Young Family Physicians Research Articles

The experience of providing end-of-life care at home: The emotional experiences of young family physicians.

End-of-life care is now a major issue in Japan as a result of the rapidly aging population; hence, the need for fostering family physicians to be engaged in end-of-life care at home is increasing. Studies in the United States and the United Kingdom have shown that physicians feel emotional and moral distress in end-of-life care, and that they develop detachment and dehumanizing attitudes toward patients as a coping mechanism. However, few studies have explored the emotional experiences that family physicians have during home-based end-of-life care. The aim of this study is to explore the emotional experiences of young family physicians in such situations. We conducted a qualitative analysis of interviews with family medicine residents or family physicians who had just completed their residency. The interviews were audio-recorded and transcripts were prepared. The coded data were analyzed according to thematic analysis using NVivo 10 software. Study participants were 12 family physicians of PGY 5-11, with experienced end-of-life care cases of 3-20. Thirteen themes were extracted from the data, which were categorized into five domains: difficulties in end-of-life discussion, emotions of physicians, the role of physicians, communicating with the family, and positivity in end-of-life care. The physicians experienced various emotions and struggles within these domains, but they also felt something positive through providing care for the dying patients and their families. Family physicians experience various emotional difficulties during end-of-life home care. However, positive emotions at the end of life were also experienced through their care.

High psychological burden of young family physicians early in the COVID-19 pandemic: Results from an exploratory survey

Background Previous pandemics such as SARS in 2002 revealed an especially high psychological burden of frontline healthcare professionals in hospitals directly involved in the treatment of confirmed cases. As family physicians are among the first exposed to the SARS-CoV-2 virus, assessing their psychological burden and needs for support is important. Methods A web-based survey was distributed among family physicians of a German university teaching practice network. The questionnaire consisted of validated instruments to evaluate symptoms of psychological distress, i.e., the patient health questionnaire (PHQ-9), generalized anxiety disorder 7 (GAD-7), peritraumatic distress inventory (PDI), and insomnia severity index (ISI). Additional self-developed items addressed sociodemographic and professional characteristics including professional duties and protective equipment available. Effects between the symptoms were examined using bivariate Pearson correlation. Results The participation rate was 31 % (36 of 116) with 33 valid cases. About 47 % (n = 17) of the respondents were 56 years old or more. 66.7 % (n = 22) physicians reported moderate to severe depressive symptoms (PHQ-9 ≥ 10) and 51.5 % (n = 17) moderate to severe signs of anxiety (GAD-7 _ 10). Physicians with depressive symptoms showed more signs of anxiety (p <.001) and insomnia (p <.001). There is a negative correlation between age and severity of depressive symptoms (p =.041) and insomnia (p =.002). The regression analysis showed that younger participants were more likely to show depressive symptoms (β = –.358, p =.046), even after correcting for gender (R2 =.402). Conclusions Depressive symptoms were frequent among family physicians, especially in younger physicians who were also more likely to report symptoms of insomnia. The symptoms of psychological distress are unlikely to be explained by a lack of protective equipment, because the majority had sufficient supplies. © 2021, Deutscher Arzte-Verlag GmbH. All rights reserved.

Characteristics of Young Family Physician Hospitalists.

Based on a 2016 survey of family physicians who were then three years out of residency training, we found that almost 9 percent self-identified as hospitalists. These family physician hospitalists were significantly more likely than their non-hospitalist peers to be male, work longer hours, be better paid, and be more satisfied with their work. These attributes may attract more family physicians to hospital medicine, with negative implications for the supply of primary care physicians. (J Am Board Fam Med 2018;31:680-681.).

Response: Re: Burnout in Young Family Physicians: Variation Across States

Dr. Kendall brings up valuable considerations as we seek to understand the personal and institutional factors influencing physician burnout. As Dr. Mack discussed in his commentary[1][1], family physicians experience burnout at rates that are higher than average for many reasons, including less time

Attitudes toward the elderly among young family physicians in Turkey.

