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

Purpose Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians’ practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice. Methods We conducted a qualitative study using framework analysis. Family physicians in their first 10 years of practice were recruited from three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Interview data were coded inductively and then charted onto a matrix in which each participant’s data was summarized by code. Results Of the 63 participants that were interviewed, 24 worked solely in community-based practice, 7 worked solely in focused practice, and 32 worked in both settings. We identified four practice characteristics that were influenced (scope of practice, practice type and model, location of practice, and practice schedule and work volume) and three categories of influential factors (training, professional, and personal). Conclusions This study demonstrates the complex set of factors that influence practice choices by early-career physicians, some of which may be modifiable by policymakers (e.g., policies and regulations) while others are less so (e.g., family responsibilities). Participants described individual influences from family considerations to payment models to meeting community needs. These findings have implications for both educators and policymakers who seek to support and expand comprehensive care. Prior presentations “Factors influencing practice choices of early-career family physicians: A qualitative interview study.” North American Primary Care Research Group Conference (NAPCRG), Virtual, November 2021 Data also included in the following presentations on the broader study: “Addressing the need for greater primary care coverage: A discussion on primary care practice patterns”, Evidence Café, Ontario Ministry of Health & ICES. February 14, 2023. “The ‘kids’ are alright: Practice patterns among early-career family physicians and implication for primary care policy and workforce planning.” Family Medicine Grand Rounds, University of Ottawa. September 22, 2022. “Practice patterns among Early-Career Primary Care (ECPC) physicians and workforce planning implications: A mixed methods study. Summary of preliminary results.” British Columbia Ministry of Health and British Columbia General Practice Services Committee. February 25, 2022.