Explaining primary care physicians' decision to quit patient‐centered medical homes: Evidence from Quebec, Canada. (6th February 2019)

• Record Type: Journal Article
• Authors: Ammi, Mehdi; Diop, Mamadou; Strumpf, Erin
• Is Part Of: Health services research. Volume 54:Number 2(2019)
• Page Start: 367
• Page End: 378
• Publication Date: 2019-02-06
• Subjects: Canada -- health care workforce -- patient‐centered medical homes -- physician retention -- primary care; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.13120
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract : Objective: To examine the factors explaining primary care physicians' (PCPs) decision to leave patient‐centered medical homes (PCMHs). Data Sources: Five‐year longitudinal data on all the 906 PCPs who joined a PCMH in the Canadian province of Quebec, known there as a Family Medicine Group. Study Design: We use fixed‐effects and random‐effects logit models, with a variety of regression specifications and various subsamples. In addition to these models, we examine the robustness of our results using survival analysis, one lag in the regressions and focusing on a matched sample of quitters and stayers. Data Collection/Extraction Methods: We extract information from Quebec's universal health insurer billing data on all the PCPs who joined a PCMH between 2003 and 2005, supplemented by information on their elderly and chronically ill patients. Principal Findings: About 17 percent of PCPs leave PCMHs within 5 years of follow‐up. Physicians' demographics have little influence. However, those with more complex patients and higher revenues are less likely to leave the medical homes. These findings are robust across a variety of specifications. Conclusion: As expected, higher revenue favors retention. Importantly, our results suggest that PCMH may provide appropriate support to physicians dealing with complex patients.