Primary care renewal strategies in Manitoba: Family physicians' perceptions.

Objective: To understand family physicians' perceptions of Manitoba's strategies for primary care renewal or reform (PCR).

Design: Qualitative substudy of an explanatory case study.

Setting: Rural and urban Manitoba.

Participants: A total of 60 family physicians (31 fee-for-service physicians, 26 alternate-funded physicians, and 3 physicians representing provincial physician organizations).

Methods: Semistructured interviews and focus groups.

Main Findings: Many physicians were hesitant to participate in PCR initiatives, perceiving clear risks but uncertain benefits to patients and providers. Additional barriers to participation included concerns about the adequacy and import of communication about PCR, the meaningfulness of opportunities for physician "voice," and the trustworthiness of decision makers. There was an appetite for tailored, clinic-level support in addressing concrete, physician-identified problems; however, the initiatives on offer were not widely viewed as providing such support.

Conclusion: Although some of the observed barriers might fade over time, concentrating PCR efforts on the everyday realities of family physician practice might be the best way to build a primary care system that works for patients and providers.