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Tina Felfeli, Yaping Jin, Mayilee Canizares, Yvonne M Buys; Practice Pattern Differences in Generations of Canadian Ophthalmologists over Two Decades. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5215.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the effect of generational and gender differences on practice patterns of Canadian ophthalmologists in the province of Ontraio over the past two decades.
The Ontario Health Insurance Plan for physician billings database for fiscal years 1992 to 2013 was used to calculate number of ophthalmologists, yearly median billings, number of patients and number of patient visits. Age, gender, fiscal year, and year of birth were also extracted. Cohorts were defined based on birth year into 10-year categories (i.e. 1915-1924) and fiscal year was used as an indicator of period. Age groups were defined by 5-year increments (i.e. <35 to 75-79). Yearly median billing dollars were converted to 2013 dollars. Hierarchical age-period-cohort (APC) models were used to disentangle the unique effects of age, period, and cohort on changes in total payments and the number of visits per ophthalmologist over time.
A total of 388 (11.3% female) ophthalmologists were practicing in Ontario in 1992 and 457 (19.9% female) in 2013. Results from the unadjusted APC model indicated significant age affects (p < 0.0001) with the overall age-trajectory of payments peaking in middle age and a decline in older ages. There was also a general trend of increasing yearly billing dollars in both men and women (p < 0.001). In addition to the age and period effects, cohort effects were significant for both men and women (p < 0.001) with a general trend of higher total payments in each succeeding recent cohort. To note, there were significant interactions between gender and birth cohort (p = 0.048) and gender and age (p = 0.015) suggesting that the gender gap in payments widens in recent cohorts (e.g. 1975-1984 to 1945-1954). However, after adjusting for the volume of visits and patients in practice, gender differences were largely reduced although remained significant (p < 0.001).
Recent cohorts of Canadian ophthalmologists have a greater yearly dollars billed compared to the older cohorts at the same age group. The widening gender gap of billing dollars in more recent cohorts was partially explained by differences in the number of visits per patients among female and male ophthalmologists in each cohort. Generational differences in practice patterns of ophthalmologists will likely shift the effective healthcare supply and demand, and thus have important implications for ophthalmology workforce planning.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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