The Ontario Medical Association (OMA) released data in December showing that while more than 2.5 million Ontarians currently don’t have access to a family physician (FP), 52% of current FPs are considering retirement or plan to retire in the next 5 years.

At the same time, a survey released by the Ontario Medical Students Association (OMSA) showed that only 42% of students were considering pursuing family medicine as a career. Only half of those students said they wanted to provide comprehensive cradle-to-grave care, the traditional type of family medicine, as opposed to undertaking enhanced skills training, which would enable them also to pursue another discipline and not work full time as an FP.

“Seeing the percentage of our family doctors considering retirement in the next 5 years and the decreased interest in longitudinal comprehensive family medicine among those coming into the field is sobering and concerning,” OMA President Zainab Abdurrahman, MD, told Medscape News Canada.

“The percentage of students who are interested in doing enhanced training is 80%, which is very, very high,” Rhea Saini, OMSA’s vice president of education told Medscape News Canada. “It was surprising and indicated to us that even if folks are matching into family medicine, that doesn’t necessarily mean that they’re planning on having a career as a comprehensive family medicine provider.”

“I would put myself in that category,” she added. “I’m interested in doing the dual program in public health and family medicine.”

Administrative Burden, Compensation

Administrative burden is one of the biggest hurdles for those already working in family medicine and a deterrent to those considering entering the specialty, Abdurrahman said. A whopping 94% of OMSA survey respondents said they would be more likely or much more likely to pursue comprehensive family medicine if there were a decrease in administrative burden.

“They say, ‘I love the actual practice of it. But when I see my supervisors, they seem to be spending so much time on this other part,’” she said. “And when they see supervisors fighting the system to get their patients care, they worry.”

Mentors also play a large role in students’ ultimate choice of specialty, Saini noted. “The folks that you’re exposed to early in training can make a big difference. Seeing family doctors who really enjoy their career and tell you positive things is important. But then the question becomes ‘Do we like the specialty, or do we like the person that we’re working with that day?’ I think it’s best for students to work with lots of different people so that they’re not influenced one way or the other by just one person.”

That said, she noted that FPs who might traditionally be strong mentors are also facing challenges with administrative tasks, particularly physicians working in rural areas. That means they’re less able to take on students. 

Compensation is also an issue, but, interestingly, its power to affect choices was on par with that of administrative burden. Ninety-four percent of survey respondents said they would be more likely or much more likely to pursue comprehensive family medicine if there were a decrease in administrative burden, whereas 93% said they would be more likely or much more likely to pursue comprehensive family medicine if there were changes to the current pay model. Seventy-one percent said they would be more likely or much more likely to pursue comprehensive family medicine if there were loan relief and tuition refund programs.

‘Future-Proofing’ the System

“Our work is not just about what we are going to do for those who are just coming into training; it’s what are we going to do about those who want to remain in practice,” Abdurrahman said. “How can we keep them in practice while we’re bringing in people who are ready to practice? And what are we going to do to future-proof the system, so we don’t make things better and then let it drop off again?”

A robust and enduring multipronged approach is needed to curb the FP shortage, according to Abdurrahman. A cornerstone of the approach would be the use of technology to free FPs from tasks such as patient referrals to specialists. “We need to create centralized referral pathways where the family doctor just has to enter the patient’s issues, how far they’re willing to travel, wait times, and any nuances that need to be in there. Then the system can match the patient to a specialist who’s available, instead of the doctor sending a letter, getting a rejection, and then having to send another letter. That’s not family medicine. That’s something a system can do.”

Another key to reducing the FP shortage is building core teams around family doctors to help them care for more patients, she said. “The right team support — working with nurses, physician assistants, physical therapists, and other specialists — allows doctors to extend their capacity, serve the patients who need them, and focus on their work as physicians.”

To implement new technology and build teams, government support is needed, she added. Funding would allow allied health professionals to be located together and to share a system of care, so that when a patient visits a physical therapist, the family doctor can see the notes and the outcome.

“A lot of care is really about communication,” Abdurrahman said. “We need to have a digital infrastructure that allows us to do that and a partnership with the government to support it. In addition, specialist care needs to be covered in the public health system so that patients can access it when needed.”

Despite the challenges, Abdurrahman is hopeful. Funding through the Primary Care Action Plan and the expansion of Ontario’s family health organization model are among the initiatives taking effect this year. “We’re hoping these supports will also resonate with our medical students when they see changes,” she concluded. 

Abdurrahman and Saini were among the speakers at a recent OMA briefing that delved into the issues, the new data, and what must be done to ensure better care.

Abdurrahman and Saini reported no relevant financial relationships. 

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDEdge, The Lancet (where she was a contributing editor), and Reuters Health.