Physician Supply and Breast Cancer Survival

Background: This study tested the hypothesis that physician supply thresholds are associated with breast cancer survival in Ontario. Methods: The 5-year survival of 17,820 female breast cancer patients diagnosed between 1995 and 1997 was surveilled until 2003 for all-cause mortality. Physician supply densities in 1991 and 2001 were computed for 49 Ontario regions. Results: There were independent threshold effects for general practitioners (GP; 7.25 per 10,000) and obstetrician/gynecologists (OB/GYN; 6 per 100,000) at or above which women with breast cancer were more likely to survive for 5 years. The respective risk of living in areas undersupplied with OB/GYN and GP increased 30% to nearly 5-fold during the 1990s. Five-year survival tended to be lower in provincial areas outside of Toronto, which experienced GP (odds ratio, 0.83; 90% CI, 0.70-0.99) and OB/GYN (odds ratio, 0.76; 95% CI, 0.61-0.96) supply decreases. Conclusion: As they do in America, primary care physician supplies in Canada seem to matter in the effective provision of cancer care. Community resources such as health care service endowments, including physician supplies, may be particularly critical to the performance of health care systems such as Canada's, which aim to provide medically necessary care for all. (J Am Board Fam Med 2010;23:104-108.)