title: Health care system reform. Ontario family physicians' reactions.
abstract: OBJECTIVE
  To determine the effect on a cohort of family physicians of health care system reforms in Ontario and the relationship of reforms to their career satisfaction.
  
  
  METHODS
  Follow-up survey in 1999 of a cohort initially studied in 1993, posing many of the original questions along with some new ones. Four focus groups of other Ontario family physicians.
  
  
  METHODS
  Family practices in Ontario.
  
  
  METHODS
  All family physicians who had received certification after completing a family medicine residency between 1989 and 1991 and were practising in Ontario in 1993. This report addresses only those members of the cohort who continued to practise family medicine in Ontario (N = 236). Four focus groups with a total of 27 family physicians.
  
  
  METHODS
  Reaction to health care system reforms. Perceived effect of reforms on practice. Current perception of quality of health care system and level of career satisfaction and changes in these variables since 1993.
  
  
  RESULTS
  Response rate was 53% of original cohort. Only three of 13 selected health reforms were believed to have had a favourable effect. Physicians reported lower levels of satisfaction with their careers. Overall quality of the health care system was perceived by both respondents and focus group members to have declined. Several difficulties affected practice and personal life.
  
  
  CONCLUSIONS
  Family physicians viewed the effect of health care reforms negatively and were significantly less satisfied with their careers than they were in 1993. Better consultation with stakeholders before implementation of reforms is needed to ensure that these stakeholders understand the likely effects of these reforms.
authors.affiliation: Department of Family Medicine, McMaster University in Hamilton, Ont.
authors.forename: M
authors.initials: M
authors.lastname: Cohen
authors.forename: B
authors.initials: B
authors.lastname: Ferrier
authors.forename: C A
authors.initials: CA
authors.lastname: Woodward
authors.forename: J
authors.initials: J
authors.lastname: Brown
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003695:Delivery of Health Care; D005194:Family Practice; D005195:Family Relations; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform; D019538:Health Care Surveys; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011787:Quality of Health Care