Are Enough Canadian Residents Choosing Family Medicine?

Amid an ongoing shortage of primary care doctors across Canada, Dalhousie University in Halifax, Nova Scotia, Canada, reported that 52% of this year’s graduating class of medical students matched to a family medicine residency program. The finding showed a dramatic increase from the 25% of Dalhousie graduates who pursued family medicine in 2018.

The number of graduates matching to family medicine across Canada lingered around 30%; however, this is below what is needed to serve the population. An estimated 6.5 million Canadians don’t have regular access to a primary care provider, which limits their access to a wide range of services.

“Family physicians make up the backbone of our primary care workforce,” Michael Green, MD, MPH, president of The College of Family Physicians of Canada, Mississauga, Ontario, Canada, and professor of family medicine and public health at Queen’s University in Kingston, Ontario, Canada, told Medscape Medical News. Among graduating medical students selecting residency programs, “we need to have more than 31.4%” choosing family medicine.

Regional Differences

Across Canada, a range of factors have caused the percentage of doctors pursuing family medicine to decline over the years. Relatively poor working conditions and pay, compared with in other specialties, have had particular significance, said Green. Family doctors now care for increasingly complex patients, but they often aren’t paid for the extra time they spend seeing these patients or performing burdensome administrative tasks.

At the same time, differences among provinces and individual schools lead to diverse rates of residents pursuing family medicine, said Green. For example, each province sets its own contract between physicians and the government, which is known as a physician services agreement. While British Columbia recently agreed on a new, more favorable payment model in its agreement, the Ontario Medical Association hasn’t made a comparable change. Rates of residents reflect these policies.

Notably, nearly all of this year’s 75 unfilled residency spots were in Quebec. The province funds many positions that are specifically for rural areas and entail a French language requirement. “They don’t always have enough candidates for those spots,” said Green.

On a local level, different schools put varying emphasis on family medicine. For example, Queen’s University recently created a regional campus that focuses heavily on the specialty from the beginning of medical school. Exposing students to the scope of what family medicine entails is one way to cultivate interest in the specialty, he said. Medical schools can also create admissions policies that prioritize students who are keen to become generalists.

Practicing After Residency

While it’s important to cultivate interest during medical school and residency, the most important factors influencing young doctors’ career choices are systemic, Michelle Morros, MD, a practicing physician and the director of the family medicine program at the University of Alberta in Edmonton, Alberta, Canada, told Medscape Medical News. Reducing after-hours administrative work, increasing team-based care (rather than single-doctor clinics), and incorporating teaching as a paid part of physician jobs could help encourage graduates’ interest in family medicine, she added.

Reducing systemic issues is also essential for addressing another “pinch point” contributing to the shortage of family doctors after residency, said Morros. Because family medicine residents are trained as generalists, they can work in alternative settings such as hospitals, rather than providing longitudinal care in a clinic. These alternatives are appealing to many residents who are wary of the burdens that traditional family doctors face.

“They see that we’re burnt out, that we’re tired, that we’re overworked and undersupported,” said Morros. During exit interviews in 2023, only four of Morros’s 75 residents indicated that they planned to take on a panel of patients. “This focus on increasing numbers [of residents] without paying attention to what’s happening afterward isn’t going to solve the problem.” 

Today’s Residents, Tomorrow’s Workforce

“There is no replacement for a community family doctor,” said Emmanuel Hebert, MD, chair of The College of Family Physicians of Canada’s Section of Residents, Mississauga, Ontario, Canada. Hebert recently completed his residency at Dalhousie University and plans to open his own family practice this summer.

Hebert also believes that addressing systemic issues, such as the payment model, is key to increasing interest in family medicine. He noted that provinces, including British Columbia and Nova Scotia (where he practices), have recently transitioned from fee-for-service to a time-based model, which allows family doctors to take more time with complex patients and receive compensation on par with their colleagues. As a result, “there’s been quite a lot of interest just from my own cohort about doing office-based, comprehensive family medicine” in the past year, he said. Some of Hebert’s colleagues have chosen to stay and practice in Nova Scotia for this reason.

As a member of the Section of Residents, Hebert has also worked to increase communication between residents and the organization. “The people who are residents now are going to be staff for the next 20 or 30 years,” he said. “That’s going to be the future of the healthcare system.” 

While more work needs to be done, Hebert is hopeful about the future. Thanks to recent changes, “even since I’ve been a resident, we’ve anecdotally seen interest increase. So I suspect over the next 5 years, as things continue, that we’re going to have a lot more people doing generalist family medicine.” 

Gwendolyn Rak is a health reporter for Medscape Medical News based in Philadelphia.