If I want to be a GP/Family Physician, how hard is it to get a residency in Canada?

[Prokinetic]

Hello

I am a practicing pharmacist who is looking to go abroad to study medicine.

The schools I am looking at are in AUS or IRE as what many people do as a secondary option away from CAN and US.

I've been hearing from many places about how difficult it is to come back to Canada to practice as residency spots are limited for IMG.

However, I have not yet heard anything about the family practice resdiency.

I am not looking for any other popular specialization but just family physician and I do not mind living in a rural areas like Manitoba.

How hard is it to get a residency in Canada if I want to pursue family practice and is willing to move to a rural area if I were to graduate from Ireland and AUS?

Is it still something of a big risk? Would my chance be higher if I were to finish my residency in IRE/AUS then comeback? Would I need to complete residency in Canada again?

 

Thank you in advance

[MDee2B]

9 hours ago, brackenferns said:

Pharmacists have just opened up a walk-in clinic in Edmonton.

To anyone who still wants to go into primary care family medicine... I don't know what to tell you at this point.

honestly as a pharmacist you might want to just consider staying put and not pursuing medicine altogether  (from what I've been reading recently on this forum! see quote above)

[GH0ST]

What is your motivation? If it's just having a MD behind your name I don't think it's worth it. You're not really thinking of going into a specialty either like surgery... so I don't see how much incremental increase in scope would be worth 6-7 years (4 years of medical school and 2-3 years of FM residency) would be. 

- G

[LoquaciousLoquat]

Don't go back to med school if you're just thinking of being a family physician.

The whole point of getting accepted to med school is so you can access careers still exclusives to MDs (medical specialties, surgery, etc...). Family medicine is not one of them. In fact, NPs already have full scope with family physicians (i.e. they are COMPLETELY equivalent). 

Pharmacists are making rapid advances in expanding their scope. I estimate in 2-3 years they will have full scope with family physicians (i.e. make referrals, order investigations, prescribe everything, etc...). I would definitely stick with being a pharmacist. Family medicine is a dying field. 

Take the money that would've gone towards your med school tuition ($80000 or even more), combine it with your lost income potential over the three years, and voila - you've got yourself a healthy down payment for a house. Or save a part of it, let it compound over decades of your working life, and you'll have easily a million dollars for retirement - which means retiring MUCH earlier than the family physician you would've been.

Oh yeah, did I mention pharmacists will have full scope with family doctors in 2-3 years? You'll basically be doing the EXACT same work.

Avoid family medicine.

[pyridoxal-phosphate]

1 hour ago, brackenferns said:

Don't go back to med school if you're just thinking of being a family physician.

The whole point of getting accepted to med school is so you can access careers still exclusives to MDs (medical specialties, surgery, etc...). Family medicine is not one of them. In fact, NPs already have full scope with family physicians (i.e. they are COMPLETELY equivalent). 

Pharmacists are making rapid advances in expanding their scope. I estimate in 2-3 years they will have full scope with family physicians (i.e. make referrals, order investigations, prescribe everything, etc...). I would definitely stick with being a pharmacist. Family medicine is a dying field. 

Take the money that would've gone towards your med school tuition ($80000 or even more), combine it with your lost income potential over the three years, and voila - you've got yourself a Off healthy down payment for a house. Or save a part of it, let it compound over decades of your working life, and you'll have easily a million dollars for retirement - which means retiring MUCH earlier than the family physician you would've been.

Oh yeah, did I mention pharmacists will have full scope with family doctors in 2-3 years? You'll basically be doing the EXACT same work.

Avoid family medicine.

Off topic here and I apologize in advance to OP. 

I remember you mentioning you were between IM vs FM at one point and chose FM. Would you pick differently now? Or would you avoid both altogether. 

[GH0ST]

2 hours ago, pyridoxal-phosphate said:

Off topic here and I apologize in advance to OP. 

I remember you mentioning you were between IM vs FM at one point and chose FM. Would you pick differently now? Or would you avoid both altogether. 

Let me guess that he/she would... 

I'm sure they might be cool to hang out with but it's clear in many posts that they are pessimistic, borderline derogatory towards FM. 

Look I get it that there's many downsides but take it with a grain of salt... the catastrophizing is hilarious if it wasn't sad. 

