Left by a trusted physician and colleague: Impacts of primary care physician exits in a group practice system

Disruptions of the patient-general practitioner (GP) relationship due to GP exits affect patient outcomes in various ways. The literature suggests that the loss of a trusted professional can have negative effects, but also points at the benefits of being examined by a new GP. We study the impact of GP exits in the Swedish primary care setting, in which care is provided in group practices and even those patients who have a main GP usually see different GPs. Since the practice is responsible for organizing a replacement GP after an exit, we expect the transition between GPs to be relatively smooth for patients. Using two different control groups we are able to separate the effects of being affected by the loss of ones main GP from the reduction of a practices' workforce. Our results show that GP exits have a negligible effect on patients health care utilization in the Swedish setting. We do observe some shifts in health care utilization patterns, however, this is not driven by the loss of the main GP but rather practice level disruptions. These findings suggest that in organizational settings such as in Sweden - where continuity of care is maintained at practice rather than GP level - patient outcomes are less dependent on individual GPs. Importantly, this conclusion holds even for patients with high baseline continuity of care.