Factors influencing practice choices of early-career family physicians in Canada: A qualitative interview study

Abstract

Purpose Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians’ practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice.

Methods We conducted a qualitative study using framework analysis. Family physicians in their first 10 years of practice were recruited from three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Interview data were coded inductively and then charted onto a matrix in which each participant’s data was summarized by code.

Results Of the 63 participants that were interviewed, 24 worked solely in community-based practice, 7 worked solely in focused practice, and 32 worked in both settings. We identified four practice characteristics that were influenced (scope of practice, practice type and model, location of practice, and practice schedule and work volume) and three categories of influential factors (training, professional, and personal).

Conclusions This study demonstrates the complex set of factors that influence practice choices by early-career physicians, some of which may be modifiable by policymakers (e.g., policies and regulations) while others are less so (e.g., family responsibilities). Participants described individual influences from family considerations to payment models to meeting community needs. These findings have implications for both educators and policymakers who seek to support and expand comprehensive care.

“Factors influencing practice choices of early-career family physicians: A qualitative interview study.” North American Primary Care Research Group Conference (NAPCRG), Virtual, November 2021

Data also included in the following presentations on the broader study:

“Addressing the need for greater primary care coverage: A discussion on primary care practice patterns”, Evidence Café, Ontario Ministry of Health & ICES. February 14, 2023.

“The ‘kids’ are alright: Practice patterns among early-career family physicians and implication for primary care policy and workforce planning.” Family Medicine Grand Rounds, University of Ottawa. September 22, 2022.

“Practice patterns among Early-Career Primary Care (ECPC) physicians and workforce planning implications: A mixed methods study. Summary of preliminary results.” British Columbia Ministry of Health and British Columbia General Practice Services Committee. February 25, 2022.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by Canadian Institutes of Health Research (R-PJT-155965).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee of Simon Fraser University gave ethical approval for this work. Ethics committees of the University of British Columbia, The University of Ottawa, the University of Western Ontario, the University of Ontario Institute of Technology, and the Nova Scotia Health Authority gave harmonized ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The data sets generated and/or analysed during the current study are not publicly available due to participant confidentiality and research ethics board requirements.

Abbreviations● ONOntario● BCBritish Columbia● NSNova Scotia

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