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Publication Title

Canadian Journal of Rural Medicine





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Breast Neoplasms/epidemiology, Breast Neoplasms/therapy, California, Cohort Studies, Family Practice/manpower, Female, Health Services Needs and Demand/statistics & numerical data, Health Services Research, Humans, Internal Medicine/manpower, Ontario, Physician's Practice Patterns/statistics & numerical data, Physicians/supply & distribution, Primary Health Care/manpower, Women's Health, Women's Health Services/manpower

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INTRODUCTION: We examined the differential effects of the supply of physicians on care for breast cancer in Ontario and California. We then used criteria for optimum care for breast cancer to estimate the regional needs for the supply of physicians.

METHODS: Ontario and California registries provided 951 and 984 instances of breast cancer diagnosed between 1998 and 2000 and followed until 2006. These cohorts were joined with the supply of county-level primary care physicians (PCPs) and specialists in cancer care and compared on care for breast cancer.

RESULTS: Significant protective PCP thresholds (7.75 to = 8.25 PCPs per 10 000 inhabitants) were observed for breast cancer diagnosis (odds ratio [OR] 1.62), receipt of adjuvant radiotherapy (OR 1.64) and 5-year survival (OR 1.87) in Ontario, but not in California. The number of physicians seemed adequate to optimize care for breast cancer across diverse places in California and in most Ontario locations. However, there was an estimated need for 550 more PCPs and 200 more obstetrician-gynecologists in Ontario's rural and small urban areas. We estimated gross physician surpluses for Ontario's 2 largest cities.

CONCLUSION: Policies are needed to functionally redistribute primary care and specialist physicians. Merely increasing the supply of physicians is unlikely to positively affect the health of Ontarians.