Introduction:General practitioners’(GPs) role is important as they are easily accessible especially for elderly. Young GPs need to improve their attitudes toward the elderly so that they can be a part of solution for health problems of elderly in the future. The aim of this study is to determine attitudes of young GPs toward elderly by the University of California at Los Angeles Geriatrics Attitude Scale (UCLA-GAS).Methods:It is a cross-sectional study performed with questionnaires including UCLA-GAS. The study population was 260 young doctors (GP residents and GPs in their first 5 years after qualification). Statistical evaluation of the data included percentage, mean, and Kolmogorov–Smirnov test and analysis of variance test.Results:Of the participants, 58.1% (n = 151) were women, 35.4% (n = 94) of them were GPs, and the remaining were GP residents. The mean age was 31.30 ± 5.40 years (range = 24–55 years). The mean score of UCLA-GAS was 46.85 ± 5.63 (range = 30–61). Participants ≤30 years of age had significantly higher scores (47.70 ± 5.99) than age above 30 years (45.68 ± 4.89) (P = 0.003). There was no statistically significant difference between GP residents and GPs (P = 0.989) and between participants who had rotation in elderly healthcare service (n = 63) or not (n = 197) (P = 0.383). However, as the duration of work increased, the score of UCLA-GAS decreased significantly (r = −0.216, P < 0.001).Conclusion:Young doctors who were interested in elderly showed more positive attitude as expected. However, the ones who were older and worked longer had less positive attitude. It seems important to understand and prevent this unfavourable attitude with formal education system about elderly healthcare during residency.

Burnout in Young Family Physicians: Variation Across States.

Family physicians 3 years out of training report high rates of emotional exhaustion and depersonalization, symptoms of burnout, with considerable variation between states. High rates of burnout among new family physicians is concerning and significant state-level variation suggests that state-related factors may contribute to or reduce burnout.

European General Practice Research Network (EGPRN)

Latvia is a country by the Baltic Sea populated by 1 969 000 inhabitants. It is called a ‘green’ country due to its forests and abundance of wildlife. About half of inhabitants above 15 years of age (45% women and 55% men) are sure that they are in very good or good health. Inhabitants are in general appreciating family medicine as 62% are fully and 28% are partly satisfied with their family physician. Representative studies on health behaviour of the Latvian population show that there is still a significant effort needed by both family physicians and patients to implement favourable lifestyle changes. For example, half of working-age people (54.6%) are overweight or obese and traditions of riding bicycles are still to be enhanced, as 77% report not riding bicycles at all. Latvians are still to be encouraged to accept preventive measures as coverage of cancer screening programmes is below 40% and human papilloma virus vaccination rates in 12-year old females do not exceed 45%. As both healthy life expectancy at birth (67.1 years) and the public spending on health as a share of GDP per capita (below 4%) is one of the lowest in the European region, effective primary healthcare (PHC) teams are essential in Latvia.In clinical family medicine, Latvia has implemented an impressive change since 1993. It has switched from the Soviet polyclinic-based healthcare system with different specialists dealing with individual health problems of a patient towards a Western system based on a comprehensive patient-oriented approach of a family physician. Since then the number of family physicians in the country has grown from 0 to 1450. The opinion of family physicians is now considered as an effort of two powerful associations: Association of Latvian Family Physicians and Association of Latvian Rural Family Physicians. A total of 1329 physicians have public agreements with National Health Service (6.7 PHC physicians per 10 000 inhabitants) and on average 1530 patients are registered per physician. Most family physicians have their private practices supported by one or two nurses or physician’s assistants. Primary healthcare paediatricians and internists form a minor part of PHC. E-medicine is being currently piloted. After trying different financing systems and models, Latvia has now stopped at mixed capitation model. Quality criteria are set but seem to be non-motivating. In this set-up, the main challenge is to fit competencies of the family physician so well incorporated in the Wonca tree into the legislative and financial framework of Latvia.As 54% of primary healthcare physicians are older than 55, education of young family physicians is crucial. The education system of a family physician in Latvia is like Lithuania and Estonia with six undergraduate years and three post-graduate years. Two universities (Riga Stradins University and University of Latvia) are training both undergraduate and postgraduate physicians. Family medicine is incorporated in the last year of the programme for undergraduates and there is a great intention to introduce basics of family medicine earlier. The prestige and number of medical students is growing every year in Riga Stradins University, e.g., during the academic year 2016/2017, a total of 315 students (including 116 international students) undertook a basic course in family medicine. Most students are satisfied with the course and a new perspective of problem-solving. On average 40 postgraduates are trained in family medicine each year since 2014 with most training in family medicine during the last year.Research in family medicine has been slower, compared to other Baltic countries. Establishment of the Department of Family Medicine in Riga Stradins University in 2010 was a serious sign of changing attitudes towards family medicine. Now the department comprises 10 lecturers with only one assistant professor in family medicine. The main challenge is involvement of clinically active, competent physicians into academic and research environment. Capacity building in writing project proposals and publications is still essential. Postgraduates (residents) are a serious potential for further research activities. Latvia is ready to continue its journey towards academic family medicine, and hosting the EGPRN Riga Conference is another big step towards reaching this target.

