The Effects of Provincial Policies on Early Career Family Physicians’ Career Choices

Abstract

Over the past decade, the healthcare landscape has shifted for Ontario’s family physicians as government policies changed the availability of practice and compensation models. The most impacted population are early career family physicians. Given this changing healthcare environment, the factors that drive early career family physicians practice choices are unclear and not well-studied. Therefore, this thesis sought to answer the following research questions: 1. What factors shape family physician choice of practice and compensation models in Ontario? a. How do early career family physicians perceive the availability of practice and compensation models in Ontario? 2. From the perspective of Ontario family medicine residency administrators, how does residency influence family physician practice choices? This study was a part of a broader, cross-provincial study examining family medicine resident and early career family physician practice patterns in British Columbia, Nova Scotia, and Ontario. Nineteen early career physicians and 7 family medicine residency administrators were interviewed for their perceptions and understanding of the factors and policies affecting their (or in the case of administrators, residents’) career choices. In this thesis, I used thematic analysis as described by Braun and Clarke to answer the research questions. Patton and McMahon’s Systems Theory Framework (STF) provided a systems perspective that was used to model and assess the interactions between emergent themes. The factors that shaped family physician choice of practice and compensation models were divided into micro- and macro-level factors as described by the STF. Micro-level factors were ‘gender’, ‘health’, ‘interests’, and ‘world of work knowledge.’ Macro-level factors included ‘educational institutions’, ‘geographical location’, ‘historical trends’, ‘peers’, ‘family’, ‘community groups’, ‘workplace’, and ‘employment market.’ Finally, two additional factors were found: ‘flexibility’, and ‘financial considerations.’ The interaction between these factors was complex, where many linked themes gave rise to career decisions made by family physicians. A second perspective in the form of residency administrators helped develop a holistic description of these factors. Furthermore, a gap between physician training and practice opportunities after graduation was identified.