Family physicians' power and team-based care: Lessons from a 60-year-old primary care clinic

The article focuses on the tension between team-based care approaches that emphasize interprofessional collaboration and existing power imbalances between family physicians and other health care providers. It contributes to the literature on the implementation of team-based care models in primary care clinics by adopting a governance perspective, often overlooked in these transitions. While existing research has acknowledged power imbalances between family physicians and other health care providers, it has paid less attention to how governance mechanisms may shape these dynamics. Through an in-depth case study of a 60-year-old Canadian primary care co-operative, we address this gap and explore how these power issues play out in a context of collaborative governance and shared decision-making. The methodology is qualitative, relying mainly on data from 42 interviews, as well as on observations and document analysis. On the one hand, the research reveals that some governance mechanisms play an important role in team-based primary care settings, helping attenuate the tension and facilitating collaboration between providers. On the other hand, it shows that, even in a long-standing team-based care model promoting equality between health care professionals and between providers and patients, power imbalances persist. The research illustrates the cultural anchorage of medical domination, highlighting (i) the importance of looking at one organisation's informal norms and cultural context when implementing team-based approaches to care, as well as (ii) the critical need for interprofessional education to actively engage with and address the underlying power dynamics that exist within health care settings.