Some of the things that put people off family medicine are the very aspects of the field that excite Montana Hackett.
“You can see people from different backgrounds, from the moment they’re born through all parts of their lives, and you can build those long-term relationships with them,” said Hackett, a fourth-year medical student at Schulich School of Medicine and Dentistry at Western University.
“The thing about family medicine is that the clinical breadth that you get to practice with is huge. It’s huge, for better or for worse. That breadth is a good thing, but it can also be very challenging.”
Ontario is in the eye of the perfect storm when it comes to a family medicine crisis: patients needing more care because they’ve been through a pandemic and are only now seeking help for longstanding health problems; A recent study found that two million people do not have a family doctor. Another two million have someone who is 65 or older, near retirement, according to the Ontario College of Family Physicians.
As the need for family records increases, the number of medical students choosing family medicine as their specialty of choice is down year-over-year, according to data from the Canadian Resident Matching Service, a nonprofit organization that matches medical students.
“We see too few GPs being asked to do too many things with not enough resources. It’s not sustainable,” Hackett told CBC News. “Over the past 30 years, we have seen the conditions of primary care continue to deteriorate. It is no secret or surprise that GPs are leaving the profession.”
But Hackett, who grew up in London and said he has a great relationship with his own GP, said he hoped conditions would improve by the time he was a full doctor.
Burnout and paperwork
“When I went through my clinical rotations and told a doctor I was going to be a GP, they were both excited and scared for me. Excited because they know how great family medicine is, but they know it from experience or from seeing others burn out and it’s scary.”
Family doctors are essentially small business owners, said Dr. Neil Sengupta, a sophomore in Schulich resident physician. Family doctors who work in clinics spend up to 40 percent of their family on overheads like rent and utilities, he said.
Studies suggest GPs spend an average of 11 hours a week just on paperwork rather than seeing patients, and a provincial reclaim of virtual care allowance means an option that has worked for many patients and doctors during the pandemic is taken away became .
But there is pressure in medical schools to remind young doctors to take care of themselves and not work their way to burnout, including an increased focus on working with other health professionals such as occupational therapists and nurses.
“I think all medicine comes with a risk of professional burnout because it’s part of what we do, part of being a compassionate worker and caring for people. Family medicine has its own challenges, but attention has been paid to the problem and the COVID pandemic has increased that attention,” said Sengupta, who works at a London clinic.
“Ontario has recently allowed more GPs to join family health teams and this is an amazing practice that allows support systems for us to practice medicine but also takes a huge burden from just a single provider,” Sengupta said. “I think the biggest thing for me is team support. Working with a family health team or with allied health professionals takes some of the care burden off.”
There is an opportunity to talk about more private care services in Ontario, but the biggest problem will be ensuring there are enough health workers who can work in all aspects of care, Sengupta said. “With private delivery it may help reduce wait times or access a doctor at a clinic closer to home or more accessible, but where are we going to get the human resources for healthcare?”
Ultimately, more people with primary care physicians or access to other primary care providers like nurse practitioners will take pressure off the health care system across the board, said Dr. Laura Caracas, another Schulich student in training to become a general practitioner with a passion for preventive medicine.
“I believe that early intervention can change a person’s health trajectory,” Caracas said. “As a GP, you have the opportunity to see patients multiple times, and you actually have the time and space to explore with your patient and work towards better health.”
Caracas studied medicine and worked in internal medicine in Romania, but came to Canada three years ago and is now in her second year of residency. Seeing how the two different healthcare systems work gave her an appreciation for Canada’s focus on primary care, she said.
“In Romania, primary care is not well represented, so many opportunities to provide preventive medicine are missed, resulting in patients getting sicker or requiring hospitalization more often,” Caracas said. “I find that things are actually better in Canada because we have some GPs who provide primary and preventive care.”
All three students CBC News spoke to say they know family medicine has its challenges, but the variety of care they can offer patients is alluring.
“It’s a very flexible specialty that allows you to create a work-life balance and customize your practice to meet your personal and professional goals,” Caracas said.
