Future of family medicine: role of patient-centred care and evidence-based medicine.

Primary care reforms that are perceived by family physicians as threats to professional autonomy and the traditional role of community-based family medicine can lead to reduced satisfaction and perceived value, and can make recruitment and retention difficult.1,2 Over the past 8 years, Canadian family physicians have experienced many changes to their practice landscape. • Government cutbacks to primary care remuneration in Ontario have recently forced family physicians to defend their financial autonomy.3 • A move toward interdisciplinary care and patient rostering has led to the creation of complex primary care teams, with not only the positive benefits of collaborative care, but also the potential loss of physicians’ control over their own practices and the policies and management of organizations.4 • Clinical autonomy (ie, the ability to make decisions about patients’ care) might be reduced in communities where a large number of specialists provide care to family physicians’ patients, or in clinics that implement protocols and standards that limit physicians’ individual decision-making ability. • The roles of allied professionals, such as nurse practitioners and pharmacists, have expanded to overlap some of the roles traditionally dominated by family physicians, leading some to fear that allied professionals will one day usurp the role of family doctors.5-7 • The increase of government monitoring with the use of pay-for-performance incentives and electronic medical records might also be seen as a threat to clinical and political autonomy.8-10 • Internal conflict is occurring within the profession with respect to the role of family physicians, most notably in the form of intergenerational professional dissonance. An increasing number of younger family physicians looking to strike a work-life balance no longer perform some of the responsibilities previously considered integral to the role of the family physician (eg, deliveries, hospitalist work) or choose to focus their practices (eg, sports medicine, psychotherapy).11 • Strong patient movements such as informed consumerism (eg, increased use of online health information)12,13 and an increasing uptake of complementary and alternative medicine14,15 might threaten some family physicians’ sense of autonomy. Many family physicians are increasingly uncertain about their future in primary care.5,6 Clinical uncertainty is not foreign to family physicians, but what happens when the discipline itself is faced with professional uncertainty?