Family doctors’ report card says little progress in increasing their ranks

TORONTO — Too little progress has been made in addressing the national shortage of family doctors that has left up to five million Canadians without a primary-care provider, says the College of Family Physicians of Canada.
In a report card released Thursday, the college assigned a “D” grade for Canada’s lack of progress in creating a national strategy for increasing the country’s family medicine workforce.

“It may be a surprise to people to know that in spite of this ongoing shortage of family doctors, we don’t have a plan in Canada,” CFPC president Dr. Ruth Wilson told a Toronto news conference.
“We don’t have a place or a table or a process where government, medical schools, medical organizations such as ourselves sit down and plan together for how we’re going to solve this crisis, or this shortage, that we’ve got.”
“So that’s our plea, that we have an overall Canadian strategy to come to terms with it.”
Last year, the college called on federal, provincial and territorial governments to work with medical groups to create an action plan that would see 95 per cent of Canadians in every community across the country with their own family doctor by 2012.
The organization says a pan-Canadian program is needed to determine how many more family doctors are needed and in which specific communities. Such a plan should also address how to train, recruit and retain primary-care physicians and to decide how many members of other medical specialities are needed in the health-care mix.
“But unfortunately, what has been done in the past is considering plans to make plans,” said president-elect Dr. Sarah Kredentser of Winnipeg. “In other words, there has not actually been a strategy or an infrastructure to co-ordinate all the efforts that are being done by different organizations.”
Some headway has been made in dealing with the shortfall in family doctors at the training level, says the college, which awarded a “B” grade to progress made in encouraging medical students to choose family medicine and in supporting the training of more family-practice residents.
Between 2002 and 2006, there was a 22 per cent increase in spots for medical students in Canada’s 17 medical schools, the CFPC said.
But the group, which represents about two-thirds of the country’s 32,000 family doctors, is calling for further increases.
It wants first-year openings for medical students boosted to 3,000 by 2010 from the current level of about 2,500 and a minimum of 45 per cent of resident positions assigned to family medicine, from the current 39 per cent.
“How to distribute them (new family doctors) and how to get strategies that will encourage them to end up in the right community is a huge part of what a plan has to include,” said Dr. Calvin Gutkin, the college’s executive director and CEO.
Yet how many more family physicians are needed to reach the 2012 target is part of the debate — and even the college admits it doesn’t know.
Gutkin estimates that number at 2,500 to 3,000.
Kredentser said one aspect of a national plan would help “clearly define in what communities there is the greatest need, how many doctors are needed in Belleville, Ontario, how many are needed in Okotoks, Alberta.”
“We don’t know how many people in each community require family physicians and we don’t know what the landscape looks like in terms of how many physicians are available in that community, what types of practice they are practising ... we don’t have all of that information.”
The proportion of residents with a family doctor varies from province to province. A recent survey conducted for the college by Decima Research suggests 92 per cent of Ontarians have their own doctor, while just 76 per cent of Quebecers can make the same claim.
“So there is some information, but it’s certainly not community by community,” Kredentser said.
The college also wants the national plan to include the setting up of community or regional registries for patients seeking a family doctor, to be matched with registries of practising physicians who could take on some new patients over time.
Such registries would help pin down the scope of shortages at the local level, said Wilson of Kingston, Ont., noting that family doctors like herself may be able to take on a few new patients per year as current patients move away or die.