Ontario family physicians’ perspectives about their scope of practice: what is it, what drives it and how does it change?

Abstract

Background There is little evidence to show what scope of practice (SOP) means from the point of view of family physicians, how family physicians think about their SOP as it changes over time, or what factors shape and influence their SOP. Understanding family physician perspectives on SOP and the factors that influence it can aid our understanding of how it can constrain and enable physicians’ agency and autonomy in professional practice. Methods Using qualitative description and incorporating constructivist grounded theory data collection and analysis techniques, four focus groups were conducted involving twenty-four Ontario-based family physicians from different contexts, at different career stages, and with different practice experiences. Results Participants’ SOP was highly dynamic, changing throughout their careers due to factors both within and beyond their control. Their sense of their own SOP was the product of a continuous cycle of personal and professional transitions, exposures, and experiences throughout their careers. These family physicians sought regular and sustained mentorship, support, and engagement for their SOP throughout their careers. This was particularly the case during professional transitions and for drivers of their SOP for which they felt unprepared early in their careers, such as through the first years of independent practice, and when functioning as owner-operators of medical practices. Four descriptive themes were identified focusing on the nature of their current practice, their professional preparedness and supports, practice management dynamics, and ‘doctors are people, too’. Conclusions The SOP of the family physicians in this study was dynamic and unique to each individual, it emerged from interactions between their personal and professional lives and identities, and it was embedded in their lived experiences. SOP was also to some extent imposed and externally driven. This study advances understanding by exploring the ‘why’ and ‘how’ of SOP rather than focusing solely on what it is.

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

“…While many studies have examined factors that influence medical students' choice of family medicine [22,23], few have examined choice of practice characteristics among active family physicians. Those that have often focus on a single practice characteristic, such as scope [4,[24][25][26] or practice type and model [27], and few examine early-career family physicians [24,27]. These studies confirm our findings of the influential nature of certain individual and regulatory factors on practice choicesincluding training and mentorship [4,[25][26][27], earlycareer experiences [25,26], work-life balance [4,26,27], professional satisfaction [4,[24][25][26][27], family [4,26], policies and regulations [4,26], and remuneration [24][25][26][27].…”

Factors that influence scope-of-practice decisions of early-career family physicians

“…In alignment with the literature, we also found that educational, organizational, community, and system factors influence SOP decisions of FPs. 7,8 However, these findings contrast with a US study that found workplace, environmental, and population factors were most influential on the actual SOP. 8 Differences in results may be due to the substantial differences between the 2 countries' funding, organization, and delivery of health care.…”

“…These trends raise important questions for educators and policy-makers about the factors influencing SOP decisions of early-career FPs in Canada. Jurisdiction-specific studies indicate various personal, organizational, system, educational, and community factors influence FPs' decisions about providing a broader SOP 7,8 (Table 1). 8,9 To date, Canadian studies have focused on single 7 or specific jurisdictions 9 and have not represented national perspectives of FPs on factors that influence SOP decisions and how these factors are similar or different across jurisdictions, which vary in the design and delivery of primary care services.…”

“…Jurisdiction-specific studies indicate various personal, organizational, system, educational, and community factors influence FPs' decisions about providing a broader SOP 7,8 (Table 1). 8,9 To date, Canadian studies have focused on single 7 or specific jurisdictions 9 and have not represented national perspectives of FPs on factors that influence SOP decisions and how these factors are similar or different across jurisdictions, which vary in the design and delivery of primary care services. Thus, this study explores the similarities and differences in personal, educational, organizational, community, and system factors that influence the SOP decisions of early-career FPs across the 13 Canadian jurisdictions.…”

Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review

“…rural location, community size, distance to a large hospital), personal physician characteristics, professional education, and patient factors influenced scope of practice, while Kabir et al [ 67 ] discovered that training, organisational structure, inadequate remuneration, workload, professional satisfaction, and the amount of patient care required per treatment influenced scope of practice. Additionally, Myles et al [ 68 ] reported that geography, the practice environment, the needs of those within communities, and regional and jurisdictional variations in healthcare delivery were key elements in determining scope of practice of family physicians in Ontario, Canada. One influencing factor that was not discovered in the literature search that should be acknowledged is that of intra- and inter-professional issues.…”