Family doctors in decline By ANDR� PICARD From Wednesday's Globe and Mail If you think finding a family doctor is difficult today, just wait a few years: Family medicine has become so unpopular that almost one-third of residency positions for future general practitioners are unfilled. New data show that only 24 per cent of medical students chose family medicine for their residency training this year. And many university hospitals failed to fill even half the spots that were allocated to the training of general practitioners, according to numbers published Tuesday in e-CMAJ, the online news service of the Canadian Medical Association. "There appears to have been a complete disengagement from family medicine," said Sandra Banner, executive director of the Canadian Resident Matching Service. Calvin Gutkin, CEO of The College of Family Physicians of Canada, said the data are disturbing and mean big trouble for patients in years to come. "The future of family doctors being available in this country is in jeopardy," he said. Students' disinterest stems from poor working conditions and the "perception that it's become too hard to become a family doc" because the hours are too long and the prestige too low, he said. There's a feeling that GPs are second-class physicians, compared with specialists. Last year, a poll released by the college suggested that 4.5 million Canadians � about 15 per cent of the population � do not have family doctors. In his report, Roy Romanow, chairman of the Commission on the Future of Health Care in Canada, called the situation "absolutely untenable" and said governments must act swiftly to reform primary care. He said timely access to family doctors is a key to sustaining medicare. Medical training takes place in three phases: academic learning, a period of internships in which students train in a number of areas and residency, where students train on the job in a chosen specialty. This year, there are 484 residency-training positions in family medicine, and 139 are unfilled. At the same time, 115 students are "unmatched," meaning they did not get residencies in their chosen fields. Ms. Banner said the unmatched are unlikely to turn to family medicine but likely will seek specialty training in the United States. Danielle Martin, president of the Canadian Federation of Medical Students, told e-CMAJ that the declining interest in family medicine is due principally to the view that it is a second-class career choice. "It all comes back to the perception that this is not a sexy field," she said. Ms. Martin said that lifestyle considerations are also important: Increasingly, GPs cannot necessarily practice where they choose and, because of shortages, often have to work long hours. Specialists, on the other hand, usually can work regular office hours and earn much more money and more respect. However, Ms. Martin, a fourth-year student at the University of Western Ontario, is bucking the trend and will do her residence in family medicine, saying it is a challenging and rewarding field. But she believes that changes have to be made to make family medicine more attractive. "We have to make it affordable for people to make socially responsible choices, and yes, I consider choosing family medicine is socially responsible because our system depends on it," Ms. Martin said. About half of Canadian physicians are specialists, while the balance are general practitioners and family physicians. However, almost two-thirds of requests for residency training are for specialties. According to Statistics Canada, physicians in this country earn an average of $105,200 a year. Specialists earn, on average, 18-per-cent more than generalists � $116,500 versus $98,700. But the top 5 per cent of wage earners, those who bring in $250,000 or more, are almost all specialists in areas such as dermatology and ophthalmology. http://www.globeandmail.com/servlet/story/RTGAM.20030305.wxdocs0305/BNStory/National
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