Governments at all levels must address structural issues in health care if we are to reverse the trend of reduced interest in family medicine as a career, according to unpublished results from a College of Family Physicians of Canada (CFPC) survey.
That we are in a primary care crisis in Canada has been well documented. One third of people living in Quebec, British Columbia and the Atlantic provinces do not have a primary care provider. More than two million Ontarians do not have access to a family doctor. To address the gaps in primary care, new medical schools are set to open in British Columbia, Prince Edward Island and Ontario. Though 213 additional family physician residency positions have been added to current Canadian universities over the past 10 years, it has not been matched by interest from applicants. The percentage of filled family medicine residency positions in the first matching iteration dropped from 93.3 per cent (1,387 out of 1,487) in 2014 to 85.2 per cent (1,449/1,700) in 2024. In 2023, more than 100 residency spots in family medicine were unfilled across Canada after the second iteration. By comparison, other specialties had no more than two spots left unfilled. Simply put, fewer medical school graduates are looking to become family doctors than ever before.
However, despite the concerns of burnout and increased stresses on primary care, many students are still choosing a career in comprehensive family medicine.
The Family Medicine Longitudinal Survey is administered by university training programs on behalf of the CFPC to all incoming and outgoing family medicine residents. In unpublished results from a recent survey we have conducted , incoming residents from the University of Toronto (one of the largest family medicine training programs in the world) identified flexibility for future practice and the desire to form long-term relationships with patients and families as top reasons for choosing family medicine as a career.
Positive exposure to family medicine experiences and role models in medical school were also cited as factors likely to influence their decision. These findings echo previous work describing the importance of role modelling and exposure to varied and welcoming practice settings to students choosing a career in family medicine.
Family physicians play a unique role in patients’ lives, addressing a variety of health concerns, ensuring continuity of care and advocating for patients as they navigate the sometimes unfamiliar and complex health care system. We know that in countries with robust primary care systems, people are healthier, and there is better equity in outcomes at reduced cost.
Nine out of 10 trainees across the country are proud to become family physicians.
Data from thousands of incoming and outgoing trainees across the country over the last five years tells us that the vast majority of graduates (nine out of 10) are proud to become family physicians. A recent cross-sectional survey of the public’s experience of primary care in Canada shows that patients place high value on longstanding relationships with their health-care providers. However, while most family medicine residents report feeling that family medicine is respected by patients, this perception has decreased appreciably, with almost a third of residents now reporting their discipline is undervalued by patients.
Even more striking is that almost two-thirds of family medicine residents in Canada reported feeling that the government does not perceive family medicine as essential to the health-care system. Unpublished 2023 survey data from 150 University of Toronto residents depict primary care infrastructure challenges as the top obstacle in choosing family medicine as a speciality, followed by lesser pay and perceived lower status than specialists.
Family physicians are working in a system that is in crisis: increasingly under-resourced and under-funded while the acuity and complexity of patients continues to rise. Since the COVID-19 pandemic, the prevalence of psychological and medically complex diagnoses has increased, while access to already limited health-care resources has worsened. In addition, the administrative burden on family physicians has dramatically increased. To date, government measures to address these issues have not been adequate, contributing to residents’ perception of feeling undervalued.
While there is much valuable information to be gleaned from residents that have chosen a career in family medicine, it may be even more instructive to understand the declining interest in family medicine by surveying residents who chose a different speciality.
To ensure that we will produce enough family physicians to meet our populations’ needs, we need to take a closer look at factors that influence medical students’ choice both positively and negatively and address them accordingly.
