Family medicine in decline?

In describing the historical demise of family medicine, Walter Rosser1 misses an essential point: at one time there was a large pool of recent graduates in the locum pool. This provided much-needed vacation and education relief for busy family doctors. It also provided an opportunity for medical graduates to expose themselves to a variety of communities and practice styles, something lacking in their “big-city” educations. Many of them (myself included) settled in the communities they first got to know during a locum.

The locum pool has shrunk markedly in the last few decades as medical students are forced to lock into residency programs. I was in the last cohort that was allowed to return to complete a residency after being out in the “real world.” Medical students are now forced to commit themselves to family medicine or specialty training at a stage when they have little experience in clinical medicine. This is a huge disincentive to choose family medicine. It also shows little respect for the experience a family doctor can bring to any specialty.

I hope the task force organized by the College of Family Physicians of Canada will take into account the locum physicians who play such an important role in rural medicine. Unfortunately, they are dispersed and mobile. They have no political voice. But, in many ways, they are the (declining) future of rural medicine.

Bruce D. Woodburn Ophthalmologist Sechelt, BC