Last march, the University of Calgary issued a press release with some big news from its medical school: 45 percent of graduating students had chosen family medicine as their first choice for a residency program. It’s a dramatic turnaround for a school that saw just 18 percent choosing the profession in 2008.
Then, more good news. In the first round of “matches” between grads and residency programs – a dating-type service organized by the Canadian Resident Matching Service – U of Calgary’s own family medicine residency spots filled up, as did those at Queen’s University, University of Toronto and University of British Columbia. The phenomenon was unheard of in previous decades.
“For most students in medical school, they think being a family doctor is about doing [prescription] refills and hand holding,” says David Keegan, undergraduate director of the department of family medicine at U of Calgary. His program and many others across the country have been working for the past several years to change this perception and to improve how they teach family medicine at the undergraduate and residency level. The results of their efforts are starting to emerge.
The U of Calgary medical school garnered $14 million a year in provincial funding for family medicine initiatives, mainly for the residency program. Exposure begins before the very first day of medical school, with a one-day event called Med.Zero. Launched in 2011, it exposes new students to fresh ideas about being a general practitioner – it’s different every day, you can work in the Far North or in ER, you can deliver babies and save lives by spotting early signs of cancer and heart disease in your patients. The soon-to-be medical students at Med.Zero also learn how to put on a cast and suture a wound.
U of Calgary also moved the family medicine offices from a mall adjacent to its clinic to a central location in the main medical school building so that students would pass by it every day. It started sending first-year students into the field to see family doctors at work, and it hired more general practitioners as lecturers.
At the University of Alberta, 41 percent of its undergraduates selected family medicine as a first choice, up from a slump of 20 percent a few years ago. Lee Green, chair of the department of family medicine, says hiring more family doctors as professors and lecturers does more than simply promote the profession: it also makes for better curriculum.
“Students in their first and second years are learning the basics of how to be a physician. They don’t need to learn from a specialist,” says Dr. Green. Who knows more about the bigger picture when it comes to broken bones, the flu, eyes, and heart health than a family doctor? “A generalist can better teach it,” he says.
The push to promote family practice extends beyond Alberta. In Quebec, the university-affiliated hospitals filled 424 residency positions in family medicine this year, up almost 16 percent from the previous year. In Ontario, the province’s six medical schools have been part of the decade-old Family Medicine Expansion Project, a multi-layered collaboration with the provincial government that included pay raises for GPs, the introduction of family health teams and the use of electronic health records.
“It’s a lot better to be a family doctor in Ontario today,” says Stephen Wetmore, chair of family medicine at the Schulich School of Medicine & Dentistry at Western University. More residency spots have opened and funding has been available to find and train doctors in the community to take on residents in their practices.
Like U of Calgary, Western University runs a pre-med day of family medicine clinical skills, and has been doing so since 2008. This and other initiatives promoting family medicine have led to 43 percent of the undergraduate class making family medicine a first choice at Western.
At Queen’s University, the family medicine expansion project turned the 18 residency spots from a decade ago into 30. The school added more community teaching sites, mostly in rural areas, with a director overseeing each site to make sure every placement is top-notch. Residency classroom time includes new courses such as Nightmares, which addresses how to cope with having very sick patients. “We’ve got these exciting new programs and the word is getting out,” says Karen Schultz, director of the Queen’s family medicine program.
Canadian medical schools are bolstering family medicine for good reason: they know that GPs should make up 50 percent of all doctors. “When you have a health system that’s balanced between family doctors and specialists, the overall healthcare system performs better,” says U of Calgary’s Dr. Keegan. Moreover, having too many specialists can lead to unemployment for their graduates. (As an example, the Canadian Orthopaedic Association says 50 percent of newly trained orthopedic surgeons in Canada can’t find jobs.)
But even though schools are training more family doctors, there’s still a shortage of primary care physicians. A recent Health Council of Canada survey estimates that seven percent of Canadians, about 2.5 million, don’t have a family doctor.
When today’s bumper crop of new family practice residents starts working about two years from now, that situation could improve. But once the profession is rebalanced and medical education is made better as a result, those who’ve advocated for these changes worry the momentum and funding could start drying up.
“This is an ongoing priority,” says Dr. Keegan. “If we lose sight of that, we will slide back.”