What happens when the family doctor retires?

According to surveys, 90% of the Swiss population have a family doctor. Family medicine is part of primary care and forms one of the foundations of the Swiss healthcare system, as it offers a simple and cost-effective point of contact for health problems. However, GPs not only provide healthcare services themselves, they also decide whether a patient should be referred to a specialist or not. Over time, GPs gather valuable information about their patients and build trust with them. According to numerous studies, this close, often long-term relationship between doctor and patient - known as interpersonal continuity - leads to more efficient healthcare.

GPs also get older every year and retire at some point. This event suddenly interrupts the long-standing doctor-patient relationship. In addition, access to primary care becomes more difficult if the GP is unable to find a suitable successor for the practice. However, even in the case of an organised succession, the new doctor may have a different style of practice, which means certain adjustments for patients. For health policy measures, it is important to understand exactly how each of these three impact channels influences primary care. The literature to date has only been able to analyse the overall impact of the loss of the GP. For example, while the majority of previous studies have found a shift towards often more expensive secondary care, the exact causes behind this remain unclear.

To enable us to identify and quantify the impact channels individually, we explicitly focus on practice handovers where the retired doctor has found a successor for the medical practice. Accordingly, the access, the route to the practice and often also the other staff remain the same for the patients - only the GP changes. This allows us to analyse the effects of interpersonal discontinuity and the doctor's practice style without changes in access. While discontinuity tends to have a short-term effect, as a doctor-patient relationship is re-established with the new doctor after a certain period of time, the consequences of the practice style are often of a long-term nature. By dividing the effects into short-term and long-term, we can therefore identify the effects of the above-mentioned channels separately.

We apply a version of the difference-in-differences method in which we compare the development between patients who are affected by a practice closure and a group of similar patients who do not experience a practice closure at the same time. Assuming that the two groups would have developed in the same way over time if no one had been affected by a practice closure, this procedure enables the identification of causal effects, as in a classic randomised experiment. We look at various results in the categories of healthcare utilisation, costs and hospitalisations.

Our results show that a practice handover leads to a short-term increase in the total number of doctor visits and healthcare costs (primary and secondary care). This observation can mainly be explained by the new GP's reassessment of the patient's state of health. In the long term, we observe a persistent increase in the use of secondary care, outpatient costs, costs for laboratory analyses and costs per visit. This can be explained by a change in the practice style of new doctors, who are on average significantly younger and more often women. Earlier studies have shown that practice styles can vary considerably along these characteristics. For example, women perform laboratory analyses more frequently, are more likely to refer to a specialist and spend more time with their patients, all of which is consistent with our findings.

In contrast to our earlier study, in which we explicitly analysed practice closures without regulated succession, we find no decline in the use of primary care in the case of practice handovers. On the contrary, we even find evidence for a potential increase in the quality of primary care. We observe a significant increase in the prevalence of common chronic diseases that can be recognised by the medication prescribed. This may be due to the new GP diagnosing previously unrecognised conditions or may reflect a preference for the use of medication. The latter can in turn be explained by different practice styles. Overall, our study shows that, provided access to primary care is guaranteed, a change of GP does lead to a slight increase in costs, but the quality of treatment is also positively influenced. Such a change can therefore have a positive effect on patients' health.

In view of the impending wave of GP retirements, policymakers should ensure that access to primary care is maintained. While practice closures without a successor, particularly in rural regions, have negative effects on healthcare provision, this is not the case with practice handovers. These findings emphasise the need to strive for uninterrupted primary care in order to maintain a cost-effective healthcare system. For example, patients of retiring GPs without a regular successor can be helped to find a suitable new GP. Alternatively, other medical professionals could be temporarily deployed to provide certain healthcare services, as is done in the USA with "practical nurses".