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Long-term trends in the work hours of physicians in Canada
ABSTRACTBackgroundPhysician work hours directly influence patient access to health care services and play a vital role in physician human resource planning. We sought to evaluate long-term trends in hours worked by physicians in Canada, overall and by subgroup. MethodsWe used Statistics Canada’s Labour Force Survey to identify physicians via occupation and industry coding information. We estimated descriptive statistics and performed graphical analysis of the average weekly hours worked by physicians over the 1987–2021 period. ResultsOverall, weekly physician work hours remained stable from 1987 until 1997, after which they declined. Average weekly hours decreased by 6.9 hours ( p < 0.001), from 52.8 in 1987–1991 to 45.9 in 2017–2021. Among male physicians, work hours declined notably after 1997, while those of female physicians remained relatively stable at around 45 per week. Hours worked by married physicians declined significantly, amounting to 7.4 fewer hours per week ( p = 0.001). In contrast, unmarried physicians displayed a statistically insignificant decline of 2.2 hours ( p = 0.3). The COVID-19 pandemic was associated with a sharp but brief disruption in weekly hours; by the end of 2020, physicians’ work hours had returned to prepandemic levels. InterpretationThese findings may indicate a long-term shift in work preferences among Canadian physicians; male physicians may be seeking a better work–life balance, which, in turn, has narrowed the gap in hours worked by sex, with potential implications for pay equity. Policymakers and planners should carefully consider changes in hours worked, rather than just the total number of physicians, to ensure an accurate evaluation of the physician workforce.
Journal Article
Physician workforce planning in Canada: the importance of accounting for population aging and changing physician hours of work
Canada has long struggled to maintain an appropriately sized physician workforce. The recruitment of foreign-trained physicians over recent decades and, starting in the mid-2000s, increased domestic enrollments in medical schools has led to Canada currently having an historically high physician-to-population ratio. However, concerns about physician shortages and burnout, as well as limited access to physician care,9,10 continue. Previous analyses of physician supply and demand have not adjusted for both population aging and evolving physician hours of work, despite discussions of these factors being quantitatively important. To provide insights into the aforementioned challenges -- and to inform the profession, the public and governments in planning regarding the appropriate number of new physicians who should enter practice -- we analyzed data from 1987 to 2020 to quantify increasing demand because of an aging population and changing service supply given declining physician self-reported hours of work.
Journal Article
Trends in obesity defined by body mass index among adults before and during the COVID-19 pandemic: a repeated cross-sectional study of the 2009–2023 Canadian Community Heath Surveys
The COVID-19 pandemic affected health behaviours and the social determinants of health. We sought to describe trends in the prevalence in body mass index (BMI) categories before and during the COVID-19 pandemic among adults in Canada.
We conducted a repeated cross-sectional study of adults in the 2009–2023 Canadian Community Health Surveys. We compared changes after the onset of the COVID-19 pandemic (April 2020 to December 2023) to an 11-year prepandemic period (January 2009 to March 2020). We calculated odds ratios (ORs) and absolute percentages from, respectively, weighted logistic and linear regression models.
Our unweighted analytic sample included 746 250 adults from the 2009–2023 surveys. The prevalence of BMI-defined obesity increased from 24.95% in 2009 to 32.69% in 2023 (absolute increase 7.74%). The COVID-19 pandemic period was associated with an adjusted annual increase in the relative odds of obesity that was 1.02 (95% confidence interval [CI] 1.01–1.04) times greater than the prepandemic period. The absolute rate of increase of BMI-defined obesity nearly doubled during the pandemic, with an annual average excess rate of 0.44 (95% CI 0.14–0.74) percentage points. Class II and III obesity increased at a greater absolute rate than class I, indicating a shift toward more severe obesity. The relative increase in class III obesity was greater among young adults and females.
Since the COVID-19 pandemic, the prevalence of BMI-defined obesity, and especially class III obesity, increased at a faster rate than before the pandemic. Some groups that historically had lower levels of obesity were disproportionately affected during the pandemic.
Journal Article
Family physician pay inequality: a qualitative study exploring how physician responses to perceived patient expectations may explain gender, race, and immigration status pay differences
Pay inequality related to social identity has been observed among physicians, even after accounting for hours worked and specialty. Physician identity factors, such as gender and race, may contribute to practice behaviours in ways that affect income. In this study, we sought to explore how Ontario family physicians understand the relation between their identities and practice patterns and to form a theory of how identities may influence practice decisions in ways that result in income disparities.
We conducted a constructivist grounded theory study to understand how social identities affect income discrepancies among physicians. We conducted interviews with family physicians practising in Ontario. Physicians were purposively and then theoretically sampled for variation on several identity factors. We staged the analysis using constant comparative techniques.
Fifty-five family physicians participated. The analysis identified physician perception of patient expectations as a key factor influencing income. Based on the interviews, we developed a 4-stage theory to explain this mechanism: physician understanding of patient expectations, the nature of the expectations, physician responses to those expectations, and financial implications of those responses. We illustrate this theory with data from 2 frequently occurring examples: how physician gender influences income via patient expectations, and how physician culture, language, and immigrant or nonimmigrant status influence income via patient expectations.
