Papers

Changing practice patterns

Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken R, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. (2023). Declining comprehensiveness of services delivered by Canadian family physicians is not driven by early-career physicians. Annals of Family Medicine, 21(2): 151-156.

• Comprehensiveness is declining among family physicians in Canada, but declines are no greater among physicians within their first 10 years of practice.

• Efforts to enhance or maintain comprehensiveness of care delivered by family physicians should address the service delivery contexts in which all physicians are practicing, rather than interventions in training or early practice.

​
Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken RK, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. (2023). Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces. Canadian family physician / Medecin de famille canadien, 69(8): 550–556.

• We observe that comprehensiveness, defined as number of service settings and service areas (that could be part of office-based practice), is declining among family physicians in all provinces studied (British Columbia, Manitoba, Ontario, and Nova Scotia). Declines were greater for settings than for service areas.

• Changes   in comprehensiveness were observed across all physician characteristics, but on average, were greater among physicians in practice 20 years or longer, male physicians, and physicians practising in urban areas.

• That declining comprehensiveness was observed across all physician characteristics points to changes in the practice and policy contexts in which all family physicians work, not to gaps in training among more recent cohorts.

​
Lavergne R, Peterson S, Rudoler D, Scott I, Mccracken R, Mitra G, Katz A. (2023). Productivity Decline or Administrative Avalanche? Examining Factors That Shape Changing Workloads in Primary Care. Healthcare policy / Politiques de sante, 19(1): 114–129.

• Findings suggest that population aging and increased complexity of care are contributing to increased coordination workload per patient visit among family physicians providing care in community-based settings.

• At the same time, a larger proportion of family physicians are providing care outside of community-based settings and patient visits per family physician are falling.

• Efforts to improve efficiency of coordination work, sometimes described as administrative workload, may increase supply of community-based primary care. 

 
Rudoler D, Peterson S, Stock D, Taylor C, Wilton D, Blackie D, Burge F, Glazier RH, Goldsmith L, Grudniewicz A, Hedden L, Jamieson M, Katz A, MacKenzie A, Marshall E, McCracken R, McGrail K, Scott I, Wong ST, Lavergne MR. (2022). Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces​. Canadian Medical Association Journal, 194(48): E1639-E1646.

• Recent cohorts of family physicians practice similarly to predecessors in terms of practice volumes and continuity of care.

• Since FPs of all career stages show declining patient contacts, system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.

 
​May C, Peterson S, Gooderham E, Hedden L, McCracken RK, Lavergne MR. (2024). Chronic pain management in primary care. Canadian Family Physician, 70(9): 570-579.
​
Jamieson M, Juda M, Lavergne MR, Kurdyak P, Laporte A, Rudoler D. (2024). Demographic and temporal trends in mental health and substance use services provided by primary care physicians in British Columbia, Canada. BMC Primary Care, 25(1): 335. 
​
Grudniewicz A, Randall E, Jones L, Bodner A, Lavergne R. (2025). Comprehensiveness in Primary Care: A Scoping Review. The Milbank Quarterly, 103(1): 153-204.

Practice intentions and choices

Grudniewicz A, Randall E, Lavergne MR, Marshall EG, Jones L, Rudoler D, Horrey K, Mathews M, McKay M, Mitra G, Scott I, Snadden D, Wong ST, Goldsmith LJ. (2023). Factors influencing practice choices of early-career family physicians in Canada: a qualitative interview study. Human Resources for Health, 21(1): 84. 

• We identified four practice choices by early-career physicians: 1) scope , 2)  type and model, 3) location, and 4) schedule and work volume.

• Practice choices were found to be influenced by three key categories of factors: 1) Training factors; 2) Professional factors; and 3) Personal factors.

• Early-career physicians' decisions regarding their practice are subject to the influence of multiple interconnected factors, some of which can be addressed through policy interventions (e.g., regulations) while others are more entrenched (e.g., family obligations).

​
Kabir M, Randall E, Mitra G, Lavergne MR, Scott I, Snadden D, Jones L, Goldsmith LJ, Marshall EG, Grudniewicz A. (2022). Resident and early-career family physicians’ focused practice choices in Canada: A qualitative study. British Journal of General Practice, 72(718): e334–e341.

• Focused practice is viewed by family medicine residents and early-career physicians as a way to circumvent the burnout or exhaustion with comprehensive practice in the current structure of the healthcare system.

