Go Teams! A Situational Analysis of Interdisciplinary Primary Care Teams in Ontario

Abstract

Arguably, no reform in health care in the past decade has generated as much attention, idealism, and optimism as the movement toward interdisciplinary teams. Since the early 2000s, the Canadian federal government has made access to interdisciplinary primary care teams a policy priority. Ontario has been one of Canada’s most active provinces in promoting teams in primary care, investing approximately $938 million since 2004 into three models of interdisciplinary primary care team: Family Health Teams, Community Health Centres, and Nurse Practitioner-led Clinics. Analysing a variety of documents (n=383) and key informant interviews (n=15), and drawing on techniques and assumptions of situational analysis, I critically examine the development of these three models of interdisciplinary primary care teams in Ontario since 2004. Specifically, I focus on how teams are talked about and acted on by the provincial government and opposition parties, and the leadership organizations of four health professions: family medicine, nurse practitioners, dietetics, and chiropractic. While all the groups in this study talk about teams in the usual idealized terms as beneficial and necessary, they also talk about teams in ways that attempt to advance their particular interests. In government, teams are used to promote political agendas and lay claim to political legacies. Family medicine uses a variety of discursive strategies about teams in an attempt to maintain autonomy and a dominant position vis-à-vis other professions. The nurse practitioner and dietetic professions use discursive strategies about teams to justify attempts to expand their respective scopes of practice. Chiropractic talks about teams in ways that reinforce and expand its longstanding project to legitimize the profession. Further, my analysis reveals that while the three models are accepted equally among the nurse practitioner, dietetic, and chiropractic professions, both the provincial government and family medicine favor the largely physician-led Family Health Team model more than the other models, with possible implications for the future of teams in Ontario and other provinces.