title: A tale of two cultures: specialists and generalists sharing the load.
abstract: OBJECTIVE
  To understand what contributes to good collaborative physician working relationships through identifying the factors that affect working relationships between generalist physicians and specialists.
  
  
  METHODS
  Qualitative study using in-depth interviews.
  
  
  METHODS
  University and community hospital inpatient family practice settings in Edmonton, Alta.
  
  
  METHODS
  Eleven physicians from various specialties who graduated between 1977 and 2001.
  
  
  METHODS
  A grounded-theory approach, including constant comparison and creation of memorandums, helped to conceptualize the main concern and generated a framework for how the main concern was being resolved. A semistructured interview guide was developed and individual, in-depth interviews were audiotaped. Purposeful and theoretical sampling techniques were used. Three researchers participated in the analysis.
  
  
  RESULTS
  The findings suggested that when generalist physicians perceived that work had been imposed on them by specialists without negotiation, they felt overwhelmed by the workload. Differing priorities determined whether physicians were left holding the bag or sharing the load. In a system that valued technology and specialized knowledge and skills, the specialists were better able to control resources, set boundaries, and influence learners. This precipitated a culture of protecting valuable specialty resources, increasing physician isolation, and generalists feeling that they were left holding the bag. In order to reverse this cycle, it was important for physicians to develop good working relationships based on accessibility to needed expertise and tests, with negotiated agreements on how to share resources; mutual empowerment, including negotiation of roles and responsibilities to develop flexible relationships with a clear understanding of roles; and concern for fairness by sharing the load.
  
  
  CONCLUSIONS
  Medical systems that value technology and focused interests might lead to someone being left holding the bag, contributing to generalists feeling overwhelmed and isolated within the system. A comprehensive system that values relationships might help to resolve issues created through perceived inequities in workload, disempowerment, and lack of understanding of roles.
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, AB. dmanca@planet.eon.net
authors.forename: Donna P
authors.initials: DP
authors.lastname: Manca
authors.forename: Lorraine
authors.initials: L
authors.lastname: Breault
authors.forename: Paul
authors.initials: P
authors.lastname: Wishart
mesh_terms: D000416:Alberta; D001291:Attitude of Health Personnel; D005194:Family Practice; D005260:Female; D006739:Hospital Administration; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D015279:Organizational Culture; D010348:Patient Care Team; D036301:Qualitative Research; D013038:Specialization