Saturday, October 25, 2008

Family medicine training is not a cure-all.

Now that the election campaign is finally over, I have been inspired by this blog to vent about a most ridiculous and preposterous element in the NDP platform regarding improvements to the health care system.

Train substantially more health care professionals – including more doctors, nurses, nurse practitioners and midwives – to ease staffing shortages and cut wait times. We will work with the provinces and territories to make it happen:

• We will implement a program designed to increase the number of doctors and nurses trained in Canada by 50%. As part of that program, we will offer to forgive the student loans of health professionals who commit to dedicate the first ten years of their careers to family medicine.

Everything described in that goal, up to the last sentence, seems sensible and doable. But the last point can't be implemented without a significant transformation of the way physicians are currently trained.
In their fourth year as medical students complete their studies, they must choose a specialty and apply to become a resident. This is a de facto requirement for physicians to practice in Canada after they graduate from any Faculty of Medicine.
Family medicine is a specialty and requires a minimum of 2 years in residence. Thus a physician who chooses to become a family doctor will be approaching 40 years of age after completing a commitment to this specialty. The challenge at this moment is that the training program is not currently designed to accommodate physicians who drop one specialty and then apply to become a resident in another. In effect, physicians who commit to family medicine are likely to be stuck in that specialty for the rest of their professional career.
That in itself should not be a deterrent except for the reality that doctors dedicated to this specialty earn 1/2 to 2/3 less than their colleagues who have completed 2-4 years more in residence, in a different specialty. Yet they often work harder, with a greater likelihood of burning out and that is a tremendous loss, given that they provide primary health care.
Here are a few ideas. Provide incentives to nurse practitioners and family doctors to set up offices together. Change the billing system so they are paid a basic salary, based on a minimum and maximum of patients' visits. Change the restrictive family doctor specialty to something more interdisciplinary. In Québec, there is a field of general medicine whose physicians are called 'une omnipraticienne' or 'un omnipraticien'. Encourage Faculties of Medicine to develop residencies and continuing education programs that allow physicians to study and master an additional specialty. Thus, if doctors leave family medicine after a ten year commitment, they will be able to complete the educational and practical requirements of another specialty field of medical science.

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