Let’s bring the prestige back to family medicine

Do you remember getting that news? Perhaps it came in a thick envelope or an email with a cordial tone. The medical school admission letter. Your life would never be the same. If your experience was like mine, the pedestal was swift. Friends and family calling with congratulations. Acquaintances suddenly finding single friends for you to meet. Neighbours asking for advice for their children who wanted to become doctors (or for whom they wanted to become doctors.) Insurance agents and banks becoming very friendly—often insistently so. For better or worse, we became different to those around us, and that metamorphosis brought me more attention and respect than I had previously experienced. Read: Who will save primary care? But what goes up must come down, at least a bit. Upon arriving to medical school I was introduced to the phrase “Just a GP,” as in, “you’ve got potential, are you sure you want to be just a GP?” During medical school most of my lectures were taught by consulting specialists. The cases we discussed in small, group-learning sessions often started with a patient visiting their family doctor, receiving an incorrect diagnosis, then deteriorating until a referral was made that led to the proper diagnosis and treatment. Although most care is given in the community, the vast majority of my clinical education was done in hospitals. That meant most of my preceptors and role models were facility-based. There were some attempts to drop us students occasionally into a selfless family doctor’s office, but for the most part only one of my core rotations was in Family Medicine while the other five were in facilities where we learned about Surgery, Pediatrics, Internal Medicine, Psychiatry, and Obstetrics and Gynecology. Little wonder then that by the time I graduated and chose my particular path of practice, those who started as equals were seen as anything but. I distinctly remember an event hosted by McGill University where medical students in the graduating class had the opportunity to announce where they had matched and into which program. I recall one student announcing he had matched to urology at an Ivy League program; this was met with rousing applause. A similar ovation greeted the next person who had matched to ophthalmology at a large urban school. The next student humbly announced that she would be staying at McGill for family medicine; an awkward smattering of polite hand claps ensued. Read: Virtu(al) and vice: 22 thoughts on care in 2022 Now the plight of family doctors is front-page news with patient-led rallies on legislative lawns demanding action for a grim situation: almost 6 million Canadians don’t have a Family Doctor. Of those who do, fewer than half can see them the same day for urgencies. And 40% of people with a Family Doctor fear losing them in the coming years, a reality evidenced by the permanent closure of family practices and the reduced hours of emergency rooms staffed by family doctors. It’s become a veritable primary care pity party. Patients apologize for contacting me because they hear how we are overworked and under-resourced. They offer to present one complaint at a time since most doctors are paid by the visit rather than time or complexity. Some offer to call me because I get paid more for doing the same work by phone than I do by text or email. They see my working hours and rightfully wonder how sustainable this is and when I too will join the growing list of healthcare professionals burned out by the pandemic and a collapsed medical system. It doesn’t have to be this way, nor should it be. It’s clear that the best healthcare systems in the world are founded on strong primary care. People with family doctors receive higher quality care. This care is less costly for the system since these patients have fewer hospital visits and shorter stays, not to mention earlier cancer diagnoses. Yes, #EveryoneDeservesAFamilyDoctor. As happened to us, every year brings a new group of students who receive that life-changing acceptance to medical school. For the sake of us all we need to show them what Family Medicine can be—and demand the system that they want to work in: one that values and respects them, offers team-based care and a chance to focus on patients, while providing administrative support, functional electronic records and information-sharing. Because if we don’t save family doctors of the present and future, what will remain of our healthcare system will be a real pity indeed. Read: With family docs heading for the exits, addressing the crisis in primary care is key to easing pressure on emergency rooms

Let’s bring the prestige back to family medicine

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