Training spots for family docs left empty

With Hamilton already short 68 family doctors, filling the positions seen as crucial

McMaster University has seen a significant and unexpected jump in the number of unfilled positions to train family doctors.

It’s a major concern amid a longstanding primary-care shortage that has left Hamilton down 68 family doctors.

“We know that patient demand is probably running at about 120 per cent of normal right now in primary care,” said Dr. Cathy Risdon, lead physician at the McMaster Family Health Team. “All of the pandemic health and human resource shortages are impacting family medicine and primary care offices, too ... It’s not as well understood as the pressures we see in the hospitals.”

Despite the obvious need in primary care, McMaster had 12 unfilled spots for family-medicine residencies in Hamilton after the firstround of hiring in April. It also had three open positions in Kitchener-Waterloo and three in Niagara.

The university had 87 familymedicine spots for medical school graduates and 12 more for foreigntrained physicians. Many years they’re filled immediately.

“Usually we would be disappointed if we had five unmatched spots across the program,” said Risdon, chair of the Department of Family Medicine. “So 12 is an unusually high number.”

Getting the spots filled is key considering Hamilton loses nearly as many family doctors as it recruits. From 2005 to 2021, the city’s recruiter Hamilton Physicians brought in 385 family doctors. But during that time the overall number of physicians stayed the same at 345.

In addition, the city’s population is growing, which increases the number of family doctors required.

“The current challenge facing the health system right now ... is the essential anchoring role that primary care/family medicine plays and the ways that we can see evidence of that anchor slipping a bit and being threatened,” said Risdon.

“The ability to ensure training spots, to replace the retirements and so on, we know that’s a challenge.”

McMaster wasn’t alone in struggling to fill its family-doctor positions. About 14 per cent of Canada’s family-medicine residencies went unmatched after the first round of hiring. It translates into 225 spots left empty out of 1,569, shows data by the Canadian Resident Matching Service (CaRMS).

The pandemic is believed to have played a role in that unusually high number, said Risdon.

“For a period of time, we really had to decrease the number of elective students that we could bring in to our clinical setting,” she said.

“That is a really critical piece of a medical school educational journey to test drive family medicine as a career choice so students didn’t get access to that experience in the same way.”

For some of the medical students, their time in primary care was virtual and they never got to see patients in-person at all.

“I think not giving students a chance to taste it definitely impacted us,” said Risdon. “Primary care is the less glamorous sibling of the of the medical health-care system. Once you get to experience it in its fullness, you realize what an essential role it plays. It is a very different lifestyle than a hospital-based medical career.”

There were also some unexplained quirks in the matching, such as McMaster’s rural spots all filling up in the first round.

“That is unusual,” said Risdon. “Most previous years we’d have between one in three or one in four unmatched rural spots ... Sometimes they’d have to revert to a more urban setting.”

Having all of the rural spots matched to a new doctor interested in family medicine is significant considering many physicians practise where they trained.

“We were ecstatic to fully fill our remote rural spots,” said Risdon. “We know that the shortage of family doctors in Ontario is being disproportionately felt in rural and remote areas.”

She doesn’t have an answer as to why the rural family-medicine residencies were so attractive this year.

“That’s going to be a question that we’ll take up in the coming months,” said Risdon. “Once the residents are in their new rotations, we’ll have a better chance to touch back with them and find out what allowed them to make that choice.”

The higher cost of living in urban areas isn’t considered to be a factor, said Risdon as the University of Toronto filled all of its spots in the first round.

There’s also the possibility that the makeup of this year’s graduates played a role as each class is unique. The 12 McMaster medical school graduates who went on to residencies with other universities picked different specialties than family medicine.

“There was an above average number of surgical specialties chosen by this class,” said Risdon. “Sometimes these swings of numbers are also by chance.”

Risdon says one improvement that would help attract graduates to family medicine would be for Ontario to create more family health teams that allow physicians to practise alongside other health-care workers. The province has shifted away from this model for a number of years so no new teams have been brought on board.

“We know that the practice environment needs some policy support so that we can retain family docs in the discipline for their career,” said Risdon. “We also need to attract and retain family docs by offering a really fabulous practice environment, which means supporting a team of players to work with family docs and care for all elements of a patient’s life journey.”

Hamilton will have another chance to fill the unmatched spots during the second round, which has already started.