Med school solutions

Canada’s shortage of family physicians is no longer a looming challenge. It’s a full-blown crisis, straining doctors, sidelining patients—about 7 million of whom don’t have a family physician—and putting the future of primary care at risk.“We have to face the reality that we’re dealing with a physician deficit now that will not quickly be resolved even if we are able to engage in dramatic innovation. We need to look at ways to expand the workforce,” said Dr. Anthony Sanfilippo, a professor of cardiology at Queen’s University and author of The Doctors We Need: Imagining a New Path for Physician Recruitment, Training, and Support.There is no single fix, but Dr. Sanfilippo says that first governments and institutions should look to our “pipeline” processes for identifying and training young people who wish to become physicians.“The reality is that those processes, embedded largely in universities, have not evolved as the practice of medicine, and the needs of our citizens for medical services have expanded so dramatically over the past several decades. There’s a disconnect between supply and demand that has been unaddressed.”Innovations that are emerging and that Dr. Sanfilippo would like to see more of include a focus on primary care and streamlining medical education. For example, students on track for family medicine do not need to spend time on dozens of specialties from plastic surgery to neurology to anesthesiology. He also believes there should be a greater broadening of the admissions process to include more individuals with diverse backgrounds, such as those with prior healthcare experience, and a re-evaluation of overly restrictive and narrow admissions requirements.Currently Canada’s medical schools graduate just under 3,000 new doctors each year, but only about 700 go on to become family physicians providing full-scope care. Meanwhile, nearly 20% of the country’s 47,000 family doctors plan to retire within five years, putting further strain on the system.However, for the past 15 years, faculties of medicine in Canada have been stepping up to address the crisis in family medicine.“We had to wait for the governments to realize that the crisis was well beyond a crisis,” said Dr. Sarita Verma, a retired family physician and former dean, president and CEO of the Northern Ontario School of Medicine University (NOSM). “(But) there’s been an unprecedented expansion, especially in the last two years, of family medicine programs, residency programs, in addition to the expansion of medical schools across the country.”Dr. Verma, currently an executive advisor at the Medical Council of Canada, points to the opening of Toronto Metropolitan University and the University of Prince Edward Island (with Memorial University) medical schools this year, and upcoming programs at Simon Fraser University, York University, the University of Cape Breton (with Dalhousie), and the University of Lethbridge in Alberta (expanding seats with University of Calgary), and Lakeridge in Oshawa, Ont., (with Queen’s University).“Many of these schools and campuses are expanding specifically to train more family physicians and strengthen primary care,” she said. “Some are specifically looking only to recruit students interested in family medicine or primary care. So, it’s all good news. But the challenge is that most of this will not see any fruit for seven to eight years.”Dr. Sanfilippo says the Queen’s–Lakeridge Health MD Family Medicine Program provides an example of what’s possible. It admits students committed to family medicine and trains them through early clinical experience and teaching by practising family physicians, with the goal of preparing graduates for comprehensive, community-based care in the region.Hidden curriculumIn order to attract more family medicine students, Dr. Verma strongly believes that the “hidden curriculum” in medical schools that devalues family medicine and guides students to choose supposedly more prestigious specialties needs to be addressed and corrected.“It has an impact on students who are impressionable and are very attracted to being ‘the best.’ There is a lack of respect, and a message that, ‘You’re too smart to be in family medicine.’”Similarly, she says, remuneration in family medicine is an issue that reinforces the view of the specialty being “less than.”Then there are the conditions under which family physicians work. “You’re never going to get people to go into family practice when they see the conditions of practice,” said Dr. Verma. “If they see family doctors are exhausted, beleaguered and have no support, you aren’t going to want that. And so many family physician offices are down and dingy or in the corner of the hospital nobody wants to be in. Governments need to step up.”Outside of education, both Dr. Verma and Dr. Sanfilippo also advocate reducing the paperwork of family physicians to free them to focus on patient care. Similarly, supplementing doctor roles with non-physician roles would give physicians more time for direct patient care, requiring fewer physicians.“Seven million people in Canada do not have a family doctor. But truthfully, it’s seven million people who do not have access to primary care, and that’s a different thing,” said Dr. Verma. “It’s a shortage based on lack of proper distribution, but also an emphasis on physicians as the most important solution to our healthcare problem. . . . (But) I think 20% of what people see (physicians for) can be managed by artificial intelligence,” while non-physician allied professionals can do much of the other primary care work, she said.Despite the progress in medical education, Dr. Sanfilippo fears that both doctors and patients are growing resigned to a system that can’t keep up—and that behind that quiet acceptance lies a dangerous trajectory: Without access to timely, continuous primary care, early signs of illness are missed, prevention falls by the wayside and what could have been manageable health issues become costly, complex conditions.“The opening of new medical schools in Ontario and other provinces is promising, but only if they engage innovative and targeted approaches. More schools doing the same thing that’s gotten us into this mess will not resolve it.”

Med school solutions

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