In the 2001 Canadian Resident Matching Service (CaRMS) final match, there were 38 unmatched positions in family medicine. In the 2022,CaRMS R1 (main residency) match, there were 225 unmatched positions in family medicine. While there is a second round of matching to come May 12, it is obvious that fewer and fewer medical graduates want to be family doctors. But why?
These are my opinions and naïve solutions:
First, let’s talk about money. Most medical school graduates have more than $100,000 in debt. Family doctors make an average $330,000 in gross income, spend about $120,000 in office overhead, pay $100,000 in taxes and therefore make about $110,000 in net income. If your monthly home expenses are $10,000/month, then you are already overspending. Remember, this does not include retirement savings (pension) or saving for a house; no holidays or paying off debt. So those numbers do not work. So, if you want to make more, then you need to go for the better paid careers: surgeons or cardiologists.
Naïve solution: All doctors need to be paid within one standard deviation of the average (not a three-times difference) or paid a salary with a pension.
Second, let’s talk about respect. How many specialists talk “down” the value of family doctors? Specialists often ask patients to follow up with their family doctors instead of explaining things or arranging follow-ups for various tests. I’ve often heard from specialists, “Family doctors have time to chat and fill out forms. Best to have your GP do that.” Plus, how many family doctors teach at Canadian medical schools (besides the community placements)? How many pharmacists and nurse practitioners are talking about doing most things that family doctors do? When was the last time family doctors were respected for their exceptional work/ knowledge/ expertise outside of being “primary care practitioners?” Sorry but unconscious bias against family doctors is alive and well.
Naïve solution: We need an equal number of family doctors and specialists teaching at all Canadian medical schools and we need to value each and every member of the MD family.
Finally, let’s admit family medicine is hard. Patients have high expectations (and typically bring their own agendas). It is not easy dealing with multiple comorbidities at one time. There are issues with secondary gain, mental health, compliance, misdirected anger for delays and uncertainty, multiple administrative obstacles (from IT issues to dealing with insurance companies to daily rule changes) and social determinants of health to manage. There is a need to act expeditiously. We don’t have an hour to work through a case (nor does it make financial sense). No wonder family doctors are burning out – and that few want to be family doctors.
Naïve solution: All medical school graduates should be family doctors first for five years after their two years of residency. Then, if they choose, they can train to be specialists.
I mean this article to be provocative. I want you to tear down my opinions and solutions. Let us find a way to make family medicine the first-choice career or calling for more medical school graduates. But at this rate of apathy and neglect, I don’t think it is likely.