Changes needed to attract more medical graduates to family medicine: CMA

While family doctors are always in demand, in the past few months the Maritimes have seen several physicians leave their practice — and there is no one to take them back.

Charlottetown, PEI, lost four family doctors in one month.

And according to the Canadian Medical Association (CMA), fewer medical graduates are going into family medicine, raising concerns about what the future holds for primary care.

“I think it just reflects the current crisis we’re seeing in primary care, that there are so many structural issues with the practice of family medicine that make it unattractive to new medical graduates. Which is very concerning,” said Dr. Katharine Smart, president of the Canadian Medical Association.

According to the association, between 2015 and 2021, the number of medical graduates choosing family medicine increased from 38.5% to 31.8%. The average age of a family physician is now 49.

Smart says governments could review and rework the family practice system in a number of ways because right now it can be a burden, especially for new doctors.

“The family medicine model of care, for most family physicians, is a fee-for-service model, which is very transactional and can make it difficult to manage complex patients. »

“And with an aging population, more mental health issues in our communities, many patients need more than a 10 or 15 minute appointment to meet their needs. So sometimes those fee structures just don’t follow and don’t allow people to provide the care they want,” she said.

She says many family medicine residency programs train doctors to work with collaborative, integrated teams — but when they graduate, there aren’t necessarily jobs in those environments.

There are also other obstacles, such as inflation.

Start-up and infrastructure costs – staff, clinics and technology – have become “much higher” than what they earn from a provincial scale.

Smart says there is also “a huge increase in administrative burdens”. Family physicians are being asked to spend more time on paperwork, from arranging insurance to making referrals and coordinating a patient’s care — time for which they aren’t necessarily being compensated.

“When you put all those things together, it makes it less appealing,” she said.

Some good news — Dalhousie Medicine New Brunswick reports that between 40 and 50 percent of its graduates choose specialties in family medicine.

The school’s associate dean says the faculty encourages students to consider family medicine and that the program has strong ties to community family practices across the province.

“In 2018, when there seemed to be a decline across medical school, a number of initiatives were put in place to try to get students to see family medicine as a wonderful career,” said Dr. Jennifer Hall.

“From a medical school perspective, what we can do is have family physicians teach our students and really allow them to see the complexity of family medicine and all the possibilities it has to offer.

Hall says any conversation about the future of health care should include medical students currently in school or in residency programs.

Smart says without more family doctors, people are turning to emergency rooms. And often, the emergency doctor is also the family doctor.

“The cost of care there is much higher than if we invested and supported the people who receive primary care. I think it’s a real emergency,” she said.

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