Election 2008: where the parties stand — or not

September 23, 2008

OPINION

Dr Martin Bernier President Fédération des médecins residents du Québec

FAMILY MEDICINE HAS TO THINK BIG

Family medicine—the primary care specialty—is in crisis. The persistent shortage of family physicians, confirmed in a recent study by Dr Marie-Dominique Beaulieu, holder of the Sadok Besrour Chair at the University of Montreal, is proof positive of this. Lack of interest from medical students, specialization in narrow niches within the discipline, practice focussing on hospital and emergency care rather than patient management and continuity of care—this rapidly evolving medical practice is being comprehensively challenged.

Family physicians fulfil a unique responsibility within our health system, of which they are the linchpin. In that context, the fact that residency positions in family medicine are unfilled concerns us all. The lack of interest being seen in family medicine is not restricted to Quebec. The solution to the problem will therefore take more than just a few cosmetic adjustments, and will require taking a good look at some of the foundations of how we train our doctors.

Many students starting out in medicine who had mentioned wanting to become family physicians have subsequently chosen another discipline. So what is turning off our candidates so strongly?

There is certainly an intimidating aspect to the breadth of knowledge involved in family medicine. This may be enough to put a number of people off, and may prompt others to seek to specialize within family medicine—in emergency or hospital practice, for instance. There will likely need to be some consideration given to the structure of our medicine courses. Is family medicine adequately represented? In a curriculum with a strong specialist presence, do we have enough teachers from family medicine who are likely to act as role models for students?

It is also time for a reality check on specific medical activities (AMPs), which favour delivery of care in hospital settings, to the detriment of practice in private offices, and have meant greater numbers of new family physicians have chosen hospital practice. The requirement to perform at least 12 hours a week of AMPs in an establishment, a contribution actually rising in many cases to 25 hours, considerably reduces the attractiveness of a practice involving management of patients in the community.

In meeting these challenges, we will be fighting the stigmatization of family medicine. They are not “just” family doctors. Often it is family physicians who establish the initial diagnosis, inform and educate patients, find them a specialist physician when necessary, and provide patient management and follow-up on patients’ episodes of care. And between 500,000 and 800,000 Quebecers today have no family doctor. Family physicians do far more than just refer patients to other medical disciplines, they are also a benchmark with respect to overall health.

Where is the solution to this lack of interest in family medicine to be found? Certainly not in resorting to further coercive measures. Existing measures have already generated their share of negative impacts, even though they were instituted in a just cause. When restrictive measures are implemented, doctors feel to lose their autonomy in managing their practice and their patients, and end up losing all interest in the major issues. We will have a better chance of resolving problems if we invite family doctors to work on making their profession more attractive and introducing measures better suited to the practice of that discipline. The unique nature of family medicine and the primary care specialists who practise it has to be recognized. Let us build on our family physicians’ experience and avoid constantly wielding a heavy stick.

FOR INFORMATION, PLEASE CONTACT

Johanne Carrier Fédération des médecins résidents du Québec 630, Sherbrooke Street West, Suite 510 Montreal (Quebec) H3A 1E4 514 282-0256 or 1 800 465-0215 Johanne.carrier@fmrq.qc.ca

Conflict of Interest:

none