The results of the study show that predominantly positive opinions do shape the image of family doctors from the perspective of specialists. Especially the broad medical knowledge is rated positive. The ability for empathy and a farsighted management of care tailored to the individual patient are appraised as important competencies of a family doctor. Perceived negatively is a reduction to the function of a gateway and a growing dissatisfaction among family doctors, which might result in potentially adverse effects on patient care. Underrepresentation of family medicine at the universities as well as negative comments about family doctors by other disciplines in the course of the study was reported as possible negative factors for the family doctor's image. In the opinion of specialists the social prestige of family doctors has changed in the past years. Due to the internet especially younger patients would be better informed and would consult specialists directly. There was no evidence for systematic differences in the opinions, neither between the different specialist groups, nor between rural and urban regions, or male and female specialists. According to previous studies family doctors have the impression that specialists who work in hospitals, have a rather negative image of family doctors compared to specialists practicing in ambulatory care [3
]. The present study does not confirm this impression but rather shows an overall more positive picture of family doctors than is assumed by the family doctors themselves without relevant differences between different specialist groups or those working in a hospital or private practice. Amongst other things the specialists in the present study hold the family doctors themselves responsible for negative aspects concerning the image of family doctors. The dissatisfaction among family doctors tarnished their public professional image and warned young academics off. However, some of the respondents questioned the relevance of the traditional profession as family doctor in an age of specialization and mechanization because of the nature of an “all-rounder” not harmonizing with modern ideas. Similar trends are found in studies coming from Switzerland [12
]. Also the authors of a Canadian study, where family doctors were qualitatively interviewed, conclude from their results that there is a lack of respect of specialists towards their primary care colleagues [1
]. At least at first glance the results of the present study—in which for the first time specialists were asked about this topic—point to a different direction. However, certain expressions and phrases in the present study suggest subliminal negative assessments, too. Here a possible bias due to the method of data collection needs to be taken into account, since the interviews were conducted by a doctoral student of a department of family medicine and health services research.
A possible measure to promote the exchange between family doctors and specialists could be joint training activities such as quality circles. This would help family doctors in recognizing that their image from the perspective of specialists is characterized not as negative as assumed and the mutual respect for the work of the other could grow [14
Statements concerning the influence of social change are consistent with those of a previous qualitative study with family doctors in Germany [8
]. Family doctors also see a reason for the direct consultation of specialists in the fact that particularly younger patients keep themselves informed about medical issues on the internet. In addition, society tends to rate technical diagnostic in specialized practices increasingly higher [14
As our results show, in the view of the specialists the prestige of family doctors is also strongly influenced by politics. The (impending) shortage of family doctors in Germany currently entails a strong political support for family medicine. At present it cannot be estimated how such measures will change the prestige of family doctors in the eyes of specialists, students, or the public.
Studies in the field of undergraduate education have shown that “badmouthing” of family medicine negatively influences students in their career choice [5
]. “Badmouthing” is defined as “unjustified, negative, and slanderous comments by physicians about other physicians in various branches of medicine” [15
]. An Australian study on “badmouthing” reports that 12% of Australian medical students had changed their decision to become a family doctor because of negative comments [15
]. Also in our study some of the participants report about experiences of “badmouthing” at the university. The lack of representation at the universities might contribute to the fact that the professional image of a family doctor is virtually unknown to some students. As of today only 19 out of the 36 high school sites have at least one institutionalized (part time) professorship [17
]. An intensification of teaching and a stronger emphasis on the positive aspects of an activity as family doctor would be a prerequisite in order to gain more students interested in the subject [18
4.1. Strengths and Weaknesses
To our knowledge this is the first qualitative study evaluating the perceptions of specialists regarding the image of family doctors in Germany. A strength of this study is the widely spread sample which comprises different criteria such as specialty, region and hospital, or private practice.
When interpreting the data it must be considered that a tendency toward socially desirable answers from the side of the experts cannot be excluded. Indeed, the specialists were informed prior to the interviews that the interviewer was mandated by the Department of General Practice and Health Services Research to carry out the survey. Also, before any questioning the interviewer stressed the fact that she is a medical student with a neutral position and that the respondents should freely and openly think about the job profile of family doctors.