- G 

[bearded frog]

21 hours ago, Prokinetic said:

Hello

I am a practicing pharmacist who is looking to go abroad to study medicine.

The schools I am looking at are in AUS or IRE as what many people do as a secondary option away from CAN and US.

I've been hearing from many places about how difficult it is to come back to Canada to practice as residency spots are limited for IMG.

However, I have not yet heard anything about the family practice resdiency.

I am not looking for any other popular specialization but just family physician and I do not mind living in a rural areas like Manitoba.

How hard is it to get a residency in Canada if I want to pursue family practice and is willing to move to a rural area if I were to graduate from Ireland and AUS?

Is it still something of a big risk? Would my chance be higher if I were to finish my residency in IRE/AUS then comeback? Would I need to complete residency in Canada again?

 

Thank you in advance

Ignore the catastrophising above. If you're serious about medicine, go for it. Why are you considering IMG as opposed to Canada/US? The answer might help give you advice.

FM is easiest to get as an IMG, but it's still not a guarantee, and still something of a risk. I had a friend to went to AUS and couldn't get a residency in FM in Canada, now works FM in AUS. I don't know if you can do residency in Ireland unless you're an EU citizen, and the pathway to coming back post-AUS residency.

[LoquaciousLoquat]

19 hours ago, pyridoxal-phosphate said:

I remember you mentioning you were between IM vs FM at one point and chose FM. Would you pick differently now? Or would you avoid both altogether. 

I would absolutely avoid primary care family medicine. IM is generally good. I would also gun harder for a plus one during my family medicine residency as well.

16 hours ago, GH0ST said:

I'm sure they might be cool to hang out with but it's clear in many posts that they are pessimistic, borderline derogatory towards FM. 

Look I get it that there's many downsides but take it with a grain of salt... the catastrophizing is hilarious if it wasn't sad. 

Wait until you practice a few years out as a staff in primary care. Primary care is basically the medicolegal dumping ground of our healthcare system. Your entire practice will be built around specialists (and an increasing number of midlevels and administrators) telling your patients: "You need to followup with your family doctor". There is no joy in the work from a patient facing side either because the vast majority of patients nowadays will come in with an agenda ("You need to do bloodwork my naturopath ordered" "You need to write a letter stating I cannot work with this person" "You need to give me this sleeping pill / benzo / opioid / antibiotic" "You need to refer me to this specialist for this completely benign thing", "You need to see my family members as well when I've only booked one appointment for myself", "You need to sift through 1000 pages of poorly written medical notes because I have no idea what my history is", "You need to address 5 different issues I have in one appointment"). 

You know what happens to a specialist when they get dumped on or get assigned work they don't want to do? "YOU NEED TO FOLLOWUP WITH YOUR FAMILY DOCTOR".

 

[GH0ST]

21 hours ago, brackenferns said:

I would absolutely avoid primary care family medicine. IM is generally good. I would also gun harder for a plus one during my family medicine residency as well.

Wait until you practice a few years out as a staff in primary care. Primary care is basically the medicolegal dumping ground of our healthcare system. Your entire practice will be built around specialists (and an increasing number of midlevels and administrators) telling your patients: "You need to followup with your family doctor". There is no joy in the work from a patient facing side either because the vast majority of patients nowadays will come in with an agenda ("You need to do bloodwork my naturopath ordered" "You need to write a letter stating I cannot work with this person" "You need to give me this sleeping pill / benzo / opioid / antibiotic" "You need to refer me to this specialist for this completely benign thing", "You need to see my family members as well when I've only booked one appointment for myself", "You need to sift through 1000 pages of poorly written medical notes because I have no idea what my history is", "You need to address 5 different issues I have in one appointment"). 

You know what happens to a specialist when they get dumped on or get assigned work they don't want to do? "YOU NEED TO FOLLOWUP WITH YOUR FAMILY DOCTOR".

 

I am practicing now and have been nearly immediately upon finishing FM. In between my PHPM training. I worked most nights and every single weekend except for PARO holidays for the last 1.5 years. I do see those things you are talking about and can see why it's annoying for some people... that said, I personally have no problem spending more time to deal with various issues ... it's called general practitioner for a reason. 

