Health care system reform - Ontario family physicians' reactions

OBJECTIVE To determine the effect on a cohort of family physicians of healt h care system reforms in Ontario and the relationship of reforms to their c areer satisfaction. DESIGN Follow-up survey in 1999 of a cohort initially studied in 1993, posi ng many of the original questions along with some new ones. Four focus grou ps of other Ontario family physicians. SETTING Family practices in Ontario. PARTICIPANTS All family physicians who had received certification after com pleting a family medicine residency between 1989 and 1991 and were practisi ng in Ontario in 1993. This report addresses only those members of the coho rt who continued to practise family medicine in Ontario (N = 236). Four foc us groups with a total of 27 family physicians. MAIN OUTCOME MEASURES Reaction to health care system reforms. Perceived eff ect of reforms on practice. Current perception of quality of health care sy stem and level of career satisfaction and changes in these variables since 1993. RESULTS Response rate was 53% of original cohort. Only three of 13 selected health reforms were believed to have had a favourable effect. Physicians r eported lower levels of satisfaction with their careers. Overall quality of the health care system was perceived by both respondents and focus group m embers to have declined. Several difficulties affected practice and persona l life. CONCLUSION Family physicians viewed the effect of health care reforms negat ively and were significantly less satisfied with their careers than they we re in 1993. Better consultation with stakeholders before implementation of reforms is needed to ensure that these stakeholders understand the likely e ffects of these reforms.