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Ontario's alternate funding arrangements for emergency departments: the impact on the emergency physician workforce

Published online by Cambridge University Press:  21 May 2015

Michael J. Schull*
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Ont.; Clinical Epidemiology Unit, and Department of Emergency Services, Sunnybrook and Women's College Health Sciences Centre, Toronto; and Department of Medicine, University of Toronto, Toronto, Ont.
Marian Vermeulen
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Ont.
*
G-106, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto ON M4N 3M5; 416 480-6100 x3793, fax 416 480-6048, mjs@ices.on.ca

Abstract

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Background:

Difficulty maintaining physician staffing in emergency departments (EDs) prompted the government of Ontario to offer alternate funding arrangements (AFAs) to replace fee-for-service remuneration for physicians working in EDs.

Objective:

To analyze the effect of AFAs on physician staffing and practice patterns.

Methods:

We obtained Ontario Health Insurance Program fee-for-service and shadow-billing records for all physician services provided in EDs one year before and one year after implementation of an ED AFA. Only sites with reliable billing data were retained. Physicians were assigned to small/rural, community or teaching hospital groups based on their billing claims. For each hospital type, and all hospitals combined, we compared the pre- and post-AFA periods in terms of the number of physicians working regularly in the ED and their workload. As a possible unintended consequence of AFAs, we also compared physicians' involvement in primary care.

Results:

Overall, 76.2% of eligible hospitals adopted an ED AFA, of which 49 (42.6%) were included in our study (16 small/rural, 27 community and 6 teaching hospitals). In the post-AFA period, the number of physicians working in EDs increased by 7, from 674 to 681, representing a 1.0% increase overall in the workforce (p = 0.84). The change varied by hospital type, from a 5.8% increase in teaching hospitals to a 2.2% decrease in community hospitals, though none was significant. In the post-AFA period, the number of physicians working a moderate number of days per month increased from 190 to 214, representing a 3.2% absolute increase (p = 0.39), and the number working few (<5) or many (>10) days per month decreased. Post-AFA, the number of physicians working in EDs who also provided primary care services decreased by 1.7%, from 544 to 535 (p = 0.10).

Conclusion:

Emergency department AFAs have been widely adopted in Ontario, but have not been associated with substantial changes in the overall physician workforce in EDs. However, trends toward increased physician numbers were seen in small/rural and teaching hospitals. There was little evidence of any adverse effects on the provision of primary care services by physicians.

Type
ED Administration • L’administration de la MU
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

References

1.Chan, B, Schull, MJ, Schultz, S.Atlas of emergency department services in Ontario 1992/1993 to 1999/2000. Institute for Clinical Evaluative Sciences (ICES) Atlas Report Series. Toronto (ON): Institute for Clinical Evaluative Sciences; 2001.Google Scholar
2.OMA welcomes emergency department funding for physicians [media release]. Toronto (ON): Ontario Medical Association; 2001 Oct 10.Google Scholar
3.New deal to improve access to doctors in emergency rooms [media release]. Oakville (ON): Ontario Ministry of Health and Long-Term Care; 2000 Oct 11.Google Scholar
4.Ministry of Health and Long-Term Care responds to the recommendations of the Joshua Fleuelling inquest [media release]. Toronto (ON): Ontario Ministry of Health and Long-Term Care; 2000 Nov 17.Google Scholar
5.Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G, et al.Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. Can J Emerg Med 1999;1(3 Suppl). Online version available at: www.caep.ca/002.policies/002-02.ctas.htm (accessed 14 Feb 2005).Google Scholar
6.Lindsay, P, Bronskill, S, Schull, MJ, Chan, BTB, Anderson, GM.Clinical utilization and outcomes. In: Hospital report 2001: emergency department care. Toronto (ON): Hospital Report Research Collaborative. A joint initiative of the Ontario Hospital Association and the Government of Ontario; 2002. p. 2950. Available: www.hospitalreport.ca/pdf/FINALEDReportDec202001.pdf (accessed 2005 Jan 17).Google Scholar
7.Beveridge, RC, Lloyd, S.Manpower survey (II): remuneration and future expectations. CAEP Communique 1996;Spring:68.Google Scholar
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