Primary care physician engagement in health systems transformation.

Physician engagement is critical to the success of primary care transformation, yet strategies to support meaningful engagement remain understudied. Despite existing research, gaps persist in understanding how physician engagement unfolds within system-level initiatives in primary care. This paper examines physician engagement through the development of the London Middlesex Primary Care Alliance (LMPCA), a regional initiative uniting primary care providers in Southwestern Ontario to advocate for system improvements and support health system transformation, including the Middlesex-London Ontario Health Team (ML-OHT). Rather than centering solely on physician perspectives, our study explores physician engagement as part of a broader collaborative effort involving healthcare administrators and support personnel. Data were collected through interviews (n = 13; including primary care physicians, healthcare administrators, and administrative support personnel), document analysis, and an environmental scan. Findings highlight the importance of grassroots leadership, governance structures, and system-level supports in driving physician engagement. The role of a primary care transformation lead emerged as a key facilitator, while lack of compensation for system-level work remained a barrier. This study provides insights into the formation of a sustainable, self-governing primary care organization and offers considerations for scaling engagement strategies while mitigating burnout and ensuring long-term participation.