End-of-career practice patterns of primary care physicians in Ontario

Objective To characterize the process of end-of-career attrition among primary care physicians. Design Longitudinal, open cohort, population-based study of primary care physicians using health administrative data from ICES. Setting Ontario. Participants All family physicians providing comprehensive care between 1992 and 2013. Main outcome measures Changes in workload and scopes of practice over time. Results The cohort included 15 552 family physicians who provided comprehensive care at some point during the study period. Physicians reduced workloads and narrowed scopes of practice in advance of full retirement at an average age of 70.5 (95% CI 70.1 to 70.8) years. Female physicians provided fewer clinical services than male physicians did and retired 5 years earlier. Canadian medical graduates provided fewer clinical services and retired 2 years earlier than international medical graduates did. Up to 60% of physicians stopped providing comprehensive primary care before retirement, continuing with other clinical activities, at reduced workloads, for an average of 3 years before retiring fully. Conclusion End-of-career practice patterns are characterized by gradual, modest changes in the provision of services rather than abrupt declines, and the retirement process unfolds differently for different physicians. This study highlights the importance of considering physician workload, scope of practice, and demographic factors for more accurate prediction of physician retirement trends and effective work force planning.