PRACTICE Geographic Distribution and Availability of Physicians in Vancouver ROBERT W. MORGAN, MD PETER J. MANSFIELD, MD THE USE AND DISTRIBUTION of med- they do not accept new patients.4 A problem in using the rather ical manpower is a topic of cur- This could, of course, impede peo- small local areas is that one can- rent Canadian interest.1 Previous ple from obtaining medical services not consider an area in isolation, interest has centered on urban- or cause some individuals to attend but only in relation to the adjoin- rural comparisons, general practi- a specialist in spite of a preference ing areas' population needs and tioner-specialist ratios, and cross- for a family practitioner. Simple physician supply. For this reason, national differences. While urban- headcounts and specialists:family some analyses were conducted not rural disparity has been shown in practitioner ratios indicate very for the specific local area, but also many areas, including British Col- little about the present nature of with the addition of all contiguous umbia,2 one usually feels that the the primary physician-patient rela- areas to form what will be called a cities are well supplied with physi- tionship. The discrepancy between "Super-Area" (one is demonstrated cians. patient perception of physician in Fig. 1). There is considerable The Vancouver metropolitan availability and actual availability overlap of super-areas (see Table area was noted by the 1964 Royal has not been measured. This re- I for composition) with each "lo- Coinmission on Health Services3 to search was intended to quantify cal area" centering one "Super- have a physician:population ratio one aspect of the problem: the ac- Area". of 1:584 similar to the 1:581 ratio tual availability of physicians as Population estimates for 19666 for other metropolitan areas in measured by a standardized sti- were used in all calculations. These Canada. In February, 1968 there mulus. are the most recent available. was one private (i.e. non-institu- b) Availability. A willingness to tional) physician for every 668 peo- Methods accept an unknown "new" patient ple in the City proper (651 physi- a) Distribution. The physicians' was considered to indicate avail- cians for 435,052 people). The office addresses were taken from the ability of medical services for one Royal Commission, while pointing "Yellow Pages" listing of the 1967- type of hypothetical patient, (the out the urban:rural disparity 68 Vancouver City Telephone Di- one seeking a "family" doctor) . Ac- (1:581 vs. 1:1,474) throughout the rectory. Physicians with a hospital cordingly, a random sample of 109 country, did not report the region- or institutional address were ex- non-specialist, non-institutional list- al differences within any city. An cluded from analyses. "Specialist" ings was drawn from the Vancou- adequate physician:population ra- designation was according to the ver section of the 1967-68 College tio does not ensure availability of 1967-68 Register of the British Col- Register.5 The 109 represented ap- care. In a city like Vancouver, with umbia College of Physicians and proximately one-third of 322 such a total area of 46 square miles, dis- Surgeons.5 listings. Twenty-six physicians were tance from a physician may consti- eliminated from the sample on The physician office distribution grounds of death or retirement, tute a barrier to medical care. was studied according to 22 local While distances from physicians leaving 83 active family practition- areas (see Fig. 1), each demon- ers in the survey. are impossible to calculate for a strating a relatively high degree of city population, tile relative density A telephone call was placed to internal uniformity with respect the office of each physician in the of physicians:population may indi- to certain selected socio-economic cate whether or not some people sample. Calls were made in Febru- criteria and each containing locally ary, 1968 during weekday office may have to travel appreciable dis- relevant institutions and services tances for service. (schools, shopping, etc.) 6 For these Part of current folklore concerns areas the following parameters are Robert W. AMorgan, MD, is an in- the availability of family practi- available: owner occupancy, unem- structor in the Department of tioners. It is widely believed, both ployment, mean family income, oc- Health Care and Epidemiology at inside and outside of the profession, cupation index, fertility ratio, per- UBC. Dr. Mansfield practices in that many doctors are so busy that centage of families with children. London, England. CANADIAN FAMILY PHYSICIAN * NOVEMBER, 1969 123 THEPE'S hours. A female research assistant, A BETTER WAY posing as a married mother of chil- TO PUT YOUP dren and recently arrived in Van- couver, presented the receptionist a INSOMNIA standard story of being healthy but desirous of locating a physician for PATI ENTS future use should the need arise. After the above explanation, she TO SLEEP... specifically asked, "Does Dr. take new patients?"'There was no questioning in regard to