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Rudoler D, Lavergne MR, Marshall EG, Zaheer J, Etches S, Good KP, Grudniewicz A, Katz A, Kurdyak P, Bolton J, Kaoser R, Moravac C, Morrison J, Mulsant B, Peterson S, Tibbo PG. Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study. BMJ Open 2023; 13:e073183. [PMID: 37463812 PMCID: PMC10357719 DOI: 10.1136/bmjopen-2023-073183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workforce planning require further study. A qualitative exploration of psychiatrists' preferences for practice style and the practice choices that result is also lacking. The goal of this study is to inform psychiatrist workforce planning to improve access to psychiatric care by: (1) developing and evaluating comparable indicators of supply of psychiatric care across provinces, (2) analysing variations and changes in the characteristics of the psychiatrist workforce, including demographics and practice style and (3) studying psychiatrist practice choices and intentions, and the factors that lead to these choices. METHODS AND ANALYSIS A cross-provincial mixed-methods study will be conducted in the Canadian provinces of British Columbia, Manitoba, Ontario and Nova Scotia. We will analyse linked-health administrative data within three of the four provinces to develop comparable indicators of supply and characterise psychiatric services at the regional level within provinces. We will use latent profile analysis to estimate the probability that a psychiatrist is in a particular practice style and map the geographical distribution of psychiatrist practices overlayed with measures of need for psychiatric care. We will also conduct in-depth, semistructured qualitative interviews with psychiatrists in each province to explore their preferences and practice choices and to inform workforce planning. ETHICS AND DISSEMINATION This study was approved by Ontario Tech University Research Ethics Board (16637 and 16795) and institutions affiliated with the study team. We built a team comprising experienced researchers, psychiatrists, medical educators and policymakers in mental health services and workforce planning to disseminate knowledge that will support effective human resource policies to improve access to psychiatric care in Canada.
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Affiliation(s)
- David Rudoler
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Juveria Zaheer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Selene Etches
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberley P Good
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Agnes Grudniewicz
- Telfer School of Management University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ridhwana Kaoser
- Faculty of Health Sciences, Simon Fraser University at Harbour Centre, Vancouver, British Columbia, Canada
| | - Catherine Moravac
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Jason Morrison
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Phil G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Boschee E, Zaeem Z, Amin A, Moniz K, Rashid M. Residency training experiences of residents with children: A phenomenological study. MEDICAL EDUCATION ONLINE 2022; 27:2079395. [PMID: 35607707 PMCID: PMC9135414 DOI: 10.1080/10872981.2022.2079395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
Parenthood during postgraduate medical training has become an increasingly relevant topic in recent years. While previous research has attempted to explore the experiences of residents in a parenting role through surveys and limited qualitative studies, an in depth understanding of the postgraduate training experience of these parent residents has not been clearly described. The optimal means of supporting trainees completing residency while parenting remains unclear. The study aim was to develop a rich understanding of the residency training experience of residents in a parenting role. We conducted 15 semi-structured telephone interviews. Our study population included postgraduate trainees from 9 different programs from a large research-intensive university who were parents upon entry to residency or who became parents during residency training. Transcendental phenomenology was used as a qualitative research methodology, guided by life course theory. Thematic analysis of residents' training experiences revealed the following themes: 1) challenges of being a parent with residency responsibilities; 2) work-life balance; 3) support systems; 4) impact on patient interactions; 5) impact on other interactions; and 6) unspoken expectations. Participants suggested actionable solutions to improve the training experience for residents in a parenting role, which included: 1) family-inclusive events; 2) scheduling flexibility; 3) support for fathers; and 4) optimizing support for breastfeeding mothers. Residents in a parenting role represent a unique postgraduate trainee population. Despite focus on resident wellness, challenges remain for individuals trying to navigate parenthood and residency. This data may be utilized to inform support and strategies to optimize the training experiences of these residents.
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Affiliation(s)
- Erin Boschee
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Zoya Zaeem
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Aditi Amin
- Alberta Health Services Calgary Zone, Rural Medicine and Internal Medicine, Calgary, AB, Canada
| | - Karen Moniz
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Marghalara Rashid
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
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The effect of parenthood on the clinician’s empathy and behavior guidance technique preferences among pediatric dentists. Eur Arch Paediatr Dent 2022; 23:641-646. [DOI: 10.1007/s40368-022-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
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A qualitative study of resident and early-career family physicians' focused practice choices in Canada. Br J Gen Pract 2022; 72:e334-e341. [PMID: 35023851 DOI: 10.3399/bjgp.2021.0512] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/04/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. AIM We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. DESIGN AND SETTING We analyzed a subset of qualitative interview data from a study across British Columbia, Ontario, and Nova Scotia. METHOD A total of 22 resident family physicians and 38 early-career family physicians in their first 10 years of practice who intend to or currently practice in a focused area were included in our analysis. We compared participant types, provinces, and the degree of focused practice while identifying themes related to factors influencing the pursuit of focused practice. RESULTS We identified three key themes of factors contributing to choices of focused practice: self-preservation within the current health care system, support from colleagues, and experiences in medical school and/or residency. Minor themes included alignment of practice with skills, personal values, or ability to derive professional satisfaction; personal lived experiences; and having many attractive opportunities for focused practice. CONCLUSION Both groups of participants unanimously viewed focused practice as a way to circumvent the burnout or exhaustion they associated with comprehensive practice in the current structure of the health care system. This finding, in addition to other influential factors, was consistent across the three provinces. More research is needed to understand the implications of resident and early-career family physician choices of focused practice within the physician workforce.