Patient-centred care requires individualized approaches, yet common physician remuneration models fail to account for the time needed to provide these meaningful interactions. This dynamic may create structural disincentives for physicians who provide relational, emotionally intensive, or culturally tailored care, potentially reinforcing income disparities related to social identities.
Journal Article
A living critical interpretive synthesis to yield a framework on the production and dissemination of living evidence syntheses for decision-making
Background
The COVID-19 pandemic has had an unprecedented impact in the global research production and has also increased research waste. Living evidence syntheses (LESs) seek to regularly update a body of evidence addressing a specific question. During the COVID-19 pandemic, the production and dissemination of LESs emerged as a cornerstone of the evidence infrastructure. This critical interpretive synthesis answers the questions: What constitutes an LES to support decision-making?; when should one be produced, updated, and discontinued?; and how should one be disseminated?
Methods
Searches included the Cochrane Library, EMBASE (Ovid), Health Systems Evidence, MEDLINE (Ovid), PubMed, and Web of Science up to 23 April 2024 and included articles that provide any insights on addressing the compass questions on LESs. Articles were selected and appraised, and their insights extracted. An interpretive and iterative coding process was used to identify relevant thematic categories and create a conceptual framework.
Results
Among the 16,630 non-duplicate records identified, 208 publications proved eligible. Most were non-empirical articles, followed by actual LESs. Approximately one in three articles were published in response to the COVID-19 pandemic. The conceptual framework addresses six thematic categories: (1) what is an LES; (2) what methodological approaches facilitate LESs production; (3) when to produce an LES; (4) when to update an LES; (5) how to make available the findings of an LES; and (6) when to discontinue LES updates.
Conclusion
LESs can play a critical role in reducing research waste and ensuring alignment with advisory and decision-making processes. This critical interpretive synthesis provides relevant insights on how to better organize the global evidence architecture to support their production.
Trial registration
PROSPERO registration: CRD42021241875.
Journal Article
A taxonomy of demand-driven questions for use by evidence producers, intermediaries and decision-makers: results from a cross-sectional survey
Background
Globally, a growing number of calls to formalize and strengthen evidence-support systems have been released, all of which emphasize the importance of evidence-informed decision making. To achieve this, it is critical that evidence producers and decision-makers interact, and that decision-makers’ evidence needs can be efficiently translated into questions to which evidence producers can respond. This paper aims to create a taxonomy of demand-driven questions for use by evidence producers, intermediaries (i.e., people working in between researchers and decision-makers) and decision-makers.
Methods
We conducted a global cross-sectional survey of units providing some type of evidence support at the explicit request of decision-makers. Unit representatives were invited to answer an online questionnaire where they were asked to provide a list of the questions that they have addressed through their evidence-support mechanism. Descriptive analyses were used to analyze the survey responses, while the questions collected from each unit were iteratively analyzed to create a mutually exclusive and collectively exhaustive list of types of questions that can be answered with some form of evidence.
Results
Twenty-nine individuals completed the questionnaire, and more than 250 submitted questions were analysed to create a taxonomy of 41 different types of demand-driven questions. These 41 questions were organized by the goal to be achieved, and the goals were grouped in the four decision-making stages (i) clarifying a societal problem, its causes and potential impacts; (ii) finding and selecting options to address a problem; (iii) implementing or scaling-up an option; and (iv) monitoring implementation and evaluating impacts.
Conclusion
The mutually exclusive and collectively exhaustive list of demand-driven questions will help decision-makers (to ask and prioritize questions), evidence producers (to organize and present their work), and evidence-intermediaries (to connect evidence needs with evidence supply).
Journal Article
Former Temporary Foreign Workers and International Students as Sources of Permanent Immigration
Economie outcomes of former Temporary Foreign Workers (TFWs) and former international students (ISs) are compared to those of Skilled Worker Principal Applicants who have no Canadian experience at the time of landing. Controlling for only variables from the immigration points system, former TFWs have both higher earnings and employment rates, while ISs are no lower. When models are estimated separately by gender, male immigrants who were former TFWs have superior outcomes. Overall, the evidence provides support for the Canadian Experience Class in that former TFW, and to a lesser extent IS, status provides signals regarding immigrants' labour market integration. Dans cette étude, nous comparons la situation sur le marché du travail de deux catégories de citoyens qui ont immigré au pays en suivant des processus différents : d'une part les anciens travailleurs étrangers temporaires (TET) et les anciens étudiants étrangers (EE), et d'autre part les travailleurs qualifiés admis à titre de demandeurs principaux qui n'avaient aucune expérience de travail canadienne au moment de leur arrivée. Quand nous tenons compte des seules variables liées au système de points, nos résultats montrent que les revenus et le taux d'emploi sont plus élevés chez les TET mais moins élevés chez les EE. Quand on estime les modèles en tenant compte du sexe, on observe que la situation sur le marché du travail des immigrants hommes qui sont d'anciens TET est meilleure. Globalement, nos résultats indiquent que la situation des TET - et celle des EE, mais dans une moindre mesure - sur le marché du travail étant meilleure, cela fournit des informations intéressantes sur l'intégration des immigrants au marché de l'emploi.
Journal Article