when the hypothetical patient (s) could be seen. c) Statistics. It was decided, a priori that associations with a prob- ability of less than .01 would be significant, and less than .001 high- ly significant. Results a) Geographic Distribution. Physicians' offices are located in 21 of the 22 local areas, with 45.6 per- cent in one single area (Fairview) and 18.4 percent in another (Cen- tral Business District) (see Table II). Distribution, by east and west divisions, is detailed in Table III. There is a marked disparity in phy- sician supply between the two halves of the city. This is largely due to the unequal distribution of specialists, who are plentiful in the western half and relatively scare in the east. Not only is there physi- cian disparity in terms of totals, but even more so in terms of popu- lation:physician ratios. The eastern city, with 54.7 per- Irrro cent of the population has only 13.5 percent of the physicians, com- Glutethimide pared with the western half (45.3 percent of the population) with Non-barbiturate, hypnotic and sedative. 22.4 percent of the physician sup- Of the varied, innumerable routes of transporting Mr. Insomniac to ply. Examination of the local area slumberland, Doriden has proved, time and again, to be the better way. distribution confirms d i s p a r i t y of Doriden: * overcome (Fig. 2 and Table IV) between Advantages Helps anxiety-induced insom- east and west. nia. * Sleep comes quickly, usually within 30 minutes. m Patients sleep Super-area popula- restfully for 4 to 8 hours. * Patients awake refreshed, usually without tion:physician ratios are used be- morning "hangover". * Minimal side-effects. * Well tolerated even by cause of the problems inherent in the aged and the chronically ill * In recommended dosage, respiratory small areas with arbitrary non- depression rarely occurs even in the presence of decreased pulmonary functional boundaries. Thus, popu- function. N Non-toxic to the liver, kidney and blood. a The smooth lation:physician ratios vary from sedative action induces tranquility and a sense of well being without 193:1 (Shaughnessy) to 2,799:1 dulling psychomotor performance. (Cedar Cottage).- The five areas Indications: Insomnia, anxiety-tension states, pre- for possible signs of dependence, even though operative sedation, first stage of labor. this occurs but rarely. To minimize withdrawal best supplied with physicians are Dosage: Insomnia: 0.5 Gm. at bedtime. Daytime reactions, dosage should be reduced gradually. adjacent to Fairview or the Central sedation: 0.125 to 0.25 Gm. 3 times daily after meals. Preoperative sedation: 0.5 Gm. the night sid andocation is avaiabl o e t. Business District, emphasizing the before surgery; 0.5 to 1 Gm. 1 hour before side-effects and cautions Is available on request. anesthesia. First stage of labor: 0.5 Gm. at onset Supplied: Capsules of 0.5 Gm. (blue and white); marked centralization of medical of labor. bottles of 100 and personnel. The city's two largest Side-effects: Occasionally, nausea and a general- 500. Tablets of ized, nonpruritic skin rash. 0.25 and 0.5 Gm. hospitals (both. major diagnostic Caution: As with other sedatives, emotionally dis- (white. scored); centers) are in Fairview and the turbed patients who may receive Doriden over bottles of 100 and prolonged periods should be observed carefully 500. WHERE RESEARCH IS THE TRADITION Central Business District. CANADIAN FAMILY PHYSICIAN * NOVEMBER, 1969 Physician distribution was deter- Table 1. Local Area Content of "Super-Areas" of mined by area socio-economic status Vancouver City (Table V). The data in the table Super-Area Contents exclude Fairview and the Central Shaughnessy Shaughnessy, Fairview, Little Mountain, Business District because the very Oakridge, Kerrisdale, Arbutus- Ridge, large number of physicians com- Kitsilano. pared with the small number of Little Mountain Little Mountain, Riley Park-Kensington, people would distort the results Oakridge, Mt. Pleasant, Fairview, Shaugh- for the remaining 20 areas of the nessy. city. The area status was obtained Kitsilano Kitsilano, Fairview, Shaughnessy, Ar- by ranking areas according to an butus-Ridge, Dunbar, West Pt. Grey index composed of income, educa- Mt. Pleasant Mt. Pleasant, Strathcona, Cedar Cottage, tion and occupation status.6 The Riley Park-Kensington, Little Mountain, city was divided into approximate Fairview halves on the basis of this index. West End West End, Central Business District The population/physician differ- Strathcona Strathcona, Central Business District, ences indicate that generally the Grandview-Woodland, Cedar Cottage, poor are less well supplied with Mt. Pleasant physicians. The difference in phy- Oakridge Oakridge, Marpole, Kerrisdale, Shaugh- sician supply is not consistent for nessy, Little Mountain, Sunset all individual areas. There is no Marpole Marpole, Kerrisdale, Oakridge, Sunset close correlation between socio- West Point Grey West Point Grey, Kitsilano, Dunbar economic rank and population/ Kerrisdale Kerrisdale, Marpole, Oakridge, Shaugh- physician rank.