General Medicine · Medical Literature
Having or losing a family physician: a protocol for a survey-based study of patients continuity of primary care experience in Quebec, Canada
Abstract
Introduction Continuity of care with a family physician (FP) is a core attribute of effective primary care and is associated with improved health outcomes, reduced service use and lower healthcare costs. In Canada, an ageing FP workforce has led to an increasing number of patients losing their FP, raising concerns about access to care and disruptions in care trajectories. While the benefits of continuity are well documented, evidence on the consequences of discontinuity in primary care, particularly from the patient perspective, remains limited. Relational discontinuity occurs when there is a disruption in the relationship between an FP and a patient, which may be related to the FP’s retirement or relocation or to the closure of a clinic. Objective This study aims to assess the effects of a disruption in the relational continuity with an FP on patient’s experience and their patterns of healthcare service use. Methods and analysis A descriptive cross-sectional survey will be administered to adults residing in Quebec, Canada’s second most populous province. A total sample of 1000 respondents will be recruited, including approximately 500 individuals who have lost their FP within the past 3 years, and 500 individuals currently registered with an FP. The questionnaire covers sociodemographic characteristics, health status, access to care, use of healthcare services, out-of-pocket costs and perceived impacts of discontinuity. Descriptive and regression analyses will be used to compare experiences and perceived effects between groups and to explore equity-related differences. Ethics and dissemination The study has received ethical approval from the Research Ethics Board involving human participants at Université Laval. Findings will be shared with policymakers and healthcare stakeholders to inform them on the patient-reported consequences of primary care discontinuity and support the development of strategies to mitigate its impacts.
Clinical relevance
This protocol addresses a critical and underexplored evidence gap: while continuity of care with a family physician (FP) is robustly associated with reduced mortality, fewer emergency department visits, lower hospitalization rates, and decreased healthcare costs, the patient-reported consequences of abrupt relational discontinuity — caused by FP retirement, relocation, or clinic closure — remain poorly characterized. The study is particularly timely given Canada's accelerating FP workforce crisis: Quebec carries the largest absolute FP shortage of any province (estimated at 2,658 physicians in 2022), has consistently reported the highest proportion of residents without a regular physician, and has an FP workforce with a mean age of 51.1 years — the oldest in the country — with more senior physicians than young physicians in its ranks. Clinicians and policymakers urgently need patient-level evidence on the downstream sequelae of forced care discontinuity to design targeted mitigation strategies.
Key findings
NOTE: This is a published study protocol (BMJ Open), not a completed trial; primary outcome data are not yet available. The following represent the study's pre-specified design parameters and contextual epidemiological anchors drawn from the abstract and supporting literature: 1. Study design: Descriptive cross-sectional survey targeting n=1,000 adult Quebec residents, equally divided between ~500 who have lost their FP within the prior 3 years and ~500 currently registered with an FP, powered to detect between-group differences in care experience and service utilization patterns. 2. Exposure of interest: Relational discontinuity operationalized as loss of an established FP due to retirement, relocation, or clinic closure — distinct from voluntary care-seeking behavior changes. 3. Primary domains assessed: Sociodemographics, self-reported health status, access to care, healthcare service utilization patterns, out-of-pocket expenditures, and patient-perceived impacts of discontinuity. 4. Analytical approach: Descriptive statistics and multivariable regression models will be used to compare outcomes between groups and to examine equity-related disparities (e.g., by age, income, comorbidity burden). 5. Contextual magnitude of problem: Quebec leads all Canadian provinces in FP shortage burden (estimated gap of 2,658 FPs as of 2022) and in proportion of residents searching for a physician for more than one year (18%), providing a high-prevalence, policy-relevant study context. 6. Evidence gap being addressed: Existing literature documents benefits of continuity (e.g., 81.8% of high-quality studies in one systematic review reported statistically significant mortality reductions with higher continuity) but prospective, patient-reported data on the consequences of involuntary discontinuity — particularly out-of-pocket costs and care fragmentation — are absent from the literature.
Practice implications
Although this is a protocol paper and no actionable efficacy data are yet available, the study's eventual findings are designed to directly inform clinicians and health system planners: practitioners should recognize that patients who involuntarily lose their FP represent a distinct, high-vulnerability cohort requiring proactive care transition support — particularly older patients and those with multimorbidity, for whom relational continuity confers the greatest mortality and utilization benefit. Health systems in Quebec and analogous jurisdictions should anticipate increased emergency department utilization and out-of-pocket cost burden among patients experiencing forced FP discontinuity, and should develop structured patient-transfer and re-registration protocols when FP retirement or clinic closure is foreseeable. Findings from this study will be disseminated to policymakers and healthcare stakeholders to support evidence-based development of mitigation strategies, making engagement with this research relevant for any clinician or administrator involved in primary care network planning, quality improvement, or health equity initiatives.