Queen's prof says family doctor shortage `multi-system problem'
With an estimated 2.3 million Ontario residents lacking a family doctor, a faculty member in the Queen's University School of Medicine says something has to change to encourage students to consider comprehensive family medicine as a career, including the way young doctors are being trained.
Dr. Gena Piliotis, associate dean of undergraduate medical education in Queen's University School of Medicine, told media during a provincewide Ontario Medical Association briefing with Ontario doctors on Tuesday that more medical students need to be working alongside family doctors earlier in their education.
Piliotis said the family doctor shortage in the province is a “multi-system problem.”
“There's no question that our young medical students listen to the news and hear all of the stresses and look at a career in family medicine and say to themselves, `That seems really, really hard,'” Piliotis said. “And so there's no question that is part of the problem, as far as our students choosing family medicine as a career. But there (are) multiple layers that we have to address as well, and one of them is the actual medical school training that they undertake.”
Piliotis said schools of medicine are “still very much specialty-based, with respect to our clinical training and our pre-clinical teaching.”
“We don't have enough family doctors in front of our students at an early stage of their education to be modelling careers and the profession,” she said. “And so that's definitely part of part of what we're trying to address.”
Queen's is taking steps to address this through its newest satellite campus in Oshawa, offering a first-in-canada medical education model developed in partnership with Lakeridge Health at the organization's Oshawa Hospital.
The program was launched in 2023 and was “specifically designed to address the shortage of family doctors,” according to the Queen's website, offering handson, clinical experiences in family medicine and primary care from the first year on.
“It just opened in September of 2023, so we're really excited to see how it goes,” Piliotis said. “This is a program that is dedicated to students who have chosen a career in family medicine at the get-go.”
Piliotis said the program is “teaching from a generalist perspective, which is not an easy thing to do, and something that a lot of our schools want to try and do.”
“Hopefully, we'll learn from this and adapt that to our main campus as well, but also having our community family physicians doing the teaching, and in front of our students from Day 1, as well as integrating clinical experiences longitudinally at a very early phase,” she said.
The OMA continues to sound the alarm about the shrinking number of medical graduates choosing family medicine.
During its media briefing on Tuesday, Dr. Andrew Park, OMA president, pointed to the sharp increase in unclaimed family medicine placement spots, based on numbers from the Canadian Residency Matching Service — from 30 in 2020, with a yearly increase to 108 unfilled spots earlier this year.
The decline in interest in family medicine continues to be tied back to the stress related to the profession, funding issues, administrative burden and complexity of comprehensive care.
“Medical students must see family medicine a desirable and rewarding career choice or they will choose another specialty,” Parks said Tuesday. “Students are aware of the funding issues and the administrative work associated with practising comprehensive family medicine and don't want to enter practice in a broken system. We must address these problems and promote family medicine as a rewarding and an impactful career choice. It is clear we need to act now to ensure there is a future for family medicine.”
Piliotis said Kingston is “certainly one of the areas that have a significant deficit in family physicians,” and fewer that are involved academically with training future physicians — but not for want of willing doctors who want to assist in training new family doctors.
“There are certainly (some doctors) who want to be part of the solution and do things for free to support our medical students so that they can be at the face of our students and can support that future choice,” she said. “That's not an appropriate setup . ... We have so many that I can't even count that want to be part of our training, but we just don't have the proper resources to support them. And that's part of the problem that we're all facing, both in undergrad and postgrad.”
Dr. Jobin Varughese is the interim assistant dean at Toronto Metropolitan University School of Medicine. He says that currently, family doctors who are providing community clinical education are asked to take on students for compensation of approximately $25 per half-day.
“It ends up being an ask of goodwill and altruism,” he said.
For both students exiting their medical training, as well as doctors in comprehensive family medicine, team-based care provides an important solution to the stressors associated with primary care.
“We've heard already multiple times about the amount of increased burden and difficulty in managing care and also serving in atypical roles,” Varughese said. “This has actually led to burnout, and students have heard this. They've noted that primarily, when they work with a family physician who doesn't have access to team-based care, they actually have a more negative opinion of what's happening.”
Piliotis, who specializes in oncology and is a professor in Queen's department of oncology, stresses the importance of family medicine in caring for patients within a specialized practice.
“I follow patients for a really long time, and the best outcome is when myself and the family doctor work as a team and follow these patients together,” she said. “And it's magic when you have that wonderful relationship. And so I can't underestimate that partnership in longitudinal care patients.”