPÆP 'limited consultations'.22 Speciatties excluded from this analysis are pediatrics, rehabilitation medicine, community medicineþublic health,psychiatry, laboratory medicine and radiolory, medical oncologr and radiation oncolory (n=857) because of data limitations(i.e., high proportion of non-FFS payments or lack of physician-specific billing data). Physicians with less than <0.2 FTEwere also excluded (n=932).Principal Findings: Patterns ìn Physícían Prøctíce Scopeo The majority of specialty physicians practiced almost exclusively within their own clinicaldomain. However, there was a minority of RCPSC-trained specialists who appeared to havepractices resembling those of generalist physicians.o For GPÆPs, there was substantial variation in the degree to which they concentrated theirpractices within a single domain of clinical services.o For RCPSC-certified specialists, there were no significant differences in scope of practiceamong HI{RU regions.o For GPÆPs, substantial variability existed in the degree of practice concentration acrossHHRU regions. GPÆPs in the Vancouver and District HIIRU region provided, on the whole,a narrower scope of services than did GP/FPs in other regions. GPÆPs in the North andNorth Central resions delivered the widest arrav of services.-77 -Health Human Resourcel Unit Centre for Health Services and_Policy Researchpublic health, psyclriatry, labüatory rnedicine and radiologr, modical oncologr and radiation orcoloryAlso, o<cludes 644 GP/FPs and 288 çecialists with <0.2 FIE in I 99ó197 o¡ wl¡o had no FFS billings.Iable 4.17: Distribution of Herfindahl Index for GP/FPs & Specialists by IIHRU Regions, 1996-97,'HHRU Region nGeneral / ¡-¡milv PrâcticeMe¡n Median SDsDec¡¡l¡st¡rn I Mean Median SDVancouver ót DistictSapitalFraser Valley)kanaganSouth-Easttsland Coastlental!{orth Central:[orth1,839403177315155398t70187470.77 0.78 0.140.7s 0.76 0.130.74 0.75 0.140.73 0.7s 0.130.74 0.77 0.150.73 0.75 0.130.73 0.76 0.r40.1t 0.73 0.140.68 0.69 0.151,071r8t55t4238129585260.E9 0.96 0.150.88 0.93 0.150.92 0.95 0.100.87 0.92 0.130.88 0.94 0.140.90 0.95 0.t20.88 0.93 0.130.89 0.95 0.r20.83 0.8r 0.09Ibtal Physicians 3.691 0.75 0.76 0.14 1,732 0.90 0.95 0.1r Includes physicians on rehabilitation rr¡edicine, community medicine/-78-Health Human Resources Unit Centre for Health Services and Policy Research4.2.2.2 Physician and Practice Correlates of GP/FP Practice ScopeTable 4.18 examines the HI for GP/FPs across age, sex, place of medical school graduation, andfuIl-time-equivalency (FTE). The relationship between geographic location (urban, semi-urban,and rural) and practice scope is also presentedo stratified by the physician and practice variablesmentioned above. As discussed in the methods sectior¡ the 'geographical' variable is created bygrouping B.C.'s 83 Local Health Areas (LHAs) based on population densþ, i.e., population persquare kilometer. This variable represents an alternate way of examining geographic effects. Inthese analyses, age was positively associated with a physician's scope of practice (p<0.0001),with younger GP/FPs having a wider scope than older ones. Similarly, there was a statisticallysignificant difference between the practice scope of male GP/FPs compared with that of femaleGP/FPs; women delivered a wider array of services than did men. This finding appears to relateto their greater likelihood of providing obstetrics and gynecology services (see below). Thephysician's place of medical school was also significantly associated with his or her scope ofpractice, with U.B.C.-trained physicians having the widest scope compared to those trained inother Canadian or non-Canadian sites. Finally, part-time physicians (FTE 0.2-0.5) were morelikely to limit their practice to relatively few domains than were physicians with higher full+ime-equivalency. It is important to note, however, that these findings are unadjusted for potentiallyimportant confounders.In light of the high levels of statistical significance of these physician and practice characteristics,the remainder of the table examines the relationship between geography (i.e., ruraVsemi-urban/urban) and practice scope in a series of analyses stratified for age, gender, location of medicalschool, and FTE status. In this way, we can 'remove' the effect of potential confounders in otrexamination of the relationship between geographic locale and practice scope. \iVhen stratified byage, geography appeared to be significantly associated with the HI for some age groups but notothers. The effect of geographic location is statistically significant only for middle-agedphysicians (aged 31-60 years). For this age range, the scope of practice was narrower for GP/FPspracticing in urban locales (the Vancouver and Capital LHAs) versus those in semi-urban or ruralsettings. No statisticaþ significant differences between the three geographies were found foreither younger (530 years) or older (>60 years) GP/FPs. The relationship between geographiclocation and practice scope also appeared to be diferent for male and female physicians. Urbanmale physicians (but not female physicians) had significantly narrower practices than did theirrural or semi-urban colleagues. For the remaining two variables (medical school location and full-time-equivalency), the relationship between urban status and practice scope was consistent acrossall levels. When stratified by medical school location, the Herfindahl index was higher for urbanphysicians than for semi-urban or rural physicians for all three locations of medical schools.However, when stratified by full+ime-equivalency, statistically significant relationships werefound between the Herfindahl index and geographic location for GPÆPs in the medium and highFTE ranges. These findings suggest a complex interpþ between geographic location and otherimportant confounders that are difficult to tease out in unadjusted or stratified analyses.-79 -fable 4.18: Distribution of Herfindahl Index for GP/I?s* by Age, Sex, Place of Training and FTE Status, 1996-97All Regionsn Mean SD Statistic** P-valueUrban Semi-Urban Ruraln Mean SD I n Mean SD I n Mean SD l5¿¡¡r¡¡"r'*'r P-valueAge GroupMedical SchoolU.B.CIn Canad¡Non{anad¡Fu ll-Time-Equivalency0.24.J0.5-1.2>l-2<3(314(4l-5(5l-6(6l:7(.701FemalrMak122 0.731,248 0.721,284 0.74688 0.79286 0.8163 0.823,6911,057 0.692,634 0.773,6911,250 0.731,556 0.75885 0.7737.7 <0.000309.8 <0.000t21.4 <0.00019.38 <0.0001309 0.782,509 0.74873 0.7s0.130.140.140.130.140.r60. l30.130.140.140.140.140.140.146553654829013327))õ1,043615648336l6lr,1662710.130.130.140.140.140.r30.140. l30.140.140.140.150.140.140.730.730.760.800.810.860.700.800.740.760.800.780.760.79579 0.71776 0.744t6 0.76123 0.78t1t2 0.73536 0.7342 0.70583 0.7063 r 0.73347 0.77l3s 0.8033 0.80439 0.691339 0.750.130.140.130.130.130.160.130.140.130.140.140.140.140.1315 0.74 0.12t29 0.74 0.12105 0.68 0.1551 0.78 0.1218 0.82 0.083 0.75 0.2069 0.70252 0.7456 0.73t32 0.74133 4.7224 0.7923t 0.7366 0.730.130.130.1I0.r30. t50.t20.130.140.50 0.6056.0 0.00329.4 <0.0001s.7 0.0030.36 0.6980.97 0.3274.53 0.01I14.3 <0.00010.13 0.8797.4 0.00r13.2 <0.0001r.03 0.27257.2 <0.0001the in 1996 F-xclrrds 644 GP/FPs with <O 2 FTE in FY 19116/97 or who h¡rl no Fì rs1oooI'tF-søtistic from anaVsis ofr¿¡iance to test for differences in log HI between levels ofthe covariate ofinærest(DFeéçÞF(D(ttoÉC)(Drno(Þ(Dðrt-l(Ds)CA(Dtlo(t)À)ic.FÚoc)F(Du)(DÞ)tstr)Health Human Resources Unit Centre for Health Services and Policy ResearchGiven that the above factors achieved high levels of statistical significance in the unadjustedanalyses, anaþes that simultaneously adjust for other important predictors are appropriate.Without such anaþes, it is possible to make erroneous conclusions about which characteristics ofGP/FPs and their practices are associated with the breadth of practice that he or she chooses. Thenext section presents multivariate anaþes (using multiple linear regression techniques) as a wayto separate the independent effect ofthese physician and practice characteristics.4.2.2.3 Understanding Differences in GP/FPs' Practice Scopeusing Multivariate ModelsThis section uses multivariate regression anaþes to understand how the scope of servicesprovided by GP/FPs differs by their demographic factors, practice characteristics, and supply ofmedical services in the local market. This is sirnilar to the analyses of the specialization ofobstetricians and gynecologists by Baumgardner and Marder (1991). We also use thedecomposition proposed by Adelrnan (1969) that examines both the 'balance' of the fee-itemsbilled across domains as well as the 'breadth' across the domains where services were provided.More specificallS Adelman's decomposition ofthe Herfindahl index is:1¡¡ = ¡(cv)2 + 1/ Nl, where 'cv' refers to the coefficient of variation in the share oeach domain in a physician's ice and 'N' refers to the number of domains.In the regression anaþes that follow, \rye use logarithmic transformations of the HI and theAdelman components as the response variables.23 Based on the conceptual ûamework proposedby Baumgardner and Marder, the empirical analyses focus on three types of factors thought toinfluence a physician's range of practice: (l) demographic factors (i.e., age, sex, location ofmedical school); (2) practice-related factors (i.e., full-time-equivalency); and (3) the supply ofmedical services in the local market (i.e., location of practice, regional specialist suppl¡ regionalGP/FP supply). As such, the regression analyses incorporate the following functional form:log (HI) = I (age, sex, full-time-equivalenc¡ medical school, geographic location, GP/FPavailabilit¡ specialist availability) + eTable 4.19 presents the least squares regression coefficients (as well as the standard errors andp-values) using the log (HI) and the Adelman's subcomponents described above. The overallmodel is statistically significant (F-statistie40.5; P<0.001) but explains only a minority (12:0.12)of variation in the index across GP/FPs. Age had a strong relationship with the HI. On thewhole, physicians aged 540 years had a 4Yo lower HI index than those aged 4l-65 years,suggesting that younger physicians had less 'concentrated' practices. Moreover, the Adelmandecomposition suggests that the lower HI were because these physicians practiced over a greaternumber of domains. Older GP/FPs (aged 66+ years) had about a0.2Yo lower index than23 lt s¡ b€ shom that the regression coeficimt for the log (HI) is equal to rhe mm ofthe regression coeffcient ofAdelnun's compon€r¡ts, log f(cv) 2 + f I md log Il¡N].-81 -Health Human Resowces Unit Centre for Health Services and Policy Researchfable 4.19: GP/FP 'Scope of Practice' Multivariate Linear Regression ModelCovariatesDependenl VariablesLoe HI l,oe lcv)at-l loe l/ NEstimate lErtirut" lertirã"ßE) p-valuel (SÐ p-valuel ßÐ o-valuentercept -0.290 0.00010.0t4r.605 0.000t0.022-1.896 0.00010.022{ge <40yrs4 l -65yrs*66+yrs-0.041 0.00010.008-0.002 0.91380.0200.062 0.00010.0r 3-0.203 0.00010.032-0.t02 0.00010.0r30.201 0.00010.032Sex Male*Female -0.126 0.00010.009-0.182 0.00010.0t 40.056 0.000r0.0t4Medic¡l School UBC,Other Can.Non-Can.o.o¡r o.oool0.0070.042 0.00010.0090.008 0.49370.0t 2-0.019 0.16730.0t40.023 0.04580.0r 20.061 0.00010.0t4Full time <0.5Equivalency(FTB¡** 0.5-1.2*>1.20.072 0.00010.012-0.0r5 0.05500.008-0.151 0.00010.0t9o.oãoro.óss0.0t20.223 0.00010.0r9-0.073 0.000r0.012Geographic Urban*Location Semi-urbanRural-0.039 0.00010.009-0.055 0.000r0.0140.0480.0t40.1t70.0220.00060.0001-0.087 0.00010.0t4-0.t72 0.00010.022GPiFP [.owAvailabilif¡r#Medium*HiCh-0.075 0.01000.0290.013 0.2232O.OI I-0.022 0.62690.046-0.062 0^00020.017-0.052 0.2ss90.0460.075 0.00010.0t 7Specirlist I¡w*Availability$ Hich 0.00320.0310.011-0.014 0.39360.0t70.045 0.00740.0t7I¡teraction Rural*<40 yrsTermsRural*X5 yrsRural*Female0.014 0.33490.0r 50.067 0.08560.0390.052 0.00190.0t7-0.037 0.11320.0230.212 0.00050.0610.027 0.30950.0270.05 r 0.03040.024-0.146 0.017i0.0620.026 0.335:0.027R-squared 0.120 0.176 0.209Rsference category**Based on population density of lncal Health Areas (LHAs)**r FfEs calculated with Fee-for-Service and Salary/Sessional payments for FY 1996/97. FTEcalculations based on Health Canada#Based on 1996197 supply characteristics ofphysician's Health Region (see section 4.1). Tligh'ratios include health regions > 1.66 FTEs per 1,000, 'medium'supply includes regions at 1.29-1.66FTEs per 1,000 and'low'supply includes regions <1.29 FTEs per 1,000.$High specialist supply is defined as Health Regions with specialist/Gp ratios >0.65.-82-Health Human Resources Unit Centre for Health Services and Policy Researchphysiciaru aged 4l-65, but this coefficient was not statistically significant. In relation to the sexof GPlFPs, we found that women had a significantly lower log (HI) than their male colleagues,suggesting that female GP/FPs had less concentrated practices. Moreover, the reduced'concentration' ofthe practices for female GPIFP s appeared to be more driven by more 'balance'across the domains in which they practice (i.e., a reduced coefficient of variation). The regressionresults also indicate that a physician's practice intensity is an important correlate of theconcentration of his or her practice. There was also a significant interaction term between femalesex and rural practice. Women GP/FPs in urban locales appear to have less practice concentrationthan those in rural areas. On the whole, physicians with lower FTE values (<0.5) had moreconcentrated practices than physicians with FTEs of 0.5-1.2; this finding is driven by a reductionin the number of domains billed. Finall¡ the medical school of origin also appears to be animportant predictor of practice concentration, with U.B.C.-trained physicians having significantlyless concentrated practices than graduates trained at other medical schools.In addition to physician and practice factors, local physician supply was also strongly related tothe array of services that physicians chose to provide. In areas with low GP/FP supply, GPÆPs'practices were less concentrated than in areas of greater supply. Moreover, this reducedconcentration was driven both by GP/FPs practicing in a greater number of domains as well asreduced 'balance' among domains. The local supply of specialists, however, had an oppositeeffect. In areas with high specialist-to-GP ratios, GP/FPs were more likely to concentrate theirpractices by delivering services in smaller numbers of domains. None of the remaining interactionterms were statisticaþ significant using the log HI as the response variable.Table 4.20 suggests that some of the findings above may be particularly related to GPÆPspractice in the obstetrics and gynecology domain. As discussed in Section 4.2.3.1below, morethan 5Yo of most GPÆPs' practices are composed of billable items in the obstetrics andgynecology domain. The regression in Table 4.20 used dependent variables calculated in exactlythe same way ris those in Table 4.19, except that the obstetrics and gynecology domain wasomitted from the calculation. Several things are apparent from this table. First, there was asignificant reduction in the e4planatory power of the overall model (r-squared:0.06). Second,several regression coefficients were significantly reduced in magnitude. Most notable was thereduction from -0.108 to -0.015 in the coefficient for female physicians (although it remainsstatisticaþ significant). This finding suggests that the less concentrated practices of femalephysicians are driven largely by their delivery of a larger share of obstetrics and gynecologyservices than their male colleagues. Similarly, the magnitude of the coefficients for low practiceintensþ (i.e., low FTE), low GP/FP availability and high specialist supply are reduced, suggestingthat these factors in large part relate to the obstetrics and gynecology component of GPÆP care.One limitation to the above analyses was our inability to measure the scope of practice for thecomponent of GP/FP services paid for through Salary and Sessional payments, because noencounter records are submitted for these services. Thus, there is a tøzard that the regressioncoefficients may be biased because some physicians delivered care under these arrangementswhich was significantly different in scope than their FFS practice (if they were paid by bothmechanisms). As a sensitivity test for this bias, we repeated the above regressions after-83-Health Human Resources Unit Centre for Health Services and Policy Researchteble 4.20: GPiFP 'Scope of Practice' Multivari¡te Linear Regrcssion Model, excluding Obstetrics andSynecology Fee ltem Domain (n=3,691)lovariatesr¡s Hr oene;ffiates r-os l/ NEstimate lEstimate lEstimateßÐ o-valuel ßÐ n-valuel lSÐ n-valurlntercept -0.238 0.000r0.0ti1.512 0.00010.0216-l.7sl 0.000r0.023Age <40yrs4l-65yrs*66+yrs-0.036 0.000r0.007-0.008 0.65240.0t80.077 0.00010.0 r 23-0. r 85 0.00010.0308-0.114 0.00010.0r 30.178 0.00010-032Sex Male*Female -o.oze o.oãos0.008-0.116 0.000t0.013t0.090 0.00010.0t4Medical School UBC*Other Can.Non-Can.0.023 0.00050.0070.030 0.000r0.0080.003 0.8r2r0.01 r 2-0.028 0.03340.0t 330.020 0.08670.0120.058 0.000t0.0t4F'ull time <0.5Equivalency(FTE¡*** 0.5-t.2*>1.20.046 0.00010.u I0.000 0.95930.007-0.171 0.000r0.0t8t0.067 0.00010.0t200.2t7 0.00010.0r9-0.068 0.000r0.0t 3Geographic Urban*L¿cation** Semi-urbanRural-0.041 0.00010.008-0.052 0.00010.0r 20.055 0.000r0.0t 350.135 0.00010.02 I0-0.õse o.oãor0.0t4-0. r 87 0.00010.022GP/FP{vailabilit¡r#l¡r¡Medium*High-0.044 0.08690.0260.009 036670.0r00.004 0.92390.0444-0.078 0.00010.0 t 64-0.048 0.30530.0470.086 0.000r0.0t7Jpecialist [¡w{{,vailability$ Higt o.oro o.otoz0.009-0.026 0.10880.0163o.i+z o.oì¡¿0.0t7lnteraction Rural* s40 yrsIermsRural*>65 yrsRural*Female0.017 0.19020.0130.0sr 0.13960.0340.04t 0.00690.0t 5-0.0380.0230.18r0.0590.0180.0260.00230.48660.055 0.020ç0.024-0.130 0.036ç0.0620.022 0.40790.027R-squared 0.049 0.1 85 0.226p category**Based on populæion density of local Health Areas (LHAs)*i* FTEs calculated with Fee-for-Service and Salary/Sessional payments for FY 1996/97. FTEcalcuations based on Health Canada formula#Based on 1996197 supply characteristics of physician's Health Region (see section 4.1). 'High'ratios include health regions > 1.66 FTEs per 1,000, 'medium'supply includes regions at 1.29-1.66FTEs per 1,000 and'low' suppþ includes regions <1.29 FTEs per 1,000.$High specialist supply is defined as Health Regions with specialislGP ratios >0.65.-84-Health Human Resources Unit Centre for Health Services and Policy Researchexcluding all physicians with payments under these alternative payment mechanisms (n:581). Theresults were relatively resistant to this potential bias as the differences in the coefficients and p-values were very small (see Appendix D).4.2.3 Specialty Care Delive¡ed by GP4FPs in B.C.While RCPSC-certified specialists deliver the majority of specialized services to B.C. residents,some GP/FPs also act as 'specialists', concentrating some or all of their practice within one mainspecialty domain. For some specialist areas (e.g., emergency medicine, anesthesiology, generalsurgery), primary care physicians may receive supplemental training to provide services in regionswhere RCPSC-certified specialists are few, and which would not otherwise be serviced locally. Inother cases, physicians take a special interest in these areas (e.g., in obstetrics and gynecology)and focus a substantial portion of their practice in these areas. In still other cases, specialtyservices may be provided by GP/FPs who have received residency training in a particular specialtybut for a variety of reasons, have not obtained RCPSC certification. The latter scenario holds fornon-RCPSC certified specialists who are granted 'special' registration by the CPSBC to functionas specialists in areas ofneed.The following anaþes examine how GPÆPs deliver services in three clinical domains(anesthesiology, obstetrics and gynecology, and surgery). We focus our attention on physicianswho concentrated their practices, as evidenced by their billing records, in these areas. It isimportant to note that we defined GP/FPs 'specialists' based on their patterns of practice ratherthan on selÊreport or evidence of additional training or licersure. We concentrated onanesthesiology, obstetrics and gynecology, ild general surgery for the following reasons:(l) prior research has suggested that GPiFPs provide a substantial amount of these specialtyPrincipal Findings: The Relølíonshíp oÍ Physícíøn, Practíce, and Supply Characterístics toGP/FPs 'Scope of Practíce'o Age was strongly related to the range of services provided by GPÆPs. Younger physicians(aged 140 years) delivered a wider array of services than older ones.o Female physicians had less concentration of their practices across fee-item domains than didmale physicians. This appears to be mostly related to their delivery of a greater share ofobstetrics and gynecology services.o Physicians with low FTEs had more concentrated practices than those with higher FTEs.¡ GP/FPs who graduated from U.B.C.'s medical school delivered services across a wider arrayof fee-item domains than did those trained at other schools.. Physicians practicing in rural or semi-urban areas billed for services in a wider variety ofdomains than did those in urban areas.o Local supply characteristics had a strong effect on the concentration of GPÆP practices.Lower GP/FP supply was associated with less concentration of GPÆP practices while higherialist supply was associated with concentration.