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

Article Figures & Tables

Tables

View popup

Table 1:

Demographic and practice characteristics of the study sample

Characteristic	Group; no. (%)^*
Characteristic	Physicians new to practice n = 175	Established physicians n = 350	Total n = 525
Sex, female^†	108 (61.7)	183 (52.4)	291 (55.4)
International medical graduates	27 (15.4)	85 (24.3)	112 (21.3)
Any rural practice	46 (26.3)	65 (18.6)	111 (21.1)
Weekly work hours ± SD	46.2 ± 15.0	43.0 ± 15.2	44.1 ± 15.2
Practice model
Full-time CBPC	27 (15.4)	85 (24.3)	112 (21.3)
Mostly CBPC	42 (24.0)	99 (28.3)	141 (26.9)
Mostly other work	40 (22.9)	62 (17.7)	102 (19.4)
Hospital or facility only	26 (14.9)	71 (20.3)	97 (18.5)
Locum only	40 (22.9)	33 (9.4)	73 (13.9)
Provides call coverage	147 (84.0)	270 (77.1)	417 (79.4)
Weekly work hours
< 30	12 (6.9)	57 (16.3)	69 (13.1)
30–39	24 (13.7)	61 (17.4)	85 (16.2)
40–49	59 (33.7)	98 (28.0)	157 (29.9)
50–59	42 (24.0)	70 (20.0)	112 (21.3)
≥ 60	38 (21.7)	64 (18.3)	102 (19.4)

Note: CBPC = community-based primary care, SD = standard deviation.
↵* Unless specified otherwise.
↵† Missing data (n = 1).

View popup

Table 2:

Burnout frequency and priorities for reform

Reform priorities	Group; no. (%)			p value
Reform priorities	New-to-practice physicians n = 171	Established physicians n = 341	Total n = 513^*	p value
Burnout frequency
Never	4 (2.3)	46 (13.5)	50 (9.7)	< 0.001
A few times a year	46 (26.9)	117 (34.3)	163 (31.8)
Once a month	35 (20.4)	54 (15.8)	89 (17.4)
A few times a month	49 (28.6)	54 (15.8)	103 (20.1)
Once a week	14 (8.1)	20 (5.9)	34 (6.6)
A few times a week	18 (10.5)	30 (8.8)	48 (9.4)
Every day	6 (3.5)	20 (5.9)	26 (5.1)
High level of burnout^†	38 (22.2)	70 (20.5)	108 (21.1)	0.754
Reforms (yes or no)
Primary care reform is needed	145 (84.7)	254 (74.4)	399 (77.8)	0.009
An alternative payment model would make it easier to provide longitudinal care	117 (68.4)	136 (39.8)	253 (49.3)	< 0.001
I would prefer to be an employee of a clinic (not a small business owner)	100 (58.5)	144 (42.2)	244 (47.5)	0.001
Specific reform priorities^†
Payment structure
Alternative forms of physician payment	109 (63.7)	136 (39.8)	245 (47.8)	< 0.001
Direct funding for team roles	132 (77.2)	210 (61.6)	342 (66.7)	< 0.001
Direct clinic funding	123 (71.9)	184 (53.9)	307 (59.8)	< 0.001
Work structure
Option to practise in a team	143 (83.6)	214 (62.7)	357 (69.6)	< 0.001
Time-limited commitment to patient panel	51 (29.8)	69 (20.2)	120 (23.4)	0.015
Transparent evaluation of transformation initiatives	100 (58.5)	211 (61.9)	311 (60.6)	0.482
Option to work part-time	117 (68.4)	215 (63.0)	332 (64.7)	0.214
Job benefits
Vacation and parental leave	142 (83.1)	274 (80.3)	416 (81.1)	0.425
Loan forgiveness	68 (39.8)	70 (20.5)	138 (26.9)	< 0.001

↵* Missing data (n = 12) for all questions.
↵† No. (%) of participants who reported a priority as very important.

View popup

Table 3:

Multivariable analysis of factors associated with burnout

Variable	OR (95% CI)
New graduate (Ref. = established)	1.05 (0.64–1.73)
Model of practice (Ref. = full-time CBPC)
Mostly CBPC	1.57 (0.83–2.94)
Mostly other work	0.86 (0.39–1.88)
Hospital or facility only	1.15 (0.55–2.42)
Locum	0.54 (0.21–1.39)
Female (Ref. = male)	1.94 (1.19–3.15)
Any rural practice (Ref. = urban)	0.98 (0.55–1.75)
International training (Ref. = Canadian training)	1.12 (0.64–1.96)
Weekly work hours (Ref. ≤ 30)
30–39	0.74 (0.25–2.22)
40–49	2.03 (0.82–5.06)
50–59	1.78 (0.68–4.67)
≥ 60	6.02 (2.31–15.68)

Note: CBPC = community-based primary care, CI = confidence interval, OR = odds ratio, Ref. = reference category.

