Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Analysis

Increasing interest in family medicine

Vishal Avinashi and Elizabeth Shouldice
CMAJ March 14, 2006 174 (6) 761-762; DOI: https://doi.org/10.1503/cmaj.050752
Vishal Avinashi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elizabeth Shouldice
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading
Submit a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
References
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Minimum 7 characters.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'. Minimum 12 characters.
Your organization, institution's or residential address.
Statement of Competing Interests

Vertical Tabs

Jump to comment:

  • Future of health care in Canada
    Jan O Sundin
    Posted on: 28 March 2006
  • Posted on: (28 March 2006)
    Future of health care in Canada
    • Jan O Sundin

    Is high-quality and sustainable health care in Canada depending on family physicians?1 I don’t think so. Among many other factors, it will depend on each medical speciality doing its part. It is certainly time to stop “the idea that family physicians play a secondary role to other specialists”, as family medicine is a speciality in its own right and should be appropriately remunerated.

    It is also time to stop...

    Show More

    Is high-quality and sustainable health care in Canada depending on family physicians?1 I don’t think so. Among many other factors, it will depend on each medical speciality doing its part. It is certainly time to stop “the idea that family physicians play a secondary role to other specialists”, as family medicine is a speciality in its own right and should be appropriately remunerated.

    It is also time to stop the idea of the family physician being the gatekeeper to access specialist care. With the public’s easy access to health care information today, many people know when they need an appointment with a specialist. They should not have to go through a family physician to get that. Also, specialists doing long-term follow-up of serious diseases, one example being annual follow up of breast cancer patients, but even when they see a patient for the first time, should not have to have a referral from a family physician in order to be paid a specialist fee. This only increases the cost for the health care system and the workload for the referring physician.

    The loss of the rotating internship in 1993 plays a large role in today’s situation. My voice was not strong enough at the Annual Meeting of the Medical Licencing Authorities of Canada when this change was decided. As a result of this change three serious problems have arisen: : The first is that medical students now must select their future speciality training before they have had any exposure to the various specialities they may choose, and then as a result easily make the wrong choice. The second problem is that PGY-1 does not follow the academic year and therefore makes it impossible to change stream after 12 months. The third problem is to get into further speciality training after you have open your medical practice. One time it was impossible, there are now only a very few openings to somewhat alleviate this problem.

    The reason why students from poor neighbourhoods are seven times less likely to enter medical schools is not only a matter of cost, but also a fault of the admission system for medical schools. Applicants can polish their application2 by doing community work abroad, a travel experience that only children of well-off parents can have, and get extra attention on the admission list. Community work in a poor Canadian neighbourhood, which certainly is more valuable for a future family physician, is not valued as equally high.

    Also health care terms need to be more defined. What does “high quality health care” means? Currently it seems to mean whatever you want it to. I remember at one time it meant to get “the correct diagnose and the correct treatment at the right time”. I think this definition is sufficient and should still stand. Inclusion of cost or other financial considerations now seem to play a prominent role, although they do not belong in the definition of quality. The assessments of both quality and cost-effectiveness, the latter being a political and very subjective factor, may still be necessary which has so elegantly been described by Phil McFarlane.3

    What is rural medicine? The term is very much liked by family physicians and their interest groups. Is every community of less than 10,000 people a rural region? Let us say that a triangular area in Canada has three towns about 15 km apart, each with less than 10,000 people, but with a total population of 20,000 people within that triangle. In one corner there is a hospital with several specialities serving 60,000 people. Is this an area where family physicians should practise “rural medicine”? I don’t think so. This should be called a semi-urban area and the public will not stand for any lower quality of care or less high-tech equipment than there would be offered in a city, nor should they. I don’t think that there is any need for a family physician working within 100 km, or 60 minutes of ambulance transport time, from a hospital with secondary care to practise rural medicine. With this definition of ‘semi-urban’, hardly any physicians in the three Maritime provinces, or very few in Canada for that matter, have to practice true rural medicine because most practise within the parameters of a semi-urban area.

    Further no newly-graduated family physician today has had enough exposure to family medicine to be able to practise rural medicine.1 The romantic view, however, still seems to stick with some young physicians that it is OK to go out and to do everything: deliver babies; do minor surgery; look after acute abdomen in a small community hospital without the technical equipment necessary to practise up to date acute medicine. If somebody is going into true rural medicine, they would require a year or two of more clinical training.

    Is there a lack of family physicians in our country, or can the health care system and the family physicians’ training and role be reformed to make better use of their skills? Having grown up and worked as a physician in a country where the nurse practitioner was the backbone of primary medicine, it is difficult to understand why the training of this group of nurses has not taken off in Canada. These highly-trained nurses can work independently, but in close cooperation with family physicians, and the amount of work that they can relieve the physicians of, is amazing. There are examples in Canada of how the number of trips to the family physicians in an area served by a nurse practitioner have drastically decreased. The trend now seems to be to inappropriately utilize this group of nurses, whose main education should be in independent clinical work. Instead they are hired as research assistants; as helper in a physician’s office; or employed in hospitals. This type of work can equally well be dona by an RN or an LPN. To use a nurse practitioner this way is a waste of their training.

    So where does the family physician fit in, in today’s changing health care system? I think there should be less emphasis on acute care, especially care needing hospital resources. Small community hospitals should no longer try to offer in-hospital acute care or surgery under general anaesthetic. These hospitals should be transformed into hospitals run by family physicians for long-term care; certain types of rehabilitation; and continuation of care after the acute phase of specialist care is over. This will help decrease the pressure for acute care beds in larger hospitals. Various types of community care, public health, and preventive health are also areas not well served. I am sure that the family physicians ,themselves, have a long list of needed services which they currently cannot meet.

    So where do we go from here? It is not acceptable any longer to continue to funnel more money into doing the same thing, in the same way. We will never have the ability, nor the funds, to build enough hospital beds or to train enough physicians. The more resources we have, the lower the bar will be lowered for the public to request these resources. There has to be a new way of thinking, a new paradigm. Look outside Canada and find out what other countries have been doing to solve the same problems in their health care system that we, and all developed countries, currently have.

    References 1. Avinashi, V, Shouldice, E. Increasing interest in family medicine. CMAJ 2006;174;(6);761-2 2. Johnston, S. Medical training in Canada. CJRM 2005;10(3);183 3.. McFarlane, P. Not all guidelines are created equal. CMAJ 2006;174;(6); 814

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 174 (6)
CMAJ
Vol. 174, Issue 6
14 Mar 2006
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Increasing interest in family medicine
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Increasing interest in family medicine
Vishal Avinashi, Elizabeth Shouldice
CMAJ Mar 2006, 174 (6) 761-762; DOI: 10.1503/cmaj.050752

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Increasing interest in family medicine
Vishal Avinashi, Elizabeth Shouldice
CMAJ Mar 2006, 174 (6) 761-762; DOI: 10.1503/cmaj.050752
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • REFERENCES
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights of this issue
  • Dans ce numéro
  • PubMed
  • Google Scholar

Cited By...

  • Is Canadian women's breast cancer screening behaviour associated with having a family doctor?
  • Google Scholar

More in this TOC Section

  • Managing conflicts of interest in the development of health guidelines
  • COVID-19 in long-term care homes in Ontario and British Columbia
  • Canadian federal–provincial/territorial funding of universal health care: fraught history, uncertain future
Show more Analysis

Similar Articles

Collections

  • Topics
    • Medical education, residency, internship
    • Medical careers

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire