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Rewards and challenges of family practice

Web-based survey using the Delphi method

Stanley Varnhagen, MA PhD
Dr Varnhagen is Academic Director of Learning Solutions in the Faculty of Extension at the University of Alberta.

Pamela Brett-MacLean, MA
Ms Brett-MacLean is Co-Director of the Arts and Humanities in Health and Medicine Program of the Faculty of Medicine and Dentistry at the University of Alberta.

G. Michael Allan, MD CCFP
Dr Allan is an Assistant Professor in the Department of Family Medicine at the University of Alberta and a Research Fellow at the Institute of Health Economics.

Olga Szafran, MHSA
Ms Szafran is Research Coordinator in the Department of Family Medicine at the University of Alberta.

Allen Ausford, MD CCFP
Dr Ausford is an Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.

Carol Rowntree, MD CCFP
Dr Rowntree is an Associate Clinical Professor in the Department of Family Medicine at the University of Calgary in Alberta.

Ismael Rumzan, PhD
Dr Rumzan is a researcher at the University of Alberta.

Diana Turner, MD MSc CCFP
Dr Turner is a Clinical Lecturer in the Department of Family Medicine at the University of Calgary

Correspondence to: Dr Donna P. Manca, Grey Nuns Family Medicine Clinic, Cedars Professional Pk, 2927—66 St, Edmonton, AB T6K 4C1; telephone 780 461–3533; fax 780 490–0953; e–mail dmanca{at}planet.eon.net

OBJECTIVE To identify and describe the important rewards and challenges that affect family physicians in Alberta.

DESIGN Web-based qualitative study using the Delphi method.

SETTING Province of Alberta.

PARTICIPANTS Twenty-eight family physicians practising in Alberta.

METHODS The study website presented a description of the project, ethical information, a calendar of events, and contact information. Delphi surveys and demographic questionnaires were password protected. Five rounds of surveys were conducted between May 2004 and January 2005. Participants were notified of each round of surveys and prompted by e–mail ifthey did not respond.

FINDINGS Participants identified 8 key rewards and 9 key challenges. The research team identified 2 additional challenges that were validated by participants. In order of perceived importance, key rewards were providing diverse and comprehensive care; providing preventive care; having relationships with patients and their families; being an immersed witness to the human condition; providing continuity of care and receiving ongoing feedback; having flexibility and control of practice and job security; maintaining and acquiring skills and knowledge; teaching and sharing knowledge and gaining experience and mentoring. The challenges, in order of perceived need to be addressed, were workload and time pressures and meeting demands; the need to promote the rewards of family practice to those considering joining the profession; overhead and income inequities; getting respect from specialists; the need to ensure that the rewards identified are not adversely affected by primary care reform; lack of availability of specialists, procedures, tests, and other resources; running a practice as a small business; paperwork, telephone calls, and forms; maintaining and acquiring skills and knowledge; patients’ expectations; and medicolegal issues, insurance paperwork, and dealing with medical claims related to motor vehicle accidents.

CONCLUSION The rewards and challenges reported by participants outline the positive and negative factors in family practice. The challenges provide a focus for further work.

This article has been cited by other articles:

				D. Manca, S. Varnhagen, P. Brett-MacLean, G. M. Allan, and O. Szafran RESPECT from specialists: Concerns of family physicians Can Fam Physician, October 1, 2008; 54(10): 1434 - 1435.e5. [Abstract] [Full Text] [PDF]