Working in a team while adjusting to policies: A double challenge in the long term for health care professionals in multidisciplinary group practices

Abstract

Multidisciplinary group practice is a recent tool in public policy instrumentation. It relies first of all on the creation of a team whose members, belonging to different liberal professions, develop collective, practices. Each team is part of a history, inseparable from its members’ trajectories and the opportunities related to the local environment. But its practices and their evolution also depend closely on the public policies that support them, in a context of increasing
injunction to a multi-professional organization of primary care. Our survey was repeated four years apart in four multidisciplinary group practices with varied characteristics. It allowed us to explore contrasting ways of building multi-professional activities and working collectively, in changing configurations and environments, while public policies were evolving. It reveals tensions between the dynamics of each profession and an emerging
multi-professional dynamic. Then, these dynamics are themselves moved in different ways by the
managerial logic, associated with the public action and its tools, which was reinforced between the two moments of the survey. It emphasizes the strengths and weaknesses of the teams involved in these dynamics and logics that come together or oppose each other, transforming the roles, identities and professional boundaries during the structuration of a renewed primary care offer.