Future practice of comprehensive care: Practice intentions of exiting family medicine residents in Canada

Ivy F. Oandasan; Douglas Archibald; Louise Authier; Kathrine Lawrence; Laura April McEwen; Maria Palacios Mackay; Marie Parkkari; Shelley Ross; Steve Slade

Article Figures & Data

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Table 1.

Demographic characteristics of residents who responded to the T1 and T2 surveys (aggregate data from 6 family medicine residency programs)

CHARACTERISTIC	T1, N (%)	T2, N (%)
Age, y
• < 25	52 (15.2)	0 (0.0)
• 25–29	176 (51.6)	160 (49.2)
• 30–34	60 (17.6)	110 (33.8)
• 35–39	23 (6.7)	31 (9.5)
• ≥ 40	13 (3.8)	18 (5.5)
• No response	17 (5.0)	6 (1.8)
Marital status
• Single	194 (56.9)	131 (40.3)
• Married	98 (28.7)	120 (36.9)
• Common law	45 (13.2)	59 (18.2)
• Divorced	4 (1.2)	8 (2.5)
• Prefer not to answer	0 (0.0)	5 (1.5)
• No response	0 (0.0)	2 (0.6)
Children
• Yes or expecting	54 (15.8)	82 (25.2)
• No	285 (83.6)	238 (73.2)
• Prefer not to answer	2 (0.6)	3 (0.9)
• No response	0 (0.0)	2 (0.6)
Sex
• Female	210 (61.6)	199 (61.2)
• Male	119 (34.9)	122 (37.5)
• Prefer not to answer	0 (0.0)	1 (0.3)
• No response	12 (3.5)	3 (0.9)
Childhood environment
• Inner city	0 (0.0)	17 (5.2)
• Urban or suburban	222 (65.1)	195 (60.0)
• Small town	46 (13.5)	44 (13.5)
• Rural	42 (12.3)	34 (10.5)
• Remote or isolated	6 (1.8)	5 (1.5)
• Mixture of environments	22 (6.5)	23 (7.1)
• No response	3 (0.9)	7 (2.2)
Place of medical school graduation
• Canadian medical graduate	276 (80.9)	271 (83.4)
• International medical graduate	55 (16.1)	51 (15.7)
• No response	10 (2.9)	3 (0.9)
Total	341 (100.0)	325 (100.0)

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Table 2.

Type of FM practice envisioned

“AFTER COMPLETING YOUR RESIDENCY, HOW LIKELY ARE YOU TO PRACTISE IN THE FOLLOWING FM PRACTICE TYPES?”	DATA COLLECTION PERIOD		CI P VALUE	χ² P VALUE

	T1, %	T2, %
Comprehensive care delivered in 1 clinical setting (eg, office) (N for T1 = 336, N for T2 = 316)
• Not at all likely or somewhat unlikely	25.6	35.8	NS	< .001
• Neutral	31.8	8.5	< .01
• Somewhat likely or highly likely	42.6	55.7	NS
Comprehensive care provided across multiple clinical settings (eg, hospital, long-term care facility, office) (N for T1 = 340, N for T2 = 319)
• Not at all likely or somewhat unlikely	5.6	15.0	< .01	< .001
• Neutral	24.7	6.3	< .01
• Somewhat likely or highly likely	69.7	78.7	NS
Comprehensive care that includes special interests (eg, sports medicine, emergency medicine, palliative care) (N for T2 = 312)
• Not at all likely or somewhat unlikely	NA	14.7	NA	NA
• Neutral	NA	14.4	NA
• Somewhat likely or highly likely	NA	70.8	NA
Focused practice with a commitment to ≥ 1 specific clinical areas (eg, sports medicine, maternity care, emergency medicine, palliative care, hospital medicine) (N for T2 = 314)
• Not at all likely or somewhat unlikely	NA	49.4	NA	NA
• Neutral	NA	14.0	NA
• Somewhat likely or highly likely	NA	36.6	NA

FM—family medicine, NA—not asked in T1, NS—not significant.

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Table 3.

Changes from entry to exit (T1 to T2) in residents’ intentions to practise in domains outside the ambulatory clinical setting: The 7 family medicine clinical domains outside of ambulatory care are palliative or end-of-life care, care in long-term care facilities, intrapartum care, care in emergency departments, in-hospital clinical procedures, hospital care, and care in the home.

“IN YOUR FUTURE PRACTICE AS A FAMILY PHYSICIAN, HOW LIKELY ARE YOU TO PROVIDE CARE IN EACH OF THE FOLLOWING DOMAINS, PRACTICE SETTINGS, AND SPECIFIC POPULATIONS IN THE FIRST 3 YEARS?”	T1, N (%)	T2, N (%)
Care across the life cycle only	16 (5.8)	15 (5.6)
Care across the life cycle plus 1 domain	35 (12.8)	36 (13.3)
Care across the life cycle plus 2 domains	63 (23.0)	45 (16.7)
Care across the life cycle plus 3 domains	66 (24.1)	49 (18.1)
Care across the life cycle plus 4 domains	50 (18.2)	49 (18.1)
Care across the life cycle plus 5 domains	25 (9.1)	32 (11.9)
Care across the life cycle plus 6 domains	13 (4.7)	21 (7.8)
Care across the life cycle plus 7 domains	6 (2.2)	23 (8.5)
Total	274 (100.0)	270 (100.0)