[Geographical distribution of family physicians: which solutions for a complex problem?]

This article examines the geographical distribution of family physicians, focusing on attraction issues.

This analysis is based on a configurational approach. In simple terms, this approach stipulates that the impacts of an intervention are related, on the one hand, to the internal consistency between the characteristics of an intervention and, on the other hand, the consistency between this intervention and its context. A longitudinal case study was performed, corresponding to the Quebec experience over a 35-year period.

The measures implemented essentially consisted of training, incentives (positive and negative), support, and, since 2004, a certain degree of coercion. Note that selection of applicants for medicine training programmes according to certain individual variables likely to have an impact on the subsequent site of practice, were only rarely used. An improvement of the efficacy of the combination of measures was observed over time: this improvement can be interpreted in terms of the consistency between the characteristics of the intervention and the consistency between the intervention and its context.

Interventions designed to promote a more balanced distribution of healthcare professionals cannot be limited to activation of a single lever, but must be considered in the context of complex interventions.