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Practice patterns among early-career primary care (ECPC) physicians and workforce planning implications: protocol for a mixed methods study
  1. M Ruth Lavergne1,
  2. Laurie J Goldsmith1,
  3. Agnes Grudniewicz2,
  4. David Rudoler3,
  5. Emily Gard Marshall4,
  6. Megan Ahuja5,
  7. Doug Blackie6,
  8. Fred Burge4,
  9. Richard J Gibson7,
  10. Richard H Glazier8,9,
  11. Steve Hawrylyshyn10,
  12. Lindsay Hedden1,
  13. Jacalynne Hernandez-Lee4,
  14. Kathleen Horrey4,
  15. Mike Joyce11,
  16. Tara Kiran9,
  17. Adrian MacKenzie11,12,
  18. Maria Mathews13,
  19. Rita McCracken14,
  20. Kimberlyn McGrail5,
  21. Madeleine McKay4,
  22. Charmaine McPherson11,
  23. Goldis Mitra14,
  24. Tara Sampalli7,
  25. Ian Scott14,
  26. David Snadden15,
  27. Gail Tomblin Murphy12,16,
  28. Sabrina T Wong5,17
  1. 1 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  2. 2 Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
  3. 3 University of Ontario Institute of Technology, Oshawa, Ontario, Canada
  4. 4 Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  5. 5 Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
  6. 6 School of Leadership Studies, Royal Roads University, Victoria, British Columbia, Canada
  7. 7 Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
  8. 8 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  9. 9 Department of Family and Community Medicine, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
  10. 10 First Five Years group, College of Family Physicians of Canada, Toronto, Ontario, Canada
  11. 11 Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
  12. 12 Department of Community Health and Epidemiology and WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada
  13. 13 Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
  14. 14 Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  15. 15 Department of Family Practice, Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, British Columbia, Canada
  16. 16 School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
  17. 17 School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr M Ruth Lavergne; ruth_lavergne{at}


Introduction Canadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but little evidence to support or refute this. The goal of this study is to inform primary care planning by: (1) identifying values and preferences shaping the practice intentions and choices of family medicine residents and early career PCPs, (2) comparing practice patterns of early-career and established PCPs to determine if changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs) or period effects (changes over time across all PCPs) and (3) integrating findings to understand the dynamics among practice intentions, practice choices and practice patterns and to identify policy implications.

Methods and analysis We plan a mixed-methods study in the Canadian provinces of British Columbia, Ontario and Nova Scotia. We will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyse survey data collected by the College of Family Physicians of Canada. We will also analyse linked administrative health data within each province. Mixed methods integration both within the study and as an end-of-study step will inform how practice intentions, choices and patterns are interrelated and inform policy recommendations.

Ethics and dissemination This study was approved by the Simon Fraser University Research Ethics Board with harmonised approval from partner institutions. This study will produce a framework to understand practice choices, new measures for comparing practice patterns across jurisdictions and information necessary for planners to ensure adequate provider supply and patient access to primary care.

  • primary health care
  • health workforce
  • graduate medical education
  • mixed methods, family medicine

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  • Contributors RL wrote the first draft of the Introduction and Objective 2 methods. LG wrote the first draft of Objective 1 and 3 methods. AG, DR and EGM substantially revised the introduction, methods and analysis, and contributed to drafting Ethics and Dissemination. MA, DB, FB, RG, RG, SH, LH, JH-L, KH, MJ, TK, AM, MM, RM, KM, MM, CM, GM, TS, IS, DS, GT and SW provided feedback and revisions on the draft protocol and approved the final version for submission.

  • Funding This study was supported by Canadian Institutes of Health Research (R-PJT-155965).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study has received ethical approval from the Simon Fraser University Office of Research Ethics with harmonised approval from the University of British Columbia, the University of Ottawa, the University of Western Ontario, the University of Ontario Institute of Technology and the Nova Scotia Health Authority.

  • Provenance and peer review Not commissioned; externally peer reviewed.