Advancing team-based care in private practices: a case study of a public-private hybrid model.

BACKGROUND: Despite widespread enthusiasm for team-based care models, adoption remains a challenge across Canadian jurisdictions, especially in private practices. The transformation of primary care demands innovative approaches that reconcile physician autonomy with the systemic need for collaborative, team-based care. This article examines an innovative public-private hybrid model in which publicly funded non-physician team members are integrated into a private clinic. It offers insights into how such reconciliation might be achieved.
METHODS: This study draws on a case study of a pilot project involving a primary care private practice transitioning to team-based care in Canada. Three qualitative data collection methods were employed: document analysis, semi-structured interviews (n = 27), and non-participatory observations (six days). A manual thematic analysis of the data was conducted, results were triangulated, and the coding system was refined through research team discussions.
RESULTS: Findings highlight both the benefits and challenges of hybrid models as a pathway for primary care reform. Benefits include enabling transition to team-based care by addressing resource constraints, preserving core aspects of family physicians' professional autonomy, and incorporating patient-centered thinking within organizations typically oriented toward efficiency and sustainability. Challenges include physician distrust of public authorities, incompatibility with the fee-for-service payment model, and structural and operational barriers.
CONCLUSIONS: This research offers insights into how incremental reforms can leverage existing private infrastructure while advancing collaborative care. These findings may inform strategies in jurisdictions where primary care remains heavily reliant on independent practitioners. Future research should examine the conditions under which such models can be sustained and scaled, and how they reshape professional roles, governance, and accountability in primary care.