- G 

[LoquaciousLoquat]

On 12/15/2022 at 3:58 AM, GH0ST said:

I am practicing now and have been nearly immediately upon finishing FM. In between my PHPM training. I worked most nights and every single weekend except for PARO holidays for the last 1.5 years. I do see those things you are talking about and can see why it's annoying for some people... that said, I personally have no problem spending more time to deal with various issues ... it's called general practitioner for a reason. 

What I've realized is that being a "generalist" is not something to aspire to. In fact, the main reason (I'd say sole reason) why we have general practice in Canada is to act as a medicolegal buffer / dumping ground for our healthcare system. If one part of our healthcare is strained, family doctors are expected to pick up the slack. Our responsibility is to everyone and for everything.

I've also realized that specializing is not about limiting your scope or being a one-trick pony. In practice, specialization means setting boundaries on your scope of work, which is extremely healthy, and engenders far more respect. Ever wonder why there is simultaneously a huge need for family physicians but also wide-spread disrespect and degradation of our work? It all comes back to the issue that, as generalists, we are never allowed to set boundaries on what we see. The public, midlevels, and policy-makers have caught on to this idea and are fully intending to abuse and misuse our "open-door" policy to the fullest.

What does this mean? It means: more work notes for the greedy employer who expect you to be their in-house occupational physician, more of seeing investigations ordered by chiropractors / naturopaths / clinical pharmacists et al who are using you for their medicolegal coverage, more entitlement from patients who are increasingly expecting everything from their family doctors, more dumping from specialists who have corralled off their area of expertise and are leaving you the scutwork, more fee cuts from the government who sees family physicians as complete pushovers to be openly disrespected and bullied ...

Primary care family medicine is dying. No matter how you look at it. Personally I am already planning an exit strategy and leaving this sinking ship. Maybe you will fare better, but at least realize one previously idealistic family doctor is now completely worn down by the system and looking for an out.

 

[MedZZZ]

1 hour ago, brackenferns said:

What I've realized is that being a "generalist" is not something to aspire to. In fact, the main reason (I'd say sole reason) why we have general practice in Canada is to act as a medicolegal buffer / dumping ground for our healthcare system. If one part of our healthcare is strained, family doctors are expected to pick up the slack. Our responsibility is to everyone and for everything.

I've also realized that specializing is not about limiting your scope or being a one-trick pony. In practice, specialization means setting boundaries on your scope of work, which is extremely healthy, and engenders far more respect. Ever wonder why there is simultaneously a huge need for family physicians but also wide-spread disrespect and degradation of our work? It all comes back to the issue that, as generalists, we are never allowed to set boundaries on what we see. The public, midlevels, and policy-makers have caught on to this idea and are fully intending to abuse and misuse our "open-door" policy to the fullest.

What does this mean? It means: more work notes for the greedy employer who expect you to be their in-house occupational physician, more of seeing investigations ordered by chiropractors / naturopaths / clinical pharmacists et al who are using you for their medicolegal coverage, more entitlement from patients who are increasingly expecting everything from their family doctors, more dumping from specialists who have corralled off their area of expertise and are leaving you the scutwork, more fee cuts from the government who sees family physicians as complete pushovers to be openly disrespected and bullied ...

Primary care family medicine is dying. No matter how you look at it. Personally I am already planning an exit strategy and leaving this sinking ship. Maybe you will fare better, but at least realize one previously idealistic family doctor is now completely worn down by the system and looking for an out.

 

Would you mind sharing what your exit strategies are? Is it doing a second residency or doing other aspects of FM? and how possible is it to do either? I have heard doing a plus in ER is almost impossible after you finish your residency and if you don't have enough elective unfortunately.

[shikimate]

Well the value of longitudinal GP care is often "hidden" and sometimes only clear in hindsight, like the all too familiar story of somebody noticing some symptom but never bothered to seek care and then it's already metastatic. I think the value of GP will still be seen by a select subset of population, who may be more willing to pay or at least respect the value. This is the same as getting your eyes checked or car inspected, there will always be people who don't see value in these things until something happens. I mean mechanics are all too happy to charge you big bucks to fix car problems that should've been dealt with long time ago right?

