Family doctors and specialists play vital roles in managing chronic illnesses like diabetes, but power imbalances can make collaboration challenging. A study from The Institute of Education Research at UHN explores how clinical practice guidelines shape these dynamics and the implications for collaboration and patient care.
While power imbalances between family doctors and specialists are common in health care settings, little is understood about how clinical practice guidelines influence these dynamics. Using diabetes care as a case study, the research team reviewed clinical care and management guidelines that define the roles of family doctors and specialists. They then interviewed 15 clinicians at the University of Toronto about their experiences collaborating in patient care.
Key findings revealed that the language and structure of guidelines often create a hierarchy, positioning specialists as primary decision-makers while family doctors are placed in a supporting role. Written communications, such as consultation letters, further reinforce these imbalances, limiting open discussions and hindering the sharing of valuable insights into the best care for patients.
Acknowledging these power imbalances and promoting a more balanced approach—where the contributions of both family doctors and specialists are equally valued—can improve provider satisfaction and patient outcomes.
Dr. Rene Wong, the lead author of the study, is an Educational Investigator at The Institute for Education Research at UHN. Dr. Wong is an Associate Professor in the Department of Medicine at the University of Toronto.
Dr. Cynthia Whitehead, senior author of the study, is a Senior Scientist at The Institute for Education Research at UHN. She is also the Director and a Scientist at The Wilson Centre, as well as a Professor in the Department of Family and Community Medicine at the University of Toronto.
This work was supported by UHN Foundation and the Royal College of Physicians and Surgeons of Canada.
Wong R, Whitehead CR. Exploring how structural forms of power shape the training of intraprofessional collaboration between family physicians and specialty physicians in outpatient workplace settings. Med Educ. 2025 Jan 15. doi: 10.1111/medu.15607.