Family physician perspectives on primary care reform priorities: a cross-sectional survey

Lindsay Hedden; Setareh Banihosseini; Nardia Strydom; Rita McCracken

doi:10.9778/cmajo.20200102

Family physician perspectives on primary care reform priorities: a cross-sectional survey

CMAJ Open. 2021 May 6;9(2):E466-E473. doi: 10.9778/cmajo.20200102. Print 2021 Apr-Jun.

Authors

Lindsay Hedden¹, Setareh Banihosseini¹, Nardia Strydom¹, Rita McCracken²

Affiliations

¹ Faculty of Health Sciences (Hedden), Simon Fraser University; BC Academic Health Science Network (Hedden), Burnaby BC; Department of Family Medicine (Banihosseini, Strydom, McCracken), Providence Health Care; Department of Family Medicine (Strydom, McCracken), Faculty of Medicine, University of British Columbia; Department of Family Medicine (Strydom), Vancouver Coastal Health Authority, Vancouver, BC.
² Faculty of Health Sciences (Hedden), Simon Fraser University; BC Academic Health Science Network (Hedden), Burnaby BC; Department of Family Medicine (Banihosseini, Strydom, McCracken), Providence Health Care; Department of Family Medicine (Strydom, McCracken), Faculty of Medicine, University of British Columbia; Department of Family Medicine (Strydom), Vancouver Coastal Health Authority, Vancouver, BC Rita.mccracken@ubc.ca.

Abstract

Background: The province of British Columbia is facing a family physician shortage despite consistent increases in the number of physicians per capita and ongoing reforms to address the shortage. We identify physicians' priorities for structural reform, describe the alignment of those priorities with BC's suite of reforms and compare responses between established physicians and those new to practice; we also assessed rates of burnout.

Methods: All family physicians credentialed within Vancouver Coastal Health in 2018 were invited to participate in a cross-sectional survey. Respondents were asked about their practice model and characteristics, demographics, level of burnout and reform priorities. We used χ² tests and multivariable logistic regression to investigate associations between personal and practice characteristics, burnout and reform priorities.

Results: Of the 1017 family physicians invited to participate, 525 (51.6%) responded. Of these, 399 (76.0%) indicated a need for fundamental change to how primary care is delivered; 244 (46.4%) would prefer to be a clinic employee rather than a small business owner. Other reform priorities included options to practise in a team (stated as very important by 69.6% of respondents), direct funding for team roles (66.7%), direct clinic funding (59.8%), part-time work options (64.7%), and ability to take planned vacations and parental leave (81.1%). The importance of individual reform priorities varied based on the participants' model of practice, location and years in practice. Of respondents, 108 (21.1%) had experienced a high level of burnout.

Interpretation: Almost half of family physicians would prefer to be employees rather than small business owners and over 20% reported a high level of burnout. Practice models offering direct employment model have very limited availability and are not included in the current suite of reforms in BC, potentially pulling physicians away from community-based family medicine and into other models or specialties.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attitude of Health Personnel*
Burnout, Professional* / epidemiology
Burnout, Professional* / etiology
Burnout, Professional* / prevention & control
Canada
Cross-Sectional Studies
Female
Health Care Reform*
Health Services Accessibility / organization & administration
Humans
Male
Medically Underserved Area
Models, Organizational
Needs Assessment
Physicians, Family / supply & distribution*
Practice Patterns, Physicians'*
Primary Health Care* / methods
Primary Health Care* / organization & administration
Primary Health Care* / trends
Social Perception