-85-Health Human Resources Unit - , Centre for Health Services and Policy Researchservices, especially in rural areas (Iglesias et al 19991' Chiasson et al 1995); (2) payment largelyoccurs in the FFS system rather than through alternative payment schemes (i.e., Salary andSessional, and Service Agreements); (3) the services are mainly 'procedure'-oriented whereactivity can be largely identified through physician claims; and, (4) U.B.C.'s medical school hashad established training programs for family physicians in these areas. We chose not to focus onother specialty areas where GPÆPs may concentrate their practices (including pediatrics,psychiatry, emergency medicine, community medicine/public health, and internal medicine)because of substantial non-FFS payments in these areas or because the services are more'cognitive' than'procedural' and thus poorly captured by the MSP fee-item domains.4.2.3.1 ldentification of GP/FP'Anesthesiologists','surgeons',and'Obstetrician/ Gynecolog ists'Figures 4.16, 4.17, and 4.18 show the proportion of total billings made by GP/FPs during 1996/97in anesthesiology, general surgery, and obstetrics and gynecology (n=3,688). For these analysesowe excluded GPÆPs who made no FFS billings or were less than 0.2 FTE Gr-6aÐ. It isimportant to note that they-axis on these graphs (i.e., the fiequency of GP/FPs) is presented on alogarithmic scale.In 1996197, the vast majorþ of GP/FPs in B.C. (83%) made no billings in anesthesiology. Thebilling distribution reveals that for those who billed any anesthesiology services, the majority billedrelatively few. Based on this distributioru we chose a cutpoint of l0% (the proportion ofanesthesia services in relation to all services) to differentiate GP/FP 'anesthesiologists' ûom otherGP/FPs. Using this cutpoint we identified 79 GPÆPs as GP/FP 'anesthesiologists' during1996197. Since most of these physicians billed substantially more than l}Yo oftheir claims inanesthesiology, the identification of GP/FP 'anesthesiologists' was relatively insensitive to thechoice of cutpoint. (For example, when a 0.15 cutpoint was used, 65 GP/FPs were identified asGP/FP 'anesthesiologists'.) The distribution also reveals that 15 GP/FPs functioned almostentirely (i.e., > 90%) in anesthesiology. As discussed above, some physicians may actually havecompleted a RCPSC speciaþ training program but not obtained certification.The pattern of delivery of surgical services by GPÆPs (Figure 4.17) shows some differences tothat of anesthesiology services. As opposed to anesthesiology, the vast majority of GPÆPs(96%) made at least some billings within the surgical fee-item domains.2o However, likeanesthesiology, surgical services made up a small minority of the practices for most GPÆPs. Thefrequency distribution shows a tail of GP/FPs billing surgical fees for over l}Yo of their practices(n=196). While most of these physicians billed substantiaþ more than 10% surgical serviceso theidentification of GPÆP osurgeons' was somewhat more sensitive to the choice of cut-point (i.e.,when a 20Yo cutpoint was used, 110 physicians were identified as GP/FP osurgeons'). As withGP/FP 'anesthesiologists', there were 26 GPßP'surgeonso whose practices were made up ofmore than 90% of surgical services.2a For this analysis, all the surgical fee-item domains are aggregated within a single 'surgical' domain.-86-Health Human Resources Unit Centre for Health Services and Policy ResearchFigure 4.16 Distribution of Anesthesiology Billings for GP/FPsr 1996197 (n=3,688)Proportion of Billings in Anefhesiolory DomainX'igure 4.17 Distribution of Surgery Billings for GP/FPs,1996197 (n=3,688)Proportion of Billings in Surgery Domrins{)5 roooct)èDêrJ;erÍztUeIÊtrÙcr l0q)Í\0000000000ttt¡5õt¡tID3 rooo(t)ð¡QaÈüoq)Êcdl0l¡)ltl0000000000tr3¡36?ÙI-87 -Health Human Besources Unit Centqfor Health Services and Policy ResearchFigure 4.18 Distribution of Obstetrics & Gynecology Billings for GP/FPs,1996197 (n:3,688)o! roooct)b0êÞløFrlrËroàc(¡)cr l0ot\0Þ000000000t2ta5õ7bNNProportion of Billings in Obstetric¡ & Gynccologr DomeinThe delivery of obstetrics and gynecology services by GP/FPs was nurkedly different than thedelivery of either surgical or anesthesiology services (see Figure 4.lS). Not only did few GP/FPsexclude these tlpes of services from their practices (8.60/o), but for over one-third of GPlFPs,obstetrics and gynecology services represented more t}rrn 5% of their practices. Based on thisdistribution, we chose a higher cut-point (20%) to define GP/FP 'obstetrician/gynecologists',netting 175 physicians with this definition. Of all three GP 'specialist types' discussed here, theidentification of GPÆP 'obstetrician/gynecologists' was the most sensitive to threshold selection.For instance, we identified 328 physicians as GP/FP 'obstetrician/gynecologists' with a 15%cutpoint and only 89 using a25Yo cutpoint. V/e chose the20%o cutpoint as a way to balance bothtype I and type II errors (i.e., false negative and false positive). In trading off these enors, weaimed to maximize the specificity in our identification with the rcalization that this would come atsome expense to sensitivþ.-88-Health Human Resources Unit Centre for Health Services and Policy Research4.2.3.2 Geographic Distribution of GP/FP 'Specialists'Table 4.21 presents the geographic distribution of the GPIFP 'specialistso identified above. IVefound that GP/FP 'anesthesiologists' were overwhelmingly located in rural practice locales@<0.0001). In fact, less than l%o of physicians in either the Vancouver and District or Capitalregions were GPÆP 'anesthesiologists' by our definition. This compares with the North/1.{orthCentral, Centraf and South East regions where more than 5% of physicians tailored a significantproportion of their practices to anesthesiology. In light of the fact that RCPSC-trainedanesthesiologists are located overwhelmingly in the Capital and Vancouver and District regions(see Section 4.1.2), these findings confirm the reported reliance of rural communities on theservices of GP/FP'anesthesiologists'.For GPÆP 'surgeons' and GP/FP 'obstetrician/gynecologists'o there are no clear urbar/ruraldifferences in the locations of these GP/FP ospecialists'. While the more remote regions(North/l'{orth Central and Central) had the largest representation of GP/FP 'surgeons' in relationto their total GPiFP pool, the contribution of these physicians to the supply in the Vancouver andDistrict and Capital regions was not dissimilar. In fact, the proportion of GPÆP 'surgeons' as acomponent of the regional physician supply was not statistically significant. This distribution ofGP/FP 'surgeons' appeared to parallel that of RCPSC-certified general surgeons who alsoappeared to be equitably distributed among regions (see Section4.2l). These findings persistwhen weighted by physician FTEs. For obstetrics and gynecology, the distribution of theseGPÆPs appears even more heavily weighted in the Vancouver and District and Capital regions.Again" differences in the contribution of these GP/FP 'specialists' to the regional GP/FP supplywere not statistically significant. None of the above findings were changed significantly when 5%alterations were made in the choice of cutpoint.Principal Findings: IdentiJícøtíon of GP/FP 'Specialßts' ín Anesthesiologt, Surgery, andObstetrícs & Gynecologt usíng Billíng Recordso In 1996197, most GPÆPs delivered no services in the anesthesiology fee-item domain.However, we identified 79 physicians who concentrated more than l0%o of their practices inthis speciaþ area. Of these physicians, about one-quarter ñmctioned almost exclusively asanesthesiologists.o While most GP/FPs provided some services within the surgical fee-item domains, relativelyfew (196) concentrated more than 10% of their practice in surgery. Twenty-six GPÆPsconcentrated more than90o/o oftheir practice in surgery.o The vast majorþ of GPÆPs delivered some services in the obstetrics and gynecology domain(91.4%). Based on the distribution of the proportion of obstetrics and gynecology fee-itemsbilled, we chose a cutpoint of 20% to identify 175 GP/FP 'specialists'. Despite most GP/FPsdelivering some services in this areae we found relatively few who concentrated more than50% of their practices in obstetrics and gynecolosy.-89-fable 4.21: Geographic Distribution of GP/F?'Specialists' in Obstetrics & Gynecologr, Anesthesioloryr and Surgera, 1996197*HHRUResionAIT GP/F?SnGP/ï? ' Specialists'Obstetrics&Gvnecolosv I Anesthesiolow I Su"ee"vnP/o)lnUo\lnP/o\Vancouver & DistrictCapitalFraser ValleyOkanaganSouth-EastIsland CoastCentralNorth / North Central1,83940317731515539817023497228t63163l0(5.3)(s.5)(4.s)(s.l)(1.e)(4.0)(1.8)ø.3\12356lll0l022(0.7)(0.7)(2.8)(1.e)(7.1)(2.5)(s.e)(9.4')97247t28t9t415(s.3)(6.0)(4.0)(3.8)(s.2)(4.8)(8.2)(6.4\Nl B.C. 3.69r 175 ø.7\ 79 Q.t\ 196 t5.3)registers ofthe ofPhysicians and Surgeons ofB.C., excluding GP/FPs <0.2 FTE or who had no FFSI\ooIbillings in 1996197 (n=644). GPÆP'specialists'lÀ,ere defined by the proportion ofbillings within the respective specialty Tomains'. GP/FP'anesthesiologistsand'surgeond were defined as GP/FPs with >10% of total billings in the respective domain. GP/FP bbçetrician/gmecologiss'were defined as GP/FPswith >20% of total billings in the obstetrics & gynecology fo+item domain. Pøcents given are relative to all GP¡FPs.(D!Ds)F(}u)oÉC)(Dv)o(DF!oäFt(Þ90CA(tFlC)(DVto)Þ-o()FCDu)(D$ltlHealth Human Resources Unit Centre for Health Services and Policy Research4.2.3.3 Demographic and Training Characteristics of GP/FP 'specialists'Table 4.22 presents the demographic and training characteristics of the GPÆP 'specialists'defined above. The proportion of GP/FP 'specialists' with each characteristic is presented as wellas chi-square statistics to test for differences with non-specialist GP/FPs.GPÆP 'anesthesiologists' were more likely male than were other GPIFPs þ<0.0001) but theywere no more likely to be either younger or older. By sorting physicians according to the LHAsin which they practice, we again found that GPÆP 'anesthesiologists' were much more likely topractice in rural regions (p<0.001). These physicians were also significantly more likely thanother GPIFPs to have been trained at non-B.C. medical schools.We found that GP/FP 'surgeons' had different demographics than non-specialist GPÆPs. Agewas strongly associated with being a GP/FP 'surgeon', with more than 20Yo of this populationaged 60+ years. This finding is very similar to the age distribution of RCPSC-certified generalsurgeons (see Section 4.1.2). As with GP/FP 'anesthesiologists', GP/FP 'surgeons' were morelikely male than were other GP/FPs. However, unlike GP/FP 'anesthesiologists', they were nomore likely to practice in semi-urban or rwal areas than were other GP/FPs. \lVhile this findingmay be surprising to some, it is complementary to the relatively equitable distribution of RCPSC-certified general surgeons (see Section4.l.2). As well, no significant differences were found withrespect to medical school location.Principal Findings: Geographìc Dístríbutíon of GP/FP ,specialísts,o GP/FP 'anesthesiologists' (i.e., those GP/FPs billing >l0o/o of their services in anesthesiology)were overwhelrningly located in more rural HHRU regions. This distribution complementedthat of RCPSC-certified anesthesiologists who were located largely in urban settings.o GP/FP 'surgeons' (i.e., those GPÆPs billing >l0o/o of their services in the surgery domains)were no more likely to be located in rural HHRU regions than were other GPlFPs. Thisrelatively even distribution mirrors that of RCPSC-certified general surgeons.o GP/FPs billing >20yo of their services in obstetrics and gynecology (i.e., our definition ofGP/FP 'obstetrician/gynecologists') were no more likely to be located in one HHRU regionthan in any other.o These findings were relatively insensitive to the choice of cut-point for defining GP/FPI-,- - -!-l:-r t-91 -Iable4.22:DemographicandTrs¡n¡ngCbaracteristicsofGP/FP'Specialists'inobstetrics&GynAll GP/FPs*GP/FP 'Spccialistsr**AnesthesiolosvStatistic{t** P-valueSurservStatistic*+* P-valueObsúetrics & GvnecolosvStatistic*ù* P-valueAge median (IQR)Age Group n (7o)Sex ^(Yù MaleFer¡aleMedic¡l School n (%)u.B.c.In CanadaNon€anadaGeographic Location n (%)UrbanSemi-urbanRural<404049s0-5960+43 Q4.0)1,373 (37.2)t,283 (34.8)687 (18.6)348 (9.4)2,634 (71.4)1,0s7 (28.6)t,249 (33.8)t,ss6 (42.2)883 (23.9)1,s99 (43.3)r,771 (48.0)32t (8.7)39 (e6 (s4.9)62 (3s.4)r l (ó.3)6 (3.4)24 (13.7)r5l (86.3)74 (42.3)73 (41.7)28 (16.0)e3 (s3.1)72 (41.1)10 (5.7).0) 29.7 <0.0037.6 <0.001298.8 <0.0018.70 0-0137.83 0.02043 (14.0)2s (31.6)33 (41.8)r5 (1e.0)6 (7.6)70 (88.6)e (11.4)te Q4.t)26 (32.e)34 (43.0)9 (11.4)40 (50.6)30 (38.0)0.70.2.10 0.555rt.1 <0.00116.2 0.00198.s 0.00r4s (18.0)68 (34.7)61 (31.1)27 (13.8)40 Q0.4)169 (86.2)27 (13.8)46 Q3.s)8e (45.4)5l (26.0)80 (40.8)e3 (47.4)15 0.1)<0.001<0.001<0.00t0.27314.530.222.32.590.473 0.789tot¡ls J.Ovl t75 t9 196I\oN)¡t Includes all GPÆPs on the 'actiræ'registers ofthe College ofPh¡sicians and Surgeons ofB.C., excluding GP/FPs <0.2 FTE or who had no FFS billings ia l96M (n=Sll¡.'obstetriciar/gmecologists' were deûned as GPrfPswith >20olo oftotal biling in the obst€trics & Snecolog feeitem domain. Perceûts gi\¡€lr s¡e relúiw to all GpiFps.(DtoÞ)FCDU)oÉFt(l(D(to(DFl(Dät.DÊ)(A(D¡-t(>(!U'Þa.EoC)FCDU2(DA)()Health Human Resources Unit Centre for Health Services and Policy ResearchThe most distinguishing feature of GPIFP 'obstetriciar/gynecologists' was that they wereoverwhelmingly female (86.3%) - very different fiom the overall GP/FP population (28.60/o).These GP/FP 'specialists' were also more likely to be younger (54.9o/o were aged <40 years),which was consistent with the higher representation of female GP/FPs in the younger age groups(see Section 4.1.3). GP/FP 'obstetrician/gynecologists' were also more likely to have beentrained at U.B.C. than were other GP/FPs. Our analysis shows significantly different practicelocales between GP/FP 'obstetrician/gynecologists' and other GP/FPs (p:0.020). We found thatGP/FP 'specialists' were actually more likely to be situated in urban areas than were theircolleagues.Principal Findings: Demographic and Trøíníng Charøcterßtícs of GP 'SpecíalÍsts'r While GP/FP 'anesthesiologists' were overwhelrningly male, they were no more likely to beolder or younger than other GP/FPs. These GP/FPs practiced primarily in rural locations andwere more likely to have been trained at non-B.C. medical schools than were other GPÆPs.o GP/FP 'surgeons' were significantly older than other GPÆPs (i.e.,20Yo aged 60+ years) butno more likely to be located in urbar¡ semi-urban, or rural locales. Also, the medical schoollocations of these GPIFPs were not statistically different fiom other GP/FPs.o GP/FP 'obstetriciar/gynecologists' were overwhelmingly female (86%) and most were aged<40 years (55o/o). They were also more likely to have been trained at U.B.C. and located inurban locales than were other GP/FPs.4.3 Aim lll: Stability of B.C. Physicians 1991 - 1996The purpose of this section is to examine the patterns that developed as physicians entered andexited ûom medical practice in 8.C., by their specialty and geographic region. To shed somelight on the potential reasons underlying these migration pattems, we attempted to characterize'inflow' and 'outflow' physicians and contrast them with physicians in 'stable' practice. Throughtinking CPSBC registration files for 1991, 1993, and 1996, we were able to characterizephysicians with four stabilþ patterns: 'stable' (i.e., active registration in all three years); oinflow'(i.e., registered in 1996 but not in l99l); 'outflow' (i.e., registered in 1991 but not 1996), andoother' (i.e., acquired and withdrew registration status over the course of these three years). SeeSection 3.2 for a more detailed discussion of the construction of this variable. We also examinedthe demographic, specialt¡ and training characteristics of physicians who entered and exitedpractice within the province. By comparing these characteristics with those physicians in 'stableopractice, we sought to highlight some of the correlates important in these decisions. Our studywas not designed to understand the reasons underlying physicians' arrival to the province (e.g.,relocation, newly graduated) or departure from practice (e.g., retirement, death, re-entry intotraining programs, or migration out of the province). In addition to examining departures andarivals to the province, we also examined the migration patterns of physicians between diffbrentgeographic areas in B.C.-93 -Health Human Resor¡fces Unit _ Centre for Health Services and Policy Research4.3.1 'lnflow' and'Outflow' of Physicians to B.C. 1991-1996 by SpecialtyTable 4.23 presents the stability status of all physicians who \ilere on the 'active' registers of theCPSBC in 1991, 1993 and/or 1996, by their most recently recorded RCPSC speciaþ. Asdiscussed in Section 4.1, all specialties (except otolaryngology, general surgery, hematology, andorthopedic surgery) had net gains in their physician numbers during this time. This anaþis showsthe interaction between 'inflow' and 'outflow' in producing these results. Overall, approximately65.8% of physicians (n=5,855) were in 'stable' practice (i.e., oactively' registered in all threeyears) wknle20.3%o gained CPSBC registration (n:1,802), and ll.2o/o withdrew from registration(n:992) during this interval. oOther' physicians who both gained and withdrew from registrationaccounted for 2.7o/o (n=-244). It is interesting that the 'net' gain of 810 physicians (excluding theoother' stability pattern) was produced by both a large outflow and a very large inflow ofphysicians. There appeared to be relatively few differences in these proportions when GPÆPswere compa¡ed to all specialists. However, among the speciaþ groups, several importantdifferences emerge. The proportion of 'stable' physicians over this five year interval among thespecialties ranged l.8-fold from a high of 85.7% to a low of 46.7%. Five specialties hadparticularly stable physician pools during this interval (i.e., more than 80% of physicians wereregistered in all three years) including rheumatology, medical biochemistry, medical microbiology,respiratory medicine and dermatology. Conversel¡ six specialties showed particular instability intheir physician supply (i.e., fewer than 600/o of physicians were 'stable') including radiationoncologyo endocrinology and metabolisnr, otolaryngology, nuclear medicine, communitymedicine, and medical oncology. For these specialties, the instability was accounted for by arelatively high rate of inflow, outflowo or both. The inflow and outflow cha¡acteristics of thevarious specialties are discussed below.For comparative purposes, the proportions of inflow' and 'outflow' physicians are discussed inrelation to their 'stable' counterparts.Among specialties, the ratio of inflow' to 'stable' physicians ranged from less than 0.1 in medicalbiochemistry (i.e., low intake) to a high of 0.90 in radiation oncology (i.e., high intake). Inaddition to radiation oncology, five specialties had a particularly high intake during this interval,including psychiatry (ratio 0.43), community medicine (0.46), nuclear medicine (0.73),endocrinology, metabolism (0.75) and medical oncology (0.7S).While some specialties had a relatively large gain in the number of registered physicians, somespecialties saw a significant loss in physicians ûom the registration rolls. Six specialties hadparticularly large ratios of 'outflow' to 'stable' physicians including neurosurgery (0.26), generalpathology (0.27), community medicine (0.31), general surgery (0.33), radiation oncology (0.33)and otolaryngology (0.40). It is interesting to note that the relative instability of communitymedicine resulted from both a relatively high inflow and a high outflow of physicians over thestudy interval.-94-Health Human Resources Unit Centre for Health Services and Policy Researchtable 4.23: Stability of the Supply of B.C. Physicians from 1991 to 1996, by RCPSC Specialtylpeciolty AllMDstit¡D¡en (o/oluuülown (Voltnilown (%l!¿!!9!n P/"1f,eneral / Family Practice 4,97t J,Z4l (OJ. t 5ló fi0.4) 1,053 12t.2) lóE (3.4)AnesthesiologyCardiologyCommunity MedicineDermatologyEndocrinology & MetabolismEmergency MedicineGastroenterologyHaematologyInternal MedicineMedical BiochemistryMedical MicrobiologyMedical OncologyNephrologyNeurologyNuclear MedicinePediatricsPathology - GeneralPathology - AnatomicalPhysical MedicinePsychiatryRadiation OncologyRadiology - DiagnosticRespiratory MedicineRheumatologyCardiovascular & Thoracic SurgeryGeneral SurgeryNeurosurgeryObstetrics & GynecologyOphthalmologyOrthopedic SurgeryOtolaryngologyPlastic SurgeryUrologyVascular Surserv3786l4966t1762920416l327t7l37119257lzs794l54t4529546283ó2433821920s17992627927260 (ó8.8)42 (68.9)26 (53.1)53 (80.3)I (47.1)s7 (75.0)2t (72.4)15 (75.0)285 (ó8.s)l l (84.6)22 (81.5)e (s2.e)l0 (76.9\s8 (75.3)l l (s7.9)167 (ó5.0)78 (62.4)s2 (65.8)26 (63.4)339 (62.7)2t (46.7)20t (68.r)37 (80.4)24 (85.7)27 (7s.0)ló0 (65.8)23 (60.5)133 (60.7)t4s (70.7)t22 (68.2)55 (5e.8)43 (69.4)s2 (ó5.8)2l (77.8)45 (l l.e)4 (6.6)(ré.3)(ó.1)(5.e)(5.3)(0.0)(r0.0)(t2.7)(7.7)(3.7)(5.e)(r5.4)(e.l)(0.0)(10.5)(16.8)(r 1.4)(e.8)(8.7)(r5.6)(13.ó)Q.2)(3.6)(8.3)(2t.E)(r5.8)(r5. r)(r0.7)(r5.1)(23.e)(r r.3)(r3.e)0.4\I4I40253III270272lI447740J536332227227ll264 (16.9)15 Q4.6)t2 Q4.s)9 (13.ó)6 (35.3)14 (r8.4)7 (24.1)3 (15.0)7t (17.r)t (7.7')3 (n.r)7 (4t.2\t (7.7)r l (r4.3)8 (42.1)58 (22.6)24 (19.2)r8 (22.8)e Q2.0)4s Q6.8)t7 (37.8)46 (rs.6)7 (1s.2)3 (r0.7)5 (13.9)26 (10.7)e Q3.7)44 (20.r)35 (r7.r)26 (r4.5)t4 (ts.z)t2 (19.4)15 (19.0)4 fl4.8)Ie (2.4)0 (0.0)3 (6.r)0 (0.0)2 (n.8)r (1.3)r (3.4)0 (0.0)7 (1.7)0 (0.0)l (3.7)0 (0.0)0 (0.0)l (r.3)0 (0.0)5 (l.e)2 (1.6)0 (0.0)2 (4.9)r0 (r.8)0 (0.0)8 (2.7)t (2.2',)0 (0.0)r (2.8)4 (1.6)0 (0.0)e (4.1)3 (r.5)4 (2.2',)r (l.r)0 (0.0)l (r.3)0 10.0)Iotal Specialists 3.911 2,614 (ó6.8) 476 (r2.2\ 749 fl9.r) 76 ll.9lIotal Physicians 8,89: 5,855 (ó5.8) 992 0t.2\ 1.802 Q0.3\ 244 0.71* Includes all physicians on the bctive'CPSBC registers in 1991, 1993, and/or 199ó. 