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A patient sounds slightly short of breath with a subtle decline in their strength.
The diagnosis? It could literally be anything, says Dr. Mike Allan, CEO of the College of Family Physicians of Canada.
Subtle changes, like a slight difference in a person’s behaviour, can be harder for doctors to sort out to direct patients to the right tests and treatments, compared with someone clearly clutching their chest, which can signal a heart attack.
Family physicians don’t focus on one specific area of care. Rather, they’re skilled at taking the whole patient into consideration, said Allan. “That is where the family doctor thrives.”
But an estimated 6.5 million Canadians don’t have a family physician or nurse practitioner for their regular medical care, which Allan, who has trained with the Canadian Forces and has also worked as a civilian physician, called “beyond sad and frustrating.”
Dr. Tony Sanfilippo, a cardiologist and professor of medicine at Queen’s University in Kingston, Ont., called it astounding. In a country committed to universal health care and devoting massive resources to medical education, he says it’s a mystery that we’re in this bind.
Sanfilippo’s new book, The Doctors We Need: Imagining a New Path for Physician Recruitment, Training, and Support, explores the root causes.
“Our system for medical education and for producing doctors has not evolved with the needs of society,” he said.
Now, three new programs for family medicine are on track to start in September. The deans for Canada’s three new programs for family medicine — at Simon Fraser University in Surrey, B.C., Toronto Metropolitan University in Brampton, Ont., and the University of Prince Edward Island in Charlottetown — aim to help meet the needs by changing training and shifting focus to team-based care.
Canada is losing its family physicians to burnout and it’s creating a primary care crisis. Can a new program that prioritizes family doctor recruits help solve the shortage? The National’s Nick Purdon gets special access to Queen’s University and Lakeridge Health’s medical school program to see how it is preparing students for the realities they’ll face on the job.
In team-based care, family doctors work interdependently with a team ranging from nurse practitioners to pharmacists and social workers to provide primary care to a roster of patients.
The College of Family Physicians of Canada says team-based care helps provide patients continuity and accessibility, which in turn helps them live healthier, fuller lives.
- This Sunday, Cross Country Checkup is asking: How are you coping without a family doctor? What impact has it had on your health? Fill out this form and you could appear on the show or have your comment read on air.
Dr. David Price, dean of SFU’s medical school, said British Columbia’s government tasked his team with creating a school focused on primary care.
“I don’t think there’s another school in Canada that has a really relentless focus on primary care and training,” Price said. “What we’re trying to do is produce medical students who are more likely to go into primary care specialties,” of which family medicine is a main one along with pediatrics and psychiatry.
The training in the community will need to match increasing demands placed on family doctors, which the educators all acknowledged have changed since they trained decades ago.
“When I graduated from medical school, there [were] two types of insulin and maybe one type of oral drug to reduce blood sugars,” recalled Price. “Now, there’s tens of different types. Understanding which one to use and how to use it and what are the complications, what are the side effects — it really is so much more complex.”
Longer patient visits required
Patients themselves are also more complex, he said, meaning they often are managing several illnesses or complicated circumstances at the same time — like mental health issues or precarious housing.
WATCH | Can a new program that prioritizes family doctor recruits help solve the shortage?
Until 2021, Price chaired the department of family medicine at McMaster’s medical school in Hamilton, Ont.
“A patient visit doesn’t take the 10 or 12 minutes that it used to,” Price said, noting people also now tend to live longer.
Despite the challenges family physicians face, research points to their importance.
Several published studies in Canada, and the U.S. suggest patients — and health-care systems — benefit from having a family doctor. When those with a chronic disease have a family physician, they visit the emergency department and get admitted to hospital less often. A 2019 population-based study suggested that an increase in 10 family doctors per 100,000 people in the U.S. increased life expectancy by 51.5 days, while others found a link with better outcomes.
Given those demands, another new school is rethinking the typical month or six-week long rotations of family medicine.
Co-op stint in family medicine
“Six weeks might not be sufficient to really get a sense of what family medicine is all about,” said Dr. Teresa Chan, dean for the School of Medicine and vice-president of medical affairs for Toronto Metropolitan University.
“We are building in a focus of primary care into our undergraduate curriculum so that they get early exposure before their clinical rotations,” Chan said, likening these practical stints to “co-op for doctors.”
Instead, TMU plans six-month placements, including at a teaching clinic where family medicine residents who’ve graduated from medical school can receive crucial training and get used to team-based care working with other health professionals.
As to questions of TMU not requiring applicants to have a science background, Chan said even though she had an immunology degree when she went to medical school, there were many other science subjects to learn.
“It doesn’t really put anyone at a true disadvantage because everyone’s going to know a little tiny bit,” Chan said.
Graduates from other schools that don’t require traditional pre-med science courses, like Mount Sinai School of Medicine’s Humanities and Medicine program in New York and several medical schools in Canada, have gone on to successful careers as doctors.
Joining in with nurses and physiotherapists
Dr. Preston Smith, inaugural dean of P.E.I.’s new medical school, a regional campus of Memorial University in Newfoundland, also helps recruit physicians to P.E.I.
Smith has faced concerns about how the province’s physicians will take on teaching when the health-care system is already overloaded. In response, he points to how research suggests doctors who teach tend to stay in their community and have greater career satisfaction than those who don’t.
“One of the big things about trying to recruit medical students to want to do family medicine is to see the joy of family practice” that comes from established relationships with patients, Smith said. “They’ll be able to see that in this building from Day 1 of medical school.”
Allan, from the family medicine college, has worked in a team with physiotherapists, as many of the patients in the Canadian Forces had musculoskeletal issues: “You know, sore knees, sore backs, twisted ankles, torn shoulders.”
Allan said team-based care also includes pharmacists who may come in once a week to chase down discharge summaries — when patients come home from hospital and they’re often on different medications but the documentation doesn’t arrive fast enough.
Or it could be nurses who help educate patients on conditions like high blood pressure and stop in for a quick consult with the doctor when what was supposed to be a routine check no longer is.
Both the future med schools and a new federal report on gaps in the health-care workforce say they can’t single-handedly solve the need for primary care in Canada or do so quickly, but they’re striving to make a dent.
“In a team-based care environment, we’re providing, I think better care and we’re providing more comprehensive care and we’re allowing more patients to be seen,” Allan said.
