Slowly, quietly, insidiously, in the background, family doctors are burning out or retiring, or graduating medical students are choosing not to be family doctors. All this leads to fewer family doctors and worsening health care outcomes.
Patients who have family doctors go to the ER less; have early detection and treatment of disease; receive better evidence-based care such as cancer screening; and have fewer hospitalizations due to chronic disease. Comprehensive family doctors treat patients early in their disease, improve health outcomes and save money.
We all know family doctors can make huge differences in their patients’ lives. In fact, it’s very disconcerting when your health-care options are Telehealth Ontario advice or the ER or suffering. Let us look into to this a bit more critically.
Family doctors are burning out at the highest rate ever. There are many reasons for this but essentially: high administrative demands (forms and paperwork accounting for 20 per cent of the work day); worsening inflation affecting all costs for running a small business in the community; and more complex patients with higher expectations. My colleagues are struggling more, feeling disrespected and undervalued.
Ontario has one of the lowest numbers of family doctors per 100,000 patients among industrialized countries. It ranks seventh among Canadian provinces and, if it were a country, Ontario would have one of the lowest doctor-to-population rankings among OECD countries (29 out of 33). If our workload is increasing and our numbers are decreasing, then no wonder there are five million orphaned patients in Canada. Do you think this will get better any time soon?
Finally, no one wants to be a family doctor. This year saw the highest rate of unmatched positions in family medicine (that is, no medical graduates applied for these family physician residencies): almost 25 per cent of all family medicine positions in Canada.
Of the nearly 2,000 graduating medical students in Canada, more than 200 medical students chose anything but family medicine, essentially putting their future in jeopardy rather than be a family doctor.
Why do medical students NOT want to be family doctors? Family doctors are one of the lowest paid physician categories. Family doctors have the highest workloads. And family doctors are typically disrespected. I remembered a surgeon lecturing a medical student, “You had better work harder if you want to be successful in surgery or you will become a family doctor!” Really.
So I am truly sorry, but getting a family doctor is not going to get easier.
There are some solutions, including the following: Family doctors should be federal public employees with a national portable licence (not small business owners); all medical school graduates should be family doctors first then, if they choose, they can train to be specialists (as many other countries); and we can reduce or eliminate unnecessary administrative burdens — so we never have to consider lifewithoutadoctor.ca.
Dr. Alykhan Abdulla is a comprehensive family doctor working in Manotick; past chair of the Section of General and Family Practice; and lead for Longitudinal Leadership Curricula at uOttawa Undergraduate Medical Education. Twitter: @AlykhanAbdulla