While family physicians are always in demand, in recent months, the Maritimes have seen a number of doctors leave their practices — and there’s no one to take them over.
Charlottetown, P.E.I., has lost four family doctors within a month.
And according to the Canadian Medical Association (CMA), there are fewer medical graduates going into family medicine, which has some concerned about what the future holds for primary care.
“I think it just reflects the ongoing crisis we're seeing in primary care, that there's 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.
The association says between 2015 and 2021, the number of medical graduates choosing family medicine went from 38.5 per cent to 31.8 per cent. The average age of a family physician is now 49.
Smart says there’s a number of ways governments could review and rework the family medicine system — because right now, it can be a burden, especially for new doctors.
“The model of care for family medicine, for most family doctors, is a fee-for-service model, which is very transactional and can make it challenging to care for complex patients."
“And with an aging population, more mental health problems in our communities, a lot of patients need more than a 10 or 15 minute appointment to meet their needs. So sometimes, those fee structures just don’t keep up 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 are not necessarily jobs in those environments.
There are other barriers too, like inflation.
The start-up and infrastructure costs — of staff, clinics and technology — have gotten “much higher” than what they’re making from a provincial fee schedule.
Smart says there’s also a “huge rise in administrative burdens.” Family physicians are being asked to spend more time on paperwork, from insurance to referrals and coordinating a patient’s care — time they don’t necessarily get paid for.
“When you put all those things together, it makes it less attractive,” she said.
A little good news — Dalhousie Medicine New Brunswick is reporting between 40 and 50 per cent of its graduates are choosing family medicine specialties.
The school’s associate dean says the faculty encourage students to consider family medicine, and the program has close ties with community family practices across the province.
“In 2018 where there did seem to be a dip across the entire medical school, there were a number of initiatives put in place to try and ensure that students saw family medicine as a wonderful career,” said Dr. Jennifer Hall.
“From the medical school perspective, what we can do, is we can have family doctors teach our students and really allow them to see the complexity of family medicine and all the opportunities it affords.”
Hall says any conversations about the future of health care should include medical students currently studying, or in residency programs.
Smart says without more family physicians, people are turning to emergency rooms. And many times, the ER doctor is also the family doctor.
“The cost of receiving care there is much higher than if we were investing and supporting people that are in primary care. I think it's a true emergency,” she said.
