What happens when the family doctor retires?

According to surveys, 90% of the Swiss population has a general practitioner. General practice is a key component of primary care and serves as one of the cornerstones of the Swiss healthcare system, offering a simple and cost-effective first point of contact for health issues. General practitioners not only provide healthcare services themselves but also decide whether a patient should be referred to a specialist. Over time, they gather valuable information about their patients and build trust with them. This close, often long-standing relationship between doctor and patient—known as interpersonal continuity—has been shown in numerous studies to lead to more efficient healthcare delivery.

General practitioners also age every year and eventually retire. This event abruptly disrupts the long-standing doctor-patient relationship. Additionally, access to primary care becomes more challenging if the retiring GP cannot find a suitable successor for their practice. Even with a planned succession, the new doctor may have a different practice style, requiring patients to make certain adjustments. To design effective healthcare policies, it is crucial to understand how each of these three channels impacts primary care. Existing literature has so far only examined the overall effects of losing a GP. For instance, most previous studies have identified a shift toward often more expensive secondary care, but the precise reasons behind this shift remain unclear.

To identify and quantify the impact of individual channels, we explicitly focus on practice transitions where the retiring doctor has found a successor for their practice. Consequently, patients experience no changes in access, the location of the practice, or often the supporting staff—only the GP changes. This allows us to examine the effects of interpersonal discontinuity and the new doctor's practice style without confounding changes in access. While discontinuity tends to have short-term effects, as a new doctor-patient relationship is re-established over time, the consequences of practice style are often more long-term in nature. By separating the effects into short- and long-term impacts, we can isolate and identify the influences of the aforementioned channels.

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 transition leads to a short-term increase in the total number of doctor visits and healthcare costs (both primary and secondary care). This observation can primarily be explained by the new GP’s initial reassessment of patients' health conditions. In the long term, we observe a persistent increase in the use of secondary care, outpatient costs, laboratory analysis costs, and costs per doctor visit. This can be attributed to the differing practice styles of the new doctors, who, on average, are significantly younger and more often women. Previous studies have shown that practice styles vary substantially based on these characteristics. For instance, female doctors are more likely to conduct laboratory tests, refer patients to specialists, and spend more time with their patients—consistent with our findings.

In contrast to our earlier study, where we specifically analyzed practice closures without a planned successor, we find no decline in primary care utilization following practice transitions. On the contrary, we even find evidence of a potential improvement in the quality of primary care. We observe a significant increase in the prevalence of common chronic diseases, as identified through prescribed medications. This could be due to the new GP diagnosing previously unnoticed conditions or reflecting a preference for using medications, which can be attributed to differing practice styles. Overall, our study shows that as long as access to primary care is maintained, a GP change may lead to a slight increase in costs but also positively impacts treatment quality. Such a transition can, therefore, have a positive effect on patients' health.

Given the upcoming wave of GP retirements, policymakers should ensure that access to primary care remains intact. While practice closures without successors, particularly in rural areas, have negative effects on healthcare provision, this is not observed with practice transitions. These findings emphasize the importance of maintaining uninterrupted primary care to sustain a cost-efficient healthcare system. For example, patients of retiring GPs without planned successors could be assisted in finding a suitable new GP. Alternatively, other medical professionals could be temporarily employed to provide certain healthcare services, as is done in the United States with “practical nurses”.