Family doctors are scarce.
According to Statistics Canada, in 2013 more than 15 per cent of Canadians or approximately 4.6 million people reported they did not have a regular medical doctor.
Dr. Dean Brown, North Shore Director of the UBC Coastal Family Practice Residency, says there is a shortage of family physicians as there's something of a shortage of physicians across the board.
"I guess everyone knows about how hard it is to find a family doc these days," says Brown. "If you don't have one already, it can be a bit of a challenge."
UBC Family Medicine Residency is hoping to curb the shortage with a new program on the North Shore called Coastal Family Practice Residency, which aims to entice medical students into family medicine, or general practice.
"Family Practice Residency is a two-year program that happens all across B.C. in order to take a young doctor who's just graduated from medical school and turn them into a proper family physician," says Brown. "They've just got their MD degree and do two full years of training to take them to the point of being able to be licensed in the province to actually practise in family medicine."
The program, which has eight residents each year, was started by a group of physicians from the North Shore, Pemberton, Whistler, Squamish, Sunshine Coast and Powell River.
Brown says the program is important not only because it addresses the need for family physicians, but also because of the enhanced partnership with some rural coastal-area communities.
"The hope is to (firstly), get them additional experience and practice in working in those communities because they're wonderful primary care learning environments," says Brown. "Secondly, by practising there they may have a chance and an opportunity to put down roots in those communities and end up working there."
Brown says it could meet the need for more doctors in rural communities, which have an even greater need than urban centres.
The Society of Rural Physicians of Canada reports that towns with a population of less than 10,000 account for around 22 per cent of the nation's population but are served by approximately 10 per cent of physicians. Canada's larger rural and regional centres with populations between 10,000 and 100,000 make up almost 16 per cent of the population and have less than 12 per cent of the nation's physicians.
"When the program is fully up and running a little over a year from now, there'll be 16 residents running around in first and second year," he says, adding that most of the physicians' time throughout the two years will be spent on the North Shore as well as a significant portion in the rural communities.
"Of that time that they spend in the two years, 50 per cent of it needs to be in a family practice office, so basically one year out of the two years they'll spend in family doc offices both on the North Shore and in the rural communities," he says. "The other essentially year of the time they'll spend mostly around Lions Gate Hospital and on the wards and in the emergency department and so on, gaining experience in the hospital environment."
Phillip Simpson is a firstyear resident participating in the program. He says he wanted to become a family physician for a number of reasons, including his father.
"I was inspired by my dad," says Simpson. "He was a family doc for 40 years and a big source of inspiration for me."
Simpson was born and grew up in Kamloops and spent almost a decade in Vancouver. He attended Sydney Medical School at the University of Sydney in Australia and is one of four international graduates in the program.
"I love medicine itself, I love that you get to develop relationships with people over a course of their lifetime and really get to know them well," says Simpson. "I like the fact that you get to do a little bit of everything, you get to do delivery, you get to do a bit of emergency, you can do a bit of sports med, you can really tailor your practice to whatever you want."
Simpson says the people he has worked with in medicine have been "some of the most incredibly nice, outgoing people I've had a chance to meet."
"I think it's just a really good fit for me," he says.
After being interviewed in Winnipeg, Saskatoon, Swift Current and Ontario, Simpson chose the North Shore not only to be back in B.C. but also to be closer to his family and the outdoors.
"I love being in the mountains, I love having access to so many outdoorsy pursuits whether it's skiing, whether it's going out to Deep Cove, going for a bike ride. .. It's just a beautiful spot to live," he says. "The other part is that most family practice programs have a two-month rural rotation but the North Shore program is a bit special in that we get four months rural, which is really great."
Simpson says although the rural rotation can be more stressful because there is less support, other residents he had spoken to emphasized how much they had learned.
"It's a chance to go to these places, which are stunning in the first place, and be able to spend a bit more time there and really get our hands dirty as family docs," he says.
The program is also meant to entice new doctors to stay long-term in rural communities. Brown says there's a lot of experience and background that shows if people are trained in certain communities, they end up working there.
"These rural communities in particular are terrific learning environments," says Brown. "By being there for long periods of time - hopefully for four months at least - they will perhaps get interested in situating there in the long term."
The College of Family Physicians of Canada states, "more than 90 per cent of Canadians indicate that a family physician is the first person they would turn to in order to address their medical problems," and, "on average, one additional family physician per 10,000 people is associated with a 5.3 per cent reduction in mortality."
Brown says it is becoming increasingly clear the health care system is best when someone has a strong GP looking after him or her.
"It's important for the person's care, it's important for the right working of the system because when there isn't a good family physician, things get fragmented and lost," he says, adding that it also adds to costs. "There are reasons from both a personal, patient point of view and a system point of view and then those reasons are even more so perhaps in rural communities where it's really critical that that central person be there to make everything work and make everything happen."
In rural communities, says Brown, so much depends on the GP. "There aren't specialists and hospitalists and others to default to if there isn't a GP there," he says.
