The University of B.C. will begin in July to train 186 recent medical school graduates to become family physicians, filling all of its available residency spots at a time when there is a severe shortage of primary-care doctors across Canada.
It’s an important milestone because nearly one million British Columbians do not have a family doctor, and those who do fear they may lose their general practitioner to retirement or burn out.
While training positions for new family physicians have increased in Canada, other provinces were unable to fill all their positions — indicating that not enough new doctors across the country are interested in this type of medicine, despite the demand for their services.
In this province, several factors helped UBC attract enough candidates, including the government’s agreeing back in October to improve how family doctors are paid, said Dr. Roger Wong, vice-dean of education in the faculty of medicine. But he cautioned all the efforts being made in B.C. to mitigate the primary-care crisis will not produce instant results, as it will take at least two years for these 186 graduates to complete their training.
“I remain hopeful that the situation will improve in British Columbia. I recognize that it takes time because medical education and training takes time,” Wong said.
The B.C. College of Family Physicians says being a family doctor is challenging because of the administrative demands of running an office, which takes time away from patients, and the “chronic underfunding of proper, comprehensive” health care.
Similar complaints are heard across the country and shed light on the lacklustre recruitment statistics.
The Canadian Resident Matching Service, which matches new med school grads with specialization training, says there were 1,629 family medicine positions available in 2023 across Canada, by far the medical discipline with the highest number of training spaces.
In late April, though, the organization announced it was unable to fill 100 of those spots after doing two placement rounds. And that’s a big blow, given that 6.5 million Canadians don’t have a family doctor or nurse practitioner they see regularly.
Quebec was unable to fill 73 of its family-medicine training positions, and Alberta had 22 openings left, according to data provided to Postmedia by the service. Ontario, New Brunswick and Nova Scotia had a small number of spots left vacant, while B.C., Manitoba and Saskatchewan filled theirs.
Birth-to-death care
Dr. Marisa Levesque is one of the 186 new medical school grads who has chosen to pursue family medicine through UBC. Raised in Vernon, she completed her UBC medical degree in Kelowna and has now been matched with a rural family medicine residency. She will do her first year of training at Kelowna General Hospital and in various family practices in the Okanagan, followed by months-long stints in rural towns in her second year.
While she has heard the criticisms about family medicine, she said she was drawn to the work after doing her medical school rotations with different types of physicians.
“I’ve met a lot of family doctors who really enjoy their careers, so I saw a lot of what’s possible to love about your career in family medicine,” Levesque said. “It’s the breadth of birth-to-death care. I want to be able to be involved in caring for neonates, caring for pediatric populations, for adults, for geriatric populations, to palliative care.”
Since her main experience with doctors, before entering medical school, was visiting family physicians while growing up, it felt natural to pursue this discipline.
“My family doctors were wonderful. I always felt like I could turn to them for anything,” Levesque said. “I found my people doing family medicine rotations. I really felt like I was being welcomed into a team and they were really engaged with teaching and really helping me take ownership of patient care.”
She is happy, though, that the B.C. government has acknowledged some of the challenges that face family doctors. Now, instead of receiving $30 to $40 a visit regardless of the reason for the patient’s illness, they will be paid based on time spent with patients, the complexity of their issues, how many people they see in a day, and the total number of patients attached to their practices.
She also knows there is a desperate need for the work she can do after her two-year training.
“When I tell people I’m going into family medicine, (they say), ‘Well in two years I’ll be your patient.’ Because there are so few people here who have steady access to a family doctor,” Levesque said. “I do hear that a lot.”
UBC has the highest number of family-medicine training positions of any Canadian university, followed by the University of Toronto with 165 and the Université de Montréal with 163. However, right now, it is the only university in B.C. to do this training, compared to Ontario, which has six schools offering a total of 538 spots, and Quebec with four institutions with 514 openings.
B.C. is home to 14 per cent of Canada’s population, but this year funded just 11 per cent of the family medicine training spots in the country. However, this year’s number of 186 training spaces is slightly higher than last year and is expected to grow to more than 210 in 2024, as a result of new money from the province, Wong said.
In addition, the NDP government has promised a new Simon Fraser University medical school in Surrey, but it isn’t expected to open until at least 2026.
So far, family doctors have seemed eager to sign onto B.C.’s new compensation model, said Health Minister Adrian Dix, who insists this primary care crisis is a top priority.
But the opposition parties argue there is even more the government can do: Green Leader Sonia Furstenau has called for more community health centres, while the B.C. United Party insists waiting times at walk-in clinics — some of the longest in Canada — must be vastly reduced.
It is the 10th year in a row that UBC has been able to fill its family doctor residency seats, Wong said.
The “secret sauce” of the school’s success, he said, is the result of initiatives such as early and frequent rotations in family practices, and engaging elders such as Roberta Price to lead the Indigenous family medicine program. Also important, he said, is the 20 family medicine training sites across the province, which include urban, rural, remote and Indigenous communities, where a large cohort of doctors helps to teach these new recruits.
And most of these new doctors who train in B.C. tend to stay here, an important statistic for people hoping to find a family physician in the future. Wong said four of five doctors who did family-medicine training through UBC in the past two decades are still practising in B.C. communities.
Filling these training seats, though, is only part of the solution to the crisis, Wong said.
Other issues include adequately compensating family doctors for their work, which the province has now begun to address, as well as providing better support for the clinicians, which includes professional development resources.
“What we need to remember is that our training of new family doctors on the production side is really helpful, and it’s an important part of the solution, but it’s not the entirety of the solution. There are other factors,” Wong said. “One is how can practising family doctors be adequately supported?”
He compared ending the family-doctor shortage to trying to turn an ocean liner around: It is achievable, but not quick.
“I’m hopeful,” Wong said. “I think the stars are getting aligned and we are course correcting.”
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