Fewer medical students are pursuing family practices, and these doctors are worried
Fewer medical graduates are choosing to go into family medicine and open primary care practices, data shows, at a time when more than a million Ontarians can’t find a family doctor and as many are on the point of losing those they already have.
The data of the Canadian Resident Matching Service a non-profit organization that matches students with medical training, shows a steady decline in the number of medical students choosing family medicine as their first choice of practice over the past seven years.
Only 30.7% of students in Canada ranked family medicine as their first choice in 2022, compared to 31.4% in 2021 and 38% in 2015.
What’s more, almost all aspiring family doctors are recruited immediately after their residency placement, with more than 97% finding a match this year, which is higher than in any other discipline.
Students and researchers who spoke to CBC attribute the problem to a growing negative impression of family medicine, fueled by what they perceive to be a never-ending stream of stories about physician burnout.
« [The trend is] worrying because it means we may be training fewer family doctors in the next few years just when we need new family doctors to come into the system,” said Dr. Kamila Premji, MD family and associate professor at the University of Ottawa.
Premji has looked at the age of doctors in Ontario, and her preliminary non-peer-reviewed data estimates that 1.7 million Ontarians will see their family doctors retire by 2025.
In 2019, Statistics Canada data showed that 1.3 million patients in Ontario did not have a family doctor. Premji estimates that this number is now closer to 1.8 millionincluding approximately 134,000 people in the Ottawa region alone.
« It’s a major issue because…as primary care, you’re the foundation of the healthcare system. You’re the first point of entry for the patient, » she said. « So we definitely need more family doctors. »
For those who have chosen to go into family medicine, some are also hesitant to open a new practice, which comes with the added responsibilities of running a small business.
This includes Dr. Rachelle Beanlands, who is in her second year of family medicine residency at the University of Ottawa.
Beanlands originally thought she would specialize in something like pediatrics. But in medical school, she found she liked the idea of »watching people grow, from little babies to teenagers, seeing people go through difficult phases in their lives and holding their hand. » .
Still, Beanlands said she wasn’t ready to immediately jump into opening her own practice.
She said it’s hard for new graduates to imagine themselves managing patients and dealing with administrative burdens such as managing rent, payroll and taxes.
Additionally, Beanlands said she’s seen her older co-workers deal with burnout and she doesn’t want that to happen to her.
“Increasingly fragmented and inefficient”
Primary care providers are largely left on their own, Premji said, with insufficient support to deal with administrative tasks.
« I think the system has really become more and more fragmented and inefficient, and that’s creating an additional workload for family physicians, » she said.
« [Medical students] probably find that the family physicians supervising them are burning out or are tired and overwhelmed. And it’s just not attractive. »
She was also concerned that students were receiving negative messages about family practices at the medical school level.
« [Students] hear it might not be for smart people to go into family medicine, or it might not be for ambitious people,” she said. “So it kind of gives a negative impression that way.
That’s what Dr. Ellias Horner heard during his medical training at McGill University in Montreal.
Now specializing in emergency medicine at the University of Ottawa after completing his residency in family medicine, Horner said there’s a bit of a stigma around family medicine at McGill.
« It’s almost like family medicine is that backup. People only go there because, ‘Oh, I wasn’t good enough for another higher specialty service,' » he said.
That kind of thinking is short-sighted, Horner said, because it ignores the importance of primary care and the expertise required to be a family doctor.
Government adds more places in medical schools
In March, the Ontario government announced it would add 160 undergraduate and 295 postgraduate positions to medical schools across the province over the next five years.
Queen’s University in Kingston, Ont, has set aside 20 additional medical school spots in the fall of 2023 for those wishing to pursue a degree in family medicine.
In April 2022, the province ratified a new three-year agreement with Physicians which includes a provision that will allow more family physicians to join family health organizations.
The goal is to enable more physicians to work in teams, rather than opening their own solo, fee-for-service practices. The agreement also commits to modernizing the Ontario Health Insurance Plan (OHIP) Schedule of Benefits, which takes into account the time and complexity required for different medical services.
The government has also expanded the number of regional health teams in the province, something she says will build a more integrated health system.