The specialist world is not all rosy either. Increasing complexity means more and more subspecialization and fellowships and doing locums. Remember they all have opportunity costs too. From my personal observation this was particularly worse pre-COVID but during COVID a lot of old people retired and in some fields opportunities are finally opening up a bit. 

 

[LoquaciousLoquat]

On 12/22/2022 at 1:07 PM, MedZZZ said:

Would you mind sharing what your exit strategies are? Is it doing a second residency or doing other aspects of FM? and how possible is it to do either? I have heard doing a plus in ER is almost impossible after you finish your residency and if you don't have enough elective unfortunately.

Transition to hospitalist work. I had another career before medicine too that I can leverage as well.

On 12/22/2022 at 2:04 PM, shikimate said:

Well the value of longitudinal GP care is often "hidden" and sometimes only clear in hindsight, like the all too familiar story of somebody noticing some symptom but never bothered to seek care and then it's already metastatic. I think the value of GP will still be seen by a select subset of population, who may be more willing to pay or at least respect the value. This is the same as getting your eyes checked or car inspected, there will always be people who don't see value in these things until something happens. I mean mechanics are all too happy to charge you big bucks to fix car problems that should've been dealt with long time ago right?

The issue is not that preventative care is undervalued (which it is); it's that primary care family physicians have zero power in setting boundaries on their work and defending their medicolegal turf.

The soon-to-be-live pharmacists independently diagnosing and treating the "minor ailments" is a perfect example. With one stroke, another profession has completely eliminated a chunk of primary care practice, and family physicians can do absolutely NOTHING about it.

So what will happen if pharmacists then decide HTN / DM / dyslipidemia / osteoporosis / AFib / CHF / COPD / asthma are now "minor ailments" and they will independently screen / diagnose / treat for those conditions as well? (Maybe they already can, it wouldn't surprise me) I'll tell you what's going to happen: family physicians will do nothing. And we will continue to do nothing as more and more of our low-hanging fruits and prestigious / desirable parts of our practice are unilaterally and systemically chopped off and reassigned to every last midlevel. At that point, the only thing we will see are the cases NOBODY else wants to see. But that's not even the worst part - it's that despite it all, we will still remain the MRP and be obligated to manage all the complications, misdiagnoses, and misdirected investigations from all these midlevels practicing independently - all on top of a far more complex and degrading practice environment.

Not what I signed up for. 

 

[lovemedicinesomuch]

On 12/22/2022 at 9:37 AM, brackenferns said:

 

Primary care family medicine is dying. No matter how you look at it. Personally I am already planning an exit strategy and leaving this sinking ship. Maybe you will fare better, but at least realize one previously idealistic family doctor is now completely worn down by the system and looking for an out.

 

 

I am happy that I was able to switch from FM to IM.  However, FM is a great option if you do a +1 ( so you don't have to do the boring clinic work).. For instance, emerg is great. Palliative medicine is also awesome... I have had plenty of friends who matched to EM through FM and they are all so happy.  I know people who do derm-GP and they have really good lifestyle as well..

I have absolutely no regrets about switching to IM, but FM has its advantages - flexibility, good work life balance, jobs anywhere/everywhere.. whereas in IM - being on call 1 in 4 is tiring; there is no work life balance in IM residency; you have to worry about second match... 

[LoquaciousLoquat]

11 hours ago, lovemedicinesomuch said:

I am happy that I was able to switch from FM to IM.  However, FM is a great option if you do a +1 ( so you don't have to do the boring clinic work).. For instance, emerg is great. Palliative medicine is also awesome... I have had plenty of friends who matched to EM through FM and they are all so happy.  I know people who do derm-GP and they have really good lifestyle as well..

I have absolutely no regrets about switching to IM, but FM has its advantages - flexibility, good work life balance, jobs anywhere/everywhere.. whereas in IM - being on call 1 in 4 is tiring; there is no work life balance in IM residency; you have to worry about second match... 

Exactly. FM is great if you can specialize (i.e. set actual boundaries on your work, like what literally every other professional does).

If you are stuck in generalist practice, it is one of the most disrespected, degrading, and underpaid experiences in the entire physician profession. The whole "hidden curriculum" about specialists and allied health dumping on and trashing on family doctors is absolutely true.

