Between Redefinition of Professional Identity and Resistance: The Case of Family Physicians in the Political Context of Reforms and Public Administrationadministration

The context in which family physicians practise has changed considerably in recent decades. These professionals are more likely to be confronted by new forms of managerial rationalization that redefine efficiency standards, which in turn complicates work, redraws the boundaries of professional autonomy and leads to the negotiation of new forms of professionalism. The medical profession is, more than in the past, required to function within various administrative and bureaucratic constraints that guide physicians’ practice and limit their professional choices. To this has been added a new relationship between the professional and the beneficiary, revealed by a questioning of traditional forms of professional authority and a strengthening of the market relationship. The figure of the "professional" no longer refers only to the skilled, the expert, the self-employed, driven by values of commitment and responsibility, but also to a set of externally imposed imperatives that are not without consequence on practitioners’ relationship to work and their daily practices. The objective of this presentation is to present the results of a qualitative investigation that was carried out in the province of Quebec (Canada) regarding the evolution of family physicians' work relationship. We conducted 35 individual semi-directed interviews with physicians from three labor market integration cohorts (early, mid and late career). The findings revealed that the current healthcare context (reforms, laws and regulatory frameworks, new public management, etc.) places strong pressure on family physicians to adapt their practice to the requirements of efficiency and effectiveness that are defined by a managerial logic that contributes to a redefinition of their professional identity. However, our findings also revealed that family physicians resist these pressures in a variety of ways, defend a highly focused professional identity, and a humanistic vision of care.