'stable'ptrysicians refer to ptryslcianson the registers in each of I 99 I , I 993, and I 99ó. Inflow' and butflow' physiciarn include physicians entering or leaving the CPSBC'active'registers between l99l and 1996 respectively. 'Other'physicians include those physicians who both entered and exitedthe registration rolls during this interval. Specialty designatiors refer to most recetrtly recorded specialty ûom the CPSBC in 1996.-95-Principal Findings: Patterns of Støbìlíty by Specíoltyo During the period 1991 to 1996, only about two-thirds of the physician workforce were onthe 'active' CPSBC registers for the entire study period.o Of all physicians registered between 1991 and 1996, about 20%o were new-entrants whileabout I l% exited ûom the oactive' registration rolls.o There were few differences between GP/FPs and specialists in the percent of physiciansentering and exiting the workforce. However, there were significant differences amongspecialties. Five specialties had more than 80% of physicians registered in all three years,including rheumatology, medical biochemistry, medical microbiology, respiratory medicineand dermatology. Conversely, six specialties had a high proportion of inflow and/or outflowphysicians, including radiation oncology, endocrinology and metabolisrry otolaryngology,nuclear medicine, community medicineo and medical oncology.o Specialties with a particularly high inflow of physicians during this interval includedpsychiatry, community medicine, nuclear medicine, endocrinology and metabolism andradiation oncology. Specialties with a large outflow of specialists included neurosurgery,general pathology, community medicine, general surgery, radiation oncology, andloEealth Human Resources Unit Centre for Health Services and Policy Research4.3.2 Geographic DistrÍbutions of 'Stable','lnflow', and'Outflow, PhysiciansIn Section 4.1.2, we discussed the supply of specialty physicians among the HHRU regions forl99l and 1996. This section progresses from these cross-sectional analyses to delve more deeplyinto migration patterns. By linking the CPSBC records fiom 1991, 1993 and 1996 into aphysician-specific longitudinal file, we were able to characterizn the entry and exit patterns ofphysicians as well as the inter-regional moves during this interval. In other words, we progressedfrom performing single cross-sectional analyses in Section 4.1.2 to examining the trends inphysician supply over time with a cohort anaþis. The following analyses exclude the 244physicians who both gained and withdrew from registration during this period. For the sake ofsimplicity, this section is organized as follows. First, we examine the regional distribution of newregistrants between 199l-96 (i.e., 'inflow' physicians) and compare it to that for 'stable'physicians. Next, we examine the regional distribution of 'outflow' physicians (i.e., registered inl99l but not 1996) and compare it to that for 'stable' physicians25. Finally, we examine the inter-regional mobility patterns for 'stable' physicians that occurred over this 5-year interval. In thisanalysis,'stable'physicians were classified by whether their regions of registration in 1991 and1996 were the same or not.It is important to recall that the results presented below do not provide a complete picture ofphysician mobility over this interval. We were limited to three observations per physician25 For the 'inflow' analyses, we assigned 'stable' physicians to their 1996 region. Conversel¡ for the 'outflow' analysis,'stable' physicians were examined in relation to their l99l region. We chose these differences in assignment to in order thatthe groups were compared in relation to their resident region at the same point in time.-96-Health Human Resources Unit Centre for Health Services and Policy Research(3 different years) so that any movement occurring between our 'snapshots' may not have beencaptured. Physicians who migrated to different practice sites on multiple occasions during thisinterval may not be captured by our data. However, we view these misclassifications as rare. For'stable' physicians who were classified as not having moved between regions (i.e., the l99l and1996 Health Regions were congruent), only 20 (0.34o/o) were located in a different region duringthe intervening year (1993).4.3.2.1 'lnflow' of Physicians by HHRU and Grouped SpecialtyTable 4.24 presents the regional distribution of new registrants by their specialties and compares itto the similar distribution for 'stable' physicians. (The regions presented reflect the 1996registration status for both groups of physicians.) Taken together, these physicians represent thetotality of B.C.'s physician population in 1996 (excluding 75 'other' physicians who wereregistered in both 1991 and 1996, but not 1993). For GPÆPs, differences in the proportions ofnew entrants by HHRU region were on the whole relatively small (21 .2o/o-25.3Vo), except for thelarge proportions of new registrants in the North (56%) and North Central (32.7%) regions. Forspecialistso the contribution of new entrants across the HHRU regions (20.4-27.2%) minored thatof GP/FPs. The North Central and South East regions were exceptions, howevero with arelatively large influx of new registrant specialists (44% and 33.3%) during this period. TheNorth was also an outlier with no new specialist registrants.When broken down by grouped specialty, one main pattern emerges. For most specialty groups,oinflow' physicians make up a larger proportion of the physician supply in the more rural HHRUregions compared with the Capital and Vancouver and District regions. The largest proportionalgains ofnewly registered general internists, general surgeons, surgical subspecialists, psychiatrists,obstetricians and gynecologists, and anesthesiologists occuned, for the most part, outside thelower mainland and southern Vancouver Island. These findings are consistent with the 'net'effects presented in Section 4.1,2. The absolute number of new entrants, however, was often verysmall (i.e. fewer than 5 physicians) in many regions. For this reason, generulizations arehazardous.4.3.2.2 'Outflow'of Physicians by HHRU Region and Grouped SpecialtyTable 4.25 presents the regional distribution of physicians who left the CPSBC register between1991 and 1996 by specialty and compares it to the 1991 distribution of physicians with'stable'registration. Taken together, these physicians represent the total physician population in 1991(excluding 75 oother'physicians who were registered in both 1991 and 1996, but not 1993).26There was considerable variability between TIHRU regions in the proportion of GPÆPs who werelost from the provincial registries during the study period (p<0.001). Five of the nine26 For 'stable' physicians, there were some physicians who changed their specialty desigrations between l99l and 1996.During this time 67 physicians changed their specialty designation, including 30 physicians who shifted from generalpracticn /family medicine to RCPSC speoialties.-97 -Health Human Resources Unit Centre for Health Services and Policy Researchphysician's postal code from the 199ó CPSBC registralion records. Specialty designalions refer to most recently recorded specialty from the CPSBC in 1996.lilncludes spæialists (109'stable'and 35 'inflov/) in community medicine, physical medicine, occupational medicine, radiation oncotogy, andemergency medicine.ancouver & Districl383 (78.8)t49 (76.0)263 (?7.1)t40 (76.1)334 (76.4)t39 (74.7)t48 (67.3)531 (24.2)r03 (2t.2)41 (24.0)78 (22.e)M (23.9)r03 (23.6)47 (25.3)72 (32.?\29 (85.3)ó (75.0)t2 (70.6)9 (eo.o)t4 (66.?)7 (87.s\6 (60.0)34 (15.5)s (14.7)2 (2s.0)s (2e.4)r (r0.0)7 (33.3)l (¡2.5)4 (40.0)33 (73.3)s (7t.4)re (63.3)2 (66.7\7 (77.8)7 (87.s)4 (66.7)sr (le.0)t2 (26.7)2 (28.6)r l (36.7)l (33.3)2 (22.2)r (r2.s)2 (33.3)n (%)l n (o/"16 (8s.7)r5 (83.3)9 (75.0)t6 (76.2)I (72.7')6 (7s.0)r (5.0)l (r4.3)3 (16.7)3 (25.0)5 (23-8)3 (27.3)2 (2s.0)59 (84.3)r9 (8ó.4)35 (70.0)7 (70.0)36 (76.6)l5 (7s.0)r l (64.7)l r (15.7)3 (13.6)l5 (30.0)3 (30.0)n Q3.4)5 (25.0)6 (35.3)3 (20.0)2 (40.0)6 (42.e)l (25.0)r (e.r)r (16.7)2 (40.0)246 (73.4)44 (67.7)7 (s8.3)rs (ó8.2)6 (54.s)16 (64.0)3 (42.9)2 (28-6)8e (26.6)2t (32.3)s (4t.7)7 (3r.8)5 (45.5)e (36.0)4 (57.t)s (7t.4)83 (77.6)r3 (r00.0)4 (66.7)ll (78.ó)2 (50.0)14 (73.7)3 (50.0)2 (28-6\0 (0.0)2 (33.3)3 (21.4)2 (50.0)s (26.3)3 (50.0)s (7t-4)43 (78.2)13 (76.s)22 (81.s)l r (ó8.8)23 (79.3)l7 (r00.0)r0 (s2.6)t2 (21.8)4 (23.s)5 ( l8.s)5 (3r.3)6 (20.7)0 (0.0)9 (47.4')n (%)l n (o/o37 (88.1)8 (88.e)2t (87.5)r (20.0)r7 (ó3.0)I (80.0)6 (66.7)5 (l r.e)r (r r.r)3 (t2.5)4 (80.0)r0 (37.0)2 (20.0)3 (33.3)308 (79.6)7t (76.3)163 (73.1)50 (66.7)r55 (72.8)77 (79.4)sr (56.0)6et (79.2)220 (76.1)426 ('ts.s)teo (73.4)489 (7s.2)2t6 (76.3)199 (64.0)t82 (20.8)6e (23.9)138 (24.s)6e Q6.6)r 6 r (24.8)67 (23.7)n2 (3ó.0)' 'Slable physicians refer to ph)sicians on the 'active CPSBC registers in 199 I, 1993, and 1996. 'lnflol' physicians include newly-registered Il99l and 1996. Excludes 244 physicians who both gained and dropped CPSBC 'active' registatim over this interval. HHRU region refìects lhe98-Health Human Resources Unit Centre for Health Services and Policy Research, 1993, and 1996. 'Outno\t' physiciâns refer toactive' registers betwcen l99t and 199ó. Excludes 244 physicians who both gained and dropped CPSBC 'active' registration over this intewal.TIHRU region reflects the physician's postal code from the 1991 CPSBC registration records. Specialty designations refer to mosl recently recordedspecialty from theCPSBC in 1991.r*lncludes specialists (106'stable and l6'outflow') in community medicine, physical medicíne, occupational medicine, radiation oncology, andemergency medicine.382 (87.0)146 (8ó.9)244 (89.4)t46 (8r.6)319 (86.7)l4r (e0.4)160 (87.4)30 (78.e)57 (13.0)22 (r3.1)2e (r0.ó)33 (r8.4)49 (13.3)l5 (e.ó)23 (12.6)8 (2r.1)24 (7',t.4)7 (87.s)t3 (72.2)e (e0.0)t2 (80.0)7 (87.s)7 (100.0)7 (22.6)r (12.5)s (27.8)l ( 10.0)3 (20.0)l (r2.5)0 (0.0)30 (88.2)5 (100.0)l8 (100.0)2 (r00.0)7 (87.s)7 (r00.0)4 (100.0)4 (l 1.8)0 (0.0)0 (0.0)0 (0.0)l (r2.5)0 (0.0)0 (0.0)t7 (77.3)6 (75.0)13 (72.2)7 (87.s)l5 (75.0)l0 (6ó.7)7 (s3.8)3 (75.0)s Q2.7)2 Qs.o)s (27.8)r (r2.5)s (25.0)5 (33.3)6 (46-2\l (25.0)305 (86.2)s8 (77.3)20 (83.3)33 (73.3\6 (75.0)34 (e7.t>l5 (78.e)t2 (75.0)l (50.0)t7 (22.7)4 (t6.7)t2 (26.1\2 (25.0)t (2.9)4 (2t.1)4 (2s.0)l (50.0)ll (100.0)2 (66.7)e (8r.8)3 (75.0)7 (87.s)4 (80.0)4 (100.0)0 (0.0)r (33.3)2 (t8.2)r (25.0)¡ (12.5)l (20.0)0 (0.0)3e (84.8)6 (7s.0)l6 (100.0)4 (100.0)r l (78.6)3 (100.0)2 (r00.0)7 (ts.2)2 (2s.0)0 (0.0)0 (0.0)3 (2t.4)0 (0.0)0 (0.0)r 3 (72.2)4 (r00.0)t0 (76.9)2 (r00.0)l4 (e3.3)3 (42.e)2 (40.0)r (100.0)t7 (t7.0)5 (27.8)0 (0.0)3 (23.t\0 (0.0)t (6.7)4 (s1.t)3 (60.0)0 (0.0)2se (85.2)38 ('.10.4)13 (86.',1\le (79.2)l0 (66.7)23 (88.5)r6 (94.r)t2 (92.3)3 (100.0)16 (2e.6)2 (13.3)5 (20.8)5 (33.3)3 (¡ r.5)r (5.e)t (7.7)0 (0.0)33 (80.s)9 (90.0)ró (88.e)l (50.0)r5 (78.9)8 (80.0)4 (80.0)I (19.5)r (r0.0)2 (lr.r)l (50.0)4 Qt.t)2 (20.0)l (20.0)279 (79.5)?2 (84.7')ts2 (80.9)44 (80.0)t42 (85.0)7ó (80.9)s4 (78.3)8 (80.0)72 (20.s)r3 (15.3)3ó (19.1)il (20 0)2s (15.0)l8 (le.l)ts (21.7)2 (20.0\661 (83.7)2t8 (86.2)396 (85.9)190 (81.2)46t (86.2)2r7 (8ó.8)214 (84.9)38 (7e.2)t29 (ló.3)35 (13.8)ó5 (r4.r)44 (r8.8)74 (13.8)33 (r3.2)38 (r5.r)l0 (20.8)-99-Health Human Resources Unit Centre for Health Serviceq and Policy Researchregions had similar eút rates, ranging fuom l2.4Yo to 13.3% (Vancouver and District, Capital,Fraser Valþ, Island Coast, and North Central). The Okanagan and the Central regions hadabout l0% of their physicians drop from the registration rolls, while in two regions the exit rateswere about 20o/o ot more.Among HHRU regions, the proportion of specialists who exited from the 'active' CPSBCregistration rolls ranged from l3.l% (Vancouver and District: 265 physicians) to 2l.7Yo (NorthCentral: 15 physicians). However, there is little consistency in the rates of loss by HHRU regionsacross specialties. As with the patterns of inflow, the absolute numbers of 'outflow' physiciansoutside the large urban regions were often extremely small (<5 physicians).4.3.2.3 lnter-regional Migration PatternsParts (a) and (b) of Table 4.26 delneate the migration patterns of 'stable' physicians betweenHHRU regions based on the postal codes extracted from the 1991 and 1996 CPSBC registrationrecords. For the sake of simplicity, physicians are aggregated as 'GP/FPs' and 'All Specialists'.The rows represent the numbers of 'stable' physicians located in each HIIRU region in 1991 andthe columns represent the regions where the same physicians were located in 1996. The shadedboxes represent the physicians who were located in the same region for both registration years. Inother words, the oñdiagonal cells represent the inter-regional movements of physicians, with therows and columns representing the HHRU regionsy'oz which and to which physicians migrated.For each pair of HHRU regionso the onet'migration of physicians is simply the ocell' in the bottomleft segment of the table minus the corresponding 'cell' in the top right portion. For instance, forthe Vancouver and District region, the 'net' migration of GP/FPs from the Fraser Valley was: 3 -6: -3. The net migration patterns are presented in Table 4.26,Parts (c) and (d).Table 4.27 presents similar data for net migration patterns for the grouped specialties, except thatall the inter-regional moves are combined for each referent region. The purpose of this analysis isto examine the net migration pattern for each specialty group. A fust observation from the tableis that the number of net inter-regional moves was small regardless of specialty. In other words,no regions gained or lost physicians to any great extent to other regions during this interval.However, given that the supply of specialist physicians in many regions is relatively sparseo a netchange of one or two physicians can represent a large change in the provision of specialistservices. The specialties with the greatest net inter-regional mobility were anesthesiology,psychiatry, and pediatrics with 4.2yo,3.6yo, and 3.5 Yo of the respective physician populationsmoving between regions. One of the most striking observations is that, for all speciaþ groups(except obstetrics and gynecology where there was no net migration), Vancouver and District lostmore physicians to other regions than it gained. The North Central also had a net loss ofphysicians to other regions in all but two specialty groups (the medical subspecialties andobstetrics and gynecology). At the other end of the spectrun¡ in the Capital region, there was anet gain of physicians from the other regions in all specialty groups except two (the surgicalsubspecialties and obstetrics and gynecology). The Island Coast and the Okanagan also gained atleast one (neÐ physician from the other regions in most specialty-100-Health Human Resources Unit Centre for Health Services and Policy,Researche. Generol / Family Prscait¡oneß' l¡câa¡on of Prrctice' l99l and 1996HHRU 1996HHRUI99IHHRUI99Ic, GP/FP'Net' Migrotion Prttems t99l-1996d. Specisl¡st'Nea' Migmtion P.tterns l99l-1996b. Spec¡â¡¡sts' l,ocât¡on ofPract¡ce, l99l end 1996HHRU 1996---I-II-IIII@-IIEI-TII@III-reIIII@---IIEIII@-II-IIEII@--III-IE-ÐIIIIIITIIN.Cèntral I NorthIl@ryETÐ@@@@@EWEEE@EEEET@IEEEEE@EETE@rErErErrrqEETEEEETT@EEEEEEEET-l0r-lable 4.27: Net Inter-regional Physician Migration Patterns for'Stable' Physicians, 1991-f996ipecialtyV¡ncouver & DistrictNet Migrath Physician1991196 Poph 1991CanitalNet Migrath Physician1991196 Poph l99lFraser VallevNet Migrath Physician1991196 Poph 1991OkanasanNet Migrath Physician1991196 Poph l99lSouth EastNet Migræh Physician199l/96 Pooh l99luP/¡rsGeneral Internal MedicineMedical SubspecialtiesGeneral SurgerySurgical SubspecialtiesPediatricsPsychiatryObstetrics & GynecoloryIåboratory/RadioloryAnesthesioloryAll Smcialries¿-l-5J-1-3-100-8-840lnóð418722380306t2325683262170l-770J)420I605527JöU2729t7s9il38l338322815I00III00II2U-l122-t-lIJ4l0243l3l8t3339l6l0l9l7153IccI-l000I-lnt4cc2I862l025uNl Phvsicians -61 3,454 30 661 2tt 3C 396 0 l9(SoecialtvIsland coestNet Migrat?r Pþsician1991196 Poph l99l(-entralNet Migrath Physician1991196 Poph l99lNorth CentralNet Migrath Phpician1991196 Pooh l99lNorthNet Migrath Physician199l/96 Pooh l99lunßnownNet Migrath Physician199l/96 Poph 1991iPltPs3eneral Intemal MedicineMedical SubspecialtiesSeneral SurgerySurgical SubspecialtiesPediæricsPsychiatryf,bstetrics & Gynecoloryraboratory/Radiolory{nesthesiolory{ll Soecialtiesl620I7J5-t02t2318t2'1l5347ltt523l514300-20I00I0Il4l77l0t5433t6876-ó-l0-2-l-2-l0-2-l-9t541481253212I15n-8000000000JU00JI00IJ0r-)-l00000000-lI00000000IA.ll Phvsicians 28 461 I 211 -15 214 -t 38 -ó:'Net'mrgratlon to grating to other number of isatins from other HHRUs.It\)tInctudes only'stable'physicians on the'active'CPSBC registers in 1991, 1993 and 1996. 'Outflow'and'inflow'physicians not included. Physicianpopulation refers to the number of'stable'physicians located in each HHRU in 1991. Specialty desigrations refer to the lnost'recent specialty recorded as of 1996.(D9)ÞFoU2oôotno(D(Do'Ff(DÞ(Ao(l(}U)!0Þ-Fdo(lF(ÞU)(DÞ)ãHealth Human Resources Unit Centre for Health Services and Policy Researchcategories. No consistent migration patterns are readily apparent for the remaining HHRUregions.4.3.3 StabÍlity Súaúus by Physician Demographic and Training CharacfenlsficsTable 4.28 presents the demographic and medical school haining characteristics of oinflow'physicians in comparison to physicians in ostable' practice. Table 4.29 presents similar data forooutflow' physicians. For all analyses, the 244 physicians with an 'other' stability pattern (i.e.,both incoming and outgoing during this time) were excluded.4.3.3.1 Gharacteristics of 'lnfloW PhysiciansOverall, a much larger proportion of physicians who gained registration over the study periodwere aged <40 years (69.3%) compared with'stable'physicians (16.20/o) (p<0.001). This is notsurprising since a large proportion of new entrants (GP/FPs and specialists) to the CPSBCregisters were physicians who had recently completed their postgraduate medical education. Theproportion of newly-registered GP/FPs aged < 40 years (77.2%) was significantly larger than thesimilar proportion of newly-registered specialists (58.5%) (p<0.001). Agafuu this is expectedgiven the longer training requirements of specialty physicians. Among specialty groups, however,the proportion of new entrant physicians aged <40 years ranged ûom 33.8% for psychiatry to69.5% for the medical subspecialties. The proportion of newly registered physicians aged 65years or more was very small (less than 5%) for both GP/FPs and specialists. Among speciaþPrincipal Findings: Geogrøphìc Pøtterns in Physìcian Stabílítyo In most HHRU regions, new entrants who gained registration within the previous five yearsmade up about 20-25% of the 1996 physician populations. However, several regions hadparticularly high proportions of newly-registered physicians. For GPÆPs, new entrantscomprised more than one-third of the physician pool in the North and North Central regions.For specialists, new registrants made up more than one-third of the specialist pool in theNorth Central and South East regions.r Among regions, there was considerable variation in the proportion of 'outflow' physicians,that is, physicians who dropped their oactive' CPSBC registration between l99l to 1996.Most regions saw about líYo of their GP/FPs and specialist population leave the 'active'registers. The main outliers with higher exit rates included the South East, North and NorthCentral regions.o Across specialties and HHRU regions, the 'net' inter-regional migration rates over this timeinterval were relatively small. Vancouver and District saw the greatest net loss of physiciansto other regions across most specialties. Conversely, the Capital, Island Coast, and Okanaganregions saw the most consistent net increases in physicians on the active registers originatingfrom other resi-103-He.alth Human Resources Unit Centre for Health Service.s and Policy Researchgroups, the major exception to this finding was general surgery, where three of the 26 newly-registered physicians were aged 65 or older (11.3%).In addition to being younger, 'inflowo physicians were also more likely to be female than werephysicians in stable practice (p<0.001). Moreover, the proportion of new entrant femalephysicians was signifiÇantly higher for GP/FPs (39.9%) than for specialists (26.6%). The sexdifferentials for new entrants were also larger than those for 'stable' GP/FPs and specialists(25.8% vs. 15.6%). In other words, although new entrant GP/FPs and specialists were morelikely to be female than were 'stable' physicians, the growth in the proportion of females waslarger for GPiFPs. Among the specialty categories, there was wide variation in the proportion offemales to the new-entrant speciaþ populations (p<0.001). General $rgery and the surgicalsubspecialties had the smallest proportions (11.5% and 10.0o/o respectiveþ but they weresignificantly higher than the proportion of females in ostable' practice (3.8% and 5.7%respectively) (p<0.001). At the other end of the spectrunr" 42.1% of newly registeredpediatricians were female which was significantly higher than the 28.7% of stable pediatriciansþ<0.001), a figure that was the highest of all the speciaþ groups. The remaining specialtieswere intermediate with respect to the proportion of female new entrants, ranging from24.8%o oflaboratory and radiology physicians to 36.40/o of obstetrician and gynecologists.Extending the geographic analyses presented in Section 4.3.3, Table 4.28 also presents thegeographies of inflow' and 'stable' physicians grouped into urban, semi-urban, and rural locales.For all physicians, the differences in these geographies were statistically significant (p<0.001).'Inflow' physicians were more likely to locate in rural LHAs (9.3% vs. 4.5Yo) but less likely tolocate in urban ones (50.9% vs. 53.8%). This finding provides some insight as to the mechanismsbehind the reduction in disparities among Health Regions seen in Section 4.1.3. The geographicdistributions of inflow' versus 'stable' physicians were statisticaþ ditrerent þ<0.001) whenphysicians were divided into GPÆPs and specialists. Again, a higher proportion of new entrantsin both groups were located in rural LHAs compared with their 'stable' counterparts. Amongspeciaþ groups, new entrants were less likely than 'stable' physicians to locate in urban centres.For all specialties (except pediatrics and laboratory medicine/radiology), we also found that asmaller proportion of new entrants were located in the Vancouver and District and Capitalregions. This finding supports those presented in Section 4.3.3.The proportion of physicians graduating from the U.B.C. medical school was very similar foroinflow' physicians (25.0%) compared with 'stable' physicians (26.0%). While more ostable'GP/FPs graduated from U.B.C. (32.8%) compared with 'stable' specialists (17.9o/o) (p<0.001),these proportions did not change significantly for new entrants. Among the specialty groups, theproportion of new entrants who received their undergraduatc medical training in B.C. rangedfrom 9.1% in obstetrics and gynecology to 24.4Yo in the medical subspecialties. Overall, 26.5%of inflow' physicians received training outside of Canada compared to 29.4Yo of 'stable'physicians. New entrant GP/FPs were also significantly less likely (23.0%) than new entrantspecialists (315%) to have gained their training at non-Canadian schools. However, theseproportions were not much different from similar proportions for 'stableo physicians. Across thespecialty groups, the proportion of foreign-trained 'inflowo physicians ranged from less than 15%in the surgical subspecialties to more than 50% in psychiatry (p<0.001).