This is a medRxiv preprint, currently under review at Health Policy (previously Revise & Resubmit). We are thankful for the reviewers’ first round of feedback which has contributed to the improvement of our manuscript.

Abstract

Background: Emergency departments in underserved areas face chronic staffing challenges. One possible solution is to use physicians who are quicker to train and more pervasive in lieu of more extensively trained physicians. Canada allows for emergency medicine specialization via a 3-year pathway (CCFP(EM)) and a 5-year pathway (FRCPC) which means different geographic areas are exposed to EM physicians with different training lengths.

Methods: We examine Ontario, Canada which has both widespread geographic diversity and emergency providers with these two lengths of postgraduate training. We scrape the College of Physicians and Surgeons of Ontario public registry in 2015 and 2024. We map the geographic distribution of physician types and estimate spatial autocorrelation measures using global and local Morans I to determine whether these physicians became more geographically concentrated.

Results: Between 2015 and 2024, the number of CCFP(EM) and FRCPC physicians increased in overall numbers but their unique locations remained stable. Mapping of these locations suggests clustering into urban or suburban areas in the province. CCFP(EM) physicians have become more concentrated over time (Morans I of 0.234 and 0.308 in 2015 and 2024) relative to FRCPC physicians (Morans I of 0.096 and 0.103).

Conclusion: We find that, from 2015 to 2024, emergency physicians have become more concentrated in the province of Ontario due to CCFP(EM) physicians concentrating around urban areas with academic centres. Policies relying on less extensively trained providers to plug staffing gaps may not necessarily be effective in improving equitable access to physicians.

Recommended citation: Kanter-Eivin, D., Armstrong, C., Esleben, A., et. al (2025). Do Faster‑Trained Physicians Fill the Gaps? Geographic Concentration of Emergency Medicine physicians with different postgraduate training in Ontario Canada. Preprint. doi: https://doi.org/10.1101/2025.04.29.25326528
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