Do faster‑trained physicians fill the gaps? Geographic concentration of emergency medicine physicians with different postgraduate training in Ontario Canada

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-05-29 DOI:10.1016/j.healthpol.2025.105360

David Kanter-Eivin , Calvin Armstrong , Anil Esleben , Grant Sweeny , Michaela Dowling , Asil El Galad , Stephenson Strobel

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引用次数: 0

Abstract

Background

Emergency departments in underserved areas face chronic staffing challenges. One possible solution is to use physicians who are quicker to train and more pervasive in lieu of more extensively trained physicians. Canada allows for emergency medicine specialization via a 3-year pathway (CCFP(EM)) and a 5-year pathway (FRCPC) which means different geographic areas are exposed to EM physicians with different training lengths.

Methods

We examine Ontario, Canada which has both widespread geographic diversity and emergency providers with these two lengths of postgraduate training. We scrape the College of Physicians and Surgeons of Ontario public registry in 2015 and 2024. We map the geographic distribution of physician types and estimate spatial autocorrelation measures using global and local Morans I to determine whether these physicians became more geographically concentrated.

Results

Between 2015 and 2024, the number of CCFP(EM) and FRCPC physicians increased in overall numbers but their unique locations remained stable. Mapping of these locations suggests clustering into urban or suburban areas in the province. CCFP(EM) physicians have become more concentrated over time (Morans I of 0.234 and 0.308 in 2015 and 2024) relative to FRCPC physicians (Morans I of 0.096 and 0.103).

Conclusion

We find that, from 2015 to 2024, emergency physicians have become more concentrated in the province of Ontario due to CCFP(EM) physicians concentrating around urban areas with academic medical centres. Policies relying on less extensively trained providers to plug staffing gaps may not necessarily be effective in improving equitable access to physicians.

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训练更快的医生能填补空白吗？加拿大安大略省接受不同研究生培训的急诊医学医生的地理集中

服务不足地区的急诊科长期面临人员配备方面的挑战。一个可能的解决方案是使用训练速度更快、更普及的医生来代替训练更广泛的医生。加拿大允许通过3年途径（CCFP(EM)）和5年途径（FRCPC）进行急诊医学专业化，这意味着不同地理区域的急诊医生接受的培训长度不同。方法我们以加拿大安大略省为例，该地区具有广泛的地理多样性和具有这两种长度的研究生培训的应急提供者。我们在2015年和2024年刮掉了安大略省内科医生和外科医生学院的公共注册。我们绘制了医生类型的地理分布，并使用全球和本地Morans I估计空间自相关措施，以确定这些医生是否在地理上变得更加集中。结果2015 - 2024年，CCFP（EM）和FRCPC医师的总体数量有所增加，但其独特的位置保持稳定。这些地点的地图显示，它们聚集在该省的城市或郊区。随着时间的推移，CCFP（EM）医生相对于FRCPC医生（Morans I为0.096和0.103）变得更加集中（2015年和2024年的Morans I分别为0.234和0.308）。结论从2015年到2024年，由于CCFP（EM）医生集中在具有学术医疗中心的城市地区，安大略省的急诊医生变得更加集中。依靠缺乏广泛培训的提供者来填补人员缺口的政策不一定能有效地改善公平获得医生的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.