title: Rewards and challenges of family practice: Web-based survey using the Delphi method.
abstract: OBJECTIVE
  To identify and describe the important rewards and challenges that affect family physicians in Alberta.
  
  
  METHODS
  Web-based qualitative study using the Delphi method.
  
  
  METHODS
  Province of Alberta.
  
  
  METHODS
  Twenty-eight family physicians practising in Alberta.
  
  
  METHODS
  The study website presented a description of the project, ethical information, a calendar of events, and contact information. Delphi surveys and demographic questionnaires were password protected. Five rounds of surveys were conducted between May 2004 and January 2005. Participants were notified of each round of surveys and prompted by e-mail if they did not respond. FINDINGS Participants identified 8 key rewards and 9 key challenges. The research team identified 2 additional challenges that were validated by participants. In order of perceived importance, key rewards were providing diverse and comprehensive care; providing preventive care; having relationships with patients and their families; being an immersed witness to the human condition; providing continuity of care and receiving ongoing feedback; having flexibility and control of practice and job security; maintaining and acquiring skills and knowledge; teaching and sharing knowledge and gaining experience and mentoring. The challenges, in order of perceived need to be addressed, were workload and time pressures and meeting demands; the need to promote the rewards of family practice to those considering joining the profession; overhead and income inequities; getting respect from specialists; the need to ensure that the rewards identified are not adversely affected by primary care reform; lack of availability of specialists, procedures, tests, and other resources; running a practice as a small business; paperwork, telephone calls, and forms; maintaining and acquiring skills and knowledge; patients' expectations; and medicolegal issues, insurance paperwork, and dealing with medical claims related to motor vehicle accidents.
  
  
  CONCLUSIONS
  The rewards and challenges reported by participants outline the positive and negative factors in family practice. The challenges provide a focus for further work.
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton. dmanca@planet.eon.net
authors.forename: Donna P
authors.initials: DP
authors.lastname: Manca
authors.forename: Stanley
authors.initials: S
authors.lastname: Varnhagen
authors.forename: Pamela
authors.initials: P
authors.lastname: Brett-MacLean
authors.forename: G Michael
authors.initials: GM
authors.lastname: Allan
authors.forename: Olga
authors.initials: O
authors.lastname: Szafran
authors.forename: Allen
authors.initials: A
authors.lastname: Ausford
authors.forename: Carol
authors.initials: C
authors.lastname: Rowntree
authors.forename: Ismael
authors.initials: I
authors.lastname: Rumzan
authors.forename: Diana
authors.initials: D
authors.lastname: Turner
mesh_terms: D000416:Alberta; D001291:Attitude of Health Personnel; D002321:Career Choice; D003697:Delphi Technique; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D010818:Practice Patterns, Physicians'; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D016526:Workload