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Hui DHF, Yakub M, Tiwana S, Yong-Hing CJ, Robbins JB, Moreno CC, Zulfiqar M, Fennessy FM, Yassin A, Khosa F. Gender of Department Chair and Paid Parental Leave Benefits in Academic Radiology Residency Programs. Curr Probl Diagn Radiol 2021; 51:162-165. [PMID: 34949474 DOI: 10.1067/j.cpradiol.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES Residency training often overlaps with prime childbearing years, yet variability in availability and duration of parental leave in residency can complicate the decision to become parents. Gender disparities in attitudes towards parenthood in residency is well recognized, with females generally reporting more concerns surrounding prolonged training, hindrance of future career plans, and negative perception from peers. However, gender of the department chair has not yet been examined as a factor influencing parental leave policies for residents in Radiology. MATERIALS AND METHODS The gender of the department chair and parental leave policies for residents in 209 ACGME accredited diagnostic radiology programs across the United States were procured from their websites. These programs were stratified into 6 geographical regions to identify regional differences. Chi-squared analyses were used to compare availability of paid parental benefits with the gender of department chairs. RESULTS Seventy-seven percent of diagnostic radiology program department chairs were male. 34 of 49 programs (69%) with female department chairs advertised paid parental benefits, compared to 61 of 160 programs (38%) chaired by males (P < 0.001). When stratified by region, this gender difference remained statistically significant in the mid-Atlantic and New England. CONCLUSION Female gender of the department chair was associated with the increased availability of paid parental leave benefits for residents, yet females hold fewer academic leadership positions than males. Future discussions regarding parental leave policies for residents will have to consider the unique challenges in residency such as length of training and burden on coresidents.
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Affiliation(s)
- Daniel H F Hui
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsin Yakub
- Faculty of Medical Education, Physiology and Nutrition, California University of Science and Medicine, Colton, CA
| | - Sabeen Tiwana
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte J Yong-Hing
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Maria Zulfiqar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Aya Yassin
- Department of Radiology(,) Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Faisal Khosa
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Roberts LW. Contributions and Sacrifices of Medical Students and Health Care Workers With Family Responsibilities Deserve Our Attention and Respect. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1227-1228. [PMID: 34432656 DOI: 10.1097/acm.0000000000004211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Hedden L, Banihosseini S, Strydom N, McCracken R. Family physician perspectives on primary care reform priorities: a cross-sectional survey. CMAJ Open 2021; 9:E466-E473. [PMID: 33958382 PMCID: PMC8157978 DOI: 10.9778/cmajo.20200102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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.
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Affiliation(s)
- Lindsay Hedden
- 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
| | - Setareh Banihosseini
- 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
| | - Nardia Strydom
- 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
- 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
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Hedden L, Banihosseini S, Strydom N, McCracken R. Modern work patterns of "classic" versus millennial family doctors and their effect on workforce planning for community-based primary care: a cross-sectional survey. HUMAN RESOURCES FOR HEALTH 2020; 18:67. [PMID: 32958028 PMCID: PMC7504652 DOI: 10.1186/s12960-020-00508-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 08/27/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND There are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care. Anecdotal evidence suggests that physicians are moving away from a community-based comprehensive practice model, which could contribute to shortages. Thus, we aimed to identify and describe how family physicians are currently organizing their primary care practices in a large health region in British Columbia and to examine differences between newer graduates and more established physicians. METHODS Data for this cross-sectional study were drawn from an annual physician privileging survey. N = 1017 physicians were invited to participate. We categorized practice style into five distinct groupings and compared features across respondent groups, including personal and practice location characteristics, hospital and teaching work, payment and appointment characteristics, and scope of practice. We discuss the implications of styles of practice and associated characteristics on health workforce policy and planning. RESULTS We received responses from 525 (51.6%) physicians. Of these, 355 (67.6%) reported doing at least some community-based primary care. However, only 112 (21.3%) provided this care full time. Most respondents supplemented community-based work with part-time hours in focused practice, hospitals, or inpatient facilities. We found diversity in the scope and style of practice across practice models. Compared to established physicians, new graduates (in practice less than 10 years) work more weekly hours (more patient care, and paperwork in particular). However, we found no difference between new and established physicians in the odds of providing any or full-time community-based primary care. CONCLUSIONS Despite a lack of formalized structural reform in British Columbia's primary care system, most physicians are finding alternative ways to model their practice and shifting away from work at single-location, community-based clinics. This shift challenges assumptions that are relied on for workplace planning that is intended to ensure adequate access to longitudinal, community-based family medicine.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Academic Health Science Network, Vancouver, Canada
| | | | - Nardia Strydom
- Department of Family Medicine, Providence Health Care, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Family and Community Medicine, Vancouver Coastal Health, Vancouver, Canada
| | - Rita McCracken
- Department of Family Medicine, Providence Health Care, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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