I mean why wouldn't you disrespect family doctors? It's not like family doctors in primary care can fight back. It's not like they have any real expertise they can corral off and claim as their own. Our only "leverage" vis-a-vis specialists is..... not sending them referrals, or sending them terrible referrals. The former is a non-existent issue as family physicians will always be undertrained relative to specialists in their area of expertise, so "boycotting" a specialist can never happen (not to mention NPs can also make referrals so the point is moot). For the latter, the specialist can always flat out refuse to see a referral ("this is not my area of focus, please refer elsewhere"), or give an insultingly long wait time (I've seen specialists caustically give a two year wait time for "soft" issues, leading to patient panic and subsequent patient abuse of the primary care family doctor), or make the family doctor jump through hoops like a circus monkey (i.e. to refer, please sign up at our online portal, then please complete these modules on what constitutes an acceptable referral, then please use our individualized form, and please do these tests, and if anything is missing, we will decline the referral, but we will send you the official rejection document several months later and by then the patient's condition has deteriorated, which is still the family doctor's problem because we have not taken over care and you are still the MRP, and when we finally take over care, we will just do a one-off consult, not do any tests or labs to reduce our administrative burden, and advise the family doctor to please start a medication that only we know how to start, titrate it like this, advise patient of these complications, do tests / bloodwork q6months and check for these things, and if something's wrong, let us know, but don't actually let us know because we may take an entire month's vacation PRN, in which case you are still holding the hot potato, but that's okay because you, being a family doctor, are just a medicolegal dumping ground without any way to set boundaries like we can and practice like a real professional, so you have no choice but to take the abuse).

 

 

 

[Synth1]

This is like a self-fulfilling prophecy trying to convince all these premeds not to do primary care. What are provincial health bodies supposed to do if no one will do the work? Allied health obviously. Your bitterness is honestly really tiresome. Going to be pretty happy when you are a hospitalist and every second post isn't you feeling sorry for yourself and trashing on family medicine. Talk about not respecting the profession.. the most disrespectful comments I've seen are coming from you. 

[GH0ST]

4 hours ago, Synth1 said:

This is like a self-fulfilling prophecy trying to convince all these premeds not to do primary care. What are provincial health bodies supposed to do if no one will do the work? Allied health obviously. Your bitterness is honestly really tiresome. Going to be pretty happy when you are a hospitalist and every second post isn't you feeling sorry for yourself and trashing on family medicine. Talk about not respecting the profession.. the most disrespectful comments I've seen are coming from you. 

totally agree ... guys like @brackenferns literally salivate at looking through forums like this to bash on FM. It's hilarious if it wasn't so sad. 

guess what? many people love FM while there's definitely drawbacks, many people love what they do. FM is a great specialty, get over it. 

- G 

[gogogo]

To the premeds and med students: @brackenferns has created a caricature of family medicine and a fairytale of specialization. Don't listen. Yes, there are problems in family medicine, but there are problems across healthcare. We're all burnt out. Specialists are not any happier or more professionally fulfilled. I used to respond, point by point, to @brackenfernsposts, but it's not worth my time now that I'm in residency. Just look at my post history if you want details.

Above all, if you go into family medicine for the right reasons, it's great. Clinic is great. I'm bored as hell when I'm doing off-service and I feel at home in clinic. I enjoy it and the bad parts are acceptable because there's so much about specialization and working in a hospital that frustrate me. There are plenty of family physicians making great money, working normal hours, whose patients love them, and who do good medicine. You can make a massive impact on thousands of people through family medicine. Who cares what specialists think about you? How insecure are you? Patients don't even know some specialties. They think ophthalmologists and optometrists are the same thing. They think dermatologists are basically cosmetologists. They don't know what a pathologist is. Radiologists and radiology techs seem indistinguishable to them. They don't know what internal medicine is. 