View popup

Table 4:

Multivariable analysis of reform priorities

Variable	Primary care reform is needed	An alternative payment model would make it easier for me to provide longitudinal care	I would prefer to be an employee of a clinic (not a small business owner)	Payment structure^*			Work structure^*			Job benefits^*

				Alternative forms of physician payment	Direct funding for team roles	Direct clinic funding	Option to practice in a team	Time-limited commitment to patient panel	Transparent evaluation of transformation initiatives	Option to work part-time	Vacation and parental leave	Loan forgiveness
New graduate (Ref. = established)	1.86 (1.14–3.02)	3.08 (2.04–4.64)	1.95 (1.30–2.91)	2.70 (1.78–4.09)	2.23 (1.42–3.50)	2.27 (1.48–3.46)	3.42 (2.08–5.61)	1.62 (1.03–2.56)	0.85 (0.57–1.27)	1.26 (0.82–1.94)	1.15 (0.69–1.91)	2.48 (1.61–3.82)

Female (Ref. = male)	0.86 (0.56–1.31)	1.22 (0.84–1.78)	1.34 (0.92–1.94)	1.34 (0.92–1.97)	1.38 (0.93–2.05)	1.43 (0.98–2.09)	1.11 (0.74–1.67)	1.20 (0.77–1.87)	1.19 (0.81–1.73)	1.26 (0.85–1.87)	1.37 (0.86–2.19)	1.21 (0.79–1.85)

Model of practice (Ref. = full-time CBPC)

Mostly CBPC	1.40 (0.74–2.64)	1.94 (1.10–3.40)	2.01 (1.14–3.55)	1.75 (0.99–3.08)	1.82 (1.03–3.21)	1.09 (0.63–1.89)	1.96 (1.09–3.52)	1.28 (0.65–2.51)	1.50 (0.87–2.60)	1.89 (1.08–3.31)	0.98 (0.50–1.93)	1.28 (0.69–2.39)

Mostly other work	1.04 (0.52–2.08)	2.68 (1.43–5.02)	2.64 (1.41–4.93)	3.27 (1.71–6.26)	2.53 (1.29–4.96)	1.09 (0.58–2.05)	2.42 (1.21–4.83)	2.34 (1.13–4.84)	2.27 (1.19–4.31)	1.42 (0.75–2.68)	0.96 (0.45–2.07)	1.53 (0.76–3.08)

Hospital or facility only	1.09 (0.55–2.17)	1.33 (0.71–2.48)	2.12 (1.13–3.97)	2.32 (1.24–4.34)	2.14 (1.13–4.06)	1.50 (0.80–2.80)	2.32 (1.20–4.50)	2.13 (1.03–4.42)	1.29 (0.70–2.38)	1.20 (0.65–2.23)	0.58 (0.29–1.18)	1.50 (0.75–3.01)

Locum	1.31 (0.59–2.94)	1.59 (0.79–3.19)	1.47 (0.73–2.96)	1.42 (0.70–2.89)	1.19 (0.58–2.43)	0.66 (0.33–1.33)	1.25 (0.59–2.64)	2.44 (1.09–5.44)	1.11 (0.56–2.20)	1.83 (0.87–3.83)	1.27 (0.50–3.18)	1.43 (0.66–3.09)

Any rural practice (Ref. = urban)	0.57 (0.34–0.93)	0.75 (0.47–1.18)	0.72 (0.46–1.14)	0.67 (0.42–1.08)	0.77 (0.47–1.24)	1.14 (0.71–1.82)	0.66 (0.40–1.08)	0.69 (0.40–1.19)	0.69 (0.44–1.08)	1.17 (0.72–1.92)	1.23 (0.68–2.25)	0.86 (0.52–1.44)

International training (Ref. = Canadian training)	1.09 (0.65–1.83)	0.88 (0.55–1.39)	0.62 (0.39–0.99)	0.98 (0.61–1.57)	1.68 (1.02–2.78)	1.15 (0.72–1.82)	1.66 (0.99–2.77)	2.44 (1.46–4.07)	0.89 (0.56–1.41)	0.82 (0.51–1.33)	0.95 (0.54–1.68)	1.62 (0.98–2.68)

Weekly work hours (Ref. ≤ 30)

30–39	1.39 (0.67–2.86)	1.47 (0.75–2.89)	0.86 (0.44–1.68)	1.48 (0.74–2.94)	0.98 (0.48–2.01)	1.25 (0.63–2.46)	0.75 (0.36–1.58)	0.89 (0.39–2.02)	0.91 (0.46–1.82)	1.01 (0.45–2.27)	0.94 (0.38–2.36)	1.50 (0.64–3.47)

40–49	1.74 (0.88–3.43)	1.39 (0.75–2.61)	0.75 (0.40–1.39)	1.79 (0.95–3.39)	0.94 (0.49–1.81)	1.55 (0.83–2.89)	0.94 (0.47–1.88)	1.30 (0.62–2.71)	0.79 (0.42–1.49)	0.62 (0.30–1.28)	0.67 (0.30–1.54)	1.60 (0.73–3.48)

50–59	1.58 (0.76–3.25)	1.17 (0.60–2.28)	0.59 (0.31–1.14)	1.20 (0.61–2.36)	1.12 (0.56–2.26)	1.27 (0.65–2.46)	0.83 (0.40–1.72)	1.07 (0.48–2.39)	1.26 (0.64–2.48)	0.29 (0.14–0.61)	0.73 (0.31–1.74)	1.62 (0.71–3.67)

≥ 60	1.31 (0.62–2.78)	1.07 (0.53–2.15)	0.69 (0.34–1.37)	1.06 (0.52–2.17)	1.49 (0.70–3.15)	1.66 (0.82–3.36)	0.85 (0.39–1.85)	2.22 (0.99–4.99)	1.34 (0.66–2.75)	0.33 (0.15–0.71)	0.56 (0.23–1.37)	3.38 (1.47–7.78)

Note: CBPC = community-based primary care, Ref. = reference category.
↵* Odds ratios of reporting each reform priority as very important relative to somewhat important, not important or unsure.