Personal and professional development of teachers in family medicine.

While medical educators have devoted considerable effort to examining the optimal learning environment for teaching family medicine, less attention has been paid to "blocks" that prevent teachers of family medicine from being effective. This paper considers three major aspects of this problem: the personal and professional development of the teacher; blocks that impede this development; and the value of intervening in the teaching-learning process. These concerns are discussed in relation to an intervention program developed at the Byron Family Medical Centre, a family practice teaching unit affiliated with Victoria Hospital Corporation and the Department of Family Medicine, University of Western Ontario, London.     

The future of family practice training in California.

Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support. Medicare, the Veterans Administration, and the University of California provide more than $325 million a year in support of graduate medical education in California. Federal and state grant programs provide $5 million a year for family physician training in the state, but appropriations to these programs have been reduced in real terms. California family practice residencies are disproportionately located at county hospitals, where funding shortfalls make them especially vulnerable to cuts in grant programs. Additional resources will be needed if more family physicians are to be trained.     

Effect of medicolegal liability on patterns of general and family practice in Canada.

As part of the Federal/Provincial/Territorial Review on Liability and Compensation Issues in Health Care, in 1988 we surveyed Canadian general practitioners and family physicians to determine the effect of liability concerns on their practices in the previous 5 years. Questionnaires were sent to a random, stratified national sample of 1295 physicians, with a response rate of 64.6%. However, a high proportion of the returned questionnaires were ineligible because the physicians were not in general or family practice, were not involved in direct patient care, or had died or moved; thus, the corrected response rate was 50.8%. The newsletter of the Canadian Medical Protective Association was the source of information on liability most frequently cited (by 88.1% of the physicians) and most influential (to 62.4%). Only 15.5% of the physicians cited personal involvement with medicolegal issues as a source of information; the rate was higher for Ontario physicians and those in urban areas generally. A total of 74.6% of the respondents had altered their style of practice in the previous 5 years, and 56.3% reported changes in the scope of their practice. Concern about litigation was the most important reason for changing style of practice and reducing or eliminating administration of anesthesia, whereas lifestyle and other issues along with liability concerns most influenced decisions to reduce obstetric care and emergency department work. Our findings suggest that physicians'' perceptions of liability issues have had a profound influence on primary care practice in Canada in the past several years.     

Patient morbidity and some patterns of family practice in southeastern Ontario.

Over a 7-month period the trial version of the International Classification of Health Problems in Primary Care (ICHPPC) was studied. Ten community physicians reported 28 399 encounters wtith 11 437 patients. The overall distribution of health problems was comparable to that found in other North American studies. Some differences between the morbidity distributions in urban and rural practices varies from those of previous Canadian studies. Other differences between practices appeared to be related to the interests and training of the individual physicians. The workload of the physicians varied considerably. Many of the encounters involved problems for which there may be minimal benefit from medical intervention, and there was a large discrepancy in the frequency of follow-up visits for specified stable chronic health problems. The implications of these interpractice variations in the altering field of health care are discussed.