Specialization can really suck. I was hearing about a colleague's partner who had specialized through 8 years of post-med school training (won't say which specialization for anonymity). They couldn't find a job even close to any major city in Ontario and had to move 7 hours away. They make 800k-1 million per year...but they're working long hours ~24 days per month, on call every other day (I'm not kidding), including weekends. They've tried to get a job closer to a major city for the past 3 years and haven't been able to. I've met many FM residents who were previously in specialties like general surgery, OB, radiology, etc. They switched into FM and are far happier. Take some time to read posts on other forums from specialists and you'll find that they have the same issues and same annoyances. I mean, someone above said FM is great if you can do EM after...are you kidding me? EM is extremely high on burnout and also has to carry so many failures of the healthcare system on their shoulders. Palliative care is great if you can handle death every day, but I find it a mix between extremely boring (you have maybe 10 medications you typically cycle through), extremely depressing, or extremely frustrating. 

Be confident and choose a specialty that suits you. Ignore the negativity and work towards bettering it, even if just for yourself. Family medicine is extremely important and is the foundation of our healthcare system. Be a good doctor, know how to carry yourself with respect, and you'll have a good career.

[Patellaboy]

I've said this time and time again... medicine really attracts some of the worst people i know. Particularly in Canada, where the competition to get into medical school is so fierce, the field naturally attracts ultra-competitive, egoistical people. 

And not that money should ever be the deciding factor, there are plenty of GPs making 700K+ without ever being on call, fighting for OR time, doing multiple fellowships and useless Masters and PHD degrees to land a job. 

 

[offmychestplease]

4 hours ago, gogogo said:

Who cares what specialists think about you? How insecure are you? Patients don't even know some specialties. They think ophthalmologists and optometrists are the same thing. They think dermatologists are basically cosmetologists. They don't know what a pathologist is. Radiologists and radiology techs seem indistinguishable to them. They don't know what internal medicine is. 

There are so many things wrong with that poster's statements on family medicine, and I'm not gonna spend time on them but this stands out to me the most. A great sign of maturity is not caring about the opinion of others and truly not seeking external validation. Who cares if the random specialist down the street thinks of you? Who cares what the layperson thinks? Why are you so insecure? You would be surprised to find out just how little people actually think about other people's lives.

Did you think that becoming a doctor would somehow give you this all mighty social status and ultimate respect and now you're bitter and insecure because you think being "just a GP" takes away from that? It's honestly really sad and pathetic and screams personal issues and not issues with your profession. 

[offmychestplease]

11 hours ago, Synth1 said:

This is like a self-fulfilling prophecy trying to convince all these premeds not to do primary care. What are provincial health bodies supposed to do if no one will do the work? Allied health obviously. Your bitterness is honestly really tiresome. Going to be pretty happy when you are a hospitalist and every second post isn't you feeling sorry for yourself and trashing on family medicine. Talk about not respecting the profession.. the most disrespectful comments I've seen are coming from you. 

lol it won't end there. If they become a hospitalist just wait for the upcoming posts about how FM-hospitalists are so much more disrespected, underpaid,  and unprepared than IM-hospitalists and how NP's will be taking over all the hospitalist jobs too... this won't end until they can gain security in their self and have personal respect and pride for their work and stop craving external validation. 

[LoquaciousLoquat]

Ah yes, stirred up the proverbial hornet's nest.

It's pretty telling that all these posters who are disagreeing with me are just repeating sophomoric talking points about "insecurity". I went into primary care and family medicine because I wanted to do the job... except after being in full-time practice I'm beginning to notice serious issues with the field. Is calling out the real disrespect to family physicians "being insecure" (which by the way, this disrespect has a REAL impact on my workflow as I receive yet another scutwork dump from a specialist, or some random pharmacist clogging up my inbox informing me "I need to refer this patient for depression")? Should anyone who points out that they are unfairly treated and compensated relative to other people just shut up already because "it's insecure?".

Frankly speaking, I couldn't care less about "prestige". If you disagree with my points, and if it was so easy to debunk, why don't you actually try to challenge the issues I've raised? Instead of.. oh I don't know, falling back on the tired projection of: "you must be insecure to have made these points in the first place, and now that I've delegitimized you as a person I no longer have to address what you've said"

So to all naysayers, please kindly comment on the following points:

1 - Encroachment in primary care is only set to increase in the future, pharmacists are now opening up independent walk-in clinics, NPs have full scope with primary care family physicians (in fact, these NPs are now literally suing for equal pay with the family physicians.) Please offer your opinion on this

2 - Patients are growing far more complex and demanding. Primary care physicians are expected to do far more for less. With the rise of pharmacists / midlevels gradually slicing away "easy issues" (i.e. independently treating the minor ailments), and the administrative burden exponentially rising as every institution / work-place now require a doctor's note / form, we will soon find ourselves doing more complex / laborious work without a proportionate rise in compensation on the horizon. Please comment on this

3 - Specialists are gradually unloading their scutwork on family doctors as their workload has increased as well. If the family physician pushes back or plays chicken, then they lose the valuable referral. Please again, comment on this

4 - Family medicine residency will soon be 3 years... in an environment where we solely needed more family doctors in the pipeline yesterday. Comment please.

