It's Time To Panic About Family Medicine

I could just cut and past my thoughts on this topic from last year, but where's the fun in that?

The Canadian Resident Matching Service (CaRMS) released its complete presentation on the results of the 2018 match this weekend. There aren't many more useful or important reports out there for people interested in the Canadian medical workforce. We know already know what Canada's future doctors will look like - more female, more diverse, and more accomplished than ever - from medical school demographics. But the CaRMS match results provide a glimpse of what sort of doctors will be entering practice in the next 3-10 years as their predecessors retire or leave for greener pastures. 

In an ideal world, of course, there would be little difference between the new doctor cohort and the retiring one in terms of specialty makeup. Except when advances in medical science create the need for new specialties, all things being equal the number of obstetricians, surgeons, psychiatrists, etc., should be predictable based on easy-to-find data, and policymakers can adjust the mix of residency spots accordingly. 

The exception to this notion is, somewhat ironically, Family Medicine, the "cornerstone" and least specialized field of medical practice. As I've written about multiple times previously, Family Medicine has become deeply unloved in recent decades. Most medical students don't want to study it. Increasing numbers of doctors don't practice in the "classic" i.e. comprehensive primary care model. And governments see family doctors as replaceable and overpaid (except, that is, when compared with more "overpaid" doctors, but that's a different rant for a different day).

In the 2018 match, Family Medicine as a first choice career rather surprisingly held its own. Considering the deteriorating working conditions pretty much everywhere, it's still the top choice for about 30% of med students (while the figure is 33%, one in ten Family Medicine residents pursue a year of emergency medicine training, and will work full time in the ER). That's better than the rock bottom point of 25% in the early 2000s, and could reflect any number of reasons: better pay for family doctors; more options for focused practices; a poor job market for some specialties; more women entering medicine, who excel in primary care; and better career counseling, among others. So why panic?

In the bigger picture of health care system needs, these numbers are a looming disaster. The national sasaran for the family doctor-specialist split is 50-50, with residency spots allocated to meet that goal. We're nowhere close to that ratio if we take even a superficial look at current practice patterns. And if we harbor any hope of implementing a more effective, community-based health care system, as is the case in the Netherlands, that split needs to be more like 70-30.

And what about the changing demographics of the profession? Though the proportions of doctors over and under age 50 are fixing relativity - what doctors should be paid relative to one another - to make Family Medicine a more desirable career, suffice it to say the Middle East peace process has rosier prospects than doctors agreeing on money, and I (for one) don't believe money is the issue anymore. 

What is for certain, though, is that every day that goes by this existential crisis in Family Medicine grows and grows harder to solve, if solutions are even possible. It may very well be that Family Medicine as a specialty is doomed, and the only thing left to do is euthanize it and reinvent the discipline from the ground up. Heaven knows the entire medical education system has serious festering problems anyways.

But the consequences of inaction are disastrous for the credibility of the profession and the integrity of the health care system as a whole. Doctors owe it to one another, and to the public, to at least give it a shot.

P.S. I'm smart, I work cheap, and make a fine chocolate souffle.

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Ditulis Unknown — Monday, April 30, 2018 — Add Comment — access, burnout, College of Physicians, doctors, Family Medicine, health policy, medical education, primary care, residency