Are negative biases toward family medicine forming early in med school?

Provinces across Canada—each in their own way—are working hard to recruit family practice grads into longitudinal care. There’s been a decades long trend for young—and not so young—FPs to gravitate towards FP sub-specialties instead—as hospitalists, emerg doctors, palliative care doctors, etcetera. The efforts to lure them back to community care are vitally important to the roughly five million Canadians that lack a family doctor. But is there a negative perception of longitudinal family practice that needs to be tackled strategically at a much earlier stage? Nima Hamidi Toussi, who comes from British Columbia, is a first-year medical student at the University of Saskatchewan. He entered the program with a clear interest “in longitudinal care with people-centred care” and was really surprised to observe that many first-year peers exhibited a bias against family practice practically from day one. “I started medical school in August, and by like September I had detected those preconceived notions,” Toussi said in an interview with the Medical Post. Read: Dr. Adam Stewart: Family medicine is a dumping ground for other people’s work Concerned about the bias and because of his personal interest in family medicine, Toussi and a couple of like-minded friends have had conversations with many other first-year students. He has spoken with peers at other medical schools and, in a more focused way, informally surveyed more than 20 students (so far) at his own—in the cafeteria and in study halls. “A common thread in my conversations with other students has been the idea that, because there’s so many family residency positions and not that much demand for them, that family residency is kind of like a low-hanging fruit,” Toussi said. The students feel that: “You can breeze through medical school and pass your classes—not too much else—and still match into a family practice residency,” he said. “Or that it’s very easy to have family practice as a backup option, which I don’t think is true, necessarily. But that’s an idea that exists.” The bias—to whatever extent it exists nationally—may be an unintended consequence of the fierce competition and ambition that gets successful applicants into medical school. “It’s well documented how difficult it is to get into medical school in Canada. So once you’ve done that, the idea of settling for family medicine as a residency option—it seems like (some students) feel you’ve come so far, you should aim higher,” Toussi said. There are 100 first-year medical students at the University of Saskatchewan: 40 in Regina and 60 in Saskatoon. In the course of their studies, they get lots of exposure to FPs who serve as preceptors, Toussi said. “I’ve talked to peers at other schools too and medical schools in Canada do make a legitimate effort to promote family medicine,” he said. So what’s wrong? Do medical schools need to learn how to talk (or not talk) to a new generation that arrives at medical school already knowing about FP burnout and the special burdens it carries? “We actually had a full day to promote family practice. And we had speakers come in talking about family practice as well,” said Toussi. “But there were whispers back and forth—students saying, why are they talking about this? Or why are they defending this? And as a whole, when speakers come to talk to us about family practice, there’s often a sense that they are taking a defensive stance, rather than promoting the specialty itself. “This probably is not intended, and it’s limited to my experience,” Toussi added. He said when a doctor from another specialty comes in and gives us a talk, they do not focus on the inevitable negatives of the specialty rather they’ll talk about what type of people are a good fit for their specialty. “The presentations provided on family medicine are often a defense of, for example, the paperwork or the administrative load that family doctors have to go under.” That approach backfires, Toussi said, because too many students respond with suspicion. He would like to see presentations tackle student misinformation about the diagnostic acumen and wide range of challenging skills family medicine requires, because he believes that—with the right information—student biases could be reversed. “Maybe it’s because of the naivety of being a first-year medical student, just starting, but I heard one student say they don’t fully understand the difference in the role of a nurse practitioner versus a family doctor in practice,” he said. “I don’t think there’s a full understanding of what sets family doctors apart, what makes them unique.” Ensuring that medical students make fully informed choices about a career in family medicine, without unfortunate stereotypes, involves some critical timing. “When a student in first and second year aspires to go for a more competitive specialty, they’ll already have built research, they’ve already built extracurriculars, and connections in that area,” Toussi pointed out. “So I mean, students can change their mind at any time for sure. But if you want to go for something competitive, by the time you’re in third year, you kind of already have two feet in the water.” How has the negative bias affected him personally? Not too much. He was already committed, he said. “I don’t want to paint myself in a box in first year, but I’m interested in family practice. I was in August, I still am.” Toussi said he is contemplating a few other specialties as well. “But (the negative perceptions) haven’t turned me off of family practice—or some other students as well. They’re genuinely interested and it hasn’t pushed us away from really considering it. Although it might have done so for others. “Of course I can’t say for certain,” he added carefully. (Only time will tell). “But I think educating students earlier on what family doctors do and the uniqueness of their training would show them the value and allow them to hold family practice in a higher regard earlier on. It’s important to eliminate some of those preconceived notions,” Toussi said. “And when you present family practice (to students), discuss what type of person is a good fit for family practice. What do you need to be a good family doctor? “Not taking a defensive stance and talking about what makes a good family doctor could help students, you know, visualize themselves as a family doctor in moving forward and considering it more seriously as a future career path.” According to CaRMS, there were 98 family practice positions that remained unfilled in 2022, after the second and final iteration. (That is out of a total of 115 unfilled resident positions, all specialties.) It is a slight increase over the 90 unfilled CaRMS family practice positions in 2021. What happens to those unfilled, funded positions after the round two CaRMS match is up to the individual provinces and CaRMS has no record of that. Ann Graham Walker is the Medical Post’s B.C. writer.

Are negative biases toward family medicine forming early in med school?

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