​
Mathews M, Ryan D, Randall E, Marshall EG, Goldsmith LJ, Jones L, Lavergne MR, Snadden D, Scott I, Wong ST, Stringer K, Horrey K, Grudniewicz A. (2022). “At the mercy of some of the regulations”: The impact of the residency match and return of service requirement on the early-career decisions of international medical graduates in Canada. Human Resources for Health, 20(1): 15.

• Return of service agreements can restrict career choices and delay international medical graduates from their preferred scope of practice and location.

​
Marshall EG, Horrey K, Moritz LR, Buote R, Grudniewicz A, Goldsmith LJ, Randall E, Jones L, Lavergne MR. (2022). Influences on intentions for obstetric practice among family physicians and residents in Canada: an explorative qualitative inquiry. BMC Pregnancy and Childbirth, 22(1): 857. 

• Our results demonstrate that the decision to provide obstetric care is not influenced solely by individual factors.

• Family physicians’ choices to provide or not provide obstetric care are also influenced by community needs, organizational factors, and public policy.

• Policymakers who want to encourage obstetric practice by family physicians should consider public policy, community, organizational, interpersonal, and individual levels of intervention.

 
Mitra G, Grudniewicz A, Lavergne MR, Fernandez R, Scott I. (2021). Alternative payment models: A path forward. Canadian Family Physician, 67(11): 805–807.

• The availability of remuneration models is an important factor shaping the practice choices of early career physicians.

• In areas of the country where fee-for-service was the only payment option, some family physicians were deterred from practising comprehensive family medicine.​

​
Lavergne MR, Scott I, Mitra G, Snadden D, Blackie D, Goldsmith L, Rudoler D, Hedden L, Grudniewicz A, Ahuja M, Marshall EG. (2019). Regional Differences in Where and How Family Medicine Residents Intend to Practise: A Cross-Sectional Survey Analysis. CMAJ  Open, 7(1): E124-E130.

• ​Across Canada, two-thirds of family medicine reported it was somewhat or highly likely they would commit to providing comprehensive care to the same group of patients in their first three years of practice.

• Over 80% of family medicine residents indicated they intended to practise in a team-based model.

​
Lavergne MR, Gonzalez Patterson A, Ahuja MA, Hedden L, McCracken R. (2019). The relationship between gender, parenthood and practice intentions among Family Medicine residents: Cross-sectional analysis of national Canadian survey data. Human Resources for Health, 17(1): 67.

• ​Family medicine residents who are parents and who are women are more likely to report intentions to provide comprehensive care soon after entering practice

• Supporting family medicine residents who are parents may positively impact the quality and availability of primary care services

​​
Wang S, Buote R, Moritz LR, Lavergne MR, Marshall EG. (2024). Advice to future family physicians: findings from qualitative interviews with family medicine residents and early-career family physicians. BMC Medical Education, 24(1): 897. 
 
Moravac C, Grudniewicz A, Scott I, Randall E, Goldsmith LJ, Marshall EG, Jones L,  Lavergne MR. (2024). Early career family physician perspectives on their residency experience and practice choices in Canada: a qualitative study. Canadian Medical Education Journal, 15(5): 20–32.

Primary care policy context

McKay M, Lavergne MR, Lea AP, Le M, Grudniewicz A, Blackie D, Goldsmith LJ, Marshall EG, Mathews M, McCracken R, McGrail K, Wong S, Rudoler D. (2022). Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan.  Health Policy, 126(6): 565-575.

• Policy reforms across the three provinces (British Columbia, Ontario and Nova Scotia) were driven by physician payment.

• Practice patterns of primary care physicians are changing—so too should the policies that may shape their practice choices.

​

Lavergne MR, Bodner A, Peterson S, Wiedmeyer M, Rudoler D, Spencer S, Marshall EG.  (2022). Do changes in primary care service use over time differ by neighbourhood income? Population-based longitudinal study in British Columbia, Canada. International Journal for Equity in Health, 21(1): 80.

• Equity in access to primary care is deteriorating.

• Reforms to primary care that fail to attend to the multidimensional needs of low-income communities may entrench existing inequities.

​​​

Lavergne MR, Moravac C, Scott I, McCracken RK, Hedden L, Grudniewicz A, Marshall EG. (2023). Ending the generational blame game: Let us move forward with needed primary care change. Canadian Family Physician, 69(8): 524-526.

Presentations