Improving the Quality and Capacity of Canada's Health Services: Primary Care Physician Perspectives

While there has been much discussion concerning the sustainability and improvement of Canada's health system, the perspectives of front-line practitioners in primary care have not been the focus of reported research. There have been no published reports of the extent to which their views have been identified and/or adopted in the reform process. Recent Canadian national and provincial commissions have highlighted primary care reform (National Forum on Health 1997; Mazankowski 2001; Fyke 2001; Romanow 2002). It has been suggested that there are underlying factors both motivating and inhibiting health system changes (Tuohy 1999). Progress with primary care reform has been notably slow (Hutchison et al. 2001) and without the benefit of needed infrastructure investment (Hutchison 2007). An international survey of primary care physicians in seven countries indicated the inadequate current status of Canada's primary care system in comparison to other nations (Schoen et al. 2006). Understanding the realities of primary care service provision and identifying the enhancing and inhibiting policies and processes of Canada's health system could help to guide change. Perspectives of practising physicians could inform policy makers and planners who have an interest in health system efficiency, effectiveness and productivity. While Canada has benefited from national and provincial professional groups reporting on the challenges faced by healthcare practitioners and on potential solutions, the degree to which these suggestions address the realities of working in community primary care practice is questionable. Thomson et al. (2001) have complained about the inadequacy of physician input to such reports. Although changes in policy and practice related to primary care have been proceeding, there has been a paucity of empirical data to support or direct these changes. With the background of a prior qualitative investigation, this study utilized a survey conducted in an urban health region to determine FP/GP perspectives on the quality and capacity of the services these physicians provide and the system in which they work. The survey also assessed FP/GP attitudes to potential changes and elicited their suggestions to enhance the quality and capacity of primary care services.