A plea from a family medicine resident: We must recognize the changing nature of primary care to prevent an exodus of doctors

As I near the end of my family medicine residency, I am often asked by patients: “What are your plans after graduating?” While seemingly trivial, this question is invariably followed with: “Can you take me and my family members in your practice?”

To some degree, the two questions reflect a growing crisis in B.C. Across the province, almost 1 million people do not have a family doctor. This number is set to further increase as 40 per cent of family doctors in B.C. are expected to retire over the next 10 years.

Though there are sufficient medical students and residents to match the number of retiring physicians, the problem persists as graduates avoid full-service family practice.

Without a primary care provider, the options to access health care become limited, disjointed, and episodic. The longitudinal and preventative model of care disappears, eroding a core tenet to a healthy and robust community.

I am a family practice resident graduating amid this shortage. I grew up in B.C. and I completed my medical training here. Over these years, I have formed a strong connection to the province as my life-long home. I still intend to help address the shortage by providing primary care to B.C.’s  growing population but the circumstances of my residency training have modified these intentions.

Across Canada, most graduating family medicine residents have spent the entirety of their post-graduate training during the COVID-19 pandemic. We entered residency wearing masks and we will be leaving with them on. A failure to prevent and address the scale of this pandemic has left a permanent scar among health-care workers, with many walking away from their jobs suffering from burnout and trauma.

While B.C. cannot withstand another unfettered health crisis that will result in an exodus of health professionals, resident doctors have encountered a concurrent series of climate disasters that have battered the province over the past year. First, a deadly heat wave took the lives of 595 individuals in June, then a record-breaking wildfire season blanketed the province with smoke over the summer months. In November, an atmospheric river flooded B.C.’s Southern Interior, wreaking havoc on infrastructure key to health care supply and services.

Collectively, we witnessed and tended to the multiplying health threats of a warming planet.

To our dismay, the current structure of family medicine has not adapted.

Despite these turbulent years of residency, I remain committed to primary care. However, it is with this commitment that I must reshape my approach to longitudinal and preventative medicine. From the intertwining health emergencies, I have come to understand that primary care extends far beyond the bricks and mortars of a family practice office.

Along with many of my colleagues, I feel deep grief over the loss of lives from B.C.’s climate disasters and diminishing biodiversity. But measures taken provincially and federally have not been proportionate to the urgency of the problem. From our concern, many of us have added climate advocacy in our scope of practice. In addition to our clinical duties, we spend countless hours organizing on Zoom calls and meeting with policymakers and government officials. We are determined because we know that a failure to prevent future health emergencies will further erode our structure of primary care.

Indeed, the evolving nature of primary care has been repeatedly cited as a reason for the growing family-doctor shortage. Not only are patients becoming increasingly complex, but growing health threats also are changing the scope of primary care.

To our dismay, the current structure of family medicine has not adapted. Solutions from B.C.’s provincial government include a commitment to start a new medical school and funding for new urgent and primary care centres. These proposals remain patchwork and do little to address barriers facing graduating family doctors.

In addition to clinical practice, family doctors remain overburdened with administrative work that comes with running an office. Tasks like arranging leases, purchasing medical supplies, and hiring office staff prevent us from seeing patients and draw us away from the advocacy work built into our practice.

Many of my peers and I entered family medicine to provide holistic, longitudinal, and preventative care. But after training under repeated health crises that have harmed our patients on a large scale, we know that primary care has changed. We remain committed to family medicine, but our provincial government must adapt appropriately.

With growing health crises clearly on the horizon, policymakers must work with us and allow us to practice this new scope of primary care.