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Canadian family physicians’ decision to collaborate: Age, period and cohort effects


  • Sarma, Sisira
  • Devlin, Rose Anne
  • Thind, Amardeep
  • Chu, Man-Kee


One of the core primary care reform initiatives seen across provinces in Canada is the introduction of inter-professional primary healthcare teams in which family physicians are encouraged to collaborate with other health professionals. Although a higher proportion of physicians are collaborating with various health professionals now compared to the previous decade, a substantial number of physicians still do not work in a collaborative setting. The objective of this paper is to examine the age, period and cohort effects of Canadian family physicians’ decisions to collaborate with seven types of health professionals: specialists, nurse practitioners, nurses, dieticians, physiotherapists, psychologists and occupational therapists. To this end, this paper employs a multivariate probit model consisting of seven equations and a cross-classified fixed-effects strategy to explain the collaborative decisions of family physicians. Utilizing three cross-sectional physician surveys from Canada over the 2001–2007 period, cohorts are defined over five-year intervals according to their year of graduation from medical school. We find that newer cohorts of physicians are more likely to collaborate with dieticians, physiotherapists, psychologists and occupational therapists; newer female cohorts are more likely to collaborate with nurses while newer male cohorts are less likely to collaborate with nurses but more likely to collaborate with specialists. Older physicians are more likely to collaborate with specialists, physiotherapists, psychologists, and occupational therapists; the age effect for nurses is U-shaped for male physicians while it is inverse U-shaped for females. Family physicians are collaborating more with all seven health professionals in 2004 and 2007 compared to 2001. Belonging to a group practice has a largely positive influence on collaborations; and being paid by a fee-for-service remuneration scheme exerts a negative influence on collaboration, ceteris paribus. The findings suggest that combining a non-fee-for-service remuneration arrangement with a group practice structure would facilitate effective collaboration.

Suggested Citation

  • Sarma, Sisira & Devlin, Rose Anne & Thind, Amardeep & Chu, Man-Kee, 2012. "Canadian family physicians’ decision to collaborate: Age, period and cohort effects," Social Science & Medicine, Elsevier, vol. 75(10), pages 1811-1819.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:10:p:1811-1819
    DOI: 10.1016/j.socscimed.2012.07.028

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    References listed on IDEAS

    1. Reither, Eric N. & Hauser, Robert M. & Yang, Yang, 2009. "Do birth cohorts matter? Age-period-cohort analyses of the obesity epidemic in the United States," Social Science & Medicine, Elsevier, vol. 69(10), pages 1439-1448, November.
    2. Gené-Badia, Joan & Ascaso, Carlos & Escaramis-Babiano, Georgia & Catalán-Ramos, Arantxa & Pujol-Ribera, Enriqueta & Sampietro-Colom, Laura, 2008. "Population and primary health-care team characteristics explain the quality of the service," Health Policy, Elsevier, vol. 86(2-3), pages 335-344, May.
    3. Sarma, Sisira & Thind, Amardeep & Chu, Man-Kee, 2011. "Do new cohorts of family physicians work less compared to their older predecessors? The evidence from Canada," Social Science & Medicine, Elsevier, vol. 72(12), pages 2049-2058, June.
    4. Jinhu Li & Jeremiah Hurley & Philip DeCicca & Gioia Buckley, 2014. "Physician Response To Pay‐For‐Performance: Evidence From A Natural Experiment," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 962-978, August.
    5. Lorenzo Cappellari & Stephen P. Jenkins, 2003. "Multivariate probit regression using simulated maximum likelihood," Stata Journal, StataCorp LP, vol. 3(3), pages 278-294, September.
    6. Yang Yang & Kenneth C. Land, 2008. "Age–Period–Cohort Analysis of Repeated Cross-Section Surveys: Fixed or Random Effects?," Sociological Methods & Research, , vol. 36(3), pages 297-326, February.
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