A good family doctor, says Brown, has to have a combination of things.
"You have to have a lot of medical knowledge and skill in the complete range of health care and that's one of the things that makes it challenging but also really interesting," he says.
Another part of the skill set is the ability to be a collaborator and team player, says Brown, and see things through the patient's eyes.
"The person may have quite a range of needs and as a family physician you need to be able to understand what all of those things are and who your partners are in all kinds of different areas of health care," he says.
Demographics could be contributing to the shortage of physicians, says Brown, as physicians along with other health professionals are generally older and retiring.
The Canadian Medical Association reported in 2014 that more than 38,000 physicians practise family medicine or general practice. Of those, more than 41 per cent are age 55 or older.
"The demographics tell us that a large percentage of health professionals are going to retire in the next 10 years - not only physicians but others - so that's part of it," he says. "Another part is that it's tough work; being a GP is not easy because again you do have to understand everything and there's an expectation that you will be around and available for people, and a lot of doctors just find that a really hard task to meet up to."
In some ways, being in a specialty can be a little easier, explains Brown, in the sense that there may be a lot of technical, challenging information but your task is clearer.
"It's a little more narrow in scope and a little easier to get a handle on," he says. "The third thing is money frankly, that the specialties pay more and general practice pays less."
Brown says although it is changing worldwide, including in Canada, there remains a big difference between the earnings of a specialist and a GP.
"If you're coming through medical school and you have a six-figure debt, the inclination would be to go towards a specialty perhaps and have a chance to pay that off more easily," he says.
Medical students these days have to decide what they are going to do by third or fourth year, says Brown, so they can slant themselves towards their specialty, whether it's cardiology, urology or family practice.
"They need to start thinking about that early in their medical school, which is not always the best time," he says. "They haven't had a chance to sample everything yet but already by third or fourth year they're starting to choose their electives and frame themselves into the kind of doc they think they want to be."
But Brown says interests have changed and more graduates are looking to become family physicians.
"The kind of interest in family practice bottomed out somewhere around 2003 and since then the interest has been rising steadily in the number of docs who want to take up family practice," he says. "People are realizing it's challenging and it's fascinating."
There has also been an increased awareness at the system level, says Brown, that family practice needs to be supported.
"There's more money being put towards it," he says. "More effort is going into it in the curriculum at the medical school."
Unemployment among specialists upon graduation has also fuelled the rise in interest, adds Brown. "There's about a 20 per cent unemployment rate among young specialists graduating from their specialty programs because, frankly, all the positions in the big cities are full," he says. "Specialists often feel that they can't practise in smaller communities; it's tough for them to practise there as well, so there's a lot of unemployment among young specialists now."
Simpson, already in the midst of the program's first year, says the biggest challenge so far has been the scope of family practice. "It's a bit of a blessing but also a bit of a challenge that you can't narrow down your focus as much as you'd like to because you have to know a little bit about everything," he says. "Staying on top of that volume of material can be daunting and staying up to date with that many areas is going to be challenging."
The internet is also proving to be interesting - and challenging - says Simpson. "Patients with the internet these days are so much more educated about their illnesses than they used to be," he says. "So being able to work with them, understand, manage their information sources and their knowledge against our own, but also be open to learning from them too."
Simpson says being a family physician is a lot less patriarchal then it used to be, where patients knew little and doctors had to explain everything. "It's exciting because you get to learn a lot from them and it's nice to have patients that are educated," he says. "But it can be challenging if they're not getting good information."
The new HOpe Centre will also be an asset to the residency program, says Simpson, as will Lions Gate Hospital's reputation. "People I've talked to in health care in Vancouver who worked at Lions Gate said it's got some of the most incredible, nice physicians," he says. "Lions Gate for me is a perfect size; it's not huge and crazy busy but it's big enough that you see enough to really get a great education. So for me it's just, everything was just tick, tick, tick - it was a perfect balance of all those things for me."
Being an international graduate, Simpson is obligated after graduation to do a two-year return service in a small community.
"I'll probably work in a small community for two years, probably just in someone else's clinic and then I'll decide from there," he says. "Long term, I definitely want to open my own practice."
Simpson says for the first few years, new family physicians will often fill in for other doctors on vacation, thereby avoiding having to commit financially to a practice right away.
"It gives you a chance to get exposure to different practices, different cities, different patients and really just kind of see where you want to be and see what kind of medicine you want to practise," says Simpson. "Often after two or three years people will eventually find a place they want to settle down and then maybe think about joining an existing practice or starting their own."
Brown says UBC is committed to what they call "a distributed approach to training," which is taking training out of central hospitals, including Vancouver General Hospital and St. Paul's, and into community hospitals. "Getting the training out into community hospitals and into communities is a big thrust for the faculty of medicine these days because I think it's recognized that getting out into the real world and in different environments really provides better learning and a better impression about the care," says Brown. "So it's actually a conscious approach that UBC is taking to post-grad training."
