RESPONSIBILITY TAKING AND ROLE DEFINITION IN FAMILY-PRACTICE - EFFECTOF TRAINING AND PRACTICE SETTING

There is evidence that family physicians (FPs) reduce health care cost s by reducing patient referral to more expensive secondary and tertiar y care facilities. Presumably, the effectiveness of FPs in meeting pat ients' needs is related to their role definition and willingness to as sume responsibility. The purpose of this study was to determine the in fluence of training and practice setting on responsibility taking and role definition of FPs. A previously developed and validated self-admi nistered questionnaire was completed by 153 certified FPs and FP resid ents from five departments of family practice in Israel. The main inde pendent variables were previous training and practice setting. The mai n outcome measures were self-reported data on responsibility taking, r ole boundaries, and reported role performance. The results showed that certified FPs were more willing to assume responsibility, to define b roader role boundaries, and to perform more specialized interventions than residents. Differences in practice setting affected only reported performance, with physicians who practice in rural clinics performing more specialized activities than those in urban clinics. Multiple reg ression analysis shows that professional development is associated wit h an increased willingness to assume responsibility; this willingness affects role boundaries definitions, which affects reported performanc e. Practice setting alters the tendency to perform a wider range of in terventions, but does not affect physicians' attitudes.