Comprehensive practice: Normative definition across 3 generations of alumni from a single family practice program, 1985 to 2012

Abstract Objective To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare responses across 3 generations of alumni of a single family practice program. Design Cross-sectional survey. Setting Western University in London, Ont. Participants All graduates of the family medicineprogram between 1985 and 2012. Main outcome measures Self-reported provision of the following types of care: in-office care, in-hospital care, intrapartum obstetrics, housecalls, palliative care, after-hours care, nursing home care, minor surgery, emergency department care, sport medicine, and walk-in care. Sex, training site (urban or rural), size of community of practice, practice model, and satisfaction with practice were also reported. Results Participants practised in 7 provinces and 1 territory across Canada, but principally in Ontario. A small number were located in the United States. There was a decline in the number of services provided across 3 generations of graduates, with newer graduates providing fewer services than the older graduates. Significant decreases across the 3 groups were observed in provision of housecalls ( P = .004), palliative care ( P = .028), and nursing home care ( P P Conclusion The normative definition of comprehensive care varies across 3 generations of graduates of this family medicineprogram, with newer physicians reporting fewer overall services and procedures than older graduates. Greater understanding of the forces (institutional, regulatory, economic, and personal) that determine the meaning of comprehensive primary care is necessary if this foundational element of family medicineis to be preserved.