The plight of primary medical care: the problematics of 'committedness' to the practice

A multivariate paradigm, aimed at furthering the understanding of the factors underlying the problematics of practising primary medical care, has been developed and empirically supported. A study among a sample of Israeli primary care physicians and a comparison group of hospital physicians revealed an empirical 'structure of committedness', ascertaining that the committedness to practice primary care is contingent on the 'intrinsic' satisfaction and rewards as well as the 'extrinsic' rewards from the professional community (namely, prestige), derived from bio-medical (but not psycho-social) intervention activities. The data ascertain that salaried general practitioners and specialists employed in Sick Funds primary care clinics perceive themselves the least rewarded both intrinsically and extrinsically, and consequently the least committed to their field of practice. Specialists in family practice perceive themselves more rewarded, both intrinsically and extrinsically, the general practitioners (i.e. enjoy higher prestige), and hence are more committed to their field of practice.