-t04-t¡ble 4.2E: IÞmographic ând Training Ch¡racterbtics of'Inflow' ¡nd 'St¡bþ' Physici¡ns 199l-1996, by Grouped SpecialtyCh¡recteristicGenenl / Familv PrrcticeInflow Ståblen lolo)ln (/oluelreril rn[ernarMedicineInflow Ståblen l7o)ln P/o\Medic¿l Subs¡ecialtiesInflow Stsblen (%lln (/o\General SurserrInflow Stâblen (%ìln (%\Sulgicål SubsoeciâltiesInflow St¡blen lolo)l n P/olPediâtricsInflow Stâbhn lolo)l n (/o\<4040 to 6465r813 (77.2)229 (21.7)I r (1.0)7s0 (23.1)2,224 (68.6)267 (82\37184(62.7)(30.5)(6.8)14 (s.2)197 (73.0)59 t21.9)572s0(6e.s)(30.5)10.0120258l7(6.8)(87.s)15.81t58(s7.7)(30.8)/ll <l8 (5.0)il0 (68.8)¿.t tt 7.\77 (64.2)39 (90.7)4 (36\3538370(7.2)(78.s)ll4 3l36201(63.2)(35.1)fl.8)1013222(ó.t)(80.5)t13.4)JerMakFemalró33 (60.1)420 (39.9\2,404 (74.2)837 (25.8)4415(74.6)05.4\23733(87.8)02.2\5824(70.7)(29.3\25540(86.4)û3.6)233(88.5)(1 1.5)t546(e6.3)t3.8)108l2(e0.0)110.0)460 (94.3)28 (5.7\3324(s7.e)ø2.1\rr7 (7t.3)47 (28.7\GeogÌaphic LocationUlba¡Semi-urbarRura494 (46.9\414 (39.3)r45 (13.8)1484 (45.8)ts36 (47.4)221 (ó.8)34 (s7.6)24 (40.7)I fl.7)182844(67.4)(31.1)û.s)sl (62.2)2e (3s.4)2 Q.4',,t20983J(70.8)(28. r )(1.0)520I(le.2)(76.e)(3.8)74 (46.3)7s (46.9)1l t6.9)6552J(s4.2)(43.3)o.5\2792063(s7.2)(42.2)10.6)3818t(66.7)(3 r.6)û.8)r0953)(5s.e)(40.7)(3.4\UBCOther CanadrNnn-C¡na¡l¡31649s242(30.0)(47.0)Q3.0\r,0ó2 (32.8)1,39r (42.9)788 (24.3\1031l8(16.9)(s2.s)(30.5)3414294(r2.6)(52.6)(34.8)20 Q4.4)44 (53.7)t8 Q2.0\67t339s(22.7)(45.1 )(32.2\6t46(23.1)(s3.8)(23.1 )t78459(10.6)(s2.s)ß6.9\2974l7(24.2)(61.7)(14.2\ot256140(18.e)(52.s)Q8.7\62626(10.3)(44.8)(44.8)14 (8.s)s4 (32.9)96 t58.5)fotåb t5? ¿ll 59 7'7ll t1? 295 26 160 120 ¿rat \ta tÒ4Chår¡cterlsticPsvchl¡trvI¡Ilown l%llnStsble(o/o\Obstetrics & GvnecoloeìInflow St¡blen l%)ln f/o\l¡bor¡torv & R¡diolosvInfbw Stablen l%)ln P/o\AnesthesiolosvInflow Stebþn lolo)ln P/o\AII Soechlists**Inllow Stâblen l%)ln P/o\Total Phvsic¡åns**Inflow St¡blen lolo)l n P/o\<4040 to ó465ì4993(33.8)(64. r )(2 t\232467^(6.8)(72.6)t)^ Á\2915n(65.e)(34. l )/ô tìrl0912,J(7.s)(68.4)t)^ l\75391(64.1 )(33.3)() Â\3631644(e.l)(7e.8)lil.ll43 (67.2)le (2e.7)t l? r\28211)t(t 0.8)(81.2)1R tl418276,,^(58.s)(38.7)/t t\198 (7.6)2,032 (77.7)384 fi47\1,248 (69.3)523 (29.0)?t /l 7\9484,25665r(ló.2)(72.7)llr l)lerMaltFemalr9649(66.2)ß3.8)2s1 (74.0)88 t2ó.0)2816(63.6)ß6.4\108 (8 r.2)(18.8))<88 (7s.2)29 (24.8\30987(78.0)Q2.0\47 (73.4)t7 Q6.6\219 (84.2)41 fl5.8)550199(73.4)Q6.6\2,207407(84.4)û5.6)r,183 (65.ó)6t9 (34.4\4,611 (78.8)1.244 01.2\)nUôa¡Semi-u¡buRnn8l595(55.e)(40.7)(3.4\) <',85)(74.3)(25. l )(0.6)17234(38.6)(s2.3)(9.1)7755I(57.e)(41.4)t0.8)7341)(62.4)(3s.0)o.6\237 (59.8)146 (36.e)13 (3.3)3330I(s r.6)(46.e)û.6)16692I(74.3)(2s.1)(0.6)3972962l(5s.6)(4 1.5)o.9\l66s90841(s7.9\(41.4)(0.8)917 (50.9)71E (39.8)167 (9.1\3,r49 (53.8)2,444 (41.7)262 (4.5)UBCOther Canad¿Non-Camdr165ó73(r r.0)(38.ó)(s0.3)52143144(15.3)(42.2)G2.s\42416(e.t)(s4.5)(36.4)264760(re.s)(35.3)t4s I)26 Q2.2)53 (4s.3)38 132 sl66197t??(16.7)(49.7)11? ¡(\tt (17.2)32 (50.0),l ¡/?t R\759986(28.8)(38. r)(33 l)134 (17.9)?79 (s0.6)236 (31.5\461 (17.6)r,220 (46.7)933 (35 7\450 (25.0)874 (48.5\478 (26 S\1,s232,6111.721(26.0)(44.6)09.4)fot¡h 145 339 44 133 117 396 64 260 749 2-614 l -802 5.855ans to Ians on INIo(JrIwith regards to population density. Specialty designations refe¡ to most recently recorded specialty tom the CPSBC in I 99ó.r*lncludes specialists (109 'stable'and 35 'inflovr') in community medicine, physical medicine, occupational medicine, radiation oncology, and emergency medicine.(DçDÉôthF(DU)oooØô(Dtst(Do't-tÉ<(Dþ)CA(ÞÈlt)(DU)s)ê.ÞúoC)F(D(t)(DС.t(lteble 4.29: Denogmphic and Treining Ch¡ncte¡istics of 'Outûow' ¡nd 'Strble' Pbysicius 19l-1996, by Grouped SpecialÇCh.rrct rist¡cuacEr / ¡¡mv rmcûæOutf,ow Stlble¡ (7ôl n (/ol(t6€n [ænt M6rq¡eOutfow Stablên (7.)l n f/o\M6¡qt suNm¡tûBOutf,ow St¡blen (o/o)l n P/o\lidæl tupêBOutf,ow Strblen (o/o)l n f/olSunit¡l liuDspæ¡tltiesOudow Stablen loloìl n f/o\rqnm6Outf,ow Stsblen loloìl ¡ P/o\Age<4040to64Ásr189208l19(36.6)(40.3)(23.1\r,345 (41.5)t,170 (s4.6\126 (3.9\s (9.6)22 (42.3)2s t48.ll44 (ró.3)tgs Q2.2\3l ll 1.5)s (20.8)12 (s0.0)7 (29.2\1061827(35.e)(61.7)(2.4\sa1)A(e.4)(41.s)/¿o rì23ll4)1(14.4)(7 1.3)IIA A\l747?Á(17.0)(47.0)/2Á ñ\t20 (24.6)333 (68.2)15 (7 )\4ló7(14.8)(se.3)(25.9\40lnt3(24.4)(67.7)(7.9\texMal¡Fe¡ml403 (?8.1)I r? /rl oì 2,404 (74.2)tl? /t< tì 5r (98.1)I ll9l237 (81.8)?? /tt rt20 (83.3)A IIAl\2ss (86.4)Á /t2 A\ 530(r00.0)tfi ol154 (%.3)6 t3.8)98 (98.0)2 (2.0\4& (94.3)28 (5.7\19 (70.4)8 t29.6ìlr7 (7r.3)47 (28.7\G€ogrâph¡c Lo€tionUóarSemi-wba¡Rurâ27918156(54.r)(35. r)û0.9)t,536 (47.4)r,444 (44.6)261 t6.l)40ilt(76,9)(2t.2)lr.7)182844(67.4)(3 r. l)ll.3)222(91.?)(8.3)/o ôt2t282I(7r.9)(27.8)1ô 1\2¡ (39.6)29 (s4.7)3 ts7)747tl((46.3)(44.4')/o ,\63 (63.0)35 (35.0)t /tât288 (s9.0)r97 (40.4)3 106l20 (74.t)7 (2s.e)o /oôlil348(68.e)(29.3)û.81B.COtherCæadrNo¡-l'¡na¿l:106 (20.5)229 (44.4'l8l (35.1)1,062 (32.8)r,391 (42.9)788 eß\627r9(l l.s)(5 l.e)(36.5)34 (t2.6)t42 (52.6)94 t34.8)t29(12.s)(50.0)(37.5)67IJJ95(22.7)(45.1)(32.2\436l3(7.5)(67.e)(24.5\l78459(10.6)(s2.5)136_9)14 (r4.0)59 (59.0)21 (27.O\92 (18.9)2s6 (s2.5)lL t19a\l0t^(r l.r)(37.0)/<t o\l454oÁ(8.s)(32.9)/(l {ìfohtr t4tCb¡ncæristirPscbi¡tnOutf,ow St¡blcn 10z6)l n P/o)(rbsûctfrG ag Gvn€coloãvOudlow St¡blcn lololl n P/o\EDOETWTMOtO¡OnOutfow St¡blen lolo)l n P/o\AB6EGtOtOSOutûow St¡blen lol")l n P/o\Altùt¡@tBa-"Outfiow Strblen (7.)l n P/ol.qll rnvs¡c¡tns¡rOutfiow Stsblen (o/o)l n P/o\<4040 to 64Á<+4 (8.5)22 (46.8)Jt ha1\76'Ðo2A(22.4)(67.6)/tô ôl517ll(15.2)(5 r.5)/?? ?\2l9St1(15.8)(1t.4)/tt e\t4 (t7.7)39 (49.4))6 (7)9\il02652l(27.8)(66.e)(5.3)I26ll(17.8)(5?.8)04.4\8l (31.2)1?l (6s.8)8 t3.l)7l228t77(14.9)(47.9)(37.2\6551,767tEz(2s. l)(67.6)(7.3\260 (26.2',)436 (44.0)296 (29.8\2,000 (34.2)3,s37 (&.4)?tt /q ¿\icxMalFerml389(80.e)û9.l)zsr (74.0)88 (26.0)26 (78.8)7 (2t.2\r08 (8r.2)25 û8.8)72 (9t.t)? t8.9)309 (78.0)87 (22.O\34 (7s.6)tt (24.4\ 2t9 (84.2'¿l ¡/l ( lì42s (89.3)<t ltô ?t2,207a1(84.4)/t(K\ 828 (83.5)la 1lÁ <\ 4,611 (78.8)t )44 (71 )\Seognphic IncationUröa¡Se¡ri-uba¡PilÉ5tt0ôQ8.7)(21.3)/ô ô\247 (?2.9'90 (26.5)) TñÁ\20 (60.6)il (33.3)t /Á lt82 (61.7)s0 (37.ó)I /ôe\53 (67.r)22 (27.8'I /<r\245 (6t.9)139 (35.1)rt /1 nr29 (64.4',)l6 (35.6)0 (0.0)r70 (65.4)87 (33.5)3 0.2\3t5t49t2(66.2)(3 1.3)t2.5)1,69687444(64.e)(33.4)(l.?)59433068(s9.e)(33.3)t6.9)3,232 (ss.z'2,318 (39.6)?ô{ /s )\B.COthøCaud.4 (8.5)20 (42.6)t? /r'.R o\52 (r5.3)t43 (42.2)1ÁÀ tl, <\l (3.0)13 (39.4)lO /(? ¡(\26476Ír(19.5)(35.3)/¿{ t\942tt(l 1.4)(53.2)/1< ¿\6tnt?1(16.7)(4e.?,¿11 ¡(ì5 (lr.l)24 (s3.3)l¡< /?( Áì75 (28.8)99 (38.1)16 13? lì50 (10.5)249 (s2.3)177 (77 )\ßt (t7.6\t,220 (46.7)933 t35.7)156478358(15.?)(48.2',)(36.1)1,5232,611t,721(26.0)(u.6)(29.4\l-ot¡Ig v)¿ )-x55to on feg¡sters m to reg¡$ersIOo\¡withregudstopopulationdeosity. Specidtydesignationsreferto¡mstrec€ndyrecordedspecialtyftomtheCPSBCin 1991.trlncludæ specialists (106 ftable and 16 butflovr') in coûnu¡ity medicin€, ph]rsicål nædicing occup*ional rnedicing mdiation oncolory, and eoærgency medicine.tDÞi,ê)F(Du,or-tô(DU'éo(DPtsttÞð',(DÊ0(A(DFt()(DØs¡)Ê.FUo(lF(Dtt>(Dn9Èt()Health Human Resources Unit Centre for Health Services and Policy Research4.3.3.2 Characteristics of 'Outflow' PhysiciansNot surprisingly, we found that 'outflow' physicians were significantly older than those in 'stable'practice from l99l to 1996 (p<0.001). Overall, 29.8% of the exiting physicians were aged 65+years compared to only 5.4% of stable physicians (p<0.001). Although the reasons underlyingthese exits are unknow& the most likely explanations for this age group are retirement and death(although this is a rare occurrence). The proportion of older 'outflow' specialists (37.2%) wasalso significantly larger than a similar proportion of exiting GPÆPs (23.1%) (p<0.001). Thisfinding suggests that GP/FPS may be more likely than specialists to retire at younger ages.Another important finding was the relatively large percentage of exiting GP/FPs who were lessthan 40 years of age (36.6%). Not only was this larger than that for older 'outflow' GP/FPs(23.1o/o), but it was also much larger than the similar proportion of younger specialist physicianswho exited (14.9%). Retirement is unlikely in this age group and further research is needed tounderstand the reasons underlying these departures from practice. Across the speciaþ groups,the proportion of 'outflow' physicians aged 65+ years ranged ûom 24.4% for anesthesiology to49.1o/o for general surgery. In all cases, however, the proportion of older 'outflow' physicianswas greater than the 'stable' pool of physicians. Conversely, the proportion of exiting physiciansaged less than 40 years ranged from only 8.5% of psychiatrists to 20.8% of medical subspecialists.The specialties with the greatest proportion of outflow physicians in this youngest age group(<15%) were the medical and surgical subspecialties, anesthesiology, obstetrics and gynecology,and laboratory/radiology medicine.In contrast to the anaþis of inflow' physicians (see Section 4.3.3.1), 'outflow' physicians weresignificantly more likely to be male (83.5%) thøn were 'stable' physicians (78.8%) (p<0.001).This differential is apparent for both GP/FPs and specialists (p<0.001) and relates to the fact thatolder retiring physicians were more likely male. Among the speciaþ groups, there was somevariability in the sex distribution of 'outflow' versus 'stable' physicians. For the most part,however, the overwhelrningly male sex-mix of the 'stable' community was reflected in that of thedeparting physicians.No consistent patterns emerge in the examination of the geographic distribution of 'outflow'versus 'stable' physicians. On the whole, more 'outflow' physicians originated from urban localesthan did ostable' physicians, but this finding was not consistent across the specialty groups. Theproportion of exiting physicians originating from rural LHAs was small (10% or less) for all thespecialty groups with no large differences among them.In contrast to 'inflow' physicians who were as likely to be trained at U.B.C. as 'stable' physicians,'outflow' physicians were less likely to have received their medical degrees from U.B.C. (15.7%vs. 26.0Yo) (p<.0001). This finding was apparent for both GP/FPs and specialists. Whenseparated by specialty, smaller proportions of 'outflow' physicians were trained at U.B.C.compared with 'stable' physicians in most specialties, but there are many small cell sizes.Moreover, while exiting physicians were more likely than 'stable' ones to have been trainedoutside Canada (36.1% vs. 29.4%), this pattern was not consistent across specialties. Thus,greater representation of U.B.C.+rained physicians over time (see Section 4.1) was due not to a-107-Health Human Resources Unit Centre for Health Services and Policy Researchgreater inflow of U.B.C.-trained physicians, but rather to a higher outflow of non-Canadiantrained ones.Principal Findings: Physícían Stabilíty by Demographíc and Trøíníng Characterístícso Among specialties, there were significant age differences in physicians entering and exitingpractice. As expected, 'inflol'physicians were significantly younger and 'outflow' physicianssignificantly older than ostable' physicians.o There was also significant variability among speciaþ groups in the proportions of femalephysicians migrating in and out of practice. Overall, 'inflow' physicians were more likely andooutflow' physicians less likely to be female than were 'stable' physicians.o 'Inflow' physicians were more likely to locate in rural areas and less likely to move to urbanareas than physicians in 'stable' practice. Exiting physicians appear to be no more likely thanostable' physicians to come from urban areas.o 'Inflow' physicians were no more likely than'stable' physicians to have received their medicaldegrees at U.B.C. However, exiting physicians were less likely to be U.B.C.-trained, whichexplains the net increase in the representation of U.B.C.-trained physicians seen inSection 4.1.4.4 Aim lV: The 'Life Cycle' of a Physician's Practice, 1991192 to 1996/97In addition to examining the number of physicians entering and leaving practice, medical humanresources planning should also account for expected changes in practice intensþ. This sectionexamines how practice intensity changes over the professional olife-cycle' of a physician'spractice, from the period following completion of post-secondary education until retirement. Thepurpose of this section is to provide data with which to understand changes in practice intensity.For these analyses, physicians on the oactive' register of the CPSBC in 1991, 1993 and 1996 (i.e.,ostable' physicians) were divided into S-year birth cohorts. We aralyzed how the income of thesephysicians changed over the study period as a function of their age. Physician income was used tomeasure practice 'outputo. In general, we hypothesized that younger physicians would havegrowing practices, middle-aged physicians would have relatively stable practices, and olderphysicians would graduaþ taper their practices as they neared retirement. The departure frompractice for older physicians is discussed in Section 4.3. Incomes were indexed to remove theeffect of price changes and inflation.For this analysis, we excluded specialties where service agreements accounted for more than l}Yoof all physician payments by the Ministry of Health n 1996/97, including pediatrics, geriatricmedicine, medical oncology, and emergency medicine. Exclusion of these specialists wasnecessitated by the lack of physician-specific payment information for these service agreements.Physicians who changed specialty designation during this period were excluded. Laboratory andradiology specialists were also excluded because of the lack of physician-specific FFS billinginformation. We also excluded 110 'outlier' physicians with large changes in their billing patterns-108-Health Human Resources Unit Centre for Health Services and Policy Researchover the course of the study period. These excluded physicians were those whose proportionalchange in billings (i.e.,11996197 income - l99ll92 incomeJ + ll99ll92 incomel) were in the topor bottom percentile, compared to their peers. Given the large changes in the billings for thesephysicians, we assumed that there were other significant and unobserved factors that influencedtheir changes in practice intensity.Figure 4.19 shows the mean payments (FFS bilings combined with APB Salary/Sessionalpayments) for this subset of physicians n l99ll92 compared to their 1996197 payments. Twomain age-related findings are readily apparent. First, there were significant differences in the totalpayments for physicians in different birth cohorts in both study years þ<0.0001). During1991192, physician payments progressively increased until age 50-54 and then progressivelydecreased until age 65+. Second, there appeared to be significant differences by birth cohort inhow incomes changed over the period from baseline :rr,l99ll92. The practices of physicians aged<40 years tended to grow (with the largest increases occuning in physicians aged <30 years).Practices were relatively stable for physicians between 40-49 years of age, and then graduallydeclined after age 50 (with the largest declines occuning after age 60).Fignres 4.20,Pafis (a) to (d) show similar graphs that analyze this pattern of practice acceleratior¡stability, and deceleration for physician specialty, sex, geographic location and place of medicaleducation.Figure 4.20, Part (a) compares GP/FPs with all specialists combined. Because of the small cellsizes for grouped specialties leading to instability in the estimates, all specialists were analyzedtogether. Overall, the shapes of the two graphs appear similar (despite the very diferent meanincomes). In 1991192, middle-aged physicians had the highest incomes, while the incomes ofyounger and older physicians were substantially reduced. Also, the change in income appeared tobe age-related, with younger physicians gaining, middle-aged physicians remaining stable, andolder physicians tapering down practice. While the overall patterns were similar, there were somedifferences in which age groups the peaks occurred, as well as for the size of the changes. Inl99l/92, specialist incomes were highest for specialists aged 45-59 while for GP/FPs the peakincome was marginaþ older at ages 50-54. Over the ensuing 5 years, younger specialists (i.e.,<50 years) had larger proportional changes than did GPÆPs. Moreover, gro\Mth peaked later forspecialist practices than for GPÆP practices. The tapering of practice intensity after age 55however, was similar for both GPÆPs and specialists.Across the categories of age, geographic locatiorL and location of medical school, the convexshape of the distribution was consistent. Income tended to peak at middle age, although therewas some variation in which age group was the largest. Similarl¡ younger physicians (aged <50)consistently showed growing practices, middle-aged physicians had relatively stable practices, andolder physicians had tapering practices regardless oftheir sex, geographic location, or the locationoftheir medical school education.-109-(DA)s)Fo?t)oc)(DØo(Ð(Dõ't(DÞ(t)(Dc)(DV2ÞÞ.€oc)F(Dvt(D!e()Figure 4.19¡ Mean Total Payments n l99ll92 & 1996197 for Cohort of rstable'Physicians by Age Group i\ l99ll92 (n=4r692)ü)Ë szoo.ooo(9EIIclÈ6l:o'ã $lso,ooo(t)(t)Þd6tU)€ stoo,ooo(r)f-rl=t)IE(¡)Eþ $so,00oÊrIoINo2s3 s73 863 9zo 803 468 386 z4o<30 30-34 3s-39 4044 4549 s0-54 55-59 60-64Age Group (1991-92,Figure 4.20 Mean Total Payments in 1991/92 & 1996197 for Cohort of 6stable' Physicians by Age Group ìn l99llg2, Speciatty, Se¡ Geography,and Place of Graduationa. Primary Care/Specialty Care- Gcrenl Pr¡cdrioEn / Frnily PùysicirÊ (82942) -- Spcc¡¡lisrs (D-1J50) -32JO,000p oæ.oooi.¡6 sr50.0@è!f; sroooætË. *'*Às0559 J963t- 4ù39 44.16945-49^ß Gup (1991-92)33.û45.49Agecoup (1991-$)220 t92 t99ó050. 55. +J4 5928 ¡9{ 2A6050- 55- +54 593U tU35. 40-39 44b. Sex{0 3¡ 256050. s5.54 5924 tto3r. ¡0.39 {4- FcE¡tc ¡!tricl.¡r (0-995) -tn15-{9Asc CÈop gt9¡-t2). M¡lc PhY!lcl¡!! (o-31697) -68r1r.19Arc CÞ¡? (¡99r-91)429 352 {0r50. t5. 6054 59N.. at6 619 730<34 t3- 40.39 ¡¡::::! r,oo,o,! ''ro,*j sroo.ooo| ,*,0*IE *'*Ë *o.o*Êt izo.ooosl 40,000â sr20,000EÊE sroo.oooE¡t seo.oooI6 soo.ooo€&; s.0.000EEÊ seo.ooos0t250,0009å 32oo,ooo! rtro,oooaÞ.{lt 3r00,000¡{ sso,oooat0Health Human Resources Centre for Health Services and Policy Re$earchc. Geographic Locationr0560+21660+20155-J924650.5{50940-4442135.397560+l0?50-5¡2173J.39- Rurrl PùY¡ici¡¡r (o-l'O¡t) -t7045.19A8c GþuD (1991-92)- Scui-urb¡n Phy¡¡ci¡¡¡ (¡-1,179) -t89aJ-49.{8c Gð!D (trtt-t2)- U rb¡D Phys¡c.¡r (n-21?5)44445.19A¡c G.ocp (1991-92)I9010.11s250,000ã¡ s2oo,oooBt rrso,oooaÞt{ ¡roo.ooo2f, sro,oooÀNo 2t2<3{2t9 22t35- a0.39 119855-59.1t2.Health Human Resources Centre for Health Services and Policy Researchd. Location of Medical School- U.E.C. Gr¡du¡tc! (r-¡¡32) -t9t45-19A8c Gro¡p (t991-r2). Olh.r C¡n¡d¡¡n Grâduålc¡ (¡-2,042) -28r35.3tzta{0-116160+9550-J¡t155.593200'0003 I t0,000ãEË sr60,000t srro.ooo! srro,oooa-å sroo,ooo3I rto,oooI suo,ooo$ ,.o.oooÂs20,00030!{ szooooo.tÉ 3r50,000øIlt 3roo.oooeË s¡o,ooot0r9r I 12 16650. s5- 605t59+No, ,d8 146 {{8<t1 35. 10-l9 11t8250.5133r¿5.{9.l8c Grout (199¡-92)t250.000- Noo-C¡¡¡di¡n Gr¡dr¡aGr (n-f,318) -28r15.a9ABc Grocp (l19!-92)136 21135. 