Abstract
Abstract
Background
Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians’ practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice.
Methods
We conducted a qualitative study using framework analysis. Family physicians in their first 10 years of practice were recruited from three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Interview data were coded inductively and then charted onto a matrix in which each participant’s data were summarized by code.
Results
Of the 63 participants that were interviewed, 24 worked solely in community-based practice, 7 worked solely in focused practice, and 32 worked in both settings. We identified four practice characteristics that were influenced (scope of practice, practice type and model, location of practice, and practice schedule and work volume) and three categories of influential factors (training, professional, and personal).
Conclusions
This study demonstrates the complex set of factors that influence practice choices by early-career physicians, some of which may be modifiable by policymakers (e.g., policies and regulations) while others are less so (e.g., family responsibilities). Participants described individual influences from family considerations to payment models to meeting community needs. These findings have implications for both educators and policymakers who seek to support and expand comprehensive care.
Funder
Canadian Institutes of Health Research
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,Public Administration
Reference30 articles.
1. OECD, European Union. Health at a glance: Europe 2022: State of health in the EU cycle [Internet]. OECD; 2022 [cited 2023 Mar 9]. (Health at a Glance: Europe). Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2022_507433b0-en.
2. Statistics Canada. Primary health care providers, 2019 [Internet]. 2020. Available from: https://www150.statcan.gc.ca/n1/pub/82-625-x/2020001/article/00004-eng.pdf.
3. Chan BTB. The declining comprehensiveness of primary care. CMAJ. 2002;166(4):429–34.
4. Russell A, Fromewick J, Macdonald B, Kimmel S, Franke K, Leach K, et al. Drivers of scope of practice in family medicine: a conceptual model. Ann Fam Med. 2021;19(3):217–23.
5. Henry TL, Rich EC, Bazemore A. Comprehensiveness—the need to resurrect a sagging pillar of primary care. J Gen Intern Med. 2022;37(1):229–31.