I’m the only family doctor in a 2,000-person Ontario town. It’s impossible to be the doctor I want to be.
I got into family medicine in a roundabout way. In my 20s, I did my graduate studies in philosophy in the United States, and after that, I spent nine years working in management and software consulting, which had me on the road nearly 50 weeks out of the year. In 2002, my husband accepted a teaching position at Queen’s University in Kingston, Ontario, so we decided to move to nearby South Frontenac township. At that point, I was 39 years old and had grown disenchanted with my career. I wanted to travel less and make more of a difference in my community. Even back then, I was reading stories about a shortage of family doctors, so in 2009, I enrolled in Queen’s School of Medicine.
I was the only first-year student with kids: ours were five and one, and our third came along in year two. Motherhood forced me to become really good at time management. For four years, I diligently chipped away at my assignments, forgoing most parties and social events in favour of time with my young family. After another two years of residency, I completed my studies in 2015. After graduation, I was recruited by a medical clinic in Verona, a 2,000-person town a half-hour north of Kingston. I was replacing an older woman who was retiring. Despite being one of just two family doctors on staff caring for 1,200 patients, it sounded like a dream job. Early on, it was.
I’ve tried all kinds of ways to recruit a second family physician. I’ve published advertisements on HealthforceOntario and posted on online forums. I’ve even invited medical students to stay at my house to see if working in a small town is a good choice for them. There were a few close calls: one visiting doctor entertained us, but then chose a more urban hospital. Another eventually decided to specialize in obstetrics. A lot of new doctors in Canada are realizing that the family-doctor path often comes with a 2,000-patient roster, so they decide to specialize in something else.
Recruiting people to Verona, specifically, is an uphill battle. Nearby cities like Kingston can afford to offer six-figure signing bonuses, and communities more rural than ours (like Northbrook and Sharbot Lake) can do the same because they qualify for provincial rurality funding. Verona is in the middle—not big or small enough to do either. Why would a medical student who is probably $200,000 in debt come work with me if they can make much more money anywhere else? I sometimes think I’ll be stuck with this unsustainable burden forever.
I say “forever” because, if things stay the way they are, I don’t see how I could ever quit or retire. If I did that, I’d be leaving 2,500 patients without care. That’s a huge responsibility, one I cannot convince myself to shirk. The same could be said if I suffered an accident. For now, all I can do is continue my recruitment efforts, and hope that more family doctors enter the workforce. For that to happen, we need a better funding structure and more encouragement towards family medicine within Canadian medical schools. I’ve noticed that much of the med-school curriculum is taught by specialists, some of whom disparage—implicitly or explicitly—physicians who are just GPs. Instead, we need to communicate to students that family doctors are essential. And that, without more physicians entering longitudinal primary care in the coming years, we will face the complete collapse of our health care system— undetected heart attacks, strokes and cancers; a profound deterioration of Canadians’ mental health; and an angry, sick population looking for someone to blame for their misery.