10.39 t1s200p003 I t0.o00aå s160,000! srro-ooo'å r,to.oooaÈ t,oo,oooI€ 3t0,000p soo,oooË sno,ooo320,00030r13.Health Human Resources Centre for HealthServices and Policy RçsearchTable 4.30 shows similar analyses using the proportional change in income as the dependentvariable. On the right side of the table, we present a one-way analysis of variance analysisexamining the effect of age on changes in practice income, stratified for different sexes, locationof medical school education, full-time-equivalency, and geographic location. The intent of theseanaþes is to confirm the findings above with regard to how changes in proportional income varyover the 'life-cycle' of a physician's practice. These analyses are presented for GP/FPs only; therewere similar findings for specialists but the data are not shown for the sake of simplicity. At firstglance, it is evident that all the anaþes are statisticaþ significant, showing important age-relateddifferences across these stratification variables. Furthermore, if one analyzes the mean values(interpreted as the proportional change in income), one sees that the changes are consistentlypositive for younger physicians (<40 years), with the largest increases seen for those physiciansaged <30 n 1991192. The mean values approach zero at age 40-49 years for most categories,with the main exception being female and part-time physicians (i.e., FTE<0.5). For the cohortaged 50-59, most physician groups show a decline in practice activity (several are positive butnear zero). After age 60, all categories of physicians were found to taper their practices. Whilethe trends appear similar across categories, however, the magnitude of the changes was quitevariable. Moreover, there was significant variation around the mean in most categories. Thus, toobtain precise estimates of the age-related effects in the change in practice intensity, multivariateanalyses are required to control these confounding variables.The analyses described above suggest that there are important changes in practice intensity thatcan be expected as physicians age. This effect is evident for GP/FPs and specialists across sex,geographic location, place of medical school educatior¡ and full-time-equivalency categories. Onthe whole, physician practices appear to grow until about age 40, remain stable until about age55, and then progressively decline. The main policy implication of these findings is that thepresent cohort of physicians can be expected to expand or taper their practices as a function oftheir age characteristics. In regions and/or specialties with a large proportion of youngphysicians, increased productivþ can be predicted for those that remain in practice. Conversel¡for those specialties and/or regions with an older group of physicians (especiaþ if a largeproportion are over 55 years) significant reductions in service intensity (and thus overall suppÐcan be expected. However, predictions of this type may be hazardous, given that they involvegeneralizing from the group level to the individual physicians. In regions and/or specialties withsmall numbers, the predictabilþ of these changes is severely limited.lt4 .Ieble 430: Cbangc in Pnctiæ Incone betwæn 199U92 Ùd 1996197 forGPIFPS by Age Group, Se& Plsce of Medical School Education,Gægmph¡c Loc¡tion üd Full-timFEquiyelency*AU Agðn Mean SD Statistic*' P-ulue SDn<30 Yea¡sMem SD30-39 YærsM€ânAge Group40-49 YæreMean SD50-59 YesñMean SDn n n60+ Yon In Me¡n SD lstatistict.. P-ulueFsmlrMalrUedicsl SchoolB.CIn Caad¡Outside C¿oad¡Full-Tine.Equivalency< 0'50.5-t.i>1.2Seognphic l,ocationRuraSemi-u¡baI lrùer7æ 0.43 1.4 34.48 0.00012,t74 0.t5 t.02t,001 0.21 0.97 0.63 0.53s1t,237 0.26 t.t1704 0.21 l.3l319 0.13 1.78 t.29 0.27651,908 0.23 l.ll715 0.25 0.83815 0.24 t.23 55.46 0.0@t8r7 0.20 1.021.310 0.24 l.l5t09 0.n 1.98140 Ll 2.05t24 0.88 t.31108 1.03 2.at7 234 4.3430 0.51 1.93168 t.t2 2.2351 1.09 l.t363 0.75 1.5856 1.33 2.4130 1.06 2.02372 0.47 l.5l645 0.32 l.16431 0.28 l.l5436 0.37 t.23lso 0_65 1.789l6702562.26t.2t1.040.480.370.36299 0.5 r 1.62305 0.28 0.974r3 0.3s t.2s226 0.24 0.83839 0.02 0.6r794 -0.01490 0_ll28t 0.09o 0.t8672 0.04326 0.10285 0.05 0.7(,284 0.05 0.41496 0.09 0_710.330.820.63t.10.530.5349 0.03 0.71363 {.06 0.49I l0 4.07 0.33134 0.05 0.8t168 4.1 0_3147 -0.36 0.52297 -0.01 0.s773 0.01 0.26n7 -0.06 0.66l 19 {.07 0.43t76 4.02 0.5t2 4.21187 -o.il42 4.3269 -0.2r88 0.0489 -0.15 t.52l0r 4.10 0.599 {.06 0.251 4.25 0.4253 4.t2 Lrs95 -0.06 l.3l0.42t.l30.330.88r.437.r4 0.000t48.t8 0.000t27.1 0.000119.77 0.00012l 0.00012.6 0.032744.43 0.000120.76 0.0001t2.27 0.00012s.35 0.000124.78 0.0001t9U9 incone )/l99l/92 income. Includ6 GP/FPs on the'actiw'CPSBC regbtm in l9l, lÐ3, ad 196, ccludingthosewith exueme prcponional billing chsga (< 4.95 ed > 13.53).(,¡¡19919/ in6me sdjusted by Coremr Priæ Inds: 1996 indq = I I 1.85 (base l9l).*.F-søtistic tom æalysis of wiæ (ubalanced model) t6ting for difænccs in mm billing chæge b*rwn levels of ü¡e æwiae of intæt.I r rF6tatistic from oncwy malysis of wiaæ (unbaluced model¡ tedng for ditreme in mø billing chæç mong urbaicity lwels, stratifu by age, scx, medical schæl FIE or PGME loc¿tion.Health Human Resources Centre for Health Services and Policy ResearchPrincipal Findings: The Professional'Life cycle' of a Physician's Practiceo Important effects exist between physician age and practice output (i.e., gross income).o Overall, incomes were highest for physicians aged 40-54. Incomes progressively increasedwith age before 40 years and progressively decreased with age after age 54.o Over the S-year study period, the practices of physicians aged <40 years tended to grow inintensþ, were relatively stable for physicians between 40-49 years, and then graduaþdeclined after age 50 (with the largest declines occurring after age 60).o These age effects were generally consistent regardless of sex, geographic location, place omedical school graduatior¡ and full-time-equivalency (although there were some differences inwhat ages the peaks occurred).¡ The age of the physician pool for regions and/or speciaþ groups can have importantimplications for future supply. If current trends hold, regions and/or specialties with youngerphysicians can expect to have increased future supply (assuming limited out-migration) whilethose with older pools of physicians will likely see important reductions in activity.. 116.Health Human Resources Centre for Health Services and Policy Resea¡ch5. DiscussionConcerns about physician supply usually focus on a discrete set of questions including: Is theratio of doctors to the population enough? Will growth in physician numbers meet the demandsof an aging population? How will the introduction of new technologies change the need forphysicians? On deeper examination, the array of issues faced by B.C. policy makers charged withphysician workforce planning is much more complex, clustering around three principal themes: (l)Physician Supply. What is the cunent supply of different types of physicians in B.C.? How arethey distributed among different populations? How many more can be expected to establishpractice and how mrmy will leave? From where will the new doctors to the province come?What policy'levers' are available to influence migration patterns both into and out of the provinceand for different health regions? How is the 'load' of physician practices anticipated to change?(2) Demand for Care. What are the needs of the population for different types of physicianservices? How do these needs differ among important sub-populations? How will populationgrowth influence these needs? Is case-mix and acuity expected to change and, if so, how and inwhich populations? How will advances in medical care and the move towards 'best practices'influence those needs? What are patient expectations regarding who provides their care? (3)Physicians' Roles. How are roles and responsibilities for patient care shared between primarycare providers and the array of different specialists? Are these appropriate roles given the healthsystem goals of efficiency and quality? How does the scope of practice for physicians differ and isthis anticipated to change? ìVhat rolcs could and should be shared with non-physician providers,such as advanced practice nurses?This report provides insight into some of the supply-side considerations listed above. Requestedby the Postgraduate Medical Education Advisory Committee of 8.C., this descriptive study wasdesigned to examine the supply and distribution of GPÆPs and different types of specialistphysicians ¿rcross a variety of geographies in B.C. during the period 1991192-1996197. The studyalso examined patterns of entry to and exit from the province and its regions, differences inphysician scope of practice, and age-related changes in physicians' practices over time. While thestudy intends to provide a comprehensive 'snapshot' of physician supply over this period, it doesnot examine other key issues mentioned above. Most importantly, the study does not considerissues relating to population 'need' nor the extent to which health care needs are met with thecurrent complement of physicians. Moreover, while trends in stability and practice intensity weredescribed, it was beyond the scope of this study to predict whether these trends will continue,accelerate, or decelerate in the future. Thus, while the data presented here seek to help policymakers understand the physician supply 'landscape' in 8.C., the report presents only a small sliceof the information required for comprehensive planning of B.C.'s physician workforce andtraining programs. Policy makers at the academic, provincial, regional, or local levels shouldinterpret these findings only in the context of the broader dynamics of workforce planning andhealth services delivery. Where no or little data exist regarding the issues mentioned above,further research is required. The following discussion provides a synthesis of the key issuesaddressed in this report.-tt7 .Health Human Resources Centre for Health Services and Policy ResearchGrowth in Physician Supply Relative to Population GrowthAs a starting point, we found that there was little net change in the overall supply of physicians inB.C from l99ll92 to 1996/97. We estimate that the per capita supply of physicians remainedrelatively stable at about 18 full-time-equivalents per 10,000 B.C. residents in both study years.However, beneath this apparent stabilþ, we found that some significant changes had taken place.During this period, B.C. had a net gain of 810 physicians from the baseline of 6,922 on theoactive' registers n 1991192. However, this relatively large growth in supply was matched byequally rapid growth in the B.C. population, approximately 3Yo per year. When separated intogeneralist and specialist physicians, we found virtually no differences in the rates of growth; thesupply of GPiFPs remained at about l0 FTEs per 10,000 population while specialist supply stayedat about 8 FTEs per 10,000. Thus, there was virtually no change in the relative proportions ofprimary care physicians and specialists (55% and 45Y0, respectiveþ) over the interval.These findings underscore the importance of anticipated population changes in workforceplanning efforts. For instance, accelerations or decelerations in population growth may result insubstantial differences in per capita supply in the face of relatively stable patterns of growth inphysician numbers. Current projections are for the B.C. population to grow to approximately 4.17million by 2001, about a7.2Yo increase in the five year period since 19962?. This is about l.4Voannual gfowth - well below the observed growth in the previous 5 years. If the observed l99l-1996 physician growth pattern continues, the 2001 doctorþopulation ratios would likely increasesubstantially relative to that in 1996. However, if the growth in the number of physicians were tochange, the doctorþopulation ratio would be appreciably modified. It was beyond the scope ofthis study to examine which ¿rmong a number of alternative scenarios is more plausible.While there were only small differences in patterns of growth between GP/FPs and all specialistscombined, there were important differences in growth among RCPSC speciaþ groups. MostRCPSC specialties saw a net increase in the numbers of physicians during this period; however,four specialties saw a net decline (general surgery, otolaryngology, hematology, and orthopedicsurgery). Moreover, when examined in relation to population growth, some specialties increasedwhile others decreased in their per capita supply. The largest declines in per capita supplyoccurred in hematology (-5.3% per year), otolaryngology (-3.7% per year), general surgery(-3.6% per year), medical biochemistry (-2.8% per year), cardiovascular and thoracic surgery(-2.7% per year) and orthopedic surgery ç2.7% per year). Conversely, the largest relative gainswere in endocrinology and metabolism (+10% per year), nuclear medicine (+9% per year),medical oncology (+6.81% per year) and psychiatry (+2.5% per year).FTE/population ratios are presented in this report only to gauge how physician supply changedover the study period. In order to consider appropriateness of these ratios, they should beexamined against the backdrop of region-specific population health needs. Furthermore,sociodemographic environmental, occupational, geographic and other factors should be examinedwhen estimating population health needs. Questions pertaining to physician requirements/demandand population, health needs were beyond the scope ofthis study.zz P.E.O.P.L.E. 24, Population Section, BC STATS, B.C. Ministry of Finance and Corporate Relations.118 .Health Human Resources Centre for Health Services and Policy ResearchGeographic Disparities in Physician Supply and Patterns of GrowthA large portion of this report is devoted to anaþing differences in the regional supply ofphysicians in British Columbia. The distributions of GPIFPs and all specialists combined wereamlyzed at the level of the Health Region. For groups of specialists, we analyze'd the distributionof major RCPSC speciaþ groups for a larger unit of geography, the Health Human ResourcesUnit (HHRU) region. Only a few of the major findings are presented below. Readers areencouraged to review Sections 4.1.2 and 4.1.3 whichprovide a detailed description of regionalgrowth by specialty.For GPiFPs we found large differences in supply among the 20 Health Regions. There wasalmost a two-fold difference between the region with the largest supply, Vancouver (13.4 FTEsper 10,000), and the region with the smallest supply, Peace Liard (7.9 FTEs per 10,000). Theselarge differences suggest important and continuing differences in the supply of physician-deliveredprimary care throughout the province. In general, health regions in the lower mainland andsouthern Vancouver Island had a greater number of FTEs per capita than regions in the interior ornorthern areas ofthe province, despite also having access to much larger supplies of all specialistsand sub-specialists. The appropriateness of disparities in GP/FP supply across regions must beassessed in the context of differences in population health needs for primary care. The ProvincialHealth Officer's Annual Report on the Health of British Columbians (1996) suggests significantdisparities in health status among the regions. More work is required to develop valid and reliableindicators ofthe need for different types of physician services before one can confidently commenton the adequacy of physician and other health workforce supply.All regions (except West Kootenay-Boundary) saw a net increase in both the number ofphysicians and number of FTEs serving their populations during this time period. However, giventhe differential patterns of population growth, only 13 of the 20 regions saw increases in their percapita FTE supply. The changes in the FTE to population ratio ranged from -1.8 FTEs per10,000 in West Kootenay-Boundary to +2.6 FTEs per 10,000 in the Northwest regions.Furthermore, the disparities in the regional supply of GPÆPs decreased during the study period.On the whole, regions with the largest per capita growth of GP/FPs were those with the smallestbaseline supply. Differences in the rates of population growth among regions do not explain thesedifferences. Clearly, an issue important to physician resources planning is to understand how orwhether workforce policies in effect dwing this time influenced these changes. A variety ofphysician recruitment and retention policies were employed during some or all of this time period,some of which may have affected regional disparities in GP/FP supply. These measures includeda variety of community recruitment efforts, the 'Northern and Isolation Allowance Program', the'Subsidized Income Program', the 'Northern and Rural Locum Program' and the so-called'Interim Physician Supply Measures' (IPSM) (Barer, 'Wood, and Schneider, 1999). The latterinitiative, the best known among these policies (and which formed the basis of the PermanentPhysician Supply Measures of 1996), provided financial incentives for locating in geographicareas of defined 'need'. Further reseæch is needed to understand how these policy levers (andother factors) influenced the reduction in regional disparities in the GPIFP distribution during thistime.. 119.Health Human Resources Centre for Health Services and Policy ResearchFor specialists, we found that physician supply in the Vancouver and Capital health regionsgreatly exceeded that in all other health regions. This finding is not surprising and highlights thefact that many specialists act as 'provincial resources' delivering highly specialized care to all B.C.residents. Outside these regions, we also found considerable variability rimong regions suggestingthat specialists in the remainder of the province are coordinated around secondary care centresand regional refenal networks. All health regions (except the Peace Liard region) saw a net gainin the number of specialist FTEs during the study period. As with GPiFPs, diflerential rates ofpopulation growth resulted in an increase in per capita supply in just over one-half the regions.The changes in the specialist FTE to population ratio ranged from a drop of -1.0 FTEs per 10,000to a gain of +1.4 FTEs per 10,000. As with GPlFPs, otr analysis showed that (outside of theVancouver and Capital regions) regions with the smaller 1991 supplies were more likely to gain inper capita supply.For our major groupings of RCPSC specialties (internal medicine, general surgery, pediatrics,obstetrics/gynecology, psychiatry, medical subspecialties, surgical subspecialties, laboratorymedicine and radiology, and 'othero specialists), there were substantial differences in supplyacross the nine HHRU regions. The specialties with the smallest disparities (i.e., between onethird and 3-fold variation among main HHRU regions) included the 'general' specialties ofinternal medicineo general surgery, and laboratory medicine/radiology. These findings suggestthat there was a fairly equitable distribution of these specialists sunounding regional referralcentres (in as much as HHRU regions represent common resource units).At the other end of the spectrun¡ there was greater than a s-fold variation in the supply forpsychiatry and the medical subspecialties. Given that psychiatry can also be considered a'general' specialt¡ this finding may suggest the need for policies to improve the availability ofpsychiatric care in rural regions. Further research is required, however, to examine regionaldisparities in mental health needs. We may be overstating the regional disparities in the deliveryof mental health care, given that other mechanisms exist to deliver psychiatric services to rurallocales (Mental Health Evaluation and Cornmunity Consultation Unit (MIIECCU), 2000). A jointstudy (HHRU, MIIECCU) on the mental health workforce in BC is currently underway.Our anaþis of the geographic distribution of pediatricians is limited as we are not able todistinguish with our data sources 'general' pediatricians from pediatric subspecialists. Given thislimitation, it is not surprising to find a relatively large supply of pediatricians in Vancouver, thesite of the B.C. Children's Hospital. If one excludes this region (and the North region which hadno permanent pediatricians in either study year), the distribution of pediatricians appears fairlyequitable across the remaining HHRU regions (about a two-fold variation).Over the study period, we found that supply increased fairly consistently across regions for somespecialties, declined fairly consistently for others and was mixed for the remainder. Generalsurgery saw the most consistent declines across regions, decreasing in per capita supply in 8 of the9 HHRU regions. However, the declines \ryere greater in some regions than others leading to moreoverall disparities. Psychiatry saw the most consistent increases across regions (8 regions) whichhad the effect of reducing disparities across regions. For many of these speciaþ groups, regionsexperienced the net loss or gain of only a few specialist FTEs. These small changes in physiciant20.Health Human Resources Centre for Health Services and Policy Researchnumbers often translated into large relative changes. This finding underscores the large influenceon the regional supply of particular specialist services that the decisions of only one or twophysicians can have. Furthermore, given that anecdotal accounts of recruitment and retention ofspecialists in these regions are often portrayed to be difficult and unpredictable, other strategiesmay be required to 'stabilize' specialist physician supply. These strategies would vary by speciaþand may include (but are not limited to) mobile 'out-reach' clinics and tele-health. Also, sincethere is often a fixed supply of available specialists (unless they are recruiting from abroad),regions may unnecessarily ocompete' in trying to attract the same physicians. It is obvious fromthis analysis that efforts by one region can have large relative impacts on another. In addition, ouranaþes underscore the need for coordinated health human resource planning rrmong regions(Health Association of B.C. and Council ofUniversity Teaching Hospitals, 1999).Practice