A survey of public health nurses (PHNs) who work in official public health units in Ontario was undertaken to determine whether their perceptions of their roles and activities concurred with a 1990 Canadian Public Health Association report which describes the roles and qualifications of public health nursing in Canada. The survey questionnaire was completed by 1,849 PHNs in all 42 public health units (response rate = 85%). About one tenth of the PHNs reported no activity as a caregiver/service provider. Most PHNs reported being active in the roles of educator/consultant, social marketer, and facilitator/communicator/collaborator. The community developer, policy formulator, research/evaluator, and resource manager/planner/coordinator roles were less frequently performed, however, increased activities in such roles were expected in the future. Nurses said that they needed further preparation to perform the latter roles. These results have implications for deployment of PHNs as Ontario's health system shifts to community health and health promotion.
In an evaluative study of brief family therapy, 279 families were administered a Family Satisfaction Questionnaire in their own homes, six months after treatment terminated. This questionnaire was designed to assess several aspects of the families' satisfaction with services received. The identified patient in all families was a child with academic and/or behavioral problems at school. A variety of outcome measures were also obtained both at treatment termination and at the six-month follow-up. Families were generally satisfied with the overall services received but expressed widely varying degrees of satisfaction with various aspects of treatment. Very little dissatisfaction was expressed regarding the availability of services (less than 7 per cent), but a sizeable proportion of families (45 per cent) did not feel that the services provided were comprehensive and adequate. Despite concerns regarding comprehensiveness and adequacy of the service, the majority of families were functioning well at the time of follow-up as assessed by a number of independent measures. Global satisfaction should not be regarded as the only index of treatment effectiveness, as many families who were dissatisfied experienced successful treatment outcomes.
A survey of the first six classes to graduate from McMaster University's medical school was carried out 5 years after graduation for the classes of 1972 to 1974 and 2 years after graduation for the classes of 1975 to 1977. Although the men and women entered similar fields of medicine the women were more likely to have taken time away from work and to be working fewer hours, and more women than men were influenced by their spouses in their career choices. More women than men expressed some dissatisfaction with the 3-year undergraduate program, and more women identified the "anxiety level created" as a weakness of the program. The women compared their preparation for the first year of postgraduate training with that of other trainees somewhat less favourably than did the men.
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A study was undertaken of the career paths and decisions, and the factors influencing the decisions, of the first six graduating classes of McMaster University's medical school. Climate and geography, preference for urban or rural living and influence of spouse were the factors that most influenced the location of practice, although the graduates who moved to the United States considered economic factors important too. Nearly one third of the specialists were practising in the United States. Personal challenge and positive clinical experience in the field were the major influences on choice of medical field. Graduates entering a specialty were more likely than those entering primary care to consider encouragement of others, a positive example set by medical school faculty members, working hours and research experience in the field as important influences on their choice of medical field. Data are needed on the career decisions, and the factors affecting them, of the graduates of all Canadian medical schools if Canadian medical manpower planning is to be realistic.
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This study compares current level of workforce participation and number, type and length of career interruptions since entering medical school reported by young men and women physicians. By 10 years from medical school entry, one third of the women studied had taken a maternity/child care leave and 24% had taken time away from their careers for other reasons while only 11% of men had interrupted their careers. The average time taken and reasons given for non-maternity-related career interruption were similar for men and women. Both men and women in the types of medical careers that historically have attracted more women work shorter hours than those in medical career types where women are under-represented. Across career types, women worked shorter hours per week than men and the presence of children further reduced hours of work for women only. Although the women studied are more active professionally than previous generations during their childbearing/rearing years, a considerable gap in the participation level remains.
This article aimed to examine changes in general health and time with back pain and neck pain and to identify predictors of any such changes. Hospital workers were studied longitudinally with surveys in 1995, 1996, and 1997 (N = 712). Back and neck pain were reported only at the 2nd and 3rd surveys. There was a significant decline in general health and significant increases in time with neck pain and back pain. Predictors of changes in these outcomes were mainly work-related variables (initial or change values), such as job interference with family, job influence, work psychological demands, and hours worked.
We examined the relation between demographic characteristics and the career choices of medical students who entered McMaster University medical school between 1969 and 1975. In contrast to earlier work, this study found no significant differences in sex, age, marital status at the time of entry into medical school, undergraduate major, whether prerequisite premedical courses had been taken, undergraduate grade point average and academic performance between the graduates who chose primary care and those who chose a specialty. This suggests that many medical school graduates in the 1970s entered primary care by choice rather than by default.
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To examine the attitudes toward clinical practice guidelines of a group of family physicians who had recently entered practice in Ontario, and to compare them with the attitudes of a group of internists from the United States.
Mailed questionnaire survey of all members of a defined cohort.
Ontario family practices.
Certificants of the College of Family Physicians of Canada who received certification in 1989, 1990, and 1991 and who were practising in Ontario. Of 564-cohort members, 395 (70%) responded. Men (184) and women (211) responded at the same rate.
Levels of agreement with 10 descriptive statements about practice guidelines and analyses of variance of these responses for several physician characteristics.
Of respondents in independent practice, 80% were in group practice. Women were more likely to have chosen group practice, in which they were more likely to use practice guidelines than men. Generally favourable attitudes toward guidelines were observed. Physician characteristics occasionally influenced agreement with the descriptors. The pattern of agreement was similar to that noted in the study of American internists, but, in general, Ontario physicians were more supportive.
This group of relatively new-to-practice Ontario family physicians shows little resistance to guidelines and appears to read less threat of external control in them than does the US group.
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To determine the proportion of recently certificated Ontario family physicians who have closed their practices to new patients or restricted their services.
Cross-sectional survey mailed between September 1993 and January 1994.
Ontario family practices.
All family medicine residency-trained certificants of the College of Family Physicians of Canada from 1989 to 1991 currently practising in Ontario. Response rate was 70% (395 of 564 eligible physicians). Otherwise eligible physicians practising as locums, emergency room physicians, or military physicians were excluded.
Self-report of practices being closed to new patients and of various restrictions placed on practices.
Nearly one third of respondents had closed their practices to new patients. Although the decision to close a practice correlated with length of time in practice, physicians in metropolitan Toronto were significantly less likely to report closed practices than physicians practising in other regions of Ontario. Restrictions reported related to patients and problems, geographic area, and type of setting(s) serviced. About 45% of respondents did not provide one or more of a defined set of five services.
Results of this study suggest that family physicians restrict their practices in various ways within the first 5 years after certification.
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This paper analyzes data from a 1993 survey of 395 newly established female and male family physicians in Ontario, Canada, to examine the relationship between practice organization and gender. Previous research suggests that younger physicians, particularly women, tend to enter group practice. Compared to solo practice, groups may offer more predictable incomes, more manageable workloads, peer collaboration and review, and economies of scale. Further, female physicians in groups may develop distinctive styles of collaborative medicine. The results show that a majority of physicians in our cohort are in private community-based group practice. However, while many groups share premises, staff and expenses, and many have common charts and practice guidelines, only a minority incorporate regular meetings to discuss business or patient care, have shared care of hospitalized patients, or audits of physicians' practices. Few gender differences are observed in private group practice: although women physicians attract larger proportions of female patients than do their male colleagues, women and men organize their groups in similar ways and have similarity strong patient-centered attitudes.