This is something I hear often and consistently, everywhere I go across Canada. Plenty has been written and been in the news regarding the shortage of Family Physicians and impending crisis in primary healthcare. I see the impacts on patients daily. There are those who present to the Emergency Department because there is no one to manage screening or follow up when they don’t have a family physician, or they see specialists for issues that often would be managed by a family doctor, or they are discharged from the hospital with no one to follow up on their care. There is no one to quarterback and triage their health concerns and things slip through the cracks. When patients are seen in the Emergency Department or by specialists unnecessarily, or they end up hospitalized in part because they couldn’t access primary care, it costs the system more and creates additional backlog. It is frustrating for patients and doctors alike.

Many ask if privatization, such as in the US, is the answer. I repeatedly answer that all the data we have tell us the American system costs the most per capita with poor accessibility and equal or worse outcomes. Sure, private systems can serve the wealthy well – but what about everyone else? Someone I know in California was recently telling me about his ankle surgery and how when he got the bill, it was only about $5000. That’s not bad, I thought – thinking this was what the hospital billed the insurance company. However, that was what he had to pay out of pocket, despite having good health coverage.

As a former Management consultant and someone who studied job design, selection, training and strategic human resources, I frequently think about the macro level challenges in our health care system. Family members, friends and people I just met, will ask me what I think the issues are, and often assume that there just aren’t enough Family Physicians. This is certainly partly the case, however there are so many other contributing factors. There’s the chronic underfunding of healthcare in Canada, the continually increasing administrative burden on Family Physicians, the lack of integrated health data within health regions, provinces and across the country, inefficient processes, and tasks for which there is no compensation. There are additional hurdles such as learning to run a business, choosing an appropriate billing / compensation model in your province, hiring staff, selecting and licensing software and data management, sourcing equipment and PPE and then the added challenge the last few years of navigating this during a pandemic and global supply shortages. Of course, many physicians also graduate with a tonne of debt and must learn to plan for retirement, get their own health insurance and benefits, and save for rainy days. Many people don’t realize that most physicians in Canada aren’t salaried and don’t get pensions and benefits like people in government and corporate jobs.

Some learners come to med school from other careers and backgrounds but most physicians have never had careers before medicine. Learning how to run a business, manage IT and process issues, human resources, and interpret complex compensation models and get the most of billing codes is not something taught in medical school or residency. Having to take all of these things on as you transition to independent practice, is quite daunting for many new graduates.

To avoid this, some choose initially or longer term to locum and cover vacations, maternity leaves, etc. This can be a great option, but often it pays less. Options to locum are also somewhat limited by licensing, given physicians must apply for licensing in each province and territory where they wish to practice. This is typically a lengthy and expensive process, thereby decreasing mobility and flexibility of physicians. Although there are discussions happening about pan-Canadian licensure and integrated health data, I feel we are probably much further from achieving these goals than many of us would like.

Then of course, there’s the job of the family doctor and how practice and scope can vary drastically depending on the type of practice one wants to have, the location, size of the centre, and supporting resources around. Despite the job looking very different in various communities, the approach around how best to train a family physician is in many ways still a ‘one size fits all.’ This latter point is a much bigger discussion, one I’ll likely share more thoughts on down the line.

As I approach the finish line of training and get ready for independent practice, there are a few main themes for me. One, training in smaller centres has enabled me to learn, see, and do things I might not have had the opportunity to do by staying in a large centre like Calgary. Two, I’m grateful to be graduating at a time when Family Physicians really are needed everywhere. Three, I’m thankful I already have some experience running a business and doing some of the other things required. And four, I have some cautious optimism that issues I’ve described here are being addressed, while I simultaneously mentally prepare for many to linger.

Of course, being a Family Physician can be tremendously rewarding with an opportunity to make a substantial difference in some patients’ lives. And in some billing and practice models, primary care physicians can be quite well compensated.

I’m on my fifth year of having left my consulting career to go into medicine. I frequently get asked if it was worth it. As I prepare for another 24-hour call shift this weekend, for now, I’ll continue to respond: “I hope so. . .” (sometimes followed by,”if not. . .I can always go back to consulting” – in the unlikely event that a complete reversal is required).