To Count Heads or to Count Services? Comparing Population-to-Physician Methods with Utilization-Based Methods for Physician Workforce Planning: A Case Study in a Remote Rural Administrative Region of British Columbia.

OBJECTIVES: To demonstrate the feasibility of a population-based measure of physician services utilization by type of service as a tool for physician workforce planning.
SETTING: The Northern Health Region of British Columbia.
DESIGN: Retrospective descriptive statistics are compiled about the regional population's physician services utilization by the specialty of the service, irrespective of the specialty or location of the provider. These are compared to norms based on provincial average utilization, adjusted for age and sex, and norms based on population-to-physician ratio recommendations. METRICS: By specialty type of service: actual utilization; age-sex expected utilization; in-region, out-of-region and out-of-province utilization; full-time equivalency (FTE) values of actual and expected utilization; and FTE requirement to meet a set of recommended population-to-physician targets. Specialty substitution by general practitioners (GPs) is also quantified.
RESULTS: The overall estimated deficit in physician numbers is similar between the two methods (51 versus 54), but the magnitude of surplus or deficit by specialty is greater with the population-to-physician method.
CONCLUSION: The method targets an equitable distribution, rather than normative ideal physician supply. The magnitude of estimated surplus or deficit at the level of each specialty is greater with the population-to-physician ratio approach. The latter fails to consider interregional flow and specialty substitution. A population-based utilization approach is demonstrated to be a feasible, and in many ways superior, tool for physician resource planning.