CCHE Seminar Series: Primary Mental Health and Substance Use Service Provision in British Columbia: Exploring Age, Period, and Cohort Trends in Family Physicians from 1996-2017

Primary Mental Health and Substance Use Service Provision in British Columbia: Exploring Age, Period, and Cohort Trends in Family Physicians from 1996-2017

Margaret Jamieson
University of Toronto

Friday November 10, 2023, Zoom and HSB Rm. 412

Abstract: Background: The Canadian province of British Columbia is currently facing a double crisis: an increasing need for mental health and substance use services, and a perceived shortage in the supply of primary care services. A focal point for researchers is the ageing of the family physician labour force in the province, but it remains unclear whether retirement patterns are to blame, or if there is a fundamental difference between newer and older graduating cohorts of physicians. Methods: In this study, we use administrative data providing billing and demographic information for applicable family physicians in BC between 1996 and 2017. We use three age-period-cohort (APC) models to compare the relative impact of these three variables in determining changes in service provision. We also use latent class analysis (LCA) to segment the physician population in 1996 and 2017, describing how practice styles have changed in BC, and identify how recent practice environments may shape access. Results: Descriptive analyses showed a decrease over time in total service provision, an increase in mental health and substance use service provision, and a strong relationship between physician age and service provision. APC modeling results validated the descriptive analyses, finding strong evidence for age effects, modest evidence of period effects, and minimal evidence of cohort effects. Finally, the LCA showed that physicians in 1996 and 2017 could be broadly categorized into six and four typologies respectively, according to various measures of total and mental health-specific service provision. Conclusions: In this study, we demonstrate that changing demographics of the family physician labour force in BC will soon cause changes in access to primary care. We found limited evidence that changes can be attributed to different practice styles in newer generations of physicians. Finally, there are new typologies of physician practice style emerging over the last 20 years. These findings point to a need to increase care collaboration and availability among alternate providers for mental health and substance use patients, increase the supply of physicians to replace those that are beginning to retire, and a consideration for how physician services are remunerated.

Margaret Jamieson (she/her) is a doctoral candidate in the Institute of Health Policy, Management, and Evaluation’s Health Services Research program, focusing her studies in Health Economics. Margaret has over 5 years of experience working in the health economics space and focuses on quantitative analysis of administrative health databases and longitudinal studies. Her doctoral work looks at the labour supply patterns of British Columbia’s family physician population, particularly their provision of mental health and substance use services. Margaret holds an undergraduate degree in International Economics and Mathematics from the University of British Columbia.