The third-year question: You don’t want to read this if you have made up your mind

This article is not intended to change anyone’s mind. The reality of debate is that each side works harder and louder to convince the other side until there is a traumatic conclusion or an opportunity to find collaboration. The prior is more likely. I write this to work towards the latter. Remember I am a small town working comprehensive family doctor for 30+ years and I don’t have a hidden motive in writing this. I expect hate mail and attacks on my character. I am not speaking on behalf of any leadership role I have. Values. Understanding. Caring. We need to discuss values that I think we all share. We all understand the problems. We all care about the best outcome. No one would argue this. Family Medicine is in a crisis. And all family doctors and the College of Family Physicians of Canada (CFPC) understand this and cares about this. Family doctors (and our specialist colleagues) are working longer hours, seeing more complex patients, suffocating under heavy administrative burden, retiring earlier, burning out or leaving the profession altogether. Patients are struggling too, with over 6 million (and growing) Canadians without a family doctor, those without a family doctor having worse health outcomes, and they are waiting too long for access to high quality comprehensive care. So I would like to thank Drs. Sohail Gandhi, Teela Johnson, Liz Zubeck, Paul Dhillon and others for their willingness to provide alternate viewpoints to solutions offered by the CFPC. They understand the problems and they care about family medicine. We all care about making family medicine more attractive to medical students. We care about increasing the number of resident training spots and committed family doctors working in remote, rural, suburban and urban centers. We want to ensure every Canadian has a family doctor working in team-based care, connected electronically with the family doctor as a leader in the team. We care that family medicine is appropriately paid for given the complex work we do. We care to make this profession joyful. We want a responsive family medicine primary care team that can treat medical conditions earlier (proactively not reactively), in community (more than institutions), to minimize comorbidities and bad outcomes. I hope you can see that many of these shared outcomes are totally outside our control, but within our influence. What others see The policy developers, governments and economists see different things than working family doctors see. As of 2022, there were 48,199 family doctors in Canada, the highest number on record and the supply of family physicians is stable at 124 per 100,000. The number of family physicians graduating has decreased steadily with increasing CaRMS matches unfilled for family medicine from 2020 to 2022. However, we continue to increase family physicians from international MD programs, our income keeps increasing similarly to all other physicians (actually higher percentage increases) but we are still at the lowest average gross clinical payment of all medical specialties. But let us be clear—our problems are about more than just our incomes. What's happening concurrently Remember there are other aspects to consider like high medical student debt; delays in medical students starting on their own families; medical students and residents own health issues; poor promotion of family medicine in undergraduate medical schools; perceived or actual lack of confidence and preparedness in starting a practice for family medicine residents; our complaining about how bad family medicine is; the family medicine residency training programs trying to teach all aspects of a burgeoning primary care research world within 24 months; the inability for specialists to see referred patients efficiently so greater burden placed in primary care; artificial restrictions that prevent family doctors from working in team based care and fixed income models; more complexity and uncertainty (and perhaps liability) in patients with multi-morbidities; psychiatric conditions and high “expectations” culture; the worsening social determinants of health; the worsening environmental impact on health; inaccessibility to medications, dental care, counselling, family supports, palliative care and home care; expanding scope of all other allied healthcare providers, and so on. Let me reiterate, many of these problems are systemic and cannot be solved by family doctors or the CFPC. So we are arguing about the pathway and the implementation of these outcomes. Fair. It is time we found the best solutions together. Please understand, the status quo is unacceptable We will make positive changes to improve family medicine under the quintuple aim framework: patients wellbeing, provider satisfaction, the system’s efficiency, social accountability, and economic sustainability. Please read these links from the CFPC and see that we have a lot of work to do. No one is hiding anything. We have spoken to over 400 groups in Canada about this work and we have more engagements upcoming. Please support dues increases of 7% or $65/family doctor because it is expensive doing this generative work. In the end, we are in this together and there are honest family doctors working hard every day to make things better for all of us. Dr. Alykhan Abdulla is a comprehensive family doctor working in Manotick, Ont., Board Director of the College of Family Physicians of Canada and Director for Longitudinal Leadership Curriculum at the University of Ottawa Undergraduate Medical Education. TWITTER @AlykhanAbdulla LINKEDIN: Dr. Alykhan Abdulla MD, FCFP, Dip Sport Med, CCPE, MCPL, ICD.D

The third-year question: You don’t want to read this if you have made up your mind

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