Concept: Physician Characteristics - Primary Care Group Practices

Concept Description

Last Updated: 2007-03-08



1. Physician Resource Database (PRDB)

2. Profiling Primary Care Practice in Manitoba (Frohlich et. al., 2006)

The following steps were taken:

  1. Select list of PHYNO that bill with and without TC. Some of them bill through > 1 TC.

  2. Possibly adjust for Timing issues (see below under issues)

  3. Exclude PHYNOs w/o Birth Date, that do not have associated TC. There were 10 of these in the data period used with this study.

  4. Remaining claims after most basic exclusions (submitted by PHYNOs with PHISGRP**=1 with or without TC) were used to define practices, by summing up all claims by TC (if present) or by PHYNO (if no TC present).

  5. Make some additional exclusions, based on Practice type, size or location (< 1000 claims per practice, located in North or in Brandon ). Exclude TCs that were non-primary care practices (16 in this study), as well as Northern Medical Unit ( TC list #1 ). This list of TCs will need to be reviewed and updated for other years of data.

  6. If necessary, re-assign Billing Services practices to be TC=0 (no TC) PHYNOs (checked for % shared patients within each first). ( TC list #2 )

  7. Exclude 1 PHYNO w/o Birth Date that bills through 24 different TCs (it will result in reduction in size for several practices associated with that PHYNO, as well as in removal of at least 10 Micro-Management Systems ( MMS )TCs.

  8. Exclude 6 community clinics corresponding PHYNOs without Birth Date ( all located in North )

  9. Include 10 clinics with TC that are also identified by PHYNO w/o Birth date (these were all salaried community clinics).
    There were 2 lists created:

    • With TC (Solo and Group practices)
    • Without TC (all considered Solo for now).

    TCs with 1 PHYNO per TC were considered Solo practices (with exception of 10 salaried Community Clinics). TCs with > 1 PHYNO per TC were considered Group Practices (will calculate % shared, workload FTE, visits and N of Patients for each). List of no-TC PHYNOs -- were all Solo practices, flagged as no-TC, size=1 PHYNO
  10. Additional proposed exclusions for both TC practices and no-TC practices:
    • Those with < 1000 claims a year.
    • North/Brandon practices (that were not excluded by previous criteria).
    • TCs with total number of days worked < 100 (~5 sites) (Nov 19 meeting).
    • Look at GPs with >1 billing number. Some of them have low volume or > RHA during the year.
    • Claims from nursing stations? (N = 20 PHYNOs, 6 with low volume).
    • Apply exclusions by PHYNO to single practices (see Exclusion criteria by PHYNO in Exclusions.doc.) GPs that changed TEXTCODE (possible move?) - to be worked out.

Analyses Undertaken

  1. To determine Group/Solo Practice.
    To determine if it was Group or Solo practice we looked at # of GPs billing through same TC. Out of initial >1000 GPs, ~ 400 were classified as Family Practices (~ 300 Solo + 100 Groups). Note: We could flag docs if they practice in a group in addition to individual practice.

  2. % Shared patients
    Among all of GPs in a practice or pairs of GPs (see docs in folder Natalia/New Material for Nov 7 Meeting). We had 2 types of sharing calculated (based on 1 year of claims, but ideally should be at least 2 years, since many people do not go to the doctor every year):
    • Version One - where we counted patients with at least 1 claim (visit) and shared are counted if sharing occurred with at least 2 different doctors within TEXTCODE, independent of date. We thought to do a paired analyses, but found it too complicated. Not sure how to summarize the results back to a TC with 19 Docs and 171 possible pairs combinations (there were total 2109 pairs in selected 111 SITES (TC)).
    • Version Two - only patients who had at least 2 claims within selected TC were used - these patients have a potential to be shared. Again, we used no restriction by date.

    Comparing 2 above-mentioned numbers we noticed that for some the second % was much higher. We thought those might be Walk-Ins and Emergency, because basically very few patients go there more than once, and if they do, they see whoever is on call there, without appointments - more likely to be sharable.
    • Note 1 (Sharing). The possibility of counting shared excluding cases where MDs were sought as working successively (one MD retired and another took over) was discussed but not implemented.
    • Note 2 (Sharing). Sharing between practices was discussed but not implemented


    • PHYNO - Unique Physician Number from PRDB. In the primary care physician group this is the base number from the Provider Registry data.

    • PHISGRP=1 - Defined in the PRDB. This identifies PHYNOs that are practicing under a general practice bloc of practice (11_).

3. Continuity of Care

4. Defining Practice Populations for Primary Care (Menec et. al., 2000) and (Reid et. al., 2001)



Related concepts 

Related terms