Beaulieu Marie-Dominique, Rioux Marc, Rocher Guy, Samson Louise, Boucher Laurier
Family Medicine, Université de Montréal, Montréal, Québec, Canada.
Soc Sci Med. 2008 Oct;67(7):1153-63. doi: 10.1016/j.socscimed.2008.06.019. Epub 2008 Jul 20.
With increasingly fewer family physicians in many countries and students less interested in primary care careers, generalists are becoming an endangered species. This situation is a major health care resource management challenge. In a rapidly changing health care environment, family medicine is struggling for a clear identity -- a matter which is crucial to health system restructuring because it affects the roles and functioning of other professions in the system. The objective of our study was to explore representations of roles and responsibilities of family physicians held by future family and specialist physicians and their clinical teachers in four Canadian medical school faculties of medicine, using both focus groups and individual interviews. In addition to family medicine, we targeted residency programs in general psychiatry, radiology and internal medicine -- three areas that interface significantly between primary care and specialized medicine. In each faculty, respondents included the vice-dean of postgraduate studies; the director of each relevant program; educators in the program; residents in each specialty in their last year of training. Findings are centred around three major themes: (1) the definition of family medicine; (2) family medicine as an endangered species, and (3) the generation gap between young family physicians and their educators. The sustained physician-patient relationship is considered a core characteristic of family medicine that is much valued by patients and physicians -- both generalists and specialists -- as something to be preserved in any model of collaboration to be developed. Overall, two divergent directions emerge: preserving all the professions' traditional functions while adapting to changing contexts, or concentrating on areas of expertise and moving towards creating "specialist" general practitioners, in response to a rapidly expanding scope of practice, and to the high value attributed to specialization by society and the professional system.
在许多国家，家庭医生的数量越来越少，而且学生对初级保健职业的兴趣也降低了，通科医生正逐渐成为濒危物种。这种情况是医疗保健资源管理面临的一项重大挑战。在快速变化的医疗环境中，家庭医学正在努力确立明确的身份——这一问题对卫生系统重组至关重要，因为它影响到系统中其他专业的角色和职能。我们研究的目的是通过焦点小组和个人访谈，探讨加拿大四所医学院校中未来的家庭医生、专科医生及其临床教师对家庭医生角色和职责的认知。除了家庭医学，我们还将普通精神病学、放射学和内科的住院医师培训项目作为目标——这三个领域在初级保健和专科医学之间有显著的交叉。在每所医学院，受访者包括研究生副院长；每个相关项目的主任；项目中的教育工作者；各专业处于培训最后一年的住院医师。研究结果围绕三个主要主题展开：（1）家庭医学的定义；（2）作为濒危物种的家庭医学；（3）年轻家庭医生与其教育工作者之间的代沟。持续的医患关系被认为是家庭医学的一个核心特征，受到患者以及通科医生和专科医生的高度重视，是任何合作模式中都应保留的内容。总体而言，出现了两个不同的方向：在适应不断变化的环境的同时保留所有专业的传统功能，或者专注于专业领域，朝着培养“专科化”全科医生的方向发展，以应对迅速扩大的执业范围，以及社会和专业体系对专科化的高度重视。
