Fewer medical students are pursuing family practices, and these doctors are worried

Fewer medical school graduates are choosing to go into family medicine and open primary-care practices, data shows, at a time when more than one million Ontarians can't find a family doctor and just as many are set to lose the ones they already have.

Data from the Canadian Resident Matching Service , a not-for-profit organization that matches students with medical training, shows a steady decrease in the number of medical students choosing family medicine as their first choice of practice over the past seven years.

Only 30.7 percent of students in Canada ranked family medicine as their top choice in 2022, down from 31.4 percent in 2021 and 38 percent in 2015. 

What's more, nearly every aspiring family physician is snatched up immediately upon their residency placement, with more than 97 per cent finding a match this year — higher than any other discipline.

Students and researchers who spoke with CBC attribute the problem to a growing negative impression of family medicine, fuelled by what they feel is an endless stream of anecdotes about doctor burnout.

"[The trend is] concerning because that means that we may be graduating fewer family physicians in the coming years, just when we need new family physicians to enter the system," said Dr. Kamila Premji, a family doctor and assistant professor at the University of Ottawa.

Premji has been looking into the age of doctors in Ontario, and her preliminary, non-peer-reviewed data estimates 1.7 million Ontarians will see their family doctor retire by 2025.

In 2019, Statistics Canada data showed 1.3 million patients in Ontario were without a family doctor. Premji estimates that number is now closer to 1.8 million, including roughly 134,000 people in the Ottawa area alone.

"That's a major problem because ... as primary care, you're the foundation of the health-care system. You're the first entry point for the patient," she said. "So we definitely do need more numbers of family physicians."

Starting out slow

For those who've chosen to go into family medicine, some are also hesitant about opening up a new practice, which comes with the additional responsibilities of running a small business.

That includes Dr. Rachelle Beanlands, who's in the second year of her family medicine residency at the University of Ottawa.

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Beanlands originally thought she'd specialize in something like pediatrics. But at medical school she realized she loved the idea of "seeing people grow up from little babies to teenagers, seeing people go through difficult phases in their life and sort of holding their hand."

Still, Beanlands said she's not ready to jump into opening her own practice right away. 

She said it's hard for new graduates to picture themselves managing patients and dealing with administrative burdens like handling rent, payroll and taxes.

Plus, Beanlands said she's watched her older colleagues deal with burnout, and she doesn't want that to happen to her. 

'Increasingly fragmented and inefficient' 

Primary-care providers are largely left on their own, Premji said, with insufficient support to deal with administrative tasks. 

"I think the system has become really increasingly fragmented and inefficient, and that creates extra workload for family physicians," she said.

"[Medical students] are probably seeing that the family doctors that are mentoring them are burning out or are tired and overworked. And it's just not looking appealing."

She also worried about students receiving negative messaging about family practices at the medical school level. 

"[Students] hear that it might not be for smart people to go into family medicine, or it might not be for people who are ambitious," she said. "So it gets sort of a negative impression that way." 

That's what Dr. Ellias Horner heard while he did his medical school training at McGill University in Montreal.

Now specializing in emergency medicine at the University of Ottawa after completing his family medicine residency, Horner said there was a bit of a stigma around family medicine at McGill.

"It's almost like family medicine is that backup. People only go into it because, 'Oh, I wasn't good enough for another, higher specialty service,'" he said. 

That sort of thinking is short-sighted, Horner said, because it fails to appreciate the importance of primary care and the expertise required to be a family doctor. 

Government adding more medical school spots

In March, the Ontario government said it was going to add 160 undergraduate seats and 295 postgraduate positions at medical schools across the province over the next five years.

Queen's University in Kingston, Ont., has committed 20 additional medical school seats in fall 2023 for those wanting to pursue family medicine. 

In April 2022, the province ratified a new three-year agreement with doctors that includes a provision that will allow more family physicians to join family health organizations.

The goal is to allow more doctors to work as part of a team, rather than opening their own solo, fee-for-service practice. The agreement also commits to modernize the Ontario Health Insurance Plan (OHIP) schedule of benefits, which takes into consideration the time and complexity needed for different medical services.

The government has also expanded the number of regional health teams in the province, something it claims will build a more integrated health system.