Do family physicians suffer an identity crisis? A perspective of family physicians in Bangalore city

Structural Equation Modeling Analysis of Factors Influencing Family Doctor Contracted Services Based on Survey Data from Changning District, Shanghai

Objective

Family doctors fulfill the role of gatekeepers in protecting residents' health with contracted services. Providing these valuable services involves multiple causes, relationships, and indirectly observable variables. This study used structural equation modeling to construct a dynamic model of the work of family doctors to provide a basis for incentives.

Methods

This study used 2-year follow-up data from a survey of 294 family doctors in Changning District, Shanghai. Data were analyzed using confirmatory factor analysis and structural equation modeling. The measurement model and structural model were defined, identified, verified, integrated, and revised to identify the factors motivating family doctors to provide contracted services. A dynamic path for the family doctor contracted services model was established and eventually modified with six endogenous latent variables: cognition, environmental satisfaction, income satisfaction, support satisfaction, stability, and contracting performance, underpinned by 27 measurement variables.

Result

The standardized regression coefficient of the effect of cognition on environmental satisfaction was 0.37 (P < 0.05) and the degree of variation interpretation was 0.14. The effect of cognition on income satisfaction was 0.54 (P < 0.05) and the degree of variation interpretation was 0.29. The effect of cognition on stability was 0.40 (P < 0.01), the effect of environmental satisfaction on stability was 0.12 (P < 0.05), and the effect of income satisfaction on stability was 0.22 (P < 0.05), all with a degree of variation interpretation of 0.369. Finally, the effect of stability on contracting performance was 0.51 (P < 0.05) with a degree of variation interpretation of 0.343.

Conclusions

The degree of family doctors' understanding (cognition) of their own work largely determines their behavioral orientation and service effectiveness. These results raise the possibility of enhancing family doctors' work stability and improving the performance of contracted services by increasing the income of family doctors.

Residência de Medicina de Família e Comunidade: percepções de egressos sobre sua formação e processo de trabalho

Analisou-se como as residências de Medicina de Família e Comunidade (RMFC) de uma capital da região norte do Brasil contribuíram para a formação e o desenvolvimento do atual processo de trabalho de seus egressos. Estudo exploratório, descritivo e transversal, com abordagem qualitativa focada em 31 egressos por meio de aplicação de questionário eletrônico com perguntas abertas. As respostas foram interpretadas por Análise de Conteúdo Temática, constituídas por quatro categorias empíricas: a formação em Medicina de Família e Comunidade (MFC) no processo de trabalho do egresso; reconhecimento e aplicação dos atributos da Atenção Primária à Saúde (APS); potências da formação em RMFC; e os desafios da especialidade. Os programas de RMFC estudados contribuem para a formação da prática profissional e do perfil dos seus egressos por meio do fortalecimento e da efetivação dos atributos da Atenção Primária à Saúde (APS), inclusive estendendo-se para além da especialidade.

Family and Community Medicine Residency: graduates’ insights about their education and work process

The article analyzed how the Residency in Family and Community Medicine (RFCM) in a capital of the Northern region of Brazil contributed to the formation and development of the current work process of its graduates. This is an exploratory, descriptive and cross-sectional study, with a qualitative approach focused on 31 graduates, through electronic questionnaires with open questions. The answers were interpreted based on the Content Analysis Thematic technique, constituting four empirical categories: training in Family and Community Medicine (FCM) in the graduate’s work process; recognition and application of the attributes of Primary Health Care (PHC); potentials of the FCM training and the challenges of the specialty. The analyzed data show that the studied Programs contribute to the education for professional practice and the profile of its graduates through the strengthening and implementation of the Primary Health Care (PHC) attributes, also extending beyond the specialty.

The challenges of rural family physician program in Iran: a discourse analysis of the introduction to criticizing power imbalance between rural health and mainstream urban health

Compared with many metropolitan residents, Iranians living in rural areas have a poorer health status partly due to the inequitable access to healthcare services. However, despite policy efforts to ameliorate the disparities, the gap in healthcare between rural and urban residents is growing wider according to several published studies. Among the fundamental causes of these disparities, dominant discourses play a critical role. This paper seeks to unpack the relations of power operated by socio-politically constructed discourses around rural health-promoting interventions, including rural Family Physician Program (FPP). We adopted a Foucauldian Discourse Analysis (FDA) to examine how well-intentioned efforts to advance equity policy may unintentionally maintain discourse and practices that reinforce inequity. We followed the analytic steps, outlined by Carabine, for distinguishing discourses in order to select and analyze 25 documents, 31 interviews, and 21 observations. The analysis revealed three interconnected discourses with supporting roles constructed in opposition to the putative role of the designed program: the rural FPP to achieve the government’s ideological purposes about justice and equality (the discourse of deficits), the rural FPP to align with the urban-oriented medical curriculum (the discourse of career disadvantages) and the rural FPP to represent discipline perceptions about rural communities (the discourse of rural inferiority). These oppositional role constructions can hinder the proper functioning of this policy, usually in favor of urban claims on rural space.

