Amid shortages of family doctors across Canada, med school grads increasingly don’t want the jobs

More family-doctor jobs for new medical school grads have gone unfilled than ever before in this year’s initial round of hiring, new data shows.

The numbers indicate that fewer graduates are choosing family medicine as a discipline, despite family-doctor shortages across the country. It’s a situation that’s causing the College of Family Physicians Canada to suggest that the country’s family-doctor shortages should not be attributed solely to large numbers of retiring physicians, but also to structural problems that may be determining new grads from entering the discipline.

“(Family medicine) is a fantastic specialty, but there are pressures on it right now where it’s less attractive to medical students,” says Dr. Brady Bouchard, president of the College of Family Physicians of Canada.

“Medical students are able to see the growing burdens on family physicians throughout their schooling and, I suspect, are choosing accordingly.”

Data about 2022 hiring comes from the Canadian Resident Matching Service (CaRMS), the tool used by graduating medical students in Canada to get their first jobs out of medical school, which are called residency positions.

Over the past five years, more and more family-medicine residencies have gone unfilled after the annual initial hiring in April. In 2017, the number of unfilled positions jumped to a high of 151 from 97 positions the year before.

That figure is higher still in 2022, with 225 family-doctor positions unfilled after the first round of hiring in April. The number of vacant positions is especially acute in certain areas, such as Hamilton, where there are 12 vacant positions at McMaster University; Edmonton, where there are 16 vacant positions at the University of Alberta; and London, Ont., where there are 10 vacant positions at Western University.

A total of 1,569 family-medicine positions were available in 2022, compared to 1,561 in 2021. That means 14 per cent of family medicine positions went unfilled in the first round of hiring this year.

Many of these positions, though it is unclear exactly how many, will be filled in a second round of hiring that finishes in May.

What the numbers so far show is that fewer graduating medical students appear to be choosing the discipline of family medicine as their first choice, compared to others such as surgery, emergency medicine and internal medicine.

The first round of CaRMS hiring also left many graduating medical students without residency positions at all. Santanna Hernandez, president of the Canadian Federation of Medical Students, wrote in a statement that she found the 2022 match results to be a “slap in the face” for med-student representatives who have been working with provinces and universities to help ensure graduating students get hired into the residency positions they need to start practising.

“While the number of unmatched grads in the first iteration data is not public, the number is vast, and the stories we are hearing from students is disheartening,” she wrote. “There continues to be systemic barriers that disadvantage many students across the country.”

And access to family doctors is a problem for a large portion of the country. According to a Statistics Canada report, 4.6 million people over the age of 12 did not have a regular family doctor in 2019.

Langford, BC’s Camille Currie and her family — husband Shawn and children Aidan and Mila — lost their family doctor in January after that physician decided to move to the United States. The Currie family has multiple medical complications, including a rare autoinflammatory disease shared by Shawn and the two children.

“My children would not be on the path to living a healthier, better life if we did not have a family physician watching and monitoring them throughout the years,” Currie said. “There aren’t the words to truly express the importance of the family doctor.”

Currie said her family has not yet found a replacement family doctor, and that now when they go into walk-in clinics or urgent care centres, they have the added stress of having to recount their entire complicated medical histories to someone new — a burden that could come with “dire consequences” for their care.

Trend lines from CaRMS confirm that although the total number of medical school graduates applying for residency positions in Canada has risen over the past 10 years, the number selecting family medicine as a first choice has remained relatively steady over the same period of time.

This comes as no surprise to Bouchard, the College of Family Physicians president.

“The trend is a gradual decrease over time. And I think for most family physicians that would be an intuitive trend,” Bouchard told the Star. “There’s a trend to having family practice not really being a sustainable, healthy profession for a number of different reasons.”

The main reason that Bouchard hears from both new family doctors and long-practicing ones is the most common payment model in Canada, in which doctors receive a flat rate per patient visit, regardless of how much time is spent with them or how serious the problem is.

That flat rate varies by province, and some provinces also offer alternative payment models such as salaries or capitation, the latter (in which doctors are paid based on the number of patients in their roster) being a common model in Ontario. But in places such as British Columbia, the flat rate — about $30 — does not change no matter where the doctor is located or how much their other expenses, such as office space, cost.

“It’s not sustainable. It’s akin to running a business where you’re unable to change prices,” Bouchard said. “This newer generation of family physicians, we realize that the government’s paid a lot of money to train us and we want to work at the top of our scope most efficiently.”

He said new graduates realize that if they open a family practice, much of their time will be spent on paperwork and hiring staff, rather than seeing patients, and they will have to sustain their practice with rigid fee-for-service payments.

Bouchard wants to see provincial governments fund more salaried family-medicine roles, and clinic models that include multiple disciplines of health-care providers, such as nurses, nutritionists and physiotherapists.

Opposition parties hammered the governing BC NDP party over the issue of the doctor shortage Monday in the province, prompting an exchange that became so heated the Speaker called a recess to give everyone time to cool down.

Some provinces have started planning these alternative clinic models, but they are not in widespread use across Canada.

Currie and her family, since losing their family doctor, have learned more about the pay models for doctors and started an advocacy organization called BC Health Care Matters that calls for more consistent and better pay for family physicians.

She said she has learned that her family’s hardships are shared with the family doctors they need, and that what is needed is for the government to provide the doctors are valued.

“I’ve heard from different levels of doctors and heard that they really appreciate the support coming from citizens,” she said. “It doesn’t surprise me that family medicine has become a less desirable choice for new graduates. It does really scare me, though.”

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