Stability, Scope of Practice and Life-Gycle Activity PatternsIn addition to describing how physician supply changed during the study period, this study soughtto opeel the onion' to expose the dynamics underlying the changes in the numbers and activþ ofphysicians on the CPSBC 'active' registers. (See Figure 5.1.) In Sections 4.3 and 4.4, weexamined the principal drivers of this change: 'inflow' to and ooutflow' of physicians from'active'practice, and changes in practice intensity ûom the perspective of the professional olife cycle'.The analyses revealed a large net gain in physician numbers to 'active' practice during the studyperiod. This net gain was a product of significant numbers of physicians who exited theregistration rolls (15% of physicians registered in 1991) and an even a larger group of newentrants into practice (25% of those registered in 1996). Only about two-thirds of B.C.'s oactive'physicians from 1991 to 1996 were registered over the entire 5 year period. It was beyond thescope of this study to understand whether these trends will remain constant, accelerate, ordecelerate. In order to accurately forecast these patterns, further research is needed to on thereasons underlying entries and exits (including re-entry into training programs, shifts to non-clinical practice, migration to practice outside the province, retirement, and deatþ from the B.C.registers.A major focus of this study was to examine the age characteristics of B.C.'s physician supply andinvestigate the relationship between physician age and a variety of practice parameters. Inl99l/92, the mean age of B.C. physicians was 45.4 years while in 1996197 it was 46.2 years,signifying a modest aging of the physician population over this period. As expected, there werelarge differences in the age characteristics of GP/FPs versus specialistso with 35% and2Do/o aged<40 years and 8% and 15% aged 60+, years respectively. However, substantial differencesexisted in the age characteristics of individual specialties. Specialties which had more than}09/o oftheir physician FTEs aged 60 years or older included community medicine, dermatology, medicalmicrobiologyo nuclear medicine, psychiatry and general surgery. Given the large differences in agebetween GPiFPs and specialists and the appreciable variation among speciaþ groups, we foundlarge and important differences in the physician regional age structures which were in large part areflection of these factors.Specific life-cycle practice activity patterns by sex, geographic location and place of medicall2t.Health Human Resourceç Centre for Health Services and Policy Researchschool graduation were also delineated. This analysis indicated that there is a general pattern ofearly growth in intensity of practices, followed by a period of relative stability and eventually aperiod of tapering practice. However, while the overall trend appeared consistent, there werediscernible differences in the life cycle activity patterns between male and female physicians(especiaþ with regard to mean income) and by physicians' geographic location.In addition to changes in practice intensity over the life cycle (as measured changes in meanincomes), we also found that physician age was associated in important ways with physicianinflow and outflow and the scope of physicians' practices. Overall, younger physicians were lesslikely to migrate offthe CPSBC registers over the study period. They also tended to have a morevaried practice scope than did middle-aged physicians, as indicated by our anaþis of theHerfindahl index (Section 4.2). Conversely, older physicians were more likely to drop theirCPSBC registration status (not surprisingþ) and delivered a significantly narower scope ofservices than did their middle aged colleagues.When the age-related influences on stability, practice intensity, and scope of practice are examinedtogether, it is apparent that specialties with younger physicians will likely gain in future FTEphysician supply while those with older ones will see a substantial loss. Moreover, given theregional differences in the age structure of the physician population, these changes are likely tohave a larger impact on some regions than others. These complex regional differences aredetailed in the report. The implications of age on future physician supply are dependent, however,on the generalization of these past trends in age-related practice pattems to future periods. Wehave described in great detail the age characteristics of physicians by specialty and region in thesections discussing various aspects of supply.Location of Undergraduate Medical Education and B.G.'s Physician SupplyAnother major goal of this report was to describe the training characteristics of B.C.'s physiciansupply.28 Particular attention was paid to the contribution of B.C.'s undergraduate medicalprogftim to the supply of physicians over the study period. Overall, about one-quarter ofphysicians practicing in the province n 1996/97 received their medical degree from U.B.C.Graduates from the other 15 Canadian medical schools accounted for about one-halt while theremaining one-quarter obtained their medical degrees from schools outside Canada. Thecontribution of each of the other Canadian schools to B.C.'s physician population appears to beboth a factor of the numbers produced and proximity to B.C. In sunL the medical schools ofOntario and Alberta graduated almost one-third of all physicians practicing in the province.GPIFPs were almost twice as likely to have obtained their undergraduate medical degree fromU.B.C than were specialists, although we found wide variability in the contribution of U.B.C¿rmong the speciaþ groups.Over the study period, we found a modest increase in the contribution of the U.B.C.undergraduate medical education program to B.C.'s physician supply. There was a net increase28 Unfortunately because data on post-graduate training characteristics of B.C. physicians were unavailable in time for thisreport, descriptive analyses regarding post-graduate training are not included in this report. These characteristics will bepresented in a separate filture report.. 122.Health Human Resources Centre for Health Services and Policy Researchof l% in proportion of physicians who obtained their undergraduate medical training ûom U.B.C.between l99ll92 to 1996197. The reason behind this increase was the net flow: a greaterproportion of new entrants (25%) were trained at U.B.C. compared to exiting physicians(15.7o/o). However, the proportion of newly trained physicians from U.B.C. was no differentfrom those in 'stable' practice (25%). In addition, new entrants \üere more likely to come fromother Canadian schools and less likely to come from foreign schools than were the cohort ofphysicians entering practice in earlier years.There was also some variability in practice characteristics relating to the place of undergraduatemedical school. With respect to location, GPÆPs trained at U.B.C. were more likely to belocated in Health Regions in the lower mainland and generally less likely to be located in thenorthern and interior sections of the province. With respect to the practice scope of GP/FPs,physicians trained at U.B.C. appeared to have a significantly wider scope of practice (i.e., billed agreater number of fee items and had more balance across fee-item domains) than those trainedelsewhere.Many of the findings in this report reveal how decisions regarding workforce planning in one areamay have implications for another; the analyses presented here attempt to show which specialtieshave seen recent growth/declines in supply and which have a complement of older physicians whoare approaching retirement. Given that some types of specialties are in small numbers,recruitment of particular types to one region may have serious implications for others. Physiciansupply should be considered across the complement of regions so that these trade-offs are madeexplicit and workforce policies coordinated. Furthermore, academic training programs can assistby desþning their programs to best meet the changing needs of physicians practicing in differentlocales. In addition, they can assist by adjusting residency program numbers to produce therequired mix of specialists. Finally, the report highlights the degree to which planning forphysiciars in B.C. is constrained by the unrestricted migration patterns of physicians from otherprovinces. As such, training and licensing policies in effect in other provinces have implicationsfor B.C.'s physician supply. Thus, physician training policies in B.C. and elsewhere in Canadashould be considered in the national context to allow rational health workforce (and healthservices) planning at the Health Region level..123 .Health Human Resources Centre for Health Services and Policy Research6. ReferencesAdelman, MA 1969). "Comment on the 'H' concentration measure as a numbers-equivalent".Review of Economics and Statistics,5l:99.Association of Canadian Medical Colleges (1998) Canadian Medícal Educator Statistics,Ottawa, Ontario: Association of Canadian Medical Colleges, 17.Barkun, H (1996) '?hysician V/orkforce Policy in Canada," in Osterweis, M., et al. (eds.), TheU.S. Health W'orkforce: Power, Politics, and Policy.. Association of Academic Health Centers,Washington. 69:.77.Barer ML, L. Wood, D.G. Schneider (1999) "Toward Improved Access to Medical Services forRelatively Underserved Populations: Canadian Approacheso Foreign Lessons". HHRU 99:3Centre for Health Services & Policy Research, Vancouver, B.C.: The University of BritishColumbia.Baumgardner, JR and WD Marder (1991) "Specialization Among Obstetrician/Gynecologists:Another Dimension of Physician Supply''. Medícal Care,zg (3),272:282.British Columbia Ministry ofHealth and Ministry Responsible for Seniors (1997) A Report on theHealth of British Columbians 1996. Government of British Columbia.British Columbia Ministry of Health and Ministry Responsible for Seniors (1997) PermanentPhysician Supply Plan. Government of British Columbia.Canadian Institute for Health Information (1997) "Supply and Distribution ofPhysicians, Canada.Selected Years 1961 to 1995-. Southam Medical Database, Canadian Institute for HealthInformation.Canadian Institute for Health Information (1998) *Full-Time Equivalent Physicians Report -Canada, 1989190 to 1993194-. Southam Medícal Database, Canadian Institute for HealthInformation.Canadian Institute for Health Information (1999) "Supply, Distribution and Migration ofCanadian Physicians, 1998'. Southam Medìcal Database, Canadian Institute for HealthInformation.Charnberlayne R., B. Green, ML Barer, C Hertzman, WJ Lawrence and SB Sheps (1996)Creating a Population-Based Linked Health Database: A New Resource for Health ServicesResearch. Health Information Development Unit, Centre for Health Services and PolicyResearch, University of British Columbia.124-Health Human Resqurces Csntre for Health Services and Policy ResearchChiasson, PM and PD Roy (1995) *Role of the general practitioner in the delivery of surgical andanesthesia services in rural Carp¿dt'. Canadian Medicql Association Journal, 153(10);1447:1462.College of Physicians and Surgeons of British Columbia (1999) Polícy Manual (andamendments).Department of Pediatrics, British Columbia Children's Hospital (1995) University of BritishColumbia. Pediatrician Resource Plan.Evans RG (1993) 'New bottles, same old wine: Right and wrong on physician supply''.C anadi an M e dic al A s s o c i at i on Journal, IIPRU 98 : 8R.Hanvelt R, R. Reid, D.G. Schneider, N. Pagliccia, K. McGrail, M.L. Barer, R.G. Evans (2000)*The Effects of Rationed Access Days (RADs) on Physician Fee-for-service Payments in B.C.'HIIRU 00:1, Centre for Health Services & Policy Research, Vancouver, B.C.: The University ofBritish Columbia.Health Association of B.C./Council of University Teaching Hospitals (1999) TowardsCoordinated Health Human Resources Planning in B.C. Discussion Document.HHRU 98:1 (1998) *Rollcall 97. A Status Report of Selected Health Personnel in the Provinceof British Columbia". Centre for Health Services & Policy Research, Vancouver, B.C.: TheUniversity of British Columbia.Iglesias, S, J. Strachan, G. Ko and LC Jones (1999) "Advanced skills by Canada's Ruralphysicians" . Canadion Journal of Rural Me di cine, 4(4\; 227 :23 I .Kazaqiian A, P. Wong F*g, L. Wood (1993) "Fee Practice Medical Services Expenditures PerCapita, and Full-Time-Equivalent Physicians in British Columbia, 199l-1992". HHRU 93:7Centre for Health Services & Policy Research, Vancouver, B.C.: The University of BritishColumbia.Kaz:rniian A and N. Pagliccia (1996) "Key Factors in Physicians' Choice of Practice Location -Level of Satisfaction and Spousal Influenceo'. HHRU 96:1R Centre for Health Services & PolicyResearch, Vancouver, B.C.: The Universþ ofBritish Columbia.Maynard A and A Walker (1997) The Plrysician Worfforce in the UK: Issues, Prospects andPolícies; London, the Nuffield Trust.Medical Services Plan, British Columbia Ministry of Health and Ministry Responsible for Seniors.Payment Schedule. Government of British Columbia 1997.Mental Health Evaluation and Community Consultation Unit. Consultation Services.http ://www.mheccu.ubc. cal.t25 .Health Human Resources Centre for Health Services and Polic)¡ ResearchRivo M.L. and DA Kindig (1996) "A Report Card on the Physician V/orkforce in the US",N Engl J Med,334:892-896.Romano PS and HS Luft (1992) "Getting the Most Out of Messy Data: Problems andApproaches for Dealing with Large Administrative Data Sets", in Grady ML and Schwartz FIA,Medical Effectíveness Research Data Methods, AHCPR Publication92-0056,57:75.Roos, L, NP Roos SM Cageorge and JP Nichol (19S3) "How Good are the Data?: Reliability ofOne Health Care Data Bank' Medícal Care,20(3); 266..276.Royal College of Physicians and Surgeons of Canada (1998) Specialized Physician Resources forRemote/Rural Regions and SpecialNeeds in Canada" October 24,1997 Workshop Proceedings.V/einer J, NR Powe, D. Steinwachs and G Dent (1990) "Applying Insurance Claims Data toAssess Quality of Care: A Compilation of Potential Indicatorc" Quality Review Bulletin Journalof Quality A s surance, I 6(12); 424:438..126 .Health Human Resources Centre for Health Services and Policy Research7. AppendicesAppendix A: Population Density of Local Health Areas (LHAs) in 8.C., 1996-HA^fGa(km2l Pop'n'Pop'nDons¡û,¡"JlbånrÂr /anc,ouverVe$rWestm¡nster3umabySreater Viclorialichmondì¡¡rc-v1321591113't241C?546,21151,591187,086æô,s38155,005aqc Rtq4,1U.ùS3,500.382,066.091,834.381,252.90l.(x)8_o¡¡Sem¡-Irban*iiJgltaSeanich-angl€y\¡orth Vancouver\bbotsfordloquitlâm,Vest Vanc.Bowen lglandlo,v¡chan{ana¡molh¡ll¡wackvlaple R¡dgelentral Okanaganluel¡cum1691553243994147282357381,2981,3061,4572,922840gÐ,n259,429107,392127,8û110,338178,306ß,97251,0S689,58268,88372,653141,90737,278527.91383.81331.8(320.51266.8¡24.5.01208.3S69.269.0C52.7a49.8848.5€44.3€Rural*r* Gulf lslendgArmstrong-Spallumche€nLadysm¡thCourtenaySookePentic'tonMissionfrailSummerlandSouthøn OkanaganYernonSalmon ArmCasll€garSunshine CoaslKamloops0ranbrookNelson{lberni:nderbyPowdl R¡verSrestonGrand Forks)r¡nce Ruperl3452614'l'l,t,7531,7ß1,5591,4331JÆ6241,3145,5833,1141,W3,783'16,3184,4254,7966,6261,8615,2æ3,7972,6855 Sts13,75'l9,57816,17757,O2752,U33e,75436,17621,27711,40118,00157,47n,74813,57525,833100,85025,27725,U632,9067,27920,30512,8989,119l0 30039.8;36.d36.4'32.5iæ.8Í25.4125.2¿18.6(18.2',13.7(10.3lí9.8ì6.9t6.8í6.1r5.7'5.2:,4.9i3.9'3.8{3.413.4(a,estimates by Population istry ofProjection Model - #24. All figures are as ofJuty I, 1996'r Calculated as persons per square kilometer.***Geographic locations defined as follows: 'Urban' > 1,000 persons per square kilometer; 'Semlurban' 40-1,000 persons per square kilometer;and 'Rural' <40 persons per square kilometer..HAAfoa(km2) Pop'n'Pop'nDenslhf*Rur¿l(cont )campþell RiverHo re SoundLeke Cow¡chanKimberleyFernioKererneosSmithersAgessiz-Har¡9onMerritt'fefiæHope100 Milo HousePrince GeorgeUpper SkeenaQuesndPeace River SouthPrincetonRevdstok6Ketllo VdleySorrth Car¡booVancouver lsland NorthWindermerôArrow LåkesK¡timalLlllooetVancouver lsland WelCar¡booChilcotinQue€n CharlottoGoldenKoolenây LakePeace River NorthNechakoNisga'aNorth ThompsonBums l.akeCentrâl CoâstB€lla Coola VdleyForl NelsonSnor/ CounlryTelegraph CreokStlkine13,z,¡,'l9,1712,3974,3378,0582,4799,8354,0866,59113,2875,29110,95676,0874,ß,123,72227,æ24,8199,3034,U59,48119,80010,9787,U219,2717,4n5,49644,ß39,68613,3556,53868,37242,5095,053't2,u525,77610,14025,N889,¿13527,74623,71913233740,57927,1856,4609,02015,8494,53917,8967,42911,76623,2578,519't5,477103,6255,74726,39629,5135,0618,9883,7æ7,71215,5388,ß25,24913,0194,9383,60028,2775,8417,5773,62128,95117,8022,O715,1247,6851,U23,2026,2571,U16301.3203.0¡2.%2.742.081.971.831.82't.821.791.751.611.411.361.291.111.O71.050.970.860.810.78o.77o.710.680.660.650.640.600.570.55o.420.420.410.410.300.180.130.070.040.030.01lotâl {,ll LHAs 88,49( 3.33 1.240 37.6tions, are from the P.E.O.P.L.E..127 .Health Human Resources Centre for Health Services and Policy ReseæchAppendix B: Validation of Medical Services PIan Fee-item 'Domains'This Appendix is intended to validate the assignment of MSP fee-items to 'specialty' domains.The proportion of a physicians billings across these domains was used to examine differences inthe scope of practice provided by physicians (Aim II). Since fee-iterns ¿re placed into specialty'ownership' categories based on the specialty assumed to be 'most responsible', our validation ofthese groupings assessed the proportion of claims made by physicians assumed to oown' thatcode. We also paid particular attention to the 'other' fee-items that were assigned to no specialtygroup.Of the 2,918 fee-items that were billed in 1996197 (representing the 53,302,669 services providedthrough the MSP during the 1996/97 fiscal year), 29 items (representing 1,222,840 of thoseservices) were excluded because they were non-clinical in nature or were paid by third-partyinsurers. These fee-items included: night surcharges, tray fees, travel expenses, no-chargereferrals, and claims paid by the \Morker's Compensation Board (WCB) and InsuranceCorporation of British Columbia (ICBC). Using the MSP grouping algorithm, the remaining2,889 fee-items were clustered to I GP/FP, 21 specialist, and I oother' domain. The 'other'domain contained a total of 255 fee-items and represented approximately 49% of claims int996197.When we looked at which physicians made claims for these oother' services, we found that manyfee-items were claimed principaþ (and sometimes entirely) by physicians of a single specialtytype. For instance, although 'eye encleation' was classified as an 'other' fee-itenU 100% ofbillings for this item were submitted by ophthalrnologists. For this reason, we opted to re-classifrthe 'domain' of these fee-items billed almost exclusively by one specialist group. We recodedoother' fee-items only if they met both of the following explicit criteria: (a) more than 80% ofclaims were made by physicians in one specialty group; and, (b) two oexperts' (l generalpractitioner and I researcher trained as a nurse) agreed that this specialty group could plausibly beconsidered 'most responsible' for the fee-item. The table below provides some examples of re-classified fee-items. This process led to the reassignment of 173 'other' items to various domains(representing 2.2% of all services billed n 1996197). Eighty-two fee-items were retained in the'other' category because less than 80% of respective services were claimed by one specialtygroup and/or the oexperts' did not agree on a single assignment.For the remaining 2,634 fee-items assigned to a single domain (and that had any billings in1996197), we found that they were in large part billed by the physicians who 'owned' the item(i.e., 'in-domain' specialists).2e Across all these items, the mean percent of services billed by 'in-domain' physicians was 90% (SD 21). Moreover, no large differences in this distribution wereapparent when the items were stratified for GP/FPs and specialists separately. For the 55 fee-items in the GPÆP fee-item domain (that had any billings tî 1996197), the mean percent ofservices provided by GP/FPs was 86% (SD 29). For the 2,579 fee-items grouped in the specialist2e For fee-items assigned to multiple specialties (423), the proportions billed by each ofthe specified specialties were totaledand this proportion was defined as that billed by the 'indomain' specialty. An example of an item assigned to multipledomains is 'ganglia (wrist) removal' assigned to general surgery, orthopedics, and plastic surgery. '[he proportion the claimsfor this fee-item billed by these specialists to g¡ve the 'indomain' proportion..128 .Health Human Resources Centre for Health $ervices and Policy Researchdomains, the mean was glYo (SD 2l). In fact, only 349 fee-items (13.4%) were billed more than20Yo of the time by 'out-of-domain' physicians (representing only 7.lYo of all services).Examples ofthe Re-assignment of 'Othero Fee-itemsFee-item Descrþion00050 Enucleation of Eye00775 HydrotubationTransuretlualureterorenoscopyoExpert' opinion % Billed by Spec.Ophthalmology 100%Obstetrics &.94o/oGynecologyUrology 100%Cardiovascular 97%SurgeryInternal Medicine 97%Re-assignmentOphthalrnologyObstetricsGynecologyUrologyCardiovascularSurgerylnternal Medicine12 Selectiveangiocardiogram33 Spirometry withFVC,FEVr, FVCÆEVr ratioThus, these empirical findings suggest that the MSP fee-item'domains' have substantial validity ingrouping fee-items with respect to the 'most responsible' specialties. For over 85% of items,more than four-fifths of the services were provided by 'in-domain' physicians. Based on thesefindings, we decided not to reassign any fee-items (except for some fee-items in the 'other'domain). The fee-items with the highest likelihood of errors in domain assignment (i.e., thoseitems where more than 20o/o of services were provided by 'out-oÊdomain' physicians wereinfrequently used. In the 'other' fee-item domain, we reassigned 67Yo of the items to anotherspecialty domain..129 .Appendix C: Estimates of Full-time-Equivalence for FY 1996'97** FTEs include estimate based on Service Ageement Payments as proportion of4Oth percentile ofFee for Serviceand Salary and Sessional Payments for that specialty.