Rewards and challenges of family practice: Number of participants ranking rewards and challenges in Delphi rounds 3* and 5.†
| REWARDS IN ORDER OF RANK AND CHALLENGES IN ORDER OF THE NEED TO ADDRESS THEM | NO. OF PARTICIPANTS RANKING THEM | ILLUSTRATIVE QUOTES |
|---|---|---|
| REWARDS | ||
| Diversity and comprehensive care (reflects the variety,breadth, and diversity of practice; a complex set of skills;specific technical skills; etc) | 22/25* | Broad range of knowledge; never boring; difficulty and complexity; one physician who can look at all aspects; patient assessed as a whole person |
| Preventive care | 13/25* | Early, when it is relatively easy to educate patients, to effect change, and to focus on wellness; satisfying and fun; our most important role; integral to family medicine |
| Relationships with patients and their families | 22/25* | Advocates, highly privileged position; personal ... intense relationship; experienced birth, severe illness, or death in the family; long-term relationships— generations; emphasized more in recruiting efforts; most significant reason for continuing |
| Being an immersed witness to the human condition | 11/25* | Learn from observing; we grow from interacting; witness to the powerful moments of life; the church has the sacraments, [but] we usually are involved at some stage in the actual physical expression of them |
| Continuity of care and ongoing feedback | 17/25* | Following patients; knowing they benefited; encouragement personally and professionally; enduring feeling ... done some good; I know my patients, ... a good thing for everybody |
| Control, flexibility, and security | 19/25* | Flexibility in this occupation; being able to exert significant control over my client load, work hours, work style, and setting; type of medicine; ability to learn new skills |
| Maintaining skills and knowledge | 13/25* | Stimulation and satisfaction; learn something new each day; modern technology; maintain an advanced skill, eg, endoscopy; constructive feedback from colleagues(family physicians, nurses, consultants); key to becoming an excellent clinician |
| Teaching, sharing knowledge and experience, and mentoring | 13/25* | Bringing someone to valuing appropriately their skill and place … is of great benefit; there are things we can teach that are not teachable in the classroom |
| CHALLENGES | ||
| Workload and time pressures, meeting demands | 19/25* | Never enough time to do anything well; meeting patient needs and demands; single largest frustration; feeling rushed; affected my family life to its detriment |
| Need to promote the rewards identified to those who might consider family practice as a profession | ||
| Overhead and income Inequities | 17/21† | Family practice ... poorly paid relative to other specialties; affects our ability to take the time for paperwork [or] for extra training and with our patients; need to see enough patients to make the office ... cost-effective; cost of providing primary care is largely borne by family physicians, ourselves |
| Getting respect from specialists | 17/21† | [Specialists] do not understand our role; [do not accept] telephone appointments and[offoad] work onto our staff, undermining our credibility with our patients; negative comments about our specialty to residents and medical students reject a lack of respect; in the past [we had] more opportunities to meet and work together |
| Need to ensure that the rewards are not adversely affected by primary care reform | ||
| Availability of specialists, procedures, tests, and other Resources | 12/25* | Much time is spent either trying to access resources or patching up the cracks in the system; sometimes dangerous as we try to manage our patients in need; feeling powerless in the face of unacceptable delay; increases the “burnout factor” |
| CHALLENGES | ||
| Running a practice—a small business | 14/23† | Part... is overhead expenses, but running a practice is so much more: staffing, supplies, computer systems management, health information act; running one’s practice efficiently (time and cost) and safely is a major challenge |
| Paperwork, telephone calls, and forms | 18/25* | Bureaucracy intrudes on my ability to provide good patient care; hours of work to take home; biggest downsides to family medicine; other reports fall in our laps from specialists |
| Maintaining and acquiring skills and knowledge | 14/25* | Expanding body of knowledge is daunting; frustrating to see colleagues ... not in keeping with the need to remain current; negative incentives and barriers; difficult in a rural practice ... low volumes; ever-changing goals and standards of care |
| Medicolegal issues, insurance paperwork, and motor vehicle accidents | 13/25* | Done in non-patient-care time; assist a process that inherently delays recovery of health; wasting good clinical time |