... et cetera

I think this thread is a perfect example of shooting the messenger. Family medicine / primary care has long been in decline due to systematic issues. Some anonymous poster on a forum like me won't change any of that.

 

[Synth1]

3 hours ago, brackenferns said:

Ah yes, stirred up the proverbial hornet's nest.

It's pretty telling that all these posters who are disagreeing with me are just repeating sophomoric talking points about "insecurity". I went into primary care and family medicine because I wanted to do the job... except after being in full-time practice I'm beginning to notice serious issues with the field. Is calling out the real disrespect to family physicians "being insecure" (which by the way, this disrespect has a REAL impact on my workflow as I receive yet another scutwork dump from a specialist, or some random pharmacist clogging up my inbox informing me "I need to refer this patient for depression")? Should anyone who points out that they are unfairly treated and compensated relative to other people just shut up already because "it's insecure?".

Frankly speaking, I couldn't care less about "prestige". If you disagree with my points, and if it was so easy to debunk, why don't you actually try to challenge the issues I've raised? Instead of.. oh I don't know, falling back on the tired projection of: "you must be insecure to have made these points in the first place, and now that I've delegitimized you as a person I no longer have to address what you've said"

So to all naysayers, please kindly comment on the following points:

1 - Encroachment in primary care is only set to increase in the future, pharmacists are now opening up independent walk-in clinics, NPs have full scope with primary care family physicians (in fact, these NPs are now literally suing for equal pay with the family physicians.) Please offer your opinion on this

2 - Patients are growing far more complex and demanding. Primary care physicians are expected to do far more for less. With the rise of pharmacists / midlevels gradually slicing away "easy issues" (i.e. independently treating the minor ailments), and the administrative burden exponentially rising as every institution / work-place now require a doctor's note / form, we will soon find ourselves doing more complex / laborious work without a proportionate rise in compensation on the horizon. Please comment on this

3 - Specialists are gradually unloading their scutwork on family doctors as their workload has increased as well. If the family physician pushes back or plays chicken, then they lose the valuable referral. Please again, comment on this

4 - Family medicine residency will soon be 3 years... in an environment where we solely needed more family doctors in the pipeline yesterday. Comment please.

... et cetera

I think this thread is a perfect example of shooting the messenger. Family medicine / primary care has long been in decline due to systematic issues. Some anonymous poster on a forum like me won't change any of that.

 

Here's the thing though, you have voiced your opinion over and over again. It's like you look for any thread even remotely related to family medicine so that you can repeat the same rants and fear mongering. Don't you have anything better to do? Since you asked I will respond to your points though:

1. NPs are not cost effective in primary care (inappropriate test ordering, MRIs etc, specialist referral, less efficient etc etc), and as there is more and more data to support this health authority hiring patterns will change to reflect this. These are salaried positions, and if it's not working they will just stop creating them. That lawsuit is ludicrous by the way, I don't expect it will be successful. The premise is that it is sexist, which might have held weight in the past but there are many, many female physicians now and the fact remains that the training is not equivalent. That's the basis for the difference in pay. The pharmacist thing is also self-limiting. There is medico-legal responsibility for sure, and pharmacists are not trained to be primary care providers. There are limits to what they can do, and there will be legal repercussions if they overstep them. Not everyone has a family doctor to follow up with. The sky is not falling.

2. Complexity, sure. But medicine is getting harder for everyone. Think about specialists/acute care etc that have to navigate providing standard of care when there is no primary care provider to follow up with or specialists, ED doctors etc that have to deal with primary care issues because there is no one else to do it. Or increasing need for fellowships and the opportunity cost that goes along with that. The way bigger issue, and this applies to all of your points, is that there simply are not enough family doctors willing to do this work. You are not helping with that. 

