Broad consensus says that Canada’s health-care system is in crisis and major reform is needed, and that part of that reform is to ensure that every Canadian has access to a family doctor. I agree that our health-care system is in crisis and that the major reform must be in primary care, to ensure that every person has access to a “medical home,” a team of primary-care professionals working together to deliver high-quality, patient-centric and comprehensive patient care.
Why this is not currently the case is due in part to structural factors, policy failures, and medical-cultural issues. The fixes, therefore, must address all these factors. Sadly, I hear no pundits, funders or policy experts addressing them. By the way, privatization is not one of the fixes.
In spite of the fact that the population of medical doctors in Canada has risen faster than the population at large, too few Canadians have access to a family doctor. One statistic tells part of the story — a smaller fraction of medical graduates are choosing family medicine as their specialty, meaning that we are not producing family doctors at the rate we need. One of the policy and cultural issues we must address is to make family medicine the most desired medical specialty.
Graduating medical students must complete postgraduate training in their specialty to be licensed for independent practice. In family medicine, that training is two (sometimes three) years in length. There are training programs attached to every Canadian faculty of medicine, and through CaRMS (the Canadian Resident Matching Service) in 2022 a total of 1,399 family medicine residency positions were available.
However, of the 3,000 or so graduating medical students, only 890 (about 30 per cent) chose family medicine as their first choice, and 1,180 family residency positions were filled. (Who filled these positions? Foreign-trained graduates, either Canadians studying medicine abroad or foreign nationals seeking Canadian training).
This is a problem. Traditionally about half of Canadian physicians have been family doctors, and half were other types of specialists. That ratio has changed as these statistics demonstrate. Instead of family medicine residency positions being undersubscribed, we need the best and brightest of graduating medical students to become family doctors, providing longitudinal care to patients and their families in concert with other health professionals. Yes, we need more psychiatrists and urologists and cardiologists, but we need family doctors even more.
And we need family doctors to do full-service family medicine, as exemplified by the medical home model. For every trained family physician who is working as a hospitalist or as a surgical assistant or doing hair transplants, about 1,000 Canadians have been denied access to the care these specialists were trained to provide. (The typical family doctor will have a practice that looks after 1,000 to 1,200 patients).