PONE-D-24-16194Characterizing the services provided by family physicians in Ontario, Canada: A retrospective study using administrative billing dataPLOS ONE

Dear Dr. Mago,

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Academic Editor

PLOS ONE

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“RS is a co-investigator with DS as the principal investigator on a grant from the Northern Ontario Academic Medical Association (NOAMA) Clinical Innovation Opportunities Fund (C-18-19). Additional funding to SC from the Natural Sciences and Engineering Research Council (NSERC) of Canada supported this work.”

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“RS is a co-investigator with DS as the principal investigator on a grant from the Northern Ontario Academic Medical Association (NOAMA) Clinical Innovation Opportunities Fund (C-18-19). Additional funding to SC from the Natural Sciences and Engineering Research Council (NSERC) of Canada supported this work.”

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an excellent study: well planned, well analysed and well presented. It is of great importance for planning the education of family physicians and explaining to planners the exact situation now and in the future. My comments are only to improve the impact of their study.

Introduction

“Moreover, strong primary care systems have been shown to improve overall population health and reduce health system costs (2).”

[This is crucial to the importance and uptake of your research. Can you please provide perhaps from systematic reviews a summary that will convince readers]

“Although 69 previous studies have provided evidence for the varying scope of practice offered by different 70 family physicians in Canada, these mostly survey-based studies have suffered from low 71 response rates and recall bias when estimating the number and type of services being provided 72 (4”

[Can you provide examples of low response rates for important topics. This will greatly increase the importance of your study]

“In addition, a much smaller proportion of specialists practice in rural 79 communities as compared to urban centres. Mian et al. (2017) described the unique challenges 80 in recruiting physicians to rural communities in northern Ontario (9). For rural populations, the 81 lack of access to primary care can lead to higher levels of chronic disease, lower life expectancy, 82 and overall poorer health status (10–12).”

[This is the essence of the problem. Can you provide some supporting stats please?]

Data sources

“We retrieved Ontario’s 2017 administrative healthcare data”

[readers will wonder why 2017 and not 2023. Please explain]

Typos

107 data was anonymized, [please change to were. Latin datum = singular, data = plural]

139 in additional [change to in addition to]

193 provided a fewer number of [change to smaller]

204 Figure 2, however, the among different year in 205 practice in relatively equal [please rewrite]

I have published a study of readmission rates and mortality of seniors admitted to the Calgary hospitals 2013-2023. I sent it to the Premier, Health Minister and all the physician organisations. I was advised that the bureaucrats are the key persons who might take action on it.

Reviewer #2: Well perfomed analysis of your local situation of services by family physicians. Unfortunately, it is very difficult to understand details for persons who are not familiar with your billing system. What do all these codes mean? Why is there such a low number of items for chonic care? What is about cooperations within one practice setting? Are they complementary? Why is the number of young practicing doctors higher in rural regions? Are many of them moving to urban areas after some years? If you wsh to publish your data in an international data you should give much more informations in the appendix and you should draw international comparisons

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Reviewer #1: Yes: Roger E. Thomas

Reviewer #2: Yes: Prof. Dr. Erik Baum, Germany

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Characterizing the services provided by family physicians in Ontario, Canada: A retrospective study using administrative billing data

PONE-D-24-16194R1

Dear Dr. Mago,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Inge Roggen, M.D., Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have carefully replied to all of the reviewers' comments and questions and fully explained why they took particular strategies in the data analysis. They discussed the limitations of the data in their databases. Important and thoughtfully planned, researched and analysed and presented study on an important topic of concern to family physicians, primary care planners, primary care researchers and hopefully ministries and funding organisations. The databases is appropriate to the analysis of these concerns. The authors provided careful and thorough responses to the reviewers' comments and satisfactorily explained their strategies and decisions about the data. The authors carefully explained the data privacy requirements and why certain data cannot be disclosed in this publication. They explained why nurse practitioners' salaries are not available for publication in this article. They also explained that different billing codes would be used by a family physician practising in their office and a family physician practising in an emergency ward. They explained why the 2017 and not later dataset was used. Good discussion of differences by age between rural and urban physicians in their practices. Clearly written and analysed. Good graphics clearly presented their data and which are very easy to comprehend. The manuscript is technically sound and the analysis, discussion and graphical presentations support their conclusions.

Reviewer #2: requests for corrections were adressed adequately. Now international aspects and reader for codes are added. I have no further comments

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Roger E.Thomas

Reviewer #2: No

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