Canada's new doctors turning backs on family practice

Barbara Sibbald

CMAJ 2000;162:1347

Data from the first iteration of this year's match, completed in mid-March, indicate that 58 of the 445 family medicine residency positions went unfilled. Only 29% of new graduates selected family medicine as their first choice, compared with 32% last year and nearly 35% in 1997.

"One thing is very clear, and it is that the future of Canada's health care system is dependent upon 50% of our physicians in practice being family doctors," said Dr. Calvin Gutkin, executive director of the College of Family Physicians of Canada. He said governments, medical schools and medical leaders must pull together to reverse the trend.

Most medical specialties appeared to fare better this year. Last year, one-third of obstetrical residencies remained unfilled, but only 1 of the 46 positions went vacant this year. Anesthesia also continued to do well; all 60 positions were filled in 2000; in 1998, 15 of 58 spaces were not filled. Only psychiatry appears to be in the doldrums, with 11 of its 76 residency positions left vacant after the first round of the match.

In all, there were 101 residency vacancies left after the 1154 graduates went through the matching process. Eighty percent of students were matched to their top 3 choices, a slight increase over 1999. Of the 65 graduates who weren't matched, 12 are trying to go to the US. (Eighty-six doctors, including 39 graduates of foreign schools, were matched during the second round Mar. 28. Six slots in rural family medicine remained unfilled, and there were 3 unfilled spaces in psychiatry and 1 each in general surgery, general internal medicine, community medicine and general pathology.)

Sandra Banner, executive director of the Canadian Resident Matching Service, said the "serious" number of family medicine vacancies after the first round is probably due to "the radical change in the way family medicine is practised." A family physician shortfall is a sign that these doctors are overworked, and Banner said this has a negative effect on lifestyle. In addition, nearly all the incentives and disincentives for practice location focus on family medicine. Another factor in the declining numbers may be re-entry restrictions that make it very difficult for residents to switch from family medicine to a specialty later in their careers. "These things could be scaring them off," said Banner. Conversely, nearly every specialty has job opportunities galore, and several, including anesthesia and obstetrics, have been actively recruiting residents.

Whatever the cause, "nationally, planners have some thinking to do on policies to address this," said Banner. "This is particularly true now that national groups are calling for a 50-50 split between family medicine and specialties."

Dr. Richard MacLachlan, head of family medicine at Dalhousie, heartily concurs, because 20 of his 44 family medicine residency positions remained empty after the first round of the match. This is partly because Dalhousie is in one of only 2 provinces that have increased the proportion of family medicine positions in its training program. Dalhousie, which had 29 of the positions in 1997, has 44 today.

This year, Dalhousie accounted for about a third of the vacancies in family medicine residencies after the first round, a result that MacLachlan describes as a "disturbing revelation."

Contributing factors include increased workload for family physicians, a growing reluctance to work in rural areas, and lower resident salaries and higher tuition fees on the East Coast. "There's a difference of about $10 000 just for the privilege of coming to Dalhousie," he said.

Saskatchewan was also hit hard, with half of its 22 family medicine position remaining empty after the first iteration. The main deterrent, according to a 1999 survey, is a reluctance to train in Regina, which has no medical school; 9 of the vacant positions are located in that city. Dr. Gill White, head of family medicine at the University of Saskatchewan, says something has to be done quickly given his province's declining number of family physicians. The university is planning to step up recruitment efforts. "The problems we have in this area are tied to problems we have with physician recruitment generally," said White.

The chairs of family medicine across Canada were slated to discuss the issue at the Association of Canadian Medical Colleges meeting in April.

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