Exploring the factors that influence the ratio of generalists to other specialists in Canada.

OBJECTIVE To explore perceptions about the factors that influence the ratio of generalists to other specialists. DESIGN Semistructured interviews. SETTING Canada. PARTICIPANTS Thirteen individuals who were closely involved in medical education and health human resource planning or had a role in influencing medical education policy. METHODS Telephone interviews were conducted with participants until data saturation was reached. Interviews were transcribed and analyzed using constant comparison techniques. For the purpose of simplifying discourse, family medicine and generalism were treated as synonymous throughout the interviews. MAIN FINDINGS Seven themes emerged from participants' responses: ratio of generalists to specialists, importance of generalism, barriers to generalism, role of the medical education system, role of policy makers, geographic location, and the future of generalism. CONCLUSION Most respondents perceived the ratio of specialists to generalists as roughly even and believed the reasons for this balance included increased attention from policy makers, a greater presence of family physicians in research and teaching, and a shift toward a more regional and representative distribution of medical education facilities. Respondents also highlighted challenges within family medicine including providers choosing a narrower scope of practice, a shift away from generalism, and ongoing inequities between family physicians and other specialties in terms of remuneration, lifestyle, and prestige.