Adam: Despite doctor shortage, politicians not focusing on health care

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It has been said again and again, but as a trio of recent reports shows, it needs emphasizing once more: the future of family medicine in Ontario and across Canada is getting bleaker and bleaker. And yet governments appear incapable of a solution.

It’s no surprise that the Ontario Medical Association’s section that represents family doctors says Ontario’s latest budget “does nothing to help family doctors stay in their practice.”

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Figures from the Canada Resident Matching Service (CaRMS), which matches medical students with residency programs, reported that this year, many graduating students are rejecting family medicine — and increasingly putting its future in some jeopardy. Apparently, medical students are waking up to the fact that family medicine is not the prized specialty it once was, and want no part of it. Across the country, 252 family medicine spots went unfilled, with 116 of them in Ontario. That’s up from 103 last year. The unclaimed spots would be offered again next month.

According to a 2023 Commonwealth Fund survey on access to primary care in 10 “high-income” countries such as Australia, France and Switzerland, Canada claimed last spot. The survey found that 86 per cent of adult Canadians reported access to primary care, down from 93 per cent in 2016. The Netherlands topped the list with 99 per cent, followed by the United Kingdom and New Zealand each with 97 per cent, and Germany at 96 per cent. In the U.S., 87 per cent reported having access to primary care. The average was 94 per cent. Clearly, Canada has some catching up to do.

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Yet another report on changes in the practice patterns of family doctors, by the Canadian Institute for Health Information (CIHI), revealed that nearly 30 per cent of Canada’s family physicians are working in other specialties, leaving gaps in family care. CIHI also found that family medicine represented 76 per cent of vacant residency positions in 2023, confirming the steady decline in medical student intake in family medicine. All together, the CaRMS data, Commonwealth Fund survey and the CIHI report show that the primary care crisis is real and abiding, and needs urgent government action.

Looking at the raw CaRMS numbers however, the problem is not total rejection of family medicine. According to Kingston family doctor Brent Wolfrom, a former director of Queen’s University’s postgraduate family medicine program, there were 1,700 family medicine spots available this year, of which 252 were not taken. That shows there is still interest in family medicine. But Wolfrom says the problem is that the trend has been going down in family medicine for years, unlike in other specialties.

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Ten years ago, the family medicine intake was 93 per cent. Today, its 85 per cent. He says the numbers speak of “a steady decline in medical student interest in family medicine,” and if that continues, it could undermine primary care, which is the foundation of health care. And, over time, there would not be enough new doctors to replace those who are retiring, or on the verge of retirement.

Wolfrom says young people entering medicine value quality of life, and “work-life balance” is important to them. But as they see the stress and poor environment family doctors currently work in, some are choosing other specialties that offer better quality of life and, often, markedly more money.

Affordability has emerged as the issue to die for among federal politicians, and for good reason. With inflation draining people’s pockets, and something as basic as owning a home becoming increasingly out of reach for the younger generation, life has become difficult for many Canadians. In hard times, pocket-book issues usually win elections. But with reports of people dying in ER waiting rooms, emergency departments closing for lack of staff, 2.3 million people in Ontario and six million across Canada without a family doctor, it is amazing that health care is on the back burner, and that Canadians are not up in arms. Now may be the time for politicians to refocus attention.

After all, what’s a good life without good health care?

Mohammed Adam is an Ottawa journalist and commentator. Reach him at [email protected]

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