Family physicians can’t carry system
Canada’s health system is facing major challenges.
Worrying reports of emergency department closures amidst staff burnout dominate the news, as well as shortages of health care professionals to provide care sorely needed across the country.
Family physician practices are experiencing a crisis of their own, with a potential for grave consequences if not addressed urgently.
The majority of all health care in Canada is delivered in community clinics and doctors’ offices, known as “primary care.” It’s the first point of contact with the health care system for most people.
This care, especially when it is provided by the same physician over time, leads to a healthy population that lives longer. It is also good for a cost-effective health care system, helping to reduce avoidable emergency department visits.
Family physicians serve as regular medical providers for a majority of people in Canada, are a trusted source of health information and connect patients with numerous health services.
Throughout the anxiety and uncertainty accompanying the COVID-19 pandemic, patients reported that family physicians maintained access to their services both in-person and virtually.
We know that well-functioning health-care systems have robust primary care at their foundations.
While the pandemic has exacerbated existing issues, the truth is that primary care and family medicine are unwell in Canada.
Growing complexity of care, a public lack of respect from some politicians and ever-increasing paperwork burden are leading to dangerous levels of burnout: a recent survey of family physicians revealed that 48 per cent were feeling either exhausted or burnt out.
Running a family practice becomes more and more of a challenge as the costs of doing so outpace the physician income in a community-based clinic.
Expenses such as rent and staff salaries (paid for by family doctors) particularly in expensive urban centres like Vancouver, can make things prohibitively expensive as well, leading to an exodus of family doctors.
This is in addition to the fact that family physicians are the lowest paid physician specialty in Canada.
Further, family physicians are often demoralized by a lack of engagement and appreciation from policymakers, being treated as replaceable by other health care providers who have significantly less training and narrower scopes of practice.
It is unreasonable to expect family physicians to continue sacrificing their personal and professional well-being to prop up a system that is badly in need of collaborative, ground-up redesign.
All Canadians deserve to be cared for as part of a family physician-led health care team, but it is a big tent: family physicians want to work in interprofessional teams that are designed to meet community needs and that allow a clinic or network to maximize the breadth and quality of care provided.
The College of Family Physicians of Canada has long advocated for a vision of family practice called the Patient’s Medical Home that would improve the experience for both patients and providers and enhance the efficiency of the health care system while strengthening primary care.
There are other solutions that have been championed by the CFPC jointly with other health organizations. These include: dedicated administrative support so family doctors can spend more time caring for patients; a national medical license to make it easier for physicians to provide care in different parts of the country (and fill urgent gaps with more flexibility); different ways of paying physicians that takes the focus away from running the business side of the practice and allows doctors to focus on providing care; making comprehensive family medicine a more attractive specialty for medical school graduates so that there are enough family doctors to care for Canadians.
It is time for all levels of government to recognize the urgency of the crisis in family medicine and to come together to address it through both urgent actions and long-term adjustments.