+¡r1 [iI'Es include estimale based on Service Agreement Payments as proportion of 50th percent¡le of Fee for Serviceand Salary and Sessional Payments for that specialty. These estimates used in Table 4. I .*+**f.TEs include estimate based on Service Agreement Payments as proportion of60th percentile ofFee for Serviceand Salary and Sessional Payments for that specialty.#FTEs include estimate based on number ofcontracted FTEs spccified on Service Agreements. 'NS' refers to'not specified'.Soecialtv No. MDsFTE EstimatesFTE FTE FTE FTE FTE+MOH(No SA) +40%SA +50oloSA +60%3A Contracted* ** *** **** FTEs #ieneral / Family PracticeJardiologyntornal Medicine)ediatricslsychiatrySeneral SurgeryJbstetrics & Gynecolos,y4,3355',l3582254881891823,772.5353.23300.09l5L33440.67150.87153.893,815.5153.89322.53220.44449.38154.461 65.1 43,809.9253.80319.71207.14448. tCr54.08163.413,805.8J53.76317.13198.91447.31153.71162.353809.3:NS310.8f200.3i448.51NS167.8!I otal (All JDecraltles) 7,732 6-796.81 6.955.5i 6.930.42 6,913.4tr FTEs based on onlv on and Sessional paym€nts (i.e., no service agreeement l-'l Es es imated).130Health Human Resources Centre for Health Services and Policy ResearchAppendix D: rscope of Practicer Multivariate Linear Regression Model, excluding GP/FPswith Salary or Sessional Payments (n=3,359)lovariatesLoeHr '*"Íi',!:;ï1"' Loe uNltEstimate /SÐ p-valuelEstimate 15ð) p-valuelEstimate /.SE) p-valurlntercept -0.287 0.000r0.015t.6r2 0.00010.0221-1.899 0.000t0.022<40yn4l-65yrsl66+yß-0.042 0.000r0.0090.003 0.89070.0210.078 0.000 r0.0t28-0.226 0.000t0.0308-0.119 0.00010.0r 30.230 0.0001n n?llex MalelFemalr -0.t24 0.00010.009-0. r95 0.00010.0138o.o7r o.oãor0.0t4Vledical School UBC'Other CanNon-Can0.000t0.00010.0300.0080.0390.0090.010 0.37950.0t t7,0.011 0.42830.0t 380.0200.0r20.0500 0t40.08980.0003F'ull-time- <0.JEquivalency(FTE)*** 0.5-1.2t>1.20.072 0.00010.0t 3-0.009 0.25850.008-0.128 0.00010.0r9r0.044 0.000300t220.200 0.00010.0t9-0.054 0.0001n nt)Geographic UrbanlLocation** Semi-urbarRura-0.043 0.00010.009-0.059 0.00010.0t s0.037 0.00780.0t 390.101 0.00010.02r4-0.õso o.oãor0.014-0.ró0 0.000r0.021;P/FP L¡v\vailability#MediumtHigl-0.106 0.00060.0310.0t3 0.2499O.OI I-0.057 0.2t270.04s3-0.048 0.0040.0165-0.049 0.27990.04s0.061 0.00020.0t7tpecialist Lowflvailability$ Higl 0.026 0.02220.01I-0.0 r 5 0.3780.01640.01610.0400.016lnteraction Rural*<40 ynfermsRural*66+ YnRural*Femal0.029 0.06710.0r 60.053 0.18530.0400.038 0.03390.0t8-0.036 0.t2t60.0230.272 0.00010.0590.037 0.16450.0270.065 0.00560.023-0.220 0.00020.0s90.002 0.936r0.027R-scuared 0.t29 0.255 0.306*Reference category**Bæed on population densþ of L,ocal Health Areas (LHAs)** FTEs calculated with fee-for-ærvice and salary & sessional payments for FY 1996/97. FTEcalcuations based on Health Canada formula#Based on 1996197 supply characteristics of physician's Health Region (see section 4.1). 'High'ratios include health regions > 1.66 FTEs per 1,000,'medium'supply includes regions atl.29-1.66FTEs per 1,000 and'low'supply includes regions <1.29 FTEs per 1,000.$High specialist supply is defined as Health Regions with specialist/GP ratios >0.65.-131 .Health Human Resources Centre for Health Services and Policy ResearchAppendix E: Map of British Columbia Health RegionsBritish ColumbiaHealth RegionsHHßU lftâllh ßegion**Va¡ro¡'ær 8¿ DisfrictCapitalFraser ValleyOkanaganSouth-EastIsl¡¡d CoastCe¡rtrelNorth Centr¡lNorthfugon¡ have been arbitrarilyby the Health Human Resor¡:cesnit, U.B.C. in o¡der to provideient b¿se for analysis of sm¿lllergroupJ.u- ,ttt.úvJ'tr,tHEALTH REGIONS1. Esst Kootenay2. West Koolenay-Bounda¡y3. North Okarngan4. South Okanngan Similkameen5. Thompson6. Froser Valley?. SouthFnserValley8. Simon Fraser9. Coast Gaúaldi10. Centnl Va¡couver Isla¡dPrcpa:eilby: Plårrrrirg e Ev¿l¡¿tio¡¡ Divisiorç MinÈlry of Health ard Ministry Responsùh for Se¡rio¡sBou¡d¡¡y Sor¡¡ce: B C STATS, Ministry of Finance ard Corporate Rel¿tio¡uI l. Upper IslandJCentrol Coast12. Ca¡iboo13. NorthWest14. Peæe Liard15. Northern Inlerior16. Vo¡couærl?. Burmby18. NorthSho¡e19. Richnond20. CapitalNorth CentralSoutlr-EastSouthern a¡d Central Va¡co¡'ær Isl¡ndVa¡co¡'¡er ¿¡d Lor¡ær Meinland.t32.Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia429 -Zl94Health Sciences MallVancouver, B.C. V6T lZ3Telcphone: (604) 822-4810Fax: (604) 822-5690Sotne of the early reports may not be available for distibutionHHRU 00:7 Nursing Workforce Study Volume V Changes in the Nursing Workforce and PolicyImplications. April 2000. (4. Kazanjian). ISBN l-894066-86-3.HHRU 00:6 Nursing Workforce Study Volume IV Nursing Workforce Deployment: A Survey ofEmployers. April2000. (4. Kazanjian, S. Rahim-Jamal, A. 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Schneider, N. Pagliccia, K. McGrail, M.L. Barer,R.G. Evans). ISBN l-894066-92-8.HHRU 99:6 Immigration and Emigration of Physicians to/fi'om Canada. December 1999. (M.L. Barer,William A. Webber). ISBN l-894066-93-6.HHRU 99:5 Intprovittg Access to Needed Medical Services ín Rural and Remote Canadian Communities:Recruitment and Retention Revisited. June 1999. (M.L. Barer, Greg L. Stoddart). ISBN l-894066-94-4.HHRU 99:4 INVENTORY UPDATE 98. A Regional Analysis of Health Personnel in the Province ofBritishColumbia. June 1999. ISBN l-894066-95-2. ISSN l196-9911.HHRU 99:3 Toward Improved Access to Medical Services for Relatively Undersened Populations:Canadian Approaches, Foreign l¿ssons. May 1999. (M.L. Barer, L. Wood, D.G.Schneider). ISBN l-894066-95-2.HHRU 99:2 ROLLCALL UPDATE 98. A Status Report of Selected Health Personttel in the Province ofBritish Columbiq. May 1999. ISBN l-894066-97-9. ISSN 0828-9360.HHRU 99:1 Regional Health Human Resources Planning & Managentent: Policies, Issues anclInformation Requirements. January 1999. (A. Kazanjian, M. Hebert, L. Wood, S. Rahim-Jamal). ISBN l-894966-98-7.HHRU 98:4 Proceedings of the Second Trilateral Physician Workforce Conference. November 14-16,1997, Vancouver, B.C. (M.L. Barer, L.Wood, eds.). ISBN l-894066-99-5.HHRU 98:3 PLACE OF GRADUATION 97. A Status Report on Place of Graduationfor Selected HeatthPersonnel in the Province of British Columbia. August 1998. (K. Kerluke, A. MacDonald,L. Wood). ISBN l-896459-99-4. ISSN 1200-0701.HHRU 98:2 INVENTORY 97. A Regional Analysis of Health Personnel in the Province of BritishColurubia. June 1998. ISSNI-896459-98-6. ISBN l-896459-98-6.HHRU 98:1 ROLLCALL 97. A Status Report of Selected Health Personnel in the Province of BritishColumbia. July 1998. ISBN l-896459-95-1. ISSN0707-3542.HHRU 97:4 COMMON PROBLEMS, DIFFERENT SOLUTIONS: Learningfro¡n InternationalApproaches to Improvirtg Medical Services Access for Underserved Populations. October1997. rSBN r-896459-96-X.HHRU 97:3 INVENTORY UPDATE 96. A Regional Analysis of Heatth Personnel in the Province ofBritishColumbía. August 1997. ISBN I-896459-94-3. ISSN 1196-9911.HHRU 97:2 ROLLCALL UPDATE 96. A Status Report of Selected Health Personnel in the Province ofBritish Columbia. August 1997. ISBN 1-896459-95-1. ISSN 0828-9360.HHRU 97:1 PLACE OF GRADUATION 95. A Status Report on Place of Graduationfor Selected HeahhPersorurcl in tlrc Province of British Coluntbia. January 1997.. (K. Kerluke, A. MacDonald,L. Wood). ISBN l-896459-93-5. ISSN 1200-0701.HHRU 96:5 INVENTORY 95. A Regional Analysis of Health Personnel in the Province of BritishColumbia. December 1996. ISBN l-896459-92-7.HHRU 96:4 PRODUCTION 95. A Status Report on the Production of Health Personnel in the Province ofBritishColumbia. October 1994. ISBN 1-896459-91-9. ISSN 1199-4010.HHRU 96:3 ROLLCALL 95. A Status Report of Health Personnel in the Provittce of British Columbia.October 1994. ISBN l-896459-90-0. ISSN 0707-3542.HHRU 96:2R ldentifyirtg the Population of Health Managers in one Canqdian Province: A Two-StageApproach. April 1996. (A. Kazanjian, N. Pagliccia). ISBN t-896459-89-7.HHRU 96:1R Key Factors in Physicians' Choice of Practice Incation - Level of Satisfaction and SpousalInfluence. March 1996. (4. Kazanjian, N. Pagliccia). ISBN l-896459-88-9.HHRU 95:5R The Impact of Professional and Personal Satisfaction On Perceptiotts of Rural and [Jrban:Some Analytic Evidence. May 1995. (N. Pagliccia, L. Apland, A. Kazanjian). ISBN l-896459-87-0.HHRU 95:4 PRODUCTION UPDATE 94. A Status Report on the Production of Selected HealthPersonnel in the Province of British Columbia. May 1995. ISBN l-896459-86-2.ISSN ll9-4010.HHRU 95:3 Health Persoatel Modelling 1975-1994: An Updated Bibliography with Abstracts. March1995. (N. Pagliccia, K. McGrail, L. Wood). ISBN l-896459-85-4.HHRU 95:2 INVENTORY UPDATE 94. A Regional Analysis of Health Personnel in the Province ofBritisltColumbia, March 1995. ISBN 1-896459-84-6. ISSN l196-9911.HHRU 95:1 ROLLCALL UPDATE 94. A Status Report of Selected Health Persorutel in the Province ofBritish Colu¡nbia. March 1995. ISBN l-896459-83-8. ISSN 0828-9360.HHRU 94:5 PLACE OF GRADUATION 93. A Stqtus Report on Place of Graduationfor Selected HealthPersonnel in the Province of British Columbia. October 1994. (K. McGrail, K. Kerluke, A.MacDonald, L. Wood). ISBN l-896459-82-X. ISSN 1200-0701.HHRU 94:4 PRODUCTION 93. A Sturus Report on the Production of Heahh Personnel in the Province ofBritishColumbiq. August 1994. ISBN l-896459-81-1. ISSN ll99-4010.HHRU 94:3 ROLLCALL 93. A Status Report of Health Personnel in the Province of British Columbia.May 1994. ISBN l-896459-80-3. ISSN 0707-3542.HHRU 94:2 Interpreting the Historical Dfficult+o-Fill Vacancy Trends - A Mulitvariate Analysis. Aprrl1994. (N. Pagliccia, A. Kazanjian, L. Wood). ISBN l-896459-79-X.HHRU 94:1 Social Work Personnel in British Columbia: Defining the population and describingdeployntent patte,'ns in 1993. January 1994. (J. Finch, A. Kazanjian, L. Wood).ISBN l-896459-78-1.HHRU 93:8R Health Care Managers in British Columbiq Pqrt I: Who Manages Our System?, Part II:Exploring Future Directions. December 1993. (4. Kazanjian, N. Pagliccia).ISBN l-896459-77-3.HHRU 93:7 Fee Practice Medical Services Expenditures Per Capita, and Full-Time-EquivalentPlrysicians in British Columbia, I99l-1992. December 1993. (4, Kazanjian, P. Wong Fung,L. Wood). ISBN l-896459-76-5.HHRU 93:6 Social Workers in Health Care in British Coluntbiq, i,99i,. July 1993. (L.8. Apland,L. Wood, A. Kazanjian). ISBN l-896459-75-7.HHRU 93:5 Dfficult-to-Fill Vacancies in Selected Health Care Disciplines in British Columbia, 1980-1991. June 1993. (A. MacDonald, A. Kazanjian). ISBN L-896459-74-9.HHRU 93:4 ROLLCALL UPDATE 92. A Status Report of Selected Health Personnel in the Province ofBritish Columbia. April 1993. ISBN l-896459-73-0. ISSN 0828-9360.HHRU 93:3 Nursing Resources in British Columbia: Trends, Tensions and Tentative Solutions. February1993. (4. Kazanjian, L. Wood). ISBN l-896459-72-2, Also listed as Health PolicyResearch Unit Report HPRU 93:5D.HHRU 93:2 Nursing Resources Models: Part I: Synthesis of the Literature and a Modelling Strategy for8.C.. February 1993. (N. Pagliccia, L. Wood, A. Kazanjian). ISBN l-896459-7I-4.HHRU 93:1 Study of Rural Physician Supply: Perceptions of Rural and Urban. January 1993.(N. Pagliccia, L.E. Apland, A. Kazanjian). ISBN l-896459-70-6.HHRU 92:8 Diagnostic Medical Sonographers in British Columbia, i,99i,. December 1992.(L.E, Apland, A. Kazanjian). ISBN l-896459-69-2.HHRU 92:7 Fee Practice Medical Service Expenditures per Capita, and Full-Time-Ecluivalent Physiciansin British Columbia, 1989-i,990. November 1992. (A. Kazanjian, P. Wong Fung, M.L.Barer). ISBN l-896459-68-4.HHRU 92:ó PLACE OF GRADUATION 9i,. A Status Report on Place of Graduationfor Selected HealthPersonnel in the Province of British Columbia. November 1992. (A. MacDonald, K.Kerluke, L.E. Apland, L. Wood). ISBN l-896459-67-6. ISSN 1200-0701.HHRU 92:5R Health "Manpower" Planning or Gender Relations? The Obvious and the Oblique. Junet992. (A. Kazanjian). ISBN l-896459-66-8.HHRU 92:4R A Human Resources Decision Support Model: Nurse Deployment Patterns in One CanadianSystent. November 1992. (A. Kazanjian,I. Pulcins, K. Kerluke). ISBN l-896459-65-X.HHRU 92:3 PRODUCTION 9l. A Status Report on the Production of Heabh Persorutel in the Province ofBritish Columbia. May 1992. ISBN l-896459-64-l,ISSN I194010.HHRU 92:2 ROLLCALL 9I. A Status Report of Health Personnel in the Province of British Columbia.May 1992. ISBN l-896459-63-3. ISSN0707-3542.HHRU 92:1 Inþrmation Needed to Support Health Human Resources Managentent February 1992. (A.Kazanjian). ISBN l-896459-62-5.HHRU 91:4R A Single Stochastic Model For Forecasting Nurse Supply and For Estimating Life-CycleActivity Patterns. May 1991. (4. Kazanjian). ISBN l-896459-61-1.HHRU 91:3 ROLLCALL UPDATE 90. A Status Report of Selected Health Personnel in the Province ofBritish Columbia. March 1991. ISBN l-896459-60-9. ISSN 0828-9360.HHRU 91:2 Study of Rural Physician Supply: Practice Location Decisions and Problems in Retention.Volume /. March 1991. (A. Kazanjian, N. Pagliccia, L. Apland, S. Cavalier, L. Wood).rsBN 1-896459-59-5.HHRU 91:1 Registered Psychologists in British Columbia, 1990: A Status Reporr. March 1991.(C. Jackson, L. Wood, K. Kerluke, A. Kazanjian). ISBN l-896459-58-7.HHRU 90:7 Place of Graduationfor Selected Health Occupations - i,989.(HMRU 90:7) November 1990. (S. Cavalier, K. Kerluke, L. Wood). ISBN l-896459-57-9.HHRU 90:6 Health Managers in B.C. Part II: Who Manages Our System? - Sociodemographic(HMRU 90:6) Characteristics, Employment Patterns, Educational Background and Training of HealthManagers. June 1990. (4. Kazanjian, C. Jackson, N. Pagliccia). ISBN l-896459-56-0.HHRU 90:5 Health Personnel Modelling: A Bibliography With Abstacts.(HMRU 90:5) June 1990. (N. Pagliccia, C. Jackson, A. Kazanjian). ISBN l-896459-55-2.HHRU 90:4 PRODUCTION 89. A Status Report on the Production of Health Personnel in(HMRU 90:4) the Province of British Colutnbia. March 1990. ISBN l-896459-54-4. ISSN ll9-4010.HHRU 90:3 ROLLCALL 89. A Status Report of Health Personnel in the Province of British(HMRU 90:3) Columbia. March 1990. ISBN l-896459-53-6. ISSN 0707-3542.HHRU 90:2 Proceedings of the Workshop on Priorities in Heqlth Human Resources Reseørch in(HMRU 90:2) Canada. March 1990. (A. Kazanjian, K. Friesen). ISBN l-896459-52-8.HHRU 90:1 Nurse Deployment Patterns: Examples for Health Human Resources Managernent.(HMRU 90:l) February 1990. (A. Kazanjian,I. Pulcins, K. Kerluke). ISBN l-896459-51-X.HHRU 89:4 Proviclers of Visiott Care in British Columbia: A Report on the Status of Ophthalmologists(HMRU 89:4) and Optometrists, and On the Utilization of Ophthalmological and Optometric Se¡yices,1975-1988. July 1989. (L Pulcins, P. Wong Fung, C. Jackson, K. Kerluke, A. Kazanjian).THE UNIVERSITY OF BRITISH COLUMBIAHealth Human Resources UnitCentre for Health Services ancl policy Research429 -2194 Health Scicnces MallVancouver, B.C. Canada V6T lZ3, .Tel: (604) 822-48t0Fax: (604) 822-5690March 20,2001Dear Reader:'We have recently become aware that computing errors were made dwing the productionof Tables 3.5, 4.1, 4.2, 4.3, 4.5, 4.6, 4.8, 4.9, qli, +:õ, 4.17, 4.1g, and 4.22in tie rrport Issuesrùurrrqt¡vl¡. Lt7 L-Attached are theconected tables. Please insert them in the appropriut. i.ìtio* ortttffiãrt.A Rescarch unit Funded by the Ministry of l{carth. British corumbia3.5 D¡stribution of Midstry of He¡lth Payments for Pàysicien Services by p¿yment Mech¡n¡snt23,436,740493,08515,290,1512,515,03813,718,8009,080,3622,411,53267,327,3167,472,U85,885,35017,518,3373,716,09014,891,50917,511,4823ô,584,621108,875,40655,093,0635,035,18176,474,98097,436,76411,025,3554,833,61810,301,29940,198,5148.163,79539,143,78458,660,93630,183,24917,339.05611,924,21720,349,0667,æ2,11598,443.498.493.859.9t0083.889.9r0099.67.396.296.4r0069.4t00r0067.867.599.894.791.010098.099,393.r99.499.3t0099.499.599.80.10.5571.66.20.4t6.25.30.43.83.óIr.t0.03?.23 r.00.25.39.00.00.7t.50.60.70.00.60.50.2VancouverGeneral, St. Paulb & B.C. Women's Hospiølvic¡oría Hospital societ¡ vancouverHospital & SL Pautb Hospiølr. Children's, S¿ Paul's Hoçial, U.B.C.Microbiology & Greârer Victoriâ llosp. SocietyChildrcn's Hospital, Surury Hill Childrcns HealrhCentre & Queen Alexandr¿ Childrenb Health CeuteJuan de Frrca Hospitat Societ¡ St. Joscph,s Gen. Hosp.,Trail Regional Hosp. & rilest Coast General Hosp.Victoria Hosp. Society & B.C. Wonæn's Hosp.6I hrcludes physicians on the'activc'reg¡sters of¡h€ CPSBC in ¡996.: Excludcs scrvicc agfc€mcnt for trilsplanration *ryiccs.an allæated to RCPSC spccialty that bcst mtchcs scnícc typc spccificd.¡ lncludes 32 Radiation Oncolo¡y Specialists.s Agrccmcnts spcciñcd for intcnsivc cuc scruices & geriatric home âssessmetrt.o Àgrecmcnts spcciñed for ¡natcm¡¡ & ncrvbon carc.t99l - 1992 1996 - 1991ìpecirlty No. FTEsFTEs/10,000Pontn2 No. FTEsFTEs/10,000PoÞ'n2lverage Annua7o Change3 lnFTEs/10,000Poo'n2leneral / Family Pracrice 3,84t 3,29r.3( 9.7¡ 4.335 3,809.92 9.81 0.0:AnesthesiologyCardiologyCommunity MedicinerDermatologyEndocrinology & MetabolismlJnrcrgcncy }lerlic¡ne¡CastroenterologyHematologylntemal MedicineMedical Biochemistry¡Medical Microbiolog¡/Medical Oncology{NephrologyNeurologyNuclear Medicine{Pediatricsl'athology - GeneralrPathology - Anatomical{Physical McdicinePsychiatryRadiation OncologyaRadiology - DiagnosricaRespiratory MedicineRheumatologylardiovascular & Thoracic Surgery3eneral Surgery\,leurosurgery.)bsrc¡rics & Cynccology)phthalnrology)nhopedic Surgery)tolar¡rgolog¡r)lastic SurgcryJrologyy'ascular Surgery3014733516592220339t223t0ll64llt9297643t3822824035263ri2r3l2slró71t65lr4el7614elßl8l260.444ó.8633.0051.127.3759.002t.2917.80266.64¡2.0023.0010.0010.6660.69I 1.00183.5897.0064.0028.t4344.4028.00240.0033.3323.651I29.t01r62.5sl8.331r4r.5III 57.501124. l0l67.66142.ssls8.52122.0610.7i0. l40. tc0. r50.020.l i0.060.050.790.040.070.030.030.r80.030.540.290.190.08t.020.080.710.¡00.070.090.480.070.420.470.370.200.t30.¡70.07329514062l47t28l8358l225¡6ll69l9225t0370374883225944273318932¡82182148695s]6slzsl297.t353.8040.0056.4213.ó67 r.0027.3515.63319.7rt2.0025.0016.00n.2663.0819.00207.14r03.0070.0034.80448. I 032.00i259.0013s.e3 I2s.2tl2s.8154.07127.97t63,42t70.47t24.4564.4750.46163.?0121.o410.7t0,lr0. l(0.1i0.040. lt0.0t0.040.820.030.060.040.030.160.050.530.2'10.r80.09l.l50.080.670.t00.060.080.400.070.420.440.320.t70.t30. t60.06-0.8:-0.0:1.0,-0.8:10.0(0.9(2.2a-5.2i0.8i-2.7i-t.t36.8t- 1.7(-2.028.4(-0.3,- 1.60-1.011.452.49-0. l4-1.280.30-t.52-2.68-3.8¡0.820.07-t.22-2.7t-3.700.40.t.t l-1.92lotal Physicians 6.922 6,06r.65 t7.9i 7,732 6.930.4t 17.8: -0. II For 1996, FTEs a¡e based on Fee for Service, Salaried and Sessional, and most Service Agreement payments, excluding payments to the British Columbiacancer Agency. For 1991. FTEs are based on Fee for Service and salaried and sessional payments.:Basedonlggl BCPopulation=3.373,399andl996BCPopulation=3,882,043. PopularionesrimatessuppliedbypopulationSection,BcsTATs,Ministry of Finance and Coçorate Relations, are from rhe P.E.O.P.L.E. Projection Model - 1124. All fìgures are as ofJuly I of the year stated.! Average annual percenl change in FTEll0,000 population is calculared as follows: [(FTE 96-97/poplTTE 9l-92lpop¡tid,- ¡¡r¡¡g.o As a more accurate representation ofpersonnel in this specialty, I person=l FTE.fable 4.2: Asc l)¡sr¡buaion of 8.('. Pl¡rsíc¡âns bv RCPSC SDec¡âlty - 1996P7'SpccialtyUndcr.l0 ras 40 thru 49 ws 50 thru 59 yrs ó0 d¡ru ó9 yrs 70 yrs ard oldø ToølsNo FTEs vo No FTEs o/o No FTEs e/ø Nù FfEs Vo No FTEs o/" No FTI!sGmsal PncticcAnacsrhesio¡ogyCardiologyCommunity Mcdicinc:DmlologyEndooinology and Metabolisn¡Emagcniy Mcdicinc:GasùocncrologyHacmolög)rtntml McdicineMcdicat Biochcnrisry:Mediel Microbiology:Medical Oncology:NçhrologyNcuologyNuclear Medicine:PacdiaricsPathology - Gaaal:Patholog¡r - Anatonrical:lh¡rsical Mcdicinc?sychiatryRadiation Oncology:Radiology - Diagnostic:Reçinory McdicincRhcumatologyCardiovascular and Thoracic SwgGcncral SurgcryNruowgcry)bstctrics and Gynaæology)pbrhâlilology)nhopacdic Sugcry)!olaryngologyllastic SugcryJrologyy'mlerSwcrvt58875t5486238357z355¡l646l5t7576t2608342384lg725l¡t3ll5trlIJJð.O'7t.t It2.434.006.t06.002t.o06.76?.5945.622.003.005.004.6t10.186.0040.38r5.oot7.003.5770.o3¡2.0060.006.982.594.0623.8t7.4536.3633.0ó2t.39¡o.05I 1.94t4.53l.0l¡6.t3 t.ó2t.5t4.624.3r0.315.937.523.217.9r0.3t3.9¡5.826.623.6t9.4t7.2r5.623.722.84-4J5.:24.t23.¿r0.(10.Í43.532.424.i16.(t5.2t6.1t2.c3 r.340.91442123aal3a)964245792933l5t67t57025t4It4265056522laat7l333t5l0il0t378.92t20.2324.95r3.0023.396.2533.0015.357.86104.883.009.006.004.3523.805.0079.4329.0033.00t6.06t59.6315.0070.0022.9tt2.34t0.854t.787.0r45.¡065.0955.lOi24.s6||I2!-331¡e.261n.4ElJÓ.(4t.s46.932.54 ¡.545.846.556.t50.334.925.036.037.538.637.726.342.328.247.t¡t6.136.246.927.058.848.937.r27.725.t?9.338.244.338.t46.230.2s4.279783lót2t6Il455956852t8,563ll8l2t2!sl7sl¡ol'ollrl5rl9I431751.9972.2tt4.85r ?.00¡ 5.050.58t4.005.245.¡892.236.008.005.002.30¡ 7.503.0045.393 t.00t8.00I ¡.78I t8.¡75.0075.008.04¡0.28t0.7652.609.r643.7953.763 1.332t.7o)r4.041t8.oel5.e31t9.925.127.933. I30.750.032.03 t.3?0.427.7r 5.824.?30.t25.733.926.815.ó29.O?.0.740.836.834.g32.728.513¡.5125.2)33.7127.8128.412s.7130.c26.1Á)t9.1t9.237539I9ilI¡62l443lt)2487!9I54763l2326lo2ir2l4lz59.ZO22'.68¡.009.00t0.840.831.00I 1.304.0018.4322.002.003.3772.4939.00¡.002.2930.784.2824.1414. re]r5.41I7-Li;l,r.o3llo.s4l?.24lj47.661.005.0017.92t.t9.82t.4to9.716.4ó.:7.51.922.:t9.26.11.4¡5.98.320.at5.t2.67.820.415.3t5.78.3t2.4I t.52,O¡7.0]t4.tt3J53422¡l36I35r5tl2613lnl'ol7l2lil44.J:0.9(.0(-ù7(9.aI0.3ct.004.04ó.mo.02?,0.35r5.00l.z71.900.074.504.37t.22o.720.t20.98o.38.20.55.31a5.85It.20.3.0.84.613o.t5.84.31¡.31o.3l2.sl2.61r.olr.rIîl4335329574062l47t28t8358t225¡ólt69l9)a<t0370374883225942733rse]321r82lrs2ir48lóel5sl6sl)sl3772.5:287. t:53.2:40.0(5ó.4:¡ 3.