Advice to future family physicians: findings from qualitative interviews with family medicine residents and early-career family physicians | BMC Medical Education

Out of the 94 participants from the ECPC study, 60 early-career family physicians and 30 family medicine residents (90 total; 30 from BC, 30 from NS, 30 from ON) shared advice they could offer to family medicine residents and were included in this analysis. Table 1 shows the demographic and practice characteristics of participants. Participants practiced in a variety of settings and models. Men and women were interviewed, most of whom were partnered, and some cared for dependents (primarily children). Participants of this study did not agree for their individual data to be shared publicly, so supporting data are not available.

Family physicians and residents provided many pieces of advice to potential family medicine residents. We identified three themes in the data: (1) advice on the importance of having diverse practice experiences; (2) advice on the unanticipated aspects of family medicine; and (3) advice on taking care of yourself while practicing family medicine.

Theme 1. Advice on the importance of having diverse practice experiences

Participants who were early-career family physicians and residents emphasized the importance of experiencing a diversity of practice settings and fields. A family physician advised that residents should spend time “test[ing] the waters” and finding “where you feel that you fit and you’re happy.” (Family Physician, BC). As one participant explained:

“I’d tell them to do as many electives in different places and experience as many different types of clinics and types of practices that they can… I never would have thought that I could be doing what I was doing. I sort of thought buying into a practice was sort of your only option… And I honestly tell people… don’t commit to something right away… there are so many opportunities out there that you’re not exposed to.” (Family Physician, BC).

Several participants recommended that residents should locum first to gain experience across a variety of family medicine models, communities, and specialties. By locuming, new physicians can “get the sense of how you want to schedule your day… You’re working with different types of administrators. You’re not having to work with your own administrators. So, you can figure out who you want to hire in a secretary or if you need more than one secretary… you get to see what it’s like either in a collaborative or a solo practice… see different areas, get different experiences as a working physician.” (Family Physician, NS).

Locum work can provide new family physicians with the opportunity to “try” out potential future practice locations “before putting roots down” (Family Physician, NS). A family physician said that residents should know “… it’s okay to locum and try out different types of models because at the end of the day, I hope that everyone can find the passion to do what they do in a model where they love how they get to practice medicine.” (Family Physician, ON).

Interviewees advised that residents seek variety in areas of practice such as emergency and obstetrics and experience practicing in rural areas, where one can “really see what the breadth of family medicine is” (Resident, ON). Experience in other areas of medicine can offer family physicians “flexibility” in their practice. As a resident said, “…you can work in a diverse number of environments… plus the operating room, palliative, long-term care, geriatrics… it’s so diverse… you just have to find as many opportunities as possible and build sort the practice you want…” (Resident, ON).

Theme 2. Advice on the unanticipated aspects of family medicine

The business of family medicine

Participants would advise residents on areas of knowledge not necessarily taught in the formal medical school curriculum but represented the realities of working as a family physician. Family physicians and residents noted a dearth of formal education about the “business” of family medicine and described situations where they learned by doing. Advice from early-career family physician participants in our study emphasized that new family physicians need to expose themselves to “lots of learning around billing and management” (Family Physician, NS) to better perform administrative tasks revolving around their future practices (e.g., billing, insurance, contract negotiations, starting financial planning early, get occupational health and safety training, and learn how to hire and fire staff). Billing is a necessary part of family medicine for fee-for-service physicians, but is not formally taught in medical school or postgraduate training. As one participant stated, “No one taught me how to bill. That was a disaster – learning how to do that.” (Family Physician, NS). Advice was given to “… talk to preceptors that you work with and see … how do they handle hiring and firing people … how do they schedule … the logistics of being a family doctor” and “know who are support people are and who can advocate for you.” (Resident, NS).

