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What does it mean to be a family physician?

Exploratory study with family medicine residents from 3 countries

Valérie Dory, MD and Dominique Pestiaux, MD
Dr Dory is a doctoral candidate and Dr Pestiaux is a Professor at the Centre universitaire de médecine générale in the Faculté de médecine of the Université catholique de Louvain in Brussels, Belgium

Denis Pouchain, MD
Professor in the Département universitaire d’enseignement et de recherche en médecine générale in the Faculté de médecine de Créteil in Créteil, France

Marc Rioux, MSc and Guy Rocher, PhD
Mr Rioux is a doctoral candidate and Dr Rocher is a Professor in the Faculty of Sociology and the Centre de recherche en droit public of the Université de Montréal

Bernard Gay, MD
Professor in the Département de médecine générale at the Université Victor Segalen Bordeaux 2 in Bordeaux Cedex, France

Laurier Boucher, MSW
Research assistant for the Chaire Docteur Sadok Besrour en médecine familiale at the Centre de recherche of Centre hospitalier de l’université de Montréal (CR-CHUM)

Correspondence: Dr Marie-Dominique Beaulieu, Département de médecine familiale, Université de Montréal, Centre de recherche du CHUM, Hôpital Notre-Dame, Pavillon L-C Simard, 1560 Sherbrooke E, 8th Floor, Montreal QC, H2L 4M1; telephone 514 890-8000, extension 28046; fax 514 412-7579; e-mailmarie-dominique.beaulieu{at}umontreal.ca

OBJECTIVE To explore the conceptions that family medicine residents from 3 countries have of the roles and responsibilities of family physicians in order to gain a better understanding of challenges that might transcend the specific contexts of different health care systems.

DESIGN Qualitative study using focus groups.

SETTING Resident training programs in France, Belgium, and Canada.

PARTICIPANTS A total of 57 residents in the last year of training.

METHOD Ten focus groups were conducted in 3 countries: 2 in France, 3 in Belgium, and 5 in Canada. All focus groups were held in different cities, with residents registered in different universities in France and Canada and with residents from the same university in Belgium. The study was informed by Abbott’s conceptual framework on the system of professions. Each 90-minute focus group was moderated by the same researchers. The transcripts were analyzed according to the immersion-crystallization method.

MAIN FINDINGS Respondents shared common conceptions of the family physician’s role: continuity of care and patient advocacy were seen as the foundations of the discipline. Respondents also shared a sense of discomfort about how accessible they were expected to be for patients and about the scope of family practice. They saw family medicine as flexible and reported that they strove for balance between their professional and personal life goals. All respondents strongly believed that their profession was undervalued by the medical schools where they trained.

CONCLUSION This exploratory study suggests that there are more similarities than differences in the understanding that future family physicians from different countries have of their discipline and of their careers. We observed a tension between a desire to develop a "new general practice" and the more traditional vision of the discipline. The culture in academic settings appears to contribute to the persistent low appeal of being a primary care physician.