Explaining primary care physicians’ decision to quit patient‐centered medical homes: Evidence from Quebec, Canada

摘要

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.