Women's health workforce and outpatient care delivery in Alberta: Evidence from 26 years of population-based data.

BACKGROUND: Many female-specific health services in Canada are delivered by obstetrician-gynecologists and family physicians. However, little is known about how patterns of care delivery, physician workforce supply, and patient characteristics have changed over time, limiting evidence-informed workforce and health system planning. OBJECTIVE: To examine long-term trends in outpatient women's health service delivery, physician workforce supply, and patient characteristics in Alberta and identify implications for workforce planning, access, and health system reform. METHODS: This population-based cohort study used linked administrative health data from Alberta between 1994 and 2020 to analyze outpatient visits for female-specific health services to obstetrician-gynecologists or family medicine physicians. We estimated temporal trends in visit rates by health complaint, physician characteristics, and patient reproductive life stage (reproductive, perimenopausal, or postmenopausal), and comorbidities. RESULTS: Over a 26-year period, >2 million females accessed care from 416 obstetrician-gynecologists and 7658 family medicine physicians. While the number of obstetrician-gynecologists and family medicine physicians per 1000 females increased (from 0.11 to 0.15 and 2.21 to 2.57, respectively), the average number of visits per physician per 1000 females declined (from 291 to 250 and 834 to 625, respectively). The nature and volume of visits varied by life stage. Physician and patient demographics shifted with more women physicians, patients with multimorbidity, and a U-shaped relationship between neighbourhood income and specialist utilization. CONCLUSION: Findings suggest that physician supply alone may provide an incomplete picture of the resources required to meet women's health care needs. Future workforce planning efforts may benefit from considering changes in patient complexity, patterns of care delivery across physician types, and potential inequities in access to specialty services.