The Impact of Debt on Young Family Physicians: Unanswered Questions with Critical Implications.

In this issue, Bazemore et al demonstrate that 58% of graduating family medicine residents have more than $150,000 of educational debt, and 26% have more than $250,000 debt.[1][1] This is important because although the debt levels of graduating US medical students are well documented, little is

Young Doctor Movements: motives for membership among aspiring and young family physicians.

Background:Over the past decade, young doctor movements (YDMs) have gained recognition for their efforts in promoting the discipline of family medicine. With growth and expansion comes the need for an inquiry into the membership motives of current/intending members.Aim and Objectives:This study was aimed at determining the main reasons why young and aspiring family physicians (FPs) joined their regional YDM. It was also concerned with determining the main factors that will make non-members want to join a YDM as well as assessing for differences in the responses within YDM members on the one hand, and between YDM members and non-members on the other.Materials and Methods:This was a cross-sectional web-based study. Using a list of 11 items generated following a series of discussions and feedback among selected FPs and FP trainees, respondents annotated levels of agreement on reasons for current or desired YDM membership. The Mann–Whitney U test was used to determine the distribution and differences in the mean of rank scores of the responses from YDM and non-YDM members while the Kruskal–Wallis test was used to describe same for the various YDMs.Results:The total number of respondents was 200, out of which 102 (51.0%) were current YDM members, 97 (48.5%) were non-members and 1 (0.5%) respondent did not state his/her membership status. Non-YDM members indicated a predominantly academic/professional motive for membership while YDM members indicated the opportunity to socialise with FPs abroad and in their country as their foremost reasons for membership. A mixture of academic, professional and social motives was observed for respondents from Vasco da Gama; predominantly academic and professional motives for respondents from Spice route.Conclusions:While gaining recognition and improving one's practice may be the ultimate goal of an aspiring FP, socialising within a network of like-minded professionals maybe the young FP's way of coping with demands of the discipline.

Unresolved Intergenerational Issues

The Keystone III Conference was held October 4–8, 2000, as a structured conversation about the current state and future of family medicine.1,2 Inspired by prior conversations organized by family medicine pioneer G. Gayle Stephens, MD, in 1984 and 1988,3 Keystone III stimulated the Future of Family Medicine Project, which aimed to “transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment.”4 This project, in turn, influenced the genesis of the patient-centered medical home5 and affected the course of US family medicine organizations’ efforts over the past decade. A widespread feeling still exists, however, that the work of renewal and transformation is not yet finished—that some precious ideals must be retained or reinvented, even as the Affordable Care Act moves health care change forward at an accelerating pace, and diverse new approaches to health care emerge. In fact, a Future of Family Medicine 2.0 already is underway.6 Perhaps the most vital aspect of the organization of the Keystone III conference was its purposeful multigenerational assembly. The conference was ordered around 8 papers presented by pairs of authors from different generations.2 The pioneers who largely came out of general practice to start the academic discipline of family medicine were reverently referred to as Generation I. The settlers, who largely trained in the residencies that Generation I had set up, were now in practice, leadership, or academic positions. They were called Generation II. Generation III were the young family physicians who either were in training or newly in practice or teaching at the turn of the 21st century. The great value of the intergenerational organization of the conference will be apparent to anyone with experience with multigenerational families, where the wisdom and mischief of experience reaches a flash point with the mischief and insight of youth, and the connections that can occur between grandparents and youngsters. The middle group is often tasked with balancing and operationalizing the competing threads of dialogue. For us, the major unresolved business of Keystone III was an intergenerational conversation that remained unmined for its gold. A crystallizing event occurred as a senior leader gave his usual brilliant summary of one of the papers and discussion, hoping to lead participants into a break on a thoughtful note. As part of his summary, he said: “We might find, that as we become less willing to be available to our patients 24/7, our moral authority is diminished.” As everyone started to get up to go, a Generation II participant from the back row jumped up, grabbed a microphone, and shouted, “How can you say that! How can you say that to be a good family physician I have to be an absentee father, and an unavailable spouse, and not have interests outside of medicine?” As people continued on to their conference break, and in small conversations at mealtimes, the need to reconcile these two perspectives became a focal point. But those conversations were never publicly vetted and certainly were never resolved. Into this unsettled space comes a paper that the Generation III participants wrote shortly after the Keystone III conference, but never published, and which will, we hope, restart that essential, lingering conversation in preparation for the next period of examination and renewal. In this issue, we publish it with minor editorial changes,7 and publish the reflections of its authors who are now in mid career almost 14 years later.8 We also publish a piece by our Editorial Fellow, Kate Rowland, calling the current new generation to a conversation about what is important and what will undoubtedly be passionate.9 We need the wisdom of our founders, who worked in demanding community environments with little respect from medical schools but who persevered to bring the discipline into being. We also need the discernment of the coming generations to help find a different way that works in the current environment, while advancing the shared values that established and defined the coming of family medicine. New ways may well be healthier for both patients and for their family physicians, as well as for the families, teams, and communities in which they live and work. But those ways are, on the whole, untested, and they need to be as adaptive and varied as the communities in which we work. We invite you to join the reflection and the conversation at www.annfammed.org/content/12/1/6.

