Can’t find a family doctor in Alberta? Training more medical students is not the silver bullet

The number of students choosing family medicine is declining in Alberta.

While the increase in medical school spots in Alberta is much needed to support a struggling health-care system, the realities of solving the family medicine crisis are more complex, writes family physicians Lauren Eastman and Samantha Horvey.

Dr. José François, head of the family medicine department at the University of Manitoba, is trying to find ways to attract medical students who want to specialize as family doctors, but he says governments also need to do their part. Karen Pauls, CBC

Lauren Eastman and Samantha Horvey, for CBC Opinion Edmonton April 20, 2023

This opinion piece is by Lauren Eastman and Samantha Horvey, family physicians and assistant professors in the Department of Family Medicine at the University of Alberta. For more information about CBC’s Opinion section, please see the FAQ.

For those one-in-four Albertans who do not have a family doctor, the recent news that the province will create 120 new medical school seats in the next three years sounds like a welcome solution to a struggling health-care system.

While the increase is much needed, the realities of solving the family medicine crisis are more complex.

To understand why increasing medical student spots may not lead to all Albertans having a family physician, it is important to understand the process of becoming a family doctor.

All medical doctors typically complete at least an undergraduate degree (which usually takes four years), then three or four years in medical school.

At the end of medical school, medical students apply to a residency program to choose their specialty, such as orthopedics, obstetrics or family medicine.

After an application and interview process, medical students are able to rank their residency programs of choice and similarly residency programs rank medical students in the order they would like to have them.

Based on the algorithm, medical students cannot be matched into a residency position they do not rank.

This is a Canada-wide matching system called the Canadian Residency Matching System (CaRMS).

About one in four Albertans do not have a family doctor

In Alberta, the number of students choosing family medicine is declining.

In the CaRMS 2022 first-round match, 30 per cent of University of Alberta students matched to family medicine.

A sobering statistic is that the family medicine residency training programs at the University of Alberta and the University of Calgary had 42 empty family medicine residency training spots.

Overall, the University of Alberta has seen a downward trend in students matching to family medicine over the past three years — based on data from 2020, 2021 and 2022 — reaching 21 spots unfilled after the first round of matching this year.

This is despite having one of the best training programs in the country.

Training more medical students does not guarantee these training spots are filled.

While the majority of medical students do not become family doctors, there is a second sobering fact.

Based on research conducted in our department, the majority of those who complete the family medicine training program do not plan on accepting new patients.

A survey conducted in December 2022 showed that only 39 per cent of University of Alberta family medicine graduates intend to accept new patients in their first five years of practice.

Instead, they choose to locum (equivalent of substitute teaching for existing doctors), work in a hospital or work in a focused area of practice, such as dermatology.

The main reasons why current family medicine residents said they do not 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 currently observed 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 end up being family doctors taking on panels of patients in the community in six to seven years.

If these 15 medical students became full-time family doctors and took 1,250 patients under their care, we would only have an additional 18,750 Albertans cared for by a family doctor in six to seven years.

We suspect the main reason in Alberta for fewer medical students choosing family medicine and fewer family medicine graduates intending to take on patients is due to the current environment of primary care in Alberta.

The quarterback of primary care

Family physicians taking on a panel of patients struggle with mountains of paperwork, the cost and maintenance of running a business and being responsible for their patients 24 hours per day, 365 days a year.

Family physicians become the hub, or quarterback, for 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 Albertan deserves a family doctor.

We also believe that a career in family medicine, with the appropriate support, is one of the most rewarding careers in medicine.

We currently work at a clinic where two doctors are retiring and we cannot find replacement physicians for their 2,500 orphaned patients. Who will look after their cancer? Depression? Diabetes?

Every week patients contact our office asking to be taken on by our existing physicians. We are heartbroken that we do not have the capacity to help these people.

We need more family 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 health-care system, it is not a silver bullet for family medicine.

The trajectory for family medicine is particularly worrisome. Alberta needs to significantly increase support for the family doctors who take on patients and care for them over their lifetime.

Critically we also need to entice more physicians to join them. The only way that can be achieved is through primary care reform — and we need it now.

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Lauren Eastman and Samantha Horvey, Freelance contributors

Lauren Eastman and Samantha Horvey are family physicians and assistant professors in the Department of Family Medicine at the University of Alberta.

Source CBC Opinion Edmonton