Similar rewards and challenges: Family physicians share views of family medicine

Barbara Kermode-Scott

According to recent qualitative research by Dr Donna Manca, her colleagues, and the College of Family Physicians of Canada (CFPC), Canadian family physicians share very similar views of the positive and negative factors in family practice.

In 2004 and 2005, Dr Manca and her research team undertook a Web-based survey using the Delphi method to identify and describe the important rewards and challenges that affect family physicians in Alberta (http://www.cfpc.ca/cfp/2007/feb/vol53-feb-research-manca.asp). Twenty-eight participants identified 8 key rewards and 9 key challenges. The 3 priority rewards identified were providing diverse and comprehensive care, providing preventive care, and having relationships with patients and their families. The 3 priority challenges identified were as follows:

workload and time pressures and meeting demands,
the need to promote the rewards of family practice to those considering joining the profession, and
overhead and income inequities.

The March issue of Family Practice e-News on the CFPC website asked members what they consider their key rewards and challenges in family practice (http://www.cfpc.ca/English/cfpc/communications/Web%20newsletter/Vol%2031%20March%2007/default.asp?s=1#qofm). Members responded that the key rewards were relationships with patients and their families, providing diverse and comprehensive care, and providing continuity of care and receiving ongoing feedback. According to the respondents, the top 3 challenges in family practice were as follows:

workload and time pressures, and meeting demands,
patients’ expectations of medicolegal issues (ie, insurance paperwork, medical claims related to motor vehicle accidents), and
overhead and income inequities (http://www.cfpc.ca/English/cfpc/communications/Web%20newsletter/Vol%2032%20April%2007/default.asp?s=1#qofm).

The responses from CFPC members are very interesting and generally fit with Alberta family physicians’ views, says Dr Manca. “The top 3 concerns [listed in the CFPC e-News survey] clearly resonate. Workload and inequities were clearly major concerns in the Alberta Delphi survey. Workload really is a big issue. Inequities are also a major issue. Patient expectations were rated lower in the Delphi; however, in the Delphi we had patient expectations, paperwork, and medicolegal issues as separate items. Medicolegal items can be very disturbing and can interfere with our relationships with our patients.”

Dr Manca also points out that the unpublished qualitative data included a lot of discussion around patient expectations. “I do think that we have a lot of concerns around our patients’ expectations…. Patients are sometimes more concerned about convenience than about taking responsibility for their own health. In some ways it’s possibly a societal problem…. We’re seeing a lot of lifestyle ills in our society, where people don’t really want to also get engaged in a process where they’re equally responsible for their health. They’d much rather have a quick fix and maybe have come to expect that.”

Dr Manca stresses another point. “The great news is that all of our rewards are inherent in our practice.… They are ingrained principles of family medicine. It’s been very hard for many of us in community practice, … but when you look, all of the rewards are right in what we do day to day. The challenges we face don’t come from our work, from our practice. A lot of them are external. They are related to the environment that we’re working in, [to] power and control, and [to] what’s being foisted upon us externally by other groups. I think we maybe need to look at how … we become empowered. How do we all come to the table in a way that we can collaborate and it can be mutually beneficial?”