Realities of working under different models

Interviewees not only detailed that learning the administrative duties of a family physician is critical for effectively running their family medicine practice, but they also emphasized the difficulties and limitations that come with working within the current payment and practice models offered. For instance, interviewees discussed how the business side of family medicine intersected with their well-being. For example, new family physicians might need to create time for vacation when working in solo practice, but “You need to find somebody to cover for you in that kind of model. So yeah, I don’t know that I can fully endorse that kind of work. But I think it is the most personally and professionally valuable” (Family Physician, BC). Another interviewee suggested that new family physicians should consider how pay might influence work-life balance: “I make twice as much per hour [working in emergency medicine] as working in a clinic. So, I can work half as much and have time for myself and my wife or kids or whatever’s in the future.” (Family Physician, BC).

Not all interviewees were responsible for their own clinic, but many provided advice about the business of family medicine. Early-career family physician and resident participants in our study advised that physicians must be careful about the contracts they sign and the agreements they make. As one participant explained:

“… avoid committing yourself to any contracts … I see so many new grads being taken advantage of all the time … they’re basically taking advantage of new grads who don’t have that knowledge.” (Family Physician, BC).

Because it can be challenging to navigate the business of family medicine, a resident advised that other residents should “… not just jump into the first offer that you’re given … you want to make sure that you’re not being over-worked. You want to make sure that you’re being compensated properly… aware of your call schedule… to know who your support people are, or who can, advocate for you. So, whether that’s [your provincial professional association], whether it’s other physicians.” (Resident, NS).

Relevancy of and support for family medicine

Family physicians and residents recommended that new residents have an awareness of the relevancy of, and support for, family medicine. Some interviewees voiced their frustration with the lower level of support family physicians receive, describing their profession as “eroding” and that residents should consider whether they want to do family medicine. As one participant explained, “I could see it becoming less and less relevant. You know, being a generalist… That’s what I’m afraid of… So, I think I would tell them to have a back-up plan… a different skillset in medicine.” (Family Physician, NS). Thus, to prevent the erosion of the family medicine profession and ensure it remains relevant, participants were urged to “keep advocating for fee parity and improvements in family medicine” (Family Physician, BC).

Complexity of family medicine

Furthermore, participants often discussed the high and increasing complexity of family medicine. Interviewees described how family physicians are responsible for caring for increasingly complex patients “due to the [family physician] shortage… or the long timelines to get people into specialists.” (Family Physician, NS). Because of the perceived growing expectations of family physicians, an interviewee advised that residents should “go easy on yourself” as there is a “tendency of that [frustration] in family medicine because all the problems always come back to us,” suggesting that once specialists have exhausted all of their options, the onus falls back on the family physician to decide “now what are you going to do about it?” (Family Physician, NS).

Participants also discussed important considerations about working with patients. As one interviewee described, “… don’t… under-estimate… a patient’s knowledge of themselves even if it doesn’t fall into a guideline” (Family Physician, NS), going on to imply the importance of considering the patients’ preferences in treatment.

As one participant described, the medical complexity of family medicine requires a flexible schedule, with consideration of patients with urgent or emergent needs, “… there’s lots of surprises that come in in family medicine… you have to allow a little bit of flexibility in the schedule for urgent people you need to fit in, or people that come in with chest pain, or suicidality, or things like that. So, it’s teaching around… being flexible and giving people the time when they need it. But also teaching residents and learners that sometimes you just have to set down some ground rules with patients for their own benefit sometimes.” (Family Physician, NS).

Importance of lifelong learning

Participants also emphasized the importance of lifelong learning in family medicine, sharing that “… the minute that I think that I know everything about a subject is probably when I do something that I don’t mean to do and potentially harm a patient.” (Family Physician, ON).

One participant advised future residents to “expect change throughout your career… [w]hether that’s government changes, whether it’s the advent of AI and technology…” (Family Physician, ON).

