Table 2.

Excerpts of participants’ comments, by theme

Practical considerations
  • Potential benefits to patients
  • “I think if you talked to most primary care physicians … whether or not they engage more is not so much ‘pay me more’ but ‘how is engaging with you going to help me better care for my patients.’ That’s the primary thing for most people” (ALT-51, urban [FG])

  • “I’d want to know what were the goals for it and does it provide an advantage for our clients in this area over what we’ve got at the moment” (FFS-31, rural)

  • Concerns about attachment deliverables
  • “We’re looking at [ITDI], but the catch is always … ‘take 500 patients’ …. And … our numbers are crazy big and … [sigh] when that’s always attached to the bottom of it, none of us will go near it” (FFS-41, urban [FG])

  • “But don’t just ask us to take more and more patients. Do you know what I mean? I think that’s the message that we are getting, that, you know, they want us to take more patients” (FFS-8, urban)

  • Financial considerations
  • “The other thing that sold it was, I think, from a financial point of view it was either neutral or favourable. So, I think there was the perception going into it that from a financial point of view it’s going to be a good thing too” (FFS-20, rural)

  • “So the [physician assistant’s] wage is paid by the province or by the [RHA] … it’s better for patient care, [but] the bottom line it doesn’t help me in any way, shape, or form” (FFS-21, urban)

  • Concerns about workload and work-life balance
  • “For the doctors who are busting their butt, day in and day out, to ask those doctors, well we want you to do more, it’s like, I don’t think so. I mean, they’re stressed to the max already; you can’t ask those people to do more” (FFS-7, rural)

  • “Yeah, I want to be able to provide the optimum care for my patients, but at the same time I also want to have time to be able to care for my family” (ALT-52, urban [FG])

  • “I have no time to participate in any sort of projects” (ALT-40, rural)

  • “If we have people joining us who do the relatively easy work, that’s not what we’re looking for ... that just leaves the crappy, harder work for us to do” (FFS-5, rural)

Social considerations
  • Communication about PCR initiatives
  • “I didn’t feel it was particularly transparent ... [there was] a lot of bureaucratic language that didn’t really mean the same thing for everyone ... [and a] lack of specific information for what it would entail. It does feel that the impetus is on me to find out anything about it …. And, you know, I’m a little busy” (FFS-4, urban)

  • “The message I get is actually very pejorative: you’re not doing your job” (ALT-58, urban [FG])

  • “I went online and I tried to look at what this was .... There’s no one page saying, ‘this is what we’ve done and this is how we feel that this is going to impact quality of care and quantity of care’ …. It’s like pie-in-the-sky type stuff” (FFS-10, urban)

  • “I think some of the website has some of it …. But I feel I don’t, I don’t know if it’s enough to really convince me to take it one step further and inquire about it” (ALT-18, urban)

  • Lack of physician voice
  • “I just wish that the region, when they approach us for our opinion, it’s because they want our opinion ... in the process of making a decision, and not our opinion on the decision that’s already been made” (FFS-42, urban [FG])

  • “The structure [of My Health Teams] was set up and it was given to physicians to say, this is the structure that it’s going to be ... these are the goals ... and the goals aren’t bad, but they were told to us” (ALT-37, urban)

  • “The reason I say maybe they don’t want us to come is because if we don’t come we can’t tell them something they don’t want to hear, and we can’t give them information that will compel actual, real change that will take actual, real money” (FFS-24, urban)

  • Climate of mistrust
  • “It left a really bad taste in everybody’s mouth. It really made you feel like you weren’t valued in the hospital, that they’d just summarily boot you out after 30 years of hard work there” (FFS-11, urban)

  • “So they need to kind of come back ... and just as group to say to family doctors, ‘We’re sorry; we screwed up; you guys are the important parts of the system” (FFS-24, urban)

  • “There’s a long, in some cases pretty entrenched, issue with trust ... and some of it’s unfounded and a lot of it is kind of long-held grudges” (EXT-1, urban)

  • Desire for targeted support
  • “So go talk to a clinic, talk about what their challenges are, where their biggest expenses are, how can the region help, where are the inefficiencies, how can we cut the inefficiencies?” (FFS-21, urban)

  • “The areas where I need help it isn’t available, and the areas where help is offered I don’t need it” (FFS-7, rural)

  • “So, I think you need somebody like I said, like on-site there who can work with you specifically to figure out what the problems are” (ALT-49, urban [FG])

  • ALT—alternate-funded, EXT—current or past leader of a provincial physician organization, FG—focus group, FFS—fee-for-service, ITDI—Interprofessional Team Demonstration Initiative, PCR—primary care renewal, RHA—regional health authority.