New medical program dedicated to producing family doctors amid shortage

Amid an ever-widening family doctor shortage, an Ontario university is hoping to start turning the tide with a dedicated program – but some experts say that to fix the problem in the long run, we may need to reimagine our health-care system completely.

This month, first-year medical students are beginning their training to become family doctors – part of a brand new, innovative program taking aim at the critical shortage of general practitioners.

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Though urgently needed, fewer and fewer med school graduates choose family practice.

This at a time when 6.5 million Canadians now have no access to primary care, and the country is expected to be short 30,000 family doctors by 2028.

“It means that for those people, really, the front door to the health-care system is closed,” Dr. Tara Kiran, a family doctor and researcher at St. Michael’s Hospital, told CTV National News. “And so they’re left without anywhere to turn if they get sick, but also even to keep them well, manage their chronic conditions. They don’t have the care that they need.”

Julie Kristoff’s son, now 18 years old, has been on Quebec’s online wait-list for nearly two years.

“Everyone is feeling overwhelmed with patients, their rosters are full,” she told CTV National News. “We are not really sure how to deal with even small issues for a healthy person.”

They were advised to go to a walk-in clinic if they needed a referral to a specialist at any time.

“He certainly doesn’t have continuity of care,” she said. “What do we do if we need to get a prescription – these are issues a GP would be able to very easily follow through on.”

The shortage of family doctors is one of the driving forces behind the new program kicking off this September at Lakeridge Health, a satellite campus of Queen’s University.

Every single student enrolled in the program has committed to becoming a family doctor after they complete their schooling – a unique approach for medical training.

“What’s really amazing about this program is we’re changing the way that medical education is being delivered,” Dr. Randy Wax, chief of staff at Lakeridge Health, told CTV National News. “We make sure that we know that these students are going to become family physicians, and as soon as they’re finished the program, they’re going to be out there and helping to solve the problem.”

Jane Philpott, former federal health minister, is the dean of health sciences at Queen’s University. She says in traditional programs, only 30 per cent of medical school graduates choose family medicine as their first choice for residency.

That number has only declined over the last decade, Philpott said.

“Part of it is there are so many specialities to choose from, so they are overwhelmed by it, some has to do with remuneration, some has to do with conditions of work for family doctors, some of it has to do with the fact we have not promoted, adequately, family medicine within our university system,” she said.

One of the biggest pros of this new program, Wax says, is how it “allows us a lot more leeway in preparing a program for them that really prepares them when they’re done to get out there and be comprehensive family physicians.”

• A snapshot of wait times at hospital emergency departments across Canada

In other medical programs, where you don’t know what direction students might take their learning afterwards, you have to provide more variety in coursework, he explained. But they’ve been able to focus their programing on getting students ready for the specific role of a family doctor.

“They are working in the community clinics during the week – it has never been done in Canada and we believe it has a lot of potential,” Philpott said.

Wax met the first-year students during orientation week, and said he was struck by their passion for the field.

“That’s, I think, different than other cohorts,” he said. “They’re driven and they’re dedicated towards solving the shortage of family physicians in Ontario and in Canada.” 

The government has proposed other cures for the health-care system, including an immigration fast-track for hundreds of health-care workers, though recognizing credentials of foreign doctors can still be a years-long process.

But some experts are searching for a more comprehensive fix.

WHAT IF FINDING A FAMILY DOCTOR WAS AS EASY AS ENROLLING YOUR CHILD IN PUBLIC SCHOOL?

Kiran, who is an associate professor at the University of Toronto as well as a family doctor, believes we need an overhaul of the ailing primary care system.

“In our current system, we have the ‘haves’ and the ‘have nots,’” she said.

She proposes that we shift to a system that guarantees access to primary care for every single Canadian.

“When you move into a new neighbourhood, your kids are automatically guaranteed access to the local public school,” she said. “We need that kind of system in primary care, where people have a right to care.”

With a system similar to how we run public education, Canadians would be immediately guaranteed access to primary care at a team-based clinic in their area, instead of having to search for a primary care provider themselves.

“Your child has to be able to go to a public school, you don’t have to go around on Google, calling, begging,” Philpott pointed out. “But we haven’t done that for primary care.”

Team-based clinics would allow patients to receive care from not only family physicians, but also nurse practitioners and other primary care health professionals. In engagements with members of the public in Ontario and B.C., patients have suggested that even in this model, the ability to choose their doctor could still be maintained by allowing patients to choose to stay with an old provider if they move, or to select the specific clinician they’d prefer at a clinic, Kiran said.

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Training more family doctors is definitely something that will help the health-care system, she said – but she believes more doctors alone won’t solve access issues.

“We’re just not going to be able to meet the need, if we continue to do things the way we currently are doing things.”

Primary care is the first line of defence for our health-care system, and if Canadians aren’t able to access it, small issues can snowball into much larger burdens on the system as a whole, Kiran explained.

“All sorts of things fall apart,” Kiran said. “(No access to primary care) means that you can’t get care for a new condition, but it also means that you don’t get recommended care for chronic diseases like diabetes or high blood pressure, care that we know could help keep you well, and it also means that people who don’t have primary care aren’t getting their recommended testing or screening that’s needed to keep them well.”

This means a greater burden for hospitals if millions of Canadians are unable to catch and treat infections and diseases in their early stages.

Guaranteeing primary care isn’t an untested concept – similar models exist in countries such as Finland and Norway, Kiran said.

“For example, in Finland, everybody in the population is automatically registered to their local health centre,” she said. “Now, they can move and choose to go to a different health centre, but they’re automatically guaranteed access at their local health centre.”

Philpott says that a health-care model similar to the one Kiran is describing could only be implemented with a new law governing health care.

“If you look at many countries of the world where people have universal access to primary care, that is founded in federal legislation, and I would argue this is what is needed in Canada,” she said.

“There is a growing sentiment among the public saying ‘what kind of a country are we that lets 20 to 25 percent of our people go without access to care?’ We wouldn't let 20 to 25 percent of our children (go) without access to public schools, we have been able to set up a public school system where everyone has access, why can't we develop systems where every Canadian has access to primary care?”

Supporters argue that investing more money in the primary care system would pay off in the long run – for every dollar spent, many more are saved if prevention leads to fewer cancers and fewer chronic diseases.

An overhaul on this scale is not only “doable” but “more affordable than what we are doing now,” Philpott says.

“But it is going to take some significant political will.”

In the meantime, Philpott is aiming to recruit more students looking to be the future of family practice.