Perceived need to specialize within family medicine

Finally, not only were family medicine residents advised to be flexible and expect change throughout their careers, but participants also urged residents to specialize within an area of family medicine to stay afloat. As a resident explained, “I think the nature of family medicine is changing, and increasingly so, there are less and less true general practitioners. And so, if you don’t carve something out that you’re interested in, I think you kind of get lost in the shuffle” (Resident, BC). Participants recommended that residents narrow their practice into a subspecialty like “sports medicine or addictions” (Family Physician, BC) and that residents “…could apply for enhanced training skills or a plus one program to help develop those skills and make them more competitive after they’re done their training” (Resident, NS).

Theme 3. Advice on taking care of yourself while practicing family medicine

Participants offered several pieces of advice for residents to understand how to take care of themselves in family medicine. Of particular concern to participants was preventing burnout. Strategies for avoiding burnout included not “jump[ing] right into a practice” (Family Physician, BC), “find[ing] a niche… Something you can do to get a good balance in your career and so you don’t burn out.” (Resident, ON), and “… guarding… personal and private time.” (Family Physician, NS).

Many participants suggested that new family medicine residents need to prioritize work/life balance. Family physician and resident participants discussed how general, full-time family medicine can lead to little personal flexibility and dissatisfaction with work and burnout. As a participant advised, “I would tell them to design their life first and then find an area within family medicine, whether that’s clinic or otherwise, that will let them actually live the life they want. Because if you just sign up to be a doctor first, you can work endlessly and not have any time for yourself” (Family Physician, BC).

Many participants discussed difficulties managing work and personal considerations and how poor balance in these areas can result in physicians leaving the profession. Participants provided advice for residents about planning for the future, with several participants suggesting that new residents should build their practice starting smaller, including core interests and then “build from that. If you find you have room in your life, then add the second or third thing. Because it’s a lot easier to build up than it is to say no.” (Family Physician, NS). Similarly, some participants advised that residents envision their personal goals and “work backwards.” As this participant suggested, “picture where you want to be in 10 to 20 years, and then kind of plant the seeds.” (Family Physician NS). Having a mentor or role model may help with this: “… find people whose work-life balance reflects your own values. And then strive to follow a similar path.” (Family Physician, BC).

Overall, participants advised that residents should find personal satisfaction in their work and “end up with a career that you are truly passionate about and that you love” (Resident NS). As previously mentioned, there was a substantial amount of advice provided on obtaining experience in a variety of areas. One participant advised that residents should “… understand… the aspects of the work that you enjoy the most. And then you can use that to guide where you end up working. So, do you like having longitudinal relationships? Do you like quick diagnostics? Do you… like to do procedures? Do you like the complexity of working in resource-limited spaces?” (Family Physician, BC). As participants described, it is essential that residents spend time finding what they like and dislike about their job because “how am I going to be able to provide the care that I want to be able to provide to my patients without feeling angry or bitter or whatever it is about the system?” (Family Physician, ON) and “no one’s going to give you a medal at the end of 30 years for making yourself miserable.” (Family Physician, BC).

Subtheme 1. Advice comparison between providers, provinces, and genders

Responses from both residents and early-career family physicians were examined showing many similarities in the advice that they would give incoming residents. Common themes include finding work-life balance, being open-minded, becoming a mentor, finding self-fulfillment, being aware of pre-mature commitment, the need for practice specialization, importance of patient advocacy, and preventing burnout. Early-career family physicians were more likely to emphasize the importance of understanding practice logistics and achieving job security.

Between the three provinces, the advice participants would give are similar, with NS and ON emphasizing the importance of practice logistics and job security more than BC. Otherwise, all provinces gave similar advice on finding work-life balance, being open-minded, becoming a mentor, finding self-fulfillment, being aware of pre-mature commitment, the need for practice specialization, importance of patient advocacy, and preventing burnout.

Responses from both genders of participants showed commonality in discussing advice on finding work-life balance, being open-minded, becoming a mentor, finding self-fulfillment, being aware of pre-mature commitment, the need for practice specialization, the importance of understanding practice logistic, and preventing burnout. Male providers emphasized more about the importance of patient advocacy and achieving job security.