Supporting Canada’s family physicians: The public has spoken; is anybody listening?

Canada today is paying the price for decades of poor health human resource planning. The good news in this sad saga is that, after nearly a decade of appeals to governments of all stripes, the cries of our worn-out doctors and nurses finally might have been heard. Of course, they were heard only when the most important voice, that of the people of Canada, joined the chorus. Multiple public polls, Statistics Canada reports, major health care commissions, and the Canada Health Council have reinforced the same message: access to care for many medical concerns is unacceptably poor; wait times for patients are often way too long; and to correct these problems more technicians, pharmacists, nurses, and doctors (especially family doctors) are needed. In its 2005 report,1 the Wait Time Alliance recognized that access to care for patients with any medical problem begins with their seeing a family doctor. More than 80% of Canadians say they prefer access to health care through family physicians,2 and two thirds declare that their family doctors are their most important caregivers.3 Starfield’s research4 shows that access to primary care and to family physicians is vital for better patient and population health outcomes. Yet, in 2003, more than 2.5 million Canadians told Statistics Canada5 and in 2004 five million reported to our Decima survey that they did not have a family physician.2 An estimated 3000 more family doctors are required to meet Canadians’ needs. Our system still does not fully reflect the value both the public and leading researchers attribute to family physicians. While the benefits of new models of care that enhance teamwork among various health professionals and that provide options for remuneration beyond fee-for-service are well worth exploring, what Canadians are saying is actually fairly simple: they want family doctors in the roles in which they have come to know them over the years and want family physician shortages fixed so they can have those doctors back. Both the public and family doctors themselves are, asking for help for the thousands of family physicians who have been providing outstanding personal care for millions of Canadians for years. They see the need for more family doctors to help share the workload (an appropriate mix of skilled Canadian and foreign graduates), for less obstruction to the continuum of care provided by family doctors and other medical specialists, for enhanced support enabling family physicians to work cohesively with skilled family practice and community nurses, and for information systems to improve the sharing of patient information. Neither the public nor family physicians are opposed to change, but they do not want to lose one of the most valued elements of our system: the ongoing relationship between patients and their family doctors. To secure the future of family medicine in Canada, the value the public places on family doctors must be reflected in family physicians’ remuneration. The income gap between family medicine and many other medical specialties is unacceptable. To attract new graduates and to recruit and retain experienced physicians to family medicine, family doctors must be paid more. This increase can and should be accomplished regardless of the payment mechanism: fee-for-service, capitation, salary, or a blend of approaches. Many strategies unfolding across Canada today recognize this reality. Emerging plans offer greater resources to family physicians, including access to information technology and team care, as well as remuneration incentives to better support comprehensive, continuing care. If these resources are maintained and increased further, they will help attract more medical school graduates to careers in family practice; they could also motivate experienced family doctors to remain in practices that offer ongoing broad-based care for patients. In 1999, the Canadian Medical Forum, whose members are the leaders of 9 national medical organizations (including the College of Famiily Physicians of Canada), created a task force to address the physician resource crisis in Canada. It recommended immediate increases in medical school enrolment across the country, which has increased entry classes in medicine from 1500 to more than 2200, heading toward 2500 students. The challenge now is to ensure that, when they graduate, at least 45% of these students select careers in family medicine. Medical schools’ encouragement of this choice and better support for practising family physicians will help to make this happen. In 2001, the Canadian Medical Forum established a second task force, which received support from the Government of Canada to develop a longer-term physician human resource strategy for Canada. This task force’s multidisciplinary national conference in January 2006 achieved consensus that we must do all we can to support and re-energize family practice in Canada. An adequate supply of family doctors was understood to be key to past successes in Canada’s health care and to achieving the best possible outcomes in the future. As new approaches to organizing and delivering health care services are introduced, the voices of the millions of Canadians who are declaring how highly they value having a family physician must be heard. Family doctors can only echo what patients are saying and hope that those responsible for planning the future of our health care system are really listening.

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