Our family medicine crisis

Many of the reasons for students' reduced interest in family medicine programs1^,2 are related to regulations introduced in 1993 that extended the training period to 2 years. This all but eliminated any chance that practising family physicians had to enter specialty training programs. However, interest in family practice was dwindling even before that. In the early 1990s, family medicine instructors began to realize that perhaps as few as 50% of their graduates would eventually enter or remain in that field of practice.

Colin Stevenson's conscientious concerns1 suggest that he would be an excellent family physician. His worries relating to the 1993 regulations are justified, but many of his other concerns are not — I hope his views are not universal among medical students. Expectations that physicians will remain in the same community forever have vanished. Today many practices are latch-key operations: staff are paid to run practices, there is no shortage of patients and, consequently, there are no financial worries. Most small communities have strong CME programs and provide opportunities to attend courses.

Today, research is possible in any community, and in smaller ones physicians are willing to cooperate and share in difficult decisions. Stevenson was also concerned about living in an isolated community; when the Ontario Ministry of Health and Long-Term Care released its list of underserviced areas earlier this year, there were 485 positions available, and approximately half of them were within an hour's drive of either a medical school or the Windsor–Detroit area.

In view of the decreased interest in family medicine and increasing shortages of family physicians in communities outside of teaching centres, these 2 letters1^,2 should serve as the catalyst for the formation of a national committee to identify the causes of these trends and make recommendations to solve the problem.

Will anyone listen to Colin Stevenson and Gillian Hamilton?1^,2