ó(7t.0(27.3:¡5.ó:300.01r2.0(25.Uró.0(¡ 1.3(ó3.O€t 9.0c187.6'lr03.m70.0034.80440.6732.00259.0038.9325.2tto t?150.8727.91t53.89t70.47t?4.4564.4750.4663.7023-0/¡fotals 2Z3t t9t7.7t za.4 259( z5zo.9 36.! l69t ¡608.9: aal 87! 645.4 9-/ 33( t20.2 77lt 6A13.ZI FIE calcutations arc bascd on Fcc for Snice u¡d Sala¡icd a¡d Sessional paymeots.: As a morc accrratc rêprcsentation ofpersonnel in this ryecitlty, I pcrson=l FTE.r âDre ¿l.J! sex Dlstrrbufion of physlclan FTEs ln B.c. by Age and speclatty -Tfg6lglTotals Under 40 40 thru 59 60 and olderF-fEs 7o Femele FTEs 7o Fcmale FTEs 7o Female FTEs 7o Female3eneral Practice 3772.5 24.i 1338. I 36.t 2t30.s t9.t 303.5 6;AnaesthesiologyCardioloryCommunity Medicine!DermatologyEndocrinology and MetabolismEmergency Medicine:GastroenterologyHaematologylntemal MediciheMedical BiochemistrfMedical MicrobiologfMedical Oncolory2NephroloryNeurolog¡lNuclear Medicine:PaediatricsPathology - General2Pathology - Anatomical!Ph¡aical MedicinePsychiatryRadiation Oncologry:Radiology - DiagnosticzRespiratory MedicineRheumatoloryCardiovascul¡r and ThoracicGeneral SurgeryNeurosurgeryObstetrics and Cynaecolog¡rOphthalmoloryOrthopaedic SurgeryOtolaryngologrPlastic SurgeryUrologyVascular Surgery297.rs3.240.056.4t3.771.027.415.6300. rt2.025.0r ó.0¡ 1.363. rt 9.0t87.7t03.070.034.8440;l32.02s9.038.925.229.2150.928.0153.9170.5124.564.s50.563.723.013.49.223.3l6,l22.(t2.2t4.c21.39.24t;150.03'.t.58.65.20.024.52t.228.212.627.322.019.4t9.022.4.63.90.02t.410.50.76.98.2l.¡4.17t.t12.44.06.16.023.06.82.645.62.03.05.04.6t0.26.040.4t5.017.03.670.0t2.060.07.02.64.123.8'1.536.433. r21.4r0.rr r.9t4.51.0t4.(l8.t25.(25.i33.:26.'l3 l.t0.(25.9r00.(33.280.(21.1t0.l¡ó.t4t.t40.(35.328.338.r25.(26.i68.24.0.(8,0.(37.123.:0.9.25.:4.10.(192.439.825.038.46.847.020.613.0197. I9.0t't.0I ¡.06.741.38.0t24.860.05t.02't.8277.820.0145.03 t.022.62t.694.416.288.9I ¡8.98ó.446.337.43't.4r8.413.93.328.0t7.06.4r0.627.4t2.933.358.8274.125.020.620.025.512.028.825.021.42.021.86.24.20.020.98.51.07.83.t6.123.6r.0I t.0I t.90.8t.057.4t.05.0I 1.65.022.528.02.03.492.854.01.03.632.74.428.618.6t6.68.2t.2I t.83.68.3t00.(8.23.10.(21.4r0.?50.c¡3.55.(2.90.2Total 6833.2 20.1 193'Ì;, 33.( 4t29., t7.: 765.i 6;.I FTE calculations are based on Fee for Service and Salaried and Sessional payments.t As a more accurate reprcsentation ofpersonnel in this specialty, I penon=l FTE.Iable 4.5: Supply of Physicians by ptace of Medical Schoot U¿uc¡t¡on - itt6tlpeclalt¡es Totalsu.B.c.(o/o)No. (o/olNo.Other C¡nada Non-C¡nadaNo. (o/olf,eneral / Family Practice 4,33: r,392 (32.1) 1,903 Ø39) 1.040 (24.O\lAnesthesiologyIlCardiotoevlCommunity MedicinelDermatologyIlEndocrinolo$ & MetabolismlEmergency MedicineGastroenteroloþyHematologyIntemal MedicineMedical BiochemistryMedical MicrobiologyMedicat OncologyNephrologyNeurologyNuclear MedicinePediatricsPathology - GeneralPathology - AnatomicalPhysical MedicinePsychiatryRadiation OncologyRadiology - DiagnosticRespiratory MedicineRheumatoloryCardiovascular & Thoracic SurgeryGeneral SurgeryNeurosurgeryCbstetrics & GynecologrCphthalmologyCrthopedic Surgery3tolaryngologyPlastic SurgeryUrologyVascular Surgery329574062l47t28l8358l225t6lt69l92251037037488322sel441271331I 891tlr 821l82lr48l6eliil88 (26J)16 (28.1)9 (22.s)16 (25.8)3 Qt.4)12 (t6.9)6 (2t.4)s (27.8)5r (t4.2)3 (2s.0)2 (8.0)4 (25.0)3 (27.3)13 (18.8)r (s.3)20 (8.e)24 (23.3)19 (27.t)6 (t6.2)7t (t4.5)8 (25.0)37 (14.3)7 (1s.9)6 (22.2)6 (18.2)24 (t2.7)4 (12.s)3l (17.0)30 (r6.s)28 (18.9)7 (10.1)24 (43.6)l8 (26.s)7 /¿8.0\t34 (40.7)23 (40.4)22 (5s.0)34 (s4.8)6 (42.9)53 (74.6)19 (67.9)I (44.4)186 (52.0)6 (50.0)r r (44.0)8 (50.0)3 (27.3)35 (s0.7)14 Q3.t'¡80 (35,6)4t (3e.8)26 (37.r)16 (43.2)200 (41.0)s (r s.6)tsz (58.7)19 (43.2)r0 (37.0)2t (63.6)100 (s2.9)20 (62.s)72 (3e.6)los (57 .7)77 (52.0)37 (53.6)24 (43.6)36 (s2.9)l0 t40.01t07 (32.s)r 8 (31.6)e (22.5)t2 (1e.4)s (3s,7)6 (8.5)3 (10.7)5 (27.8)tzt (33.8)3 (25.0)t2 (48.0)4 Qs.o)5 (45.5)2t (30.4)4 Qt.r)t2s (5s.6)38 (36.9)2s (35.7)ls (40.5)2t7 (44.5)19 (se.4)70 Q7.0)18 (40.9)l l (40.7)6 (18.2)65 Q4.4)8 (25.0)79 (43.4)47 (2s.8)43 (29.1)2s (36.2)7 (tzj)t4 (20.6)8 (32.0)lotal Specialists 3,391 609 1t7.9) 1,6t3 (47.5) 1.175 ß4.6)total BC 7,732 2,001 Qs.g) 3,516 (45.5) 2,2ts (28.6)I Includes physicians on the hctive'registers ofthe CpSBC in 1996.lable4'6:PlaceofMedicalSchoolEducation1"z¿uyspeciatty@;pecialtiesu.B.c.l99l 1996 % Chan'¿eOther Canadal99l 1996 %ChanseNon-Canadal99l 1996 % Chanseieneral / Familv Þactice 1.032.t3t. 43.0 43.9 0.9 25.9 -¡.924.0AnesthesiologyCardiologyCommunity MedicineDermatoloryEndocrinology & MetabolismEmergency MedicineGastroenterologyHematoloryIntemal MedicineMedical BiochémistryMedical MicrobiologyMedical OncologyNephrologyNeurologyNuclear MedicinePediarricsPathology - GeneralPathology - AnatomicalPhysical MedicínePsychiatryRadiation OncologyRadiology - DiagnosricRespiratory MedicineRheumatoloryCardiovæcular & Thoracic SurgeryGeneral SurgeryNeurosurgeryObstetrics & Gynecolory0phthalmologyOrthopedic Surgery0tolaryngologyPlastic SurgeryUrologyVascular Surperv26.22t.3¡8.224.60.0t6.9t8.225.014.2t6.74.320.027.320.30.08.920.625.09.714.417.9l3.lt4.319.2l6.tr0.313.816.2t3.917.413.232.727.026.126.728.122.525.82t.4t6.92t.427.8t4.225.08.025.027.3r8.85.38.923.327.t16.2t4.525.0t4.315.922.2r 8.2t2,7t2.5t7.016.5t8.9¡0.t43.626.528.00.56.84.3t.22t.40.03.22.80.18.33.75.00.0-1.55.30.02.72.t6.50.27.t1.2t.63.02.t2.4- 1.30.92.51.5-3.0I t.0-0.5t.94t.242.636.452.650.0'n.272.745.052.250.039. I30.02?.345.372.733.941.243.845.242.432.156.342.934.(t64.556.858.636.557.05 r.053.953.t47.639. I40.740.455.054.842.974.667.944.452.050.044.050.027.350.773.73s.639.837.t43.24t.0t5.658.743.237.063.652.962.539.6s7.752.0s3.643.652.940.0-0.5-2.2¡8.62.2-7.t3.54.9-0.6-0.30.04.920.00.05.41.0t.7-1.4-6.6-t.9-1.4-16.52.t0.32.4-0.9-3.93.93.00.71.0-0.3-9.45.30.932.636.245.522.850.0I t.99.130.033.633.356.550.045.534.427.ts7.338.¡31.345.243.250.030.642.946.2t9.432.927.647.329.t3 ¡.532.9t4.325.434.8t2.53t.622.519.435.78.5r0.727.833.825.048.02s.045.530.42l.t55.636.935.740.544.559.427.040.940.7t8.234.425.043.425.829.t36.2t2.720.632.00.0-4.6-23.0 '-3.5-t4.3-3.41.6-2.20.2-8,3-8.5.25.00.0-3.9-6.2-t;t-1.34.5-4.61.39.4J.6-1.9-5.4-t.2t.5-2.6-3.9-3.3-2.53,3-¡.64.8-2.8lotal Specialists t6.6 t't.g t.4 47.8 47.5 -0.3 35.6 34.6 -l.ttotal Phvsicians 24.7 25.9 t.2 45.t 4s.5 0.3 -1.628.630.2Note: l99l figures for Radiation Oncology were taken from Report Table 4.4.r¿ble 4.6: Gcogr.phic D¡stribution of Plysician in B.c. by HHRU Rcgion end Grouped Specialty, 1996/9ztGen€ml / F¡m¡¡y Pract¡c€ Gcner¡¡ lntcrnal Mcd¡c¡nÊ Mcdic2l Subsæciâh¡es Gcner¡l Sursen Surgicel Subspccialtics Pcd¡¡tris{HRU Res¡on Poputetion2!-I'¡:,No. FTES PoD.I.'¡!;No. FfEs PoD.F-rE /No FtEs PoÞ.r.TEINo, FfSs PoÞ. FfENo. F-fes Poô- !-l'ttNo. F-fEs PoD.Vancouvcr & DisrrictCapitalFnsr ValleyOkanaganSouth Eesttsland CoætScntral\¡ônh Cèntml,,lonhJnknownl,9l0J3l33t,76123t)45334J43r60,708425,3ó82O3,7422t932464,7?t2215 1,899.t49t 376.t197 t99.7343 321.7184 t57.8444 403.5t89 182.022t 2t8.651 5t.499.4)I t3Ji86.3i96.1(98.2194.8i89.3r99.617-9.43232 t77.5 9.2134 24.7 7.49 9.8 4.2i19 18.5 5.51l0 9.1 5.612t 2t.2 4.958 7.9 3.89I I r4.0 6.4(I 0.9 I.38258 234.5 t2.7145 55.3 16.ót6 5.5 2.3t29 32.6 9.7t3 2.6 t.6l9 8.2 t.9i8 9.2 4.525 5.4 2.450 0.0 0.0c86 7t.6 3.7:20 t3.2 3.9¡7 74 3.2(t9 t4.¡ 4.2(t2 9.0 5.5¡2l t9.0 4.4112 8.8 4.339 8.0 3.613 3.0 4.603?3 33t.7 t7.3170 63.2 t9.0:22 22.9 9.8f5¡ 48.2 14.31t0 Io.t 6.zt47 43.4 r0.2t2t 19.4 9.52t7 t4.7 6.7tI O.2 0-36lót t47.4 7.7115 t7.4 5.2i5 ó.1 2.6414 IO.4 3.094 4.6 . 2.81¡t 8.7 2.U6 6.0 2.955 ó.6 3.000 0.0 0.00fotalBC 3,882,0.t: 4.335 3.809.9 98.t, 345 283.6 7.31 363 353.2 9-l( r89 t54.1 3.9', 6tz 553.8 t4.2', 22t 207.2 5J¿Psychi¡try Obôtetr¡cs & Gvftcolæv t¡bor¡tory/R¡dioloel An€sthcs¡ology Othcr' All SDCci¡l¡sts{gRU Rcgion Population¡!'¡ I'Nc FTEs PoD.l-rgINo FIES Poô- I-IENo. FfEs PoD. !'t tt,No. FTES PoÞ. t¡'t !;No. FTES PoÞ. riÍEINo. F-fÊs Poú.Vancouvcr & Dist¡ictCapitalFrascr ValleyCkanag¡nSouth Eastfsland Coast3enrâl¡lonh CcnralrlonhJnknown1,9r033t33¡J6¡23t345334J43r60J08425,3ó8203,7422t932464,721339 32r.8 t6.8165 48.3 14.51t2 t0.¡ 4.31zz 2t.6 6.4ó,I t 9.9 6.1725 22.6 s327 6.9 3.397 6.9 3.t20 0.0 0.o0107 ¡02.1 5.34t5 ¡0.9 3.2i6 6.2 ?.6tt4 ¡ t.5 3.424 2.6 r.6220 t4.7 3.4Á7 7.0 3.428 7.6 3.45I 1.0 r.55335 335.0 t7.5455 55.0 t6.58¡9 t9.0 8.2t27 27.O 8.O'16 t6.0 9.9629 29.0 6.82t7 t7.0 83419 l9.o 8.663 3.0 4.64200 t7r.7 8.9!42 35.7 ¡0.7:l0 9.9 43(24 23.2 6.9¿5 3.8 2.3!79 24.7 5.r(t0 to.r 4.9Í9 E.0 3.6r0 0.0 0.0(100 97J s.tt29 27.9 8.4(0 0.0 0.0c7 8.4 Z.5tI 1.0 0.624 4.O 0.944 3.8 t.E63 3.O t.370 0.0 0.002,t9t t,99t lo4.2i390 352 t05.9(96 97 41.8:226 Zts 64.3a76 69 42.712t6 t9ó 45.9',t00 9ó 47.2a93 93 42.4'j9 8 t2.52lôral BC 3,882,04: 488 448-t I 1.5¡ t82 t63.4 4-2 520 520.0 ¡3.4( 329 287.t 7.41 148 145.8 3.71 3397 3t tó.3 80.2rt As a notc accurate rcpresctrtation ofpersonncl io this spccialty, t person-l FfE.¡ 'Othcr" category includes: Conmtunity Medicinc, Emergency Medicine, Occuparional Medicine, Physical Me<licíne, md public Hcalth.fâble4.9t Gcogrâph¡cD¡stribut¡onofPhtsiciaß¡nE,C.bIHHRURcgion¡ndCroupcdSDeciâlty,t99f/921Gcnerel / Fâmily Pråcticc Ccncr¿l lnternal Mcdicinc M€dical Subspec¡elties Gcneral Sureerr' Sùreic¡l SubsD.ê¡âttiês Pcdi¿lr¡csHHRU Rci¡on Populatíon!FTEIPop.No. FtEs R¡lio! t¡./Pop.No FfEs Il¡t¡of tÈ,Pop.No. FfEs RaaioPop.No. FfEs R¿rioÈ tÈ,1Pop.No. FfÊs R¡aio!'t E, ¡¡¿,Pop.No. FfEs R¡t¡oVecouvcr & DistrictCapitalFnscr ValþOkanaganSouth E¿s¡fslând CoastCcnralNonh CcntrâlNonhI lñkñôlht,647)58307.641¡9 1,03 ¡279,794t45,t6'l361,145t78,944202,57t59.749r 968 t,634.4 99.2 r443 333.9 108.5Jtó9 t72.3 90.2t275 264.5 94.52179 t56.8 ¡08.00372 34t.2 94.48160 156.9 87.66t84 t74.4 86.0839 39.1 65.4458 26.0233 ¡56.E 9.52.ll 23-5 73j8 8.7 4.55| 8 t7.9 6.41ro 9.0 6.22t 5 15.9 4.398 E.3 4.627 9.7 4.770 0.0 0.004 t.6223 2t2.t r2.8t34 35.6 ¡ r.st5 5.2 2.71l8 ¡9.9 7.OS2 2.5 t.7,8 7.7 2.r37 8.5 4.734 4.6 2.290 0.0 0.0c2 2.O99 77.2 4.ór22 ¡3.r 4.2<8 8.3 4.3¿¡9 t3.4 4.8(8 7.0 ,1.8:20 18.4 5.0f¡ó r0.2 5.6t13 9.4 4.614 4.3 7.1:4 t.3.155 3t8.7 t9.3a?5 64.3 20.9t24 23.7 t2.4145 40.3 t4.4t8 ó.9 4.?135 33.7 9.12¡ e t9.4 10.83t6 t4.5 7.182 0.5 0.776 3.2t45 t29.4 7.8:¡ I t3.5 4.3t3 3.9 ..2.O¿lt l¡.8 4.2i4 4.6 3.lgE 9.4 2.6(5 5.3 2.9é,4 5.7 2.83I O.0 0.0{l'ota¡ 8C 3373391 3.847 3.299.4 97.8 334 2i1.3 7.4a 303 298.¡ 8.8! 2t3 4.4"r62-6 585 525.3 ¡5.5t t92 t81.6 5.4Psych¡¿try Obst€trics & Gynæoloty l¡bor¿tor!'/Radiolosy' AncsthcsiolæY othcr' All SDcc¡¡listsHHRU Rceion Population¡FTEIPoP.No. FTEs Råt¡ofl!/Pop.No. FTES lþ.io¡¡Þ,PoP.No. FfEs Râtiot-tUIPop.No. F.fEs RatioFrE/Pop.No. FTES R2t¡oi tljtPop.Nq FTEs R¡tioVancouver & District3apitalFrascr Valley)kanagan;outh E6tlslaod Coæt:cnrÉl),¡onh CcntralNonl¡Jnk¡oml,ó47,358307,644t 9l,03t279,790145,16?36t.145t78944202,57t59,749289 264.4 tó.0546 33.6 10.9r8 8.7 4.5'116 17.4 6.2t4 2.7 1.88t4 t2.0 3.3 t3 3.8 2.102 t.9 0.93o o.o o.00r00 85.6 5.2018 l3.o 4-244 4.2 2.t9t4 I t.8 4.232 2-O 1.3815 I t.3 3.t37 6.7 3.745 5.5 2.7tI 1.0 r.59I O.4305 305.0 18.5;54 54.0 17.5:ló ró.0 8.3t24 24.0 8.5tt5 t5.0 10.3:26 26.0 7.2(t? t7.0 9.5(t3 13.0 6.4,3 3.0 5.0i2 2.0t92 ló2.84t 35.8¡0 t0.618 t?.12 0.9¡9 t5.8l0 9.65 4.70 0.04 3.29.8fI l.ó!5.5i6.t20.ói4.3€5.3J2.3C0.0c87 83.5 5.0',:19 t8.8 6.1(0 0.0 0.0(7 8.2 2.9i0 0.0 0.0(7 7.O t.943 2.7 t.490 0.0 0.0c0 0.0 0.0{2,028 t,796 108.9!35t 305 99.2:86 89 46.7i190 r82 64.9155 5 r 34.9',t67 r57 43.4f95 9¡ 5t.0(69 ó9 34.0(r I 9 t4.5323 13.3foþl BC 3373.391 3E2 344.4 ¡0.2¡ t67 t41.5 4.ll 475-O475 l4-ol 30t 260.4 7.72 t23 I20.t 3-5( 3,075 2762.3 8t.8tFIE c¿lculalions üc based on Fcc for Scrvicc md Salaricd ad Scssional paymcns. FTgPopuhtion Ratios æ ¡umbcr of FtEs pcr 10o,0o0.3 As a morc accurate ¡eprcsentâtiotr ofpersonnel in this spccialtf t person-t FTE,¡ 'Othcr'catcgory includes: Comunity Mcdicinc, Emcrgcncy Mcdicinc, Occupational Mcdicinc, Physical Medicine, md Public Hcalth.Norc; The'Nonh'âud'Nonh Cocal'rcgions have bø groupcô cmcrgacy nrdicinc, conuruiqr mcdicina physiøl mcdicinc ud public halth ac cxcluded fronr the analyses.âble 4. I 2: Rsgionål Distr¡buaion of 8C Ph)"sici¡ns by Agc Group, Sex, and P¡âce of N¡cdicâ¡ School Trâining, ¡ 99643 (r5tzl (3543 (rs.< 40 I 859 (38aotoóa | 1,208 (54.5)ó5+f 148 (6;7)u.B.c.l 79r (35.7)r09 (5522 (lr r0ó (s7.6)t2 (6.5r30 (70.737 (20.rlos (57.t¡s3 (34.5)26s (se.j)r87 (42.t4t (r3.5) 43 (rr r0 (40.4)l r,s88r5l (ss.s)l 2,467 (5ó.r r (4.0)l 280 (ó.213 (78.3)1 3,059 (59 (2t.7)l 1,2?6 (ze59 (2t.7)l t,392 (32. r99 (36.4)l r,903 (43.l14 141.9) It37 (2725t (5rGener¡l Sureen: Psvchiâtrv: Pedialricsi Obsletrics &l6 (r8.4)52 (s9.8)r9 (2r.8)72 (82.8',)l5 (r7.2)r2 (13.8)s0 (57.5)25 (28.748 (r76 (14.6)32 (78.0)3 Q.3)38 (e2.I3 (7.3)4 (e.8)t9 (46.3)53 (18.0)t4 (t4.3)u (6s.3)20 Q0.4)88 (8e.8)l0 (r0.2)5 (5.r)54 (5s.1)49 (re.o)9 (22.s)27 (67.5)4 (10.0)35 (87.5)5 (r2.5)2 (5.0)2t (s2.5)4s (r9.0)r5 (34.r)23 (s2.3)6 (13.6)36 (8r.8)8 (18.2)s (11.4)t6 (36.4)50 (r8.0)238 (ró.9)936 (6ó.3)237 (ró.8)1,102 (78.r)309 (2r.9)r89 (13.4)628 (44.s')65tr (%)nrcdian (lQR)Group n (%)<4040 lo 64School n (%)u.B.c.50 ( 17.0)tsg (17.4)608 (66.s)147 (r6.r)617 (74.1)237 (2s.9)¡4r (r5.4)384 (42.0)l ¡ (7.4)¡03 (69.r)3s (23.5)t24 (83.2)25 (r6.8)tz (8.r)73 (49.0)8 (2r.r)27 (?t.t)3 Q.g',)32 (84.2)6 (r5.8)8 (2r.r)r r (28.9)43 (12.6'79 (59.8)10 (1.6',)t22 (92.4'ro (7.6)2s (r8.e)77 (58.3)42 (il.o)13 (38.2)20 (58.8)r (2.e)29 (85.3)s (14.7)4 (11.8)2r (6r.8)47 (16.0)23 Q0.2)80 (70.2)r r (9.6)l0r (88.6)13 (n.4)22 (t9.3)60 (s2.6)47 (14.s)e (16.1)44 (78.6)3 (5.4)s4 (e6.4)2 (3.6)8 (¡4.3)33 (58.9)45 (16.0)l4 (25.s)36 (65.5)5 (e.r)49 (89.r)6 (ro.e)u (20.0)24 (43.6)47 (r4.0)38r (20.7)t293 (70.3)164 (8.e)¡,558 (84.8)280 (15.2)393 (2t.4)897 (48.8)lnsdie(lQR)Group n (7o)< ¿1040 !o ó465+n (o/olSchool n (7.)u.B.C.47 (r245 (20.8)834 (70.9)e8 (8.3)9s8 (8r.4)2r9 (r8.6)287 (24.4)529 (44.9\25 (il.8)ts1 (74.1)30 (14.2)r93 (9r.0)19 (9.0)24 (11.3)r24 (58.5)9 (1s.5)43 Q4.r)6 (r0.3)s2 (89.7)6 (r0.3)t2 (20.7)29 (J0.0)lncludes only physicians on the hctivC register of the CPSBC. IQR refers to'intcr4uartilc mge',fable 4.17: Distribution of llerfindahl Index for GP/FPs & Specialists by HHRU Regions, lggfug7rz9HHRUResionGeneral / !'amilv Practicen I Mean Median SDSpecialistsn I M""-o M"di"o sDVancouver & Distict3apitalFraser Valley)kanaganSouth-Eastlsland Coastlenüal\lorth Centalñorth1,839403t77315155398r70187470.77 0.78 0.t40.7s 0.76 0.130.74 A.75 0.140.73 0.75 0.130.74 0.77 0.150.73 0.75 0.130.73 0.76 0.140.7t 0.73 0.140.68 0.69 0.151,07118155t4238r29585260.89 0.960.88 0.930.92 0.950.87 0.920.88 0.940.90 0.9s0.88 0.930.89 0.950.83 0.810.150.150.100.130.14o.t20.13a.t20.09fotal Physicians 3-691 0.7s 0.76 0.14 1.732 0.r40.950.90¡ Includes physicians on the hctive' CPSBC registers in 1996 except for pediatrics, rehabiliation medicine, community medicine/public health, psychiatry, laboratory medicine and radiology, medical oncology and radiation oncology (N=l,377).Also, excludes 644 GP/FPs and 288 specialists with FTE < 0.2 in 1996197 or who had no FFS billings.t Noter Th. footnote on Page77 ofthe PGME Report should read (n=1,377) specialties excluded.3 Section 4.2.2.1 on Page 75 should also read (n=1,377) for specialties excluded and (n=932) for other physicians excluded.f¡ble 4.16: Gcneral Pr¡ctitioners / Fâmily Physic¡.Dr by Hedtb Reg¡on, Age, S€r, .Bd Pl.ce of Med¡c.l School Educ¡tion, 199óCh¡rrctrristic E¡st Kooten¡yÌVest Kootcn¡yEoud¡ru North Ok¡aag.rlouth Okenegar-Similk¡meen Thompson Fr*er VelleySoutü Fr¡serVdley Simon Fr¡ser Co¡st G¡r¡b¡ldiCenl V¡nclsl¡odUppcr Islaad/Ceatr¡l Co¡st{ge ¡tËcla¡r (¡qK){gc Group n (%)<4040tou65+42 5 ( 7.o)32 (37.2)47 (s4.7J7 (8.r)¿lJ (r5.v,34 (34.7)se (60.2)< /<tl¿14 (tE.0)47 (37.3'73 <s7.9)^ l^9\43 (r3.0)74 (34.t,r33 (6r.3)to 14.6144 (r6.0)46 (37.4)73 (s9.3)4 (3.3)4ó (r6.0)66 (33.s)ro9 (s5.3)22 fi1.2\¿t4 (16.0)160 (37.0)237 (s4.e)35 l8.r)43 (15.0)¡03 (37.5)ts7 (s7.1)r5 15.5ì42 (t4.o'29 (35.8)4e (60.s)3 (3.7\44 (4t .s)75 (3¡.3)r48 (6t.7)t7 (7.t\1¿ ltl.u)49 (39.8)68 (55.3)6 14.9);er n (%)MàleFennle65 (75.6)2l o4.4\65 (66.3)$ ß3.n 97 (77.O')9 t21,O\ 165 (76.0)<) a)¿.ñ\ 92 (74.8\3l (25.2\ 163 (82.?)34 (t7.3\ 302 (69.9)I30 l30.Il 204 Q4.2'7t (25.A\ s8 (71.6)23 (28-4\ r89 (78.8)5¡ t2t.3ì e0 (73.2)33 126.8)VtedicalSchool n(7c)U.B.COthcr Canad:Non{mad¡rs (t7.4)s3 (ór.6)t8 120.9)22 (22.4)52 (53.r)24 (24.5\4s (3s.7'6r (48.4)20 û5.9)55 (2s.3)u8 (s4.4)u /.'ñ1\3ó (2e.3)s9 (48.0))9 It) 9\6s (33.0)73 (37.t)59 (29.9)138 (3r.e)r85 (42.8)lag (2s.2\e6 (34.e)il8 (42.9)âl lt', t\25 (30.e)(50.ó)/t9 <\4ll<77 (32.1)96 (4o.0)67 (27.914r (33.3)50 (40.7)32 (26.01fotals 9A 126 217 t?3 t97 8l: hrr2cleris tic C¿riboo Noñh ìryest Pe¡ce L¡ard lúter¡or Vancouvcr Burnaby North Shore Rich¡nond Capit¡l All Re!¡ons\ge n¡edran (IQR)lgecroup n(%)<4040 to 64ó5{4¡ (¡r.0)3r (47.0)34 (5¡.5)r (l.5)42 (16.0)3e (38.2)60 (58.8)3 Q.g)3e (10.0)27 (52.e)22 (43.t'2 t3.9\4Z (¡).U,,44 (37.o)6e (58.0)6 15.01¿ìJ (ro.u,387 (39.7)s27 (s4.1)û (6.21{r (rJ.),69 (43.r)8r (s0.6)r0 16.3)4J (tó.U,l76 (3s.8)il6 (54.7)20 (9¿\4J (r).U'64 (39.s)e0 (55.ó)R l¿,914) (r{.u,t36 (27.7)3ls (64.2),/ì /e tì43 (r5.O)r,s88 (36.6)2,46'¡ (56.9)teô tÁ {tiex n(7o)s3 (80.3)r3 1r9.7)77 (1s.s))< t'rlt <\ 42 (82.4)9 117.6\94 (79.0)25 Qt.O\æ8 (62.4)aÂÁ ta1 A\103 (64.4)57 (35-6\t32 (62.3)80 (37.nn1 Q2.2)45 (27.8\343 (6e.e)r48 f30.t)3,059 (70.6)t 776 (?9 ¿\Vledic¿l School n(7o)U.B.COthcr Canad:Nôn..âñr'lr24 (36.4)20 (30.3)"r /îi 2ì2s (24.s)48 (47.r))o t)9^\8 (r5.7)r2 (23.s)1r /Áô tì26 Qt.e,3e (32.8)s4 k5.4\345 (35.4)4t6 (42.7'2t3 (21.9\6r (38.t)67 (41.9)1) ()OO\88 (4r.5)87 (4r.0)37 ll? 5l63 (38.e)58 (3s.8)¿l ()5,1\t37 (27.9)2sr (sr.r)rô2 /rr ô\t,392 (32.t'r,904 (43.9)r n?o /t, nìfot¡ls 66 t02 9-14 IóO zt2 t67 491 4-335Table 4.18: Distribution of Herfindahl Index for GP/FPst by Age, Sex, Place of Training and FTE Status, 1996-97All Regionsn Mean SD Statisticz P-valuUrbanIn Mean SDI nSemi-UrbanMean SDRuraln Gi sD lstat¡stic3 p-vatueAge GroupMedical School3141-5161-'122 0.731,248 0.721,284 0.74688 0.79286 0.8163 0.821,O57 0.692,634 0.771,250 0.731,556 0.75885 0.77309 0.782,509 0.74873 0.7537.7 <0.00c309.8 <0.00c21.4 <0.0009.38 <0.0000.130.140.140.130.140.160.130.130.14o.140.140.140.140.1465 0.73 0.13536 0.73 0.13290 0.80 0.14133 0.81 0.1427 0.86 0.13556 0.70 0.'t41,043 0.80 0.130.74 0.140.76 0.140.80 0j4162 0.78 0.151,'166 0.76 0.14271 0.79 0.1461564833642 0.70 0.13583 0.70 0.14631 0.73 0.13347 0.77 0.13135 0.80 0.1333 0.80 0.16432 0.69 0.131339 0.75 0.14579 0.71 0.13776 0.74 0.14416 0.76 0.14123 0.78 0.141112 0.73 0.14536 0.73 0.130.74 0.120.74 0.120.68 0.150.78 0.12o.82 0.08o.75 0.200.70 0.13o.74 0.130.73 0.110.74 0.13o.72 0.150.79 0.121o.73 0.1310.73 0.1411512910551l836925256132r3324231þo0.50 0.6056.0 0.00329.4 <0.00015.7 0.0030.36 0.6980.97 0.3271.03 0.27257.2 <0.00016.08 0.0024.53 0.01114.3 <0.00010.13 0.8797.4 0.00113.2 <0.0001Totals 3,691 1,599 1,771 321I lncludes GPÆPs on the bctive'CPSBC registers in 1996. Excludes 6214 GP/FPs with FTE < 0.2 in FY 1996/97 or who had no FFS billings.¿ F-statistic from anal¡ais ofvar¡ance to test for differences in log HI between levels ofthe covariate ofinterest.lable 4.222 Demographic and Training Characteristics of GP/FP 'Specialists' in Obstetrics & Gynecolory, Anesthesiology, and Surgery, 1996197All GP/FPsl Obstetrics & Gynecolow IStatistic3 p-value IGP/FP 'Sþecialists2AnesthesiolowStatistic3 P-valueSurgervStatistic3 P-valueAge median (IQR)Age Group n (7o)<4440-4950-596GtSex n(WMaleFemaleMedical School n (%)u.B.c.In CanadaNon-CanadaGeographic Location n (oá)UrbanSemi-urbanRural43 Q4.0)1,373 (37.2)1,283 (34.8)687 (r8.6)348 (9.4)2,634 (71.4)1,057 (28.6)1,250 (33.9)1,556 (42.2)885 (24.0)1,599 (43.3)1,77t (48.0)321 t8.7)39 (11.0)e6 (54.e)62 (35.4)1r (6.3)6 (3.4)24 (r3.7)151 (86.3)747328937210(42.3)(4t.7)(16.0)(53.1)(4r.1)6.7\29.737.6<0.001<0.001298.88.70<0.0010.0137.83 0.02043 (r4.0)(31.6)(4r.8)(re.0)(7.6)(88.6)(l r.4)(24.1)(32.e)(43.0)(11.4)(50.6)(38.0))s33l56709l92634940300.r32.r00.?t70.55511.7 <0.001t6.2 0.00198.5 0.00145 (18.0)(34.7)(31.1)( r 3.8)(20.4)(86.2)(13.8)(28.6)(4s.4)(26.0\(44.e)(47.4)0.7\686l27401692756895l8893l5t4.530.2<0.001<0.00122.32.59<0.0010.2730.473 0.789fotals ]-691 t75 79 196I Includes all GP/FPs on the'active'registers of the College of Phpicians and Surgeons of 8.C., excluding GP/FPs with FTE<0.2 or who had no FFS billings in 1996197 (n=644).GP/FP bbsterrician/gynecologisrs' were defined as GPrFPswith >20% oftotal billings in the obstetrics & gmecology fee-item domain. PercenB given are relative to all GPÆPs.THE UNTVERSITY OF BRITISH COLUMBIAHealth Human Resources UnitCentre for Health Services and Policy Research429 -2194 Health Science.s MallVancouver, B.C. Canada V6T lZ3Tel: (604) 822-4810Fax: (604) 822-5690December 20,2001Dear Reader:We have recently become aware that computing errors \ryere made during the productionof Table 4.11 in the report Issues in Physician Resources Planning in B.C.: Key Determinants ofSupply and Distribution. 1991-96. A Report to the Post-Graduate Medical Education Advisor]¡Committee. Attached is the corrected table. Please insert the table in the appropriate section ofthe report.A Research Unit Funded by the Mnistry of Health, British ColumbiaI(JtsIOcacml Intaa¡ Mcalici¡êMcdiøl SnbspæialtiæO.rc[alSì¡rgcrySurgical SuþaialticPcdiaEi6PsyôiatryObstcti6 &(}la@loryIrb@tory & Radiolog)'-1 -(0.4)35 (15.7)-t3 -(13.1)l8 (5.1)ró (u.0)50 (r7.3)? Q.o>30 (e.8)Oa€ral l¡taal McdicitrêMcdiol SubspæialticOø@lSurgcrySugiol SubspæialtisPcdiauieRyôiatryObsteti6 &O)¡acooloСf¡bcatory&R diologsr"Pqqt d¡8r8cis €lo¿ltÊd(no 1996r'y? -no l99lI9Ðl (\a l99UÐ'l@

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