Primary care reform. Physicians' participation in Hamilton-Wentworth

To determine physicians' reasons for and against participating in a primary care reform (PCR) pilot project, to identify demographic and practice characteristics associated with participation, to gauge physicians' satisfaction with implementation of the project, and to seek suggestions for change.

Cross-sectional mailed survey using a self-administered questionnaire.

Family practices in Hamilton-Wentworth, Ont.

Eighty-two of 107 (76.6%) physicians who participated in the pilot project and 101 of 150 (67.3% of a 60% random sample of the area's remaining generalist physicians) who chose not to participate.

Physicians' primary and secondary motives for participating or not; comments on the pilot project; and subjects' demographic, professional, and practice characteristics.

Despite their experience with capitation practice, after controlling for other factors, physicians from health service organizations were no more likely than their fee-for-service colleagues to join the pilot project. Those in large group practices were more likely to participate. Both participants and non-participants were concerned about disrupting call groups, burdening office staff, not having enough time, and whether the project's objectives were achievable. Other key findings were how few patients declined enrolment and how many physicians had unrealistic ideas about the demands of participation and the capabilities of currently available information technology.

While many Hamilton-area physicians were eligible and willing to participate in a PCR pilot project, many were not. Our findings suggest that physicians and government should clarify their expectations for PCR and that we need to look for better ways to register patients and select information technology for PCR.