3. If a specialist asks you to follow up, order labs etc. you can just book an appointment and bill for it. NBD. 

4. Not looking to defend a 3 year residency for family medicine, I agree with you.

 

[LoquaciousLoquat]

1 hour ago, Synth1 said:

1. NPs are not cost effective in primary care (inappropriate test ordering, MRIs etc, specialist referral, less efficient etc etc), and as there is more and more data to support this health authority hiring patterns will change to reflect this. These are salaried positions, and if it's not working they will just stop creating them. That lawsuit is ludicrous by the way, I don't expect it will be successful. The premise is that it is sexist, which might have held weight in the past but there are many, many female physicians now and the fact remains that the training is not equivalent. That's the basis for the difference in pay. The pharmacist thing is also self-limiting. There is medico-legal responsibility for sure, and pharmacists are not trained to be primary care providers. There are limits to what they can do, and there will be legal repercussions if they overstep them. Not everyone has a family doctor to follow up with. The sky is not falling.

I agree but that depends on health authorities being rational actors. I'm sure you've heard the news about how nurse practitioners in Newfoundland are paid more than family physicians for a new telehealth initiative. 

Moreover, pharmacist can bill $19.00 for treating the 13 minor ailments (but they will make a bit more with dispensing fees). Meanwhile the equivalent minor assessment A001 code for family physicians is around $24.25, for literally every single "minor assessment" imaginable. So sure, a slight difference. But let's look at virtual codes, for pharmacist treating minor ailments virtually... $15 (according to same source), and for family physicians without a prior physician-patient relationship (i.e. pure walk-ins, which is more 1:1 with the pharmacist situation) doing a phone consult (for literally every ailment imaginable) ... it's also $15. So no difference. (Again, correct me if I'm wrong).

The overarching issue is the government has systemically created the family physician shortage by not paying us our worth. If we were compensated like ophthalmologists the lack of family physicians would be solved overnight. 

1 hour ago, Synth1 said:

2. Complexity, sure. But medicine is getting harder for everyone. Think about specialists/acute care etc that have to navigate providing standard of care when there is no primary care provider to follow up with or specialists, ED doctors etc that have to deal with primary care issues because there is no one else to do it. The way bigger issue, and this applies to all of your points, is that there simply are not enough family doctors willing to do this work. You are not helping with that. 

Your point applies for the specialist consulting without a family physician. But that doesn't change the dynamic I raised where family physicians working with specialists are often expected to shoulder a disproportionate amount of administrative bloat in our healthcare system. Imagine a case where the family physician has to fill out a return-to-work form after a surgeon finishes his/her operation - that sort of thing.

1 hour ago, Synth1 said:

3. If a specialist asks you to follow up, order labs etc. you can just book an appointment and bill for it. NBD. 

Except it decreases access as it takes up an appointment slot. Also increases your administrative burden as now you have to CC the report back to the specialist. Meanwhile your patient is in limbo and may worsen with you still being the MRP. I've seen some pretty terrible cases where patients needlessly suffer because of this delay in care. Really, all because the specialist couldn't be bothered to order labs (i.e. an example where psychiatry suggested ECT but would not do it unless the family physician ordered a bloodwork panel first and faxed it back to psychiatry stating that the patient is medically cleared).

1 hour ago, Synth1 said:

4. Not looking to defend a 3 year residency for family medicine, I agree with you.

Yup! Glad we have this in common.

[Synth1]

I'm not reading anything in your response that justifies telling everyone you can to avoid family medicine at all costs.

Are there problems in our health care system? Absolutely, and it's not just a headache for family doctors. The grass is brown and dried up everywhere. Are family physicians under compensated? Sure, but you can still gross 300-400k pretty easily as a family doctor working full time. I don't care to get in to the nitty gritty of specific fee codes or isolated events such as that Newfoundland thing. And Ophthalmology is about as straw man as you can get. It's no secret they are overpaid relative to other specialists.

Things will continue to evolve, and are definitely not as rosy as they were for prior generations of physicians, but to say that primary care family medicine is over (as you have repeatedly) is alarmist and not based on anything but conjecture. I think many of us would appreciate it if you could fix your broken record.