President's column: making a difference

The purpose of the Messages from AMIA section is to provide a forum for AMIA to inform and involve its current and potential members about the goals and the directions of the association. These messages, which reflect the directions and opinions of AMIA leaders only, are intended to inspire members and readers to connect with the association on strategic objectives and activities. See also http://www.amia.org/presidents-page. As the new President and CEO of AMIA, I've been immersing feverishly in the ways of AMIA. I've talked with many leaders in the field and the organization to distill their advice concerning the future course of AMIA. The flood of information from all directions is at times a bit overwhelming and reminds me of my first days in med school at the University of North Dakota. But, if one listens and focuses, one learns … and, I am learning! What connections do I have with informatics? As a young family physician, I not only practiced, but also served as the founding Director of The Center for Rural Health at the University of North Dakota. In my work with rural communities, I came to the conclusion that if we had better information systems and robust connections between the rural providers and the larger healthcare delivery systems, we could markedly enhance the quality of care for the people living in rural America. Those formative years lit my flame of passion for informatics which has continued in my work as a leader in large healthcare systems and in new industry efforts related to web-based health education and electronic information systems. I have long felt inspired, even compelled, to pursue work that involved creating knowledge from information to improve healthcare . Here at AMIA, my clinical and industry background makes me a different kind of leader for …

Family practice: Professional identity in transition. A case study of family medicine in Canada

With increasingly fewer family physicians in many countries and students less interested in primary care careers, generalists are becoming an endangered species. This situation is a major health care resource management challenge. In a rapidly changing health care environment, family medicine is struggling for a clear identity—a matter which is crucial to health system restructuring because it affects the roles and functioning of other professions in the system. The objective of our study was to explore representations of roles and responsibilities of family physicians held by future family and specialist physicians and their clinical teachers in four Canadian medical school faculties of medicine, using both focus groups and individual interviews. In addition to family medicine, we targeted residency programs in general psychiatry, radiology and internal medicine—three areas that interface significantly between primary care and specialized medicine. In each faculty, respondents included the vice-dean of postgraduate studies; the director of each relevant program; educators in the program; residents in each specialty in their last year of training. Findings are centred around three major themes: (1) the definition of family medicine; (2) family medicine as an endangered species, and (3) the generation gap between young family physicians and their educators. The sustained physician–patient relationship is considered a core characteristic of family medicine that is much valued by patients and physicians—both generalists and specialists—as something to be preserved in any model of collaboration to be developed. Overall, two divergent directions emerge: preserving all the professions' traditional functions while adapting to changing contexts, or concentrating on areas of expertise and moving towards creating “specialist” general practitioners, in response to a rapidly expanding scope of practice, and to the high value attributed to specialization by society and the professional system.