Eden Aimee R, Barreto Tyler, Hansen Elizabeth Rose
Department of Research and Policy, American Board of Family Medicine, Lexington, Kentucky, USA.
Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Fam Med Community Health. 2019 Jun 14;7(3):e000063. doi: 10.1136/fmch-2018-000063. eCollection 2019.
This study aimed to explore how new family medicine graduates who want to include obstetrics in their scope of practice identify and select jobs and to understand how employment influences scope of practice in family medicine, particularly the ability to provide maternity care and deliver babies.
Mixed-methods study including a survey and qualitative interviews conducted in 2017.
We electronically surveyed US family physicians and followed up with a purposeful subsample of these physicians to conduct in-depth, semistructured telephone interviews.
1016 US family medicine residency graduates 2014-2016 who indicated that they intended to deliver babies in practice completed a survey; 56 of these were interviewed.
The survey measured the reasons for not doing obstetrics as a family physician. To identify themes regarding finding family medicine jobs with obstetrics, we used a team-based, immersion-crystallisation approach to analyse the transcribed qualitative interviews.
Survey results (49% response rate) showed that not finding a job that included obstetrics was the primary reason newly graduated family physicians who intended to do obstetrics were not doing so. Qualitative interviews revealed that family physicians often find jobs with obstetrics through connections or recruitment efforts and make job decisions based on personal considerations such as included geographical preferences, family obligations and lifestyle. However, job-seeking and job-taking decisions are constrained by employment-related issues such as job structure, practice characteristics and lack of availability of family medicine jobs with obstetrics.
While personal reasons drove job selection for most physicians, their choices were constrained by multiple factors beyond their control, particularly availability of family medicine jobs allowing obstetrics. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviours of newly graduating medical residents as well as for access to healthcare services by patients; understanding how employment influences scope of practice in family medicine can provide insight into how to support family physicians to maintain the scope of practice they desire and are trained to provide, thus, ensuring that families have access to care.
本研究旨在探讨希望将产科纳入其执业范围的新家庭医学毕业生如何识别和选择工作，并了解就业如何影响家庭医学的执业范围，特别是提供产科护理和接生的能力。
2017年进行的包括调查和定性访谈的混合方法研究。
我们对美国家庭医生进行了电子调查，并对这些医生中有目的抽取的子样本进行跟进，以进行深入的半结构化电话访谈。
2014 - 2016年表明打算在执业中接生的1016名美国家庭医学住院医师毕业生完成了一项调查；其中56人接受了访谈。
该调查衡量了不将产科作为家庭医生执业内容的原因。为了确定有关找到含产科的家庭医学工作的主题，我们采用基于团队的沉浸 - 结晶方法来分析转录后的定性访谈。
调查结果（回复率49%）显示，未找到包含产科的工作是打算从事产科工作的新毕业家庭医生未开展此项工作的主要原因。定性访谈表明，家庭医生通常通过人脉关系或招聘努力找到含产科的工作，并基于个人考虑做出工作决策，如地理位置偏好、家庭责任和生活方式等。然而，求职和就业决策受到与就业相关的问题的限制，如工作结构、执业特点以及缺乏含产科的家庭医学工作机会。
虽然大多数医生的工作选择受个人因素驱动，但他们的选择受到多种无法控制的因素限制，特别是允许开展产科工作的家庭医学工作机会。在美国，从医生作为执业所有者向医生作为雇员的转变对新毕业住院医师的求职行为以及患者获得医疗服务的机会都有影响；了解就业如何影响家庭医学的执业范围可以为如何支持家庭医生维持他们期望并接受过培训以提供的执业范围提供见解，从而确保家庭能够获得医疗服务。
