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‘Frightening’ shortage of Canadian family doctor residents alarms experts

A record-breaking number of Canadian residents are turning away from family medicine, as hundreds of spots in the national residency program remain vacant.

March data from the Canadian Resident Matching Service showed 268 resident family medicine residency positions remain unfilled across Canada after the first iteration of the 2023 match. Psychiatry residency was second with 23 vacant spots.

In 2019, there were 138 unfilled positions in family medicine and that number has gone up every year.

“What these numbers show us is that family medicine has become a field where we’re seeing fewer and fewer medical students choose to work in family medicine,” said Dr. Mekalai Kumanan, president of the Ontario College of Family Physicians.

Kumanan, who is also a family doctor in Cambridge, Ont., said the vacancy numbers are “disappointing to see,” and only fuel the crisis that family medicine is already experiencing in Canada.

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Around 4.6 million Canadians are without a family doctor, according to a 2019 report by Statistics Canada. In Ontario, 15 per cent of the population is without a family doctor, 2022 research released by Inspire Primary Health Care showed.

“These challenges likely are contributing to family medicine being a less attractive specialty,” Kumanan added.

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There are many reasons for residents’ lack of interest in family medicine and “paperwork burnout” may be top of the list, she said, adding that doctors in this field experience a significant administrative strain.

“Family doctors can spend up to 19 hours per week on administrative work, and it’s often done early in the morning, late at night and on the weekends because it’s after we finish seeing patients that we start doing that paperwork,” she said.

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“This administrative burden is quite significant, and we know can also contribute to burnout.”

A 2022 Canadian Medical Association (CMA) report found that family physicians reported a higher rate of burnout than other medical or surgical specialists. And 62 per cent of family doctors said increased workload and lack of work-life balance negatively affected their mental health.

David Carr, an emergency physician and associate professor at the University Health Network in Toronto, calls the shortage of family physicians in Canada “a really frightening trend.”

“With every year that shortages in family medicine are felt, it means the existing family physicians are having to do more and more. And that leads to increasing burnout and it compounds the problem,” he explained.

“If we don’t fix this, emergency departments will continue to be overcrowded.”

And that’s because many Canadians who do not have access to a primary care provider will use emergency services, whether it’s to renew a prescription or to seek advice on a non-emergency medical ailment, he said.

“We become the de facto family physician of people who really just don’t have access to a family doctor,” Carr added.

John Gallinger, the CEO of the Canadian Resident Matching Service, said although the first iteration of the 2023 resident cycle left hundreds of unfilled family medicine positions, he is hoping the second round fills most of them up.

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Residency matching occurs in two iterations. If a resident isn’t matched in the first round, then there will be an opportunity to be matched with the remaining positions in the second round. The second round takes place Thursday.

Although the number of vacancies is larger than it was last year, he explained that there are also more positions available than in 2022 because “the need for family medicine physicians keeps increasing.”

The second iteration of the resident matching service cycle is critical, he said, because it offers an opportunity for more applicants to consider another round of opportunities, such as family medicine.

“Many, many, many of those unfilled positions in consideration are filled in the second round,” he said, adding that he expects this to happen to family physician positions.

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Although positions may be filled in the second residential match, physicians like Carr worry because it’s not people’s first choice of interest, many residents may end up switching specialties later in their careers.

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“I think for all of us who looked at the results, what was very clear was a real lack of interest and a challenge to match residents into family medicine,” he said.

Carr believes more physicians are needed in family medicine, and to achieve this, there should be ways to incentivize prospective residents and make the field a more attractive field of work.

“We also need to open the doors to foreign family medicine and for American- and European-trained Canadians to be able to come back to fill the needs so we can look after Canadians and provide universal health care,” Carr added.

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