Leading with the good news in family medicine

The last few weeks  have been ones of mixed emotions for those of us who care about the future of family medicine.

Trepidation about what the CaRMS match might bring for programs across the country at this time of difficulty in our discipline. Elation that our program here at the University of Toronto is fully matched even during a period of expansion and will be welcoming 179 first-year family medicine residents to our program in July. Pride in the success achieved by some other family medicine programs, and disappointment for those who saw too many positions go unfilled in the first round. Triumph for all the MD graduates who matched to their first-choice residency program. Relief that family medicine match numbers across Canada seem broadly stable.

And frustration that, as one new DFCM resident put it, “Family medicine is a beautiful specialty that saves lives and is key to healthy communities. It breaks my heart that this is being overshadowed by system failures.”

How do we hold both these things as true – that match rates are stable but still not good enough? That our discipline is struggling, as are the communities we serve; that we are lucky to do meaningful and important work even in the midst of that struggle? Do we want to lead with the good news or the bad news?

The tug-of-war about the narrative in family medicine is hurting us. The discord between those who see our story as one of hardship and those who see it as one of hope is taking a toll on our relationships with each other, and – as balanced perspectives and nuance rarely make headlines – is almost certainly hurting our future prospects, the family doctors who might have been.

It has left many of us asking, should we be manifesting the reality we want, or decrying the current situation in the hope that tough talk will drive system change?

Even better, how might we authentically hold both truths, being honest about the challenges and advocating for much-needed system improvements, while also holding space to celebrate the positives and share the joys of our profession?

This is something we should be adept at. As Risa Freeman, our Vice-Chair Education puts it, “This is what we are trained to do for our patients. We share challenging news with compassion and honesty. We help them navigate uncertainty and nuance. We celebrate the wins, and we acknowledge the setbacks.”

It is more important to be clear about what you are fighting for than what you are fighting against.

Of course, navigating complexity is hard enough in the 1:1 of the exam room. The challenge now is that we are digging deep to do it not just for our patients, but also for our learners, and for the system. We want to be honest about the frustrations of our work while also sharing the many reasons we still want to do it.

If our goal is positive change, then sharing bad news is part of the journey. But as Harvard professor and community organizer Marshall Ganz says, it is more important to be clear about what you are fighting for than what you are fighting against.

I think we have a lot to fight for. Even here in the “ivory tower,” we know that much needs to change in how our health system works, including meeting the legitimate needs of family doctors so we can deliver on the promise of our discipline. But I – and I hope most of us – would make the same choice again when we look back on our own match day.

What are we fighting for? We are fighting for the sacred moments where we sit shoulder-to-shoulder with a family and really make a difference; for the laughter shared among colleagues who are some of the few who truly understand the mysteries of family medicine; for the excitement of a new team member who can help shoulder the work to be done; and for the new resident who is going to do great things. We can fight for the resources that we and our patients deserve while being grateful for the joy we find in our work.

I guess I pick the good news.