Doctors' professional identity and socialisation from medical students to staff doctors in Japan: narrative analysis in qualitative research from a family physician perspective

OBJECTIVE

Becoming a doctor involves transforming a lay person into a medical professional, which is known as professional socialisation. However, few studies have clarified differences in the professional socialisation process in detail. The aim of this study was to clarify the process of professional socialisation of medical students to residents to staff doctors.

DESIGN

We used narrative analysis in qualitative research as a theoretical framework.

SETTING

This study was conducted in Japan.

PARTICIPANTS

Participants were collected using a purposive sample of doctors with over 7 years of medical experience. We conducted semistructured interviews from September 2015 to December 2016, then used a structured approach to integrate the sequence of events into coherent configurations.

RESULTS

Participants were 13 males and 8 females with medical careers ranging from 8 to 30 years. All participants began to seriously consider their own career and embodied their ideal image of a doctor through clinical practice. As residents, the participants adapted as a member of the organisation of doctors. Subsequently, doctors exhibited four patterns: first, they smoothly transitioned from 'peripheral' to 'full' participation in the organisation; second, they could no longer participate peripherally but developed a professional image from individual social interactions; third, they were affected by outsiders' perspectives and gradually participated peripherally; fourth, they could not regard the hospital as a legitimate organisation and could not participate fully.

CONCLUSION

The professional socialisation process comprises an institutional theory, professional persona, legitimate peripheral participation and threshold concepts. These findings may be useful in supporting professional development.

In the Name of Family Medicine: A Nationwide Survey of Registered Names of Family Medicine Clinics in Taiwan

Family medicine is officially a specialty, but is often not regarded as a specialty by the general public. Past studies have usually investigated the opinions of medical students and resident physicians regarding family medicine, whereas few have focused on practicing family physicians themselves, especially in terms of analyzing how they represent themselves. This study aimed to investigate the patterns of clinic names to better apprehend whether general practitioners see themselves as being on an equal footing with other medical specialists. The registered names, medical specialties, and levels of urbanization of all clinics of Western medicine in Taiwan were collected. For clinics of each specialty, we examined whether their names contained the corresponding specialty designation. For example, a family medicine clinic was checked to determine whether its name contained the term “family medicine” or its abbreviation. The naming of family medicine clinics was then compared with that of clinics with other specialties. Of the 9867 Western medicine clinics included in this study, two-thirds (n = 6592) were single-specialty clinics. In contrast to the high percentages of single-specialty clinics of other specialties with specialty-containing names (97.5% for ophthalmology, 94.8% for dermatology, and 94.7% for otolaryngology), only 13.3% (132/989) of the family medicine clinics had such names. In addition, the urban family medicine clinics had a higher proportion (15.2%, 74/487) of specialty-containing names than the suburban (12.6%, 44/349) and rural family medicine clinics (9.2%, 14/153). Overall, a low percentage of family medicine clinics in Taiwan included “family medicine” in their names. This issue of professional identity deserves further qualitative investigation.

Public's perception and satisfaction on the role and services provided by family physicians in Saudi Arabia: A cross-sectional study

Background

Few studies have addressed the awareness of the family physicians' (FPs) role and its impact on the quality of primary healthcare. This study aims to explore public's perception and satisfaction on the role and services provided by FPs in the Kingdom of Saudi Arabia (KSA).

Materials and Methods

An online survey was conducted using a convenience sample of 830 participants age 18 years and above from Jazan region, KSA. Statistical analysis was done using SPSS including descriptive studies and Chi-square or Fisher's exact test.

Results

A total of 830 valid responses were analyzed, of which 55.1% were females. The median age of respondents was 32.5 years (range 18-75 years). Most of the respondents (90.2%) did not have a regular FP. A considerable proportion of the participants were aware of the principles (81.2%) and essential role of family medicine (73.3%), health conditions that FPs can treat (59.9%), and conditions they do not treat (n = 622, 74.9%). The majority agreed on the value of involving FPs in their care (76.7%), the priority of FPs in the action of health-seeking (58.9%), and the sufficiency of FPs' expertise (55.5%). However, only 28.3% had a positive experience with FPs. In addition, 59.8% preferred to first seek healthcare from specialists from other specialties.

Conclusion

In general, participants in this study had good perception of the role of FPs as important components in the healthcare system. However, there may be some gaps in the physician-patient communication which may contribute to the dissatisfaction reported by most of the present sample.