Family medicine in Canada : Vision for the future

On November 25, 2004, at a national media conference, the College of Family Physicians of Canada released its position paper Family Medicine in Canada—Vision for the Future. The paper has been shared with our chapters, university departments of family medicine, governments, and sister medical and health care organizations across Canada. It will also be part of an international forum with delegates from Canada, the United States, the United Kingdom, Australia, New Zealand, and the Netherlands that will be looking at the future of family medicine around the world. The complete paper can be found on our website at http://www.cfpc.ca. Some of the key messages follow. Canada is facing a crisis. Timely access to health care services is getting progressively worse for Canadians. The single biggest reason for this is a severe shortage of health professionals, and high on the list of those in short supply are family doctors. More than 4 million Canadians cannot find family physicians to care for them1; those without family doctors are more vulnerable to prolonged wait times throughout the system1 and are less satisfied with the performance of all other health professionals, institutions, and governments.2 Canadians continue to place high value on the role of family physicians. More than two thirds indicate that family physicians are their most important caregivers.3 For family physicians, system support has not kept pace with public support. Because of changes in the health care environment, many family doctors have had to assume greater responsibility for increasingly acute and complex patients, with little health system understanding, acknowledgment, or remuneration for their changing role. Because of increased workloads in practices, their role in medical schools and hospitals has often been undermined. For many, trying to maintain a commitment to comprehensive, continuing care has become a major challenge. For medical students—our physicians of the future—the image of family medicine has been tarnished, and increasing numbers of them are turning their backs on the opportunity to become part of one of the most rewarding and satisfying branches of the medical profession. This must change. Family Medicine in Canada—Vision for the Future presents evidence of limited access, reviews public poll indicators of Canadians’ perceptions and preferences, discusses medical student and resident training challenges, and analyzes many factors related to these issues and opportunities that could be pursued. Among its 126 recommendations are the following. Access to care for patients must include patients’ perspectives, which means measuring wait times from when symptoms are first experienced not from the much later point of a visit to a specialist (specific strategies for promoting access for underserved populations are required). Access to medical care must recognize patients’ needs for personal, comprehensive, continuing care (including public health; illness prevention; and acute, chronic, and palliative care strategies) in a variety of settings. Access for patients must focus on the full continuum of care from family physicians to specialists and to shared care for chronic diseases. Health human resource planning must ensure a sustainable supply of family physicians through a process that promotes family medicine as an attractive choice for students, that accounts for the changing demographics and practice patterns of family physicians, and that provides sufficient family medicine residency positions. Future family physicians should be educated and trained in a system that encourages visible, credible, well supported roles for the discipline of family medicine and family physician teachers and researchers in our medical schools and teaching centres. Family medicine residency programs should produce graduates with the knowledge, skills, and attitudes that will enable them to provide comprehensive continuing care for patients in rural and urban communities across Canada. Innovation and quality in family medicine must be encouraged through support for family medicine research, strategies to transfer new ideas and knowledge into practice, and recognition for family physicians committed to lifelong learning. The value of family physicians must be actively promoted. Family medicine must be recognized as a discipline equal to all specialties in Canada, and the income gap between family physicians and other specialists must be addressed. Our system must support family doctors in their important roles as teachers, researchers, and caregivers for millions of Canadians. It is critical to restore and strengthen the role of Canada’s family physicians if we hope to ensure personal, comprehensive, continuing care for patients and families across Canada. It is equally important to support the new and expanding roles family doctors play as the link between advances in science and technology and day-to-day patient care. Their future role in helping patients understand and appropriately implement medical breakthroughs, along with their responsibility to deal with challenges in public and population health, will be immense. Family Medicine in Canada—Vision for the Future highlights concerns and recommends steps that must be taken by governments, medical schools, and health professionals to ensure that family doctors and family medicine will be the vital force that Canadians want at the centre of their health care system long into the future.

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