Family doctors won’t just appear in Canada – we have to prioritize training and supporting them

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Anthony Sanfilippo is a cardiologist, a professor of medicine and a former associate dean at Queen’s University. He is the author of The Doctors We Need: Imagining a New Path for Physician Recruitment, Training, and Support.

How would any industry respond when faced with a critical shortage of essential workers? Whether large or small, whether public or private, some key strategies seem obvious.

They would work hard to identify and attract young people who were capable of providing that work, and motivated (maybe even passionate) to engage in it as their chosen career.

They would provide those motivated recruits with opportunities to undertake training that would prepare them to become very capable providers. In doing so, they would identify and eliminate any barriers that were preventing the willing and able from accessing the required educational pathways.

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They would ensure that, once prepared, those graduates had opportunities to work in settings that allowed them to provide the services for which they had trained, and to do so in a way that met their practical needs while also being personally satisfying and stimulating.

As Canadians are well aware, we face a massive shortage of family doctors and workers in many other medical specialties in our country. In addressing this critical need, we appear to be doing all the wrong things.

We continue to have highly restrictive access to medical education. The vast majority of our young people who wish to become doctors and are very capable of doing so are being turned away from our medical schools every year. Many of them take up their education in other countries and, once there, stay to take up the very types of practice we lack adequate access to in Canada.

Our admission processes do not focus on interest and aptitude for family medicine, or any particular area of specialty. Instead, they continue, as they have for decades, to identify young people who are academically very accomplished but who have unfocused (or at least undeclared) career goals, somehow hoping that from among the hundred-plus medical career options available to them after admission, sufficient numbers will somehow magically find their way to family medicine.

Our undergraduate medical education processes (still the key and essential entry point to a medical career) continue to provide an undifferentiated approach that provides students with exposure to all specialties and is increasingly focused on career exploration, to the exclusion of focused and clinically based training in generalist medicine.

We continue to expect our family doctors to not only accept less compensation than most other specialized physicians, but to practise in settings where they are required to personally take on the administrative and financial responsibilities of their practices. Hospital-based physicians, in contrast, are not required to hire the staff or pay for the hospital’s building expenses.

In short, we admit and train doctors in fundamentally the same way we have for decades, despite massive changes in medical practice and societal need. The results of this failed response to our shared crisis are predictable and have been highlighted in a recent report by nine Canadian researchers in the Annals of Family Medicine journal.

The report found that although the number of family doctors in Ontario is increasing, fewer are taking up practices that provide the comprehensive, continuing and family-based care so desperately needed within our communities. Instead, graduates of medical programs are opting for more specialized practices focusing on specific aspects of care, such as emergency medicine, hospitalist roles, anaesthesia, or palliative care.

The time has come to move beyond analyzing and collective handwringing. It’s time to accept the reality that our current processes, even if expanded dramatically, will not address our evolving needs. It’s time to begin to confront the problem with focused approaches.

Medical education needs to be expanded. We simply need more doctors. In fact, a lot more. The need for family doctors is obvious to all, but the need extends to many specialties and is certainly going to expand as our population grows, medical options expand, and our physician work force ages.

Admission to medical education must be linked to our societal needs. If we expect our graduates to take up particular forms of practice, we will need to recognize the different aptitudes required and search out folks with the appropriate skills and commitment.

Once identified, we should be providing our learners with relevant and practice-based training in that specialty, allowing them to fully engage in those roles parallel to service provision.

Finally, we need to provide our medical graduates with practice settings that do not punish them for choosing to provide the very services we need. Rather, we should be supporting them so they can do what they are trained to do – thriving rather than straining as they do the work they find personally rewarding.

The good news is that all this is achievable but will require both expansion and structural change in our medical admission and training paradigms. One without the other will certainly fail. The family medicine education program established by Queen’s University at its Lakeridge campus, which will begin its third year of operation in September, is a small but instructive example of how admissions and training can be focused on specific, much-needed training for Canadian medical-school students.

The prescription is fairly straightforward – combine the right people with the right training and immerse them in the right practice environment. We can make this happen, and Canada’s health care system will be better for it.