Global Courant 2023-04-20 13:00:00
This opinion piece is from Lauren Eastman and Samantha Horvey, family physicians and assistant professors in the Department of Family Medicine at the University of Alberta. For more information on CBC’s Opinion section, see the FAQ.
For the one in four Albertans who do not have a primary care physician, the recent news that the province will create 120 new medical school places over the next three years sounds like a welcome solution to a struggling healthcare system.
While the increase is much needed, the reality of solving the family medicine crisis is more complex.
To understand why the increasing number of medical students may not result in all Albertans having a GP, it is important to understand the process of becoming a GP.
All physicians typically complete at least a bachelor’s degree (which usually takes four years), and then three or four years in medical school.
At the end of medical school, medical students sign up for a residency program to choose their specialty, such as orthopedics, obstetrics, or family medicine.
After an application and interview process, medical students can rank their residency programs according to their choice and similarly, residency programs rank medical students in the order they would like them.
Based on the algorithm, medical students cannot be matched with a residency position that they do not rank.
This is a Canada-wide matching system called the Canadian Residency Matching System (CaRMS).
In Alberta, the number of students choosing family medicine is declining.
In the first round of CarMS 2022, 30 percent of University of Alberta students matched family medicine.
A sobering statistic is that the family medicine training programs at the University of Alberta and the University of Calgary 42 empty training places for family medicine.
Overall, the University of Alberta has seen a downward trend in the number of students matching family medicine over the past three years – based on data from 2020, 2021 And 2022 – reaching 21 unfilled places after the first matching round this year.
This is despite having one of the best training programs in the country.
Training more medical students is no guarantee that these training places will be full.
While the majority of medical students do not become general practitioners, there is a second sobering fact.
Research in our department shows that the majority of those who complete family medicine training do not intend to take on new patients.
A survey conducted in December 2022 showed that only 39 percent of University of Alberta family medicine graduates plan to accept new patients in their first five years of practice.
About one in four Albertans does not have a general practitioner. (Shutterstock)
Instead, they choose to locum (equivalent to substitute education for existing physicians), work in a hospital, or work in a specific area of practice, such as dermatology.
The top reasons current family doctors said they don’t want to accept patients include the burden of running a business, excessive paperwork, financial compensation, and the difficulty of finding someone to care for their patients during absences, such as parental leave.
If we follow the current path of medical students and their choices, with a welcome 120 students added to Alberta medical schools over the next three years, only 15 of them will become general practitioners in six to seven years.
If these 15 medical students became full-time general practitioners and took care of 1,250 patients, only 18,750 additional Albertans would receive primary care in six to seven years.
We suspect that the current primary care environment in Alberta is the main reason that fewer Alberta medical students are choosing family medicine and fewer family medicine graduates are seeking to enroll patients.
The primary care quarterback
GPs who take on a patient panel struggle with mountains of paperwork, the costs and maintenance of running a business and being responsible for their patients 24 hours a day, 365 days a year.
Family physicians become the linchpin, or quarterback, of an Albertan’s primary care with little appreciation and minimal support.
Strong primary care is the foundation of a good health care system, and we believe that every Alberta resident deserves a family doctor.
We also believe that a career in family medicine, with the right support, is one of the most rewarding careers in medicine.
We are currently working at a clinic where two doctors are retiring and we are unable to find replacement doctors for their 2,500 orphan patients. Who takes care of their cancer? Depression? diabetes mellitus?
Each week, patients contact our office to be hired by our existing physicians. We are heartbroken that we do not have the capacity to help these people.
We need more primary care physicians in Alberta who are willing to take on patients.
While increasing the number of positions in our medical schools is necessary for a struggling healthcare system, it is not a panacea for family medicine.
The trajectory for family medicine is particularly worrying. Alberta needs to significantly increase support for the primary care physicians who take patients in and care for them throughout their lives.
It is critical that we also entice more doctors to join them. The only way this can be achieved is through primary care reform – and we need it now.
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