Family doctor a dying profession
HEALTH CARE Ninety-nine jobs left empty in Canada’s yearly hiring of medical graduates
Canada’s medical system has 99 problems, and they’re the unfilled jobs for new family doctors amid a shortage of primary care.
New numbers indicate that fewer graduates are choosing family medicine as a discipline, despite the great need for family doctors across the country. There were 4.6 million people over the age of 12 who did not have a regular family doctor in 2019, according to Statistics Canada.
The problem is particularly acute in certain areas, including parts of British Columbia and Atlantic Canada.
The College of Family Physicians of Canada (CFPC) says the problem of family-doctor positions being left vacant won’t be fixed until provinces make the profession more attractive to graduates through more competitive pay models.
“There is anecdotal information/ evidence that medical students’ career choice decisions are influenced by the practice environment and key messages provided by decision makers,” reads a statement from Dr. Francine Lemire, CEO of the CFPC.
“Support and respect by provincial governments of the value they place in the work of family doctors, as well as actions to relieve the administrative burden on family practices is urgently needed to restore interest in this special, one of a kind, profession.”
The Canadian Resident Matching Service (CaRMS), the organization used by graduating medical students to get their first jobs as doctors, on Thursday released data on the second round of hiring for new doctors in Canada this year.
The second round is important because it gives new doctors who didn’t get hired in the first round a chance to apply for the remaining jobs. Many of the positions also become available to international medical graduates — Canadians or foreign applicants who completed their medical studies abroad, who cannot apply for positions during the first round of hiring.
The second-round numbers show that, while a high number of spots were filled for specialty positions such as internal medicine and neurology, only a little more than half of the remaining family-medicine positions were filled.
Of 115 total unfilled positions for new doctors in Canada this year, 99 of them were in the much-needed specialty of family medicine.
A total of 1,569 family-medicine positions were available in 2022, compared with 1,561 in 2021. About six per cent of family medicine residency positions that were available in Canada did not find any doctors trained in Canada or elsewhere to fill them.
It’s a mismatch the College of Family Physicians Canada has suggested should alert Canada to structural problems that may be deterring new grads from entering the discipline.
Family medicine is “a fantastic specialty, but there are pressures on it right now, where it’s less attractive to medical students,” Dr. Brady Bouchard, president of the College of Family Physicians of Canada, told the Star in a previous interview.
“Medical students are able to see the growing burdens on family physicians throughout their schooling and, I suspect, are choosing accordingly.”
The main reason that Bouchard hears from both new family doctors and long-practising ones is the most common payment model in Canada, in which doctors receive a flat rate per patient visit, regardless of how much time is spent with them or how serious the problem is.
That flat rate varies by province. Some provinces also offer alternative payment models such as salaries or capitation; the latter (in which doctors are paid based on the number of patients in their roster) is a common model in Ontario. But in places such as British Columbia, the flat rate — about $30 — does not change, no matter where the doctor is located or how much their other expenses, such as office space, cost.
“It’s not sustainable. It’s akin to running a business where you’re unable to change prices,” Bouchard said. “This newer generation of family physicians, we realize that the government’s paid a lot of money to train us and we want to work at the top of our scope most efficiently.”
Of the 99 family doctor positions that went unfilled this year, 73 are in Quebec, 15 are in Ontario, and 11 are in Alberta, according to the CFPC.