750 Canadian Family Physician | Le Médecin de famille canadien } Vol 64: OCTOBER | OCTOBRE 2018 RESEARCH Comprehensive practice Normative definition across 3 generations of alumni from a single family practice program, 1985 to 2012 Thomas R. Freeman MD MClSc(FM) CCFP FCFP Leslie Boisvert MPA Eric Wong MD MClSc(FM) CCFP FCFP Stephen Wetmore MD MClSc(FM) CCFP FCFP Heather Maddocks MA PhD Editor’s key points } The normative defnition of comprehensive care varied across the 3 generations of family medicine graduates, with fewer services offered by the newer graduates. } Broader ranges of services were offered by those in the earliest alumni group, in family health organization or family health network payment models, and in rural, remote, and isolated locations. } It is important that health care planners recognize and take into account that many graduates of family medicine training programs do not practise traditional “full- service” family medicine. More work needs to be done to understand those family physicians not engaged in comprehensive care. Policy makers, regulatory colleges, and educational institutions must not only consider work force supply but also payment models, certifcation requirements, undergraduate and postgraduate education, and community needs. Abstract Objective To determine the range of services and procedures offered by family physicians who defne 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 medicine program between 1985 and 2012. Main outcome measures Self-reported provision of the following types of care: in-offce 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. Signifcant decreases across the 3 groups were observed in provision of housecalls (P =.004), palliative care (P =.028), and nursing home care (P < .001). Non-signifcant changes were seen in provision of intrapartum obstetrics across the 3 alumni groups, with an initial decline and then increase in reported activity. Most respondents were in a family health organization or family health network practice model and those in such models reported offering signifcantly more services than those in family health group or salary models (P < .001). Conclusion The normative defnition of comprehensive care varies across 3 generations of graduates of this family medicine program, 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 medicine is to be preserved.