The Agenda with Steve Paikin (Audio) - Training Ontario's Way Out of the Family Doctor Crisis

Episode Date: September 13, 2024

Research shows that 2.5 million people in Ontario don't have access to a family doctor. This number is expected to nearly double in two years. Last year, Queen's University partnered with Lakeridge Health to create a new family medicine program and help train Ontario's next generation of family physicians.See omnystudio.com/listener for privacy information.

No one in this province should be without a family physician. It's almost unimaginable. The family physician shortage in Ontario is staggering. Being surrounded by family and friends who keep asking, like, can I be put on your list when you're done your schooling, right? I think everyone is really in need of a family doctor right now. It's really upsetting to me and I really want to do something about it. Right now there's 6.5 million people across Canada that do not have a family physician

and here in Ontario that number is 2.5 million. It's quite staggering. First of all, we have family physicians who are basically with administrative burden on them. It is unprecedented. And then you have students who are coming into the system and looking at the stress that the family programs, the family medicine programs are going through and deciding that this is not the life for them. But in addition to that, we have the burnout,

which is significant, and we also have the retirement. So because of that, we have a lot of members within the society who really do not have family physicians. So the Queen's Lakeridge Health MD Family Medicine Program was created, it was really a vision by our current dean, Dr. Jane Philpott, and it's the first medical education program in Canada to deal with the shortage of family physicians that we're experiencing right now. I think this is a perfect time for introduction of this program. Because of the crisis that

we're going through, we do not have primary care physicians. We have a rising population. We have complexity of conditions, but at the same time, we do not have enough primary care physicians. And this program actually, with its uniqueness, addresses the major issue that we are going through. When you look at our organization, we are an integrated system of care, and we feel that it's very important that our patients

are not only within the walls of the hospital, but actually their treatment is closer to home. And in addition to that, our Durham region is expanding in size, it's expanding in population, and it's also expanding in diversity. And we know that this is happening. And the fundamental thread that puts all this together is having a very strong primary care system within not only the Durham region, I'm using the Durham region as an example, but actually when you think about the province,

you think about the nation. So the MDFM program addresses that in a couple of ways. For starters, we have a unique curriculum design. So aside from getting the foundational knowledge you need in medical school plus the practical clinical skills, we've actually designed our curriculum to have a family medicine and primary care lens. So right from day one and first year of medical school, there's early exposure to family doctors and we do this a few different ways. Most medical schools your first two years are kind of your pre clerkship years where

you're doing a lot of didactic like in the classroom learning and it's not until third and fourth year that you really get a lot of experience with patients. Whereas in this program right from the beginning of first year we've had opportunities to work with patients in clinics so we've had a half-day mentorship program right from the beginning where we're paired with a family doctor in the community and we go there every week for half a day throughout the whole year. We have a community week in January where we're paired with a family doctor in the community and we go there every week for half a day throughout the whole year. We have a community week in January

where we go to a rural community and we kind of just get thrown in there and we get to see patients sometimes even on our own and then we report back to our preceptor or the family physician that we're observing, kind of give them a history of what we learned on physical exam with the patient and then go back in the room together

and kind of see the patient and see like, if I did all the correct exams, did I ask the right questions, did I come to the right even diagnosis sometimes and I think that's really awesome to be able to say you're already doing that in first year. And then we also got a community month in May, so that's an entire month kind of a similar concept whereas most other medical schools in Ontario right now only get a community week. Once they're accepted into the program and they carry through, they don't have to go through the competitive residency matching program like you have to do at every other

medical school. They automatically get a position to train in family medicine at Queen's, which takes a lot of pressure and stress off from going into that matching service. I've found that that really like decreases stress knowing that your spot is secured and allows you to just focus on learning as much as you can rather than doing things like outside of medicine that like research or things to like build your resume. You can do that still if you want of course, but you don't need to. You can just focus on making the experience the best it can be for yourself and what your needs are. Our patient got a chest tube and the ER. I got to flush this in.

The clinical experience is a pro in this program in that we get way more in first year than you do in a traditional program, which are more lecture-based. And similar to that is that we do case-based learning rather than lectures for the majority of our medicine course learning. So what that looks like is we go through cases in small groups and we're a class of 20,

so we get divided into three groups and each group gets about two tutors and we just go over cases that you would typically see in a clinic. So it's very like real life scenarios versus lectures I find sometimes can be more like black and white and like, this is what's normal, this is what's pathological versus in the case-based

learning, you just kind of see real life patients, you get to know a bit about them, their backgrounds. And then you also see a lot of patients have comorbidities and not just like one issue at hand. And I think learning in that way helps in the real world when you actually get put into a clinic with like real patients with comorbidities. As a guinea pig, which I don't know if I really like that one because there's such a negative connotation to guinea pig, but I've had a great time in this program and I know that

being in a new program can be scary because you don't know what's going to happen, but I also think it's a really cool privilege to be able to be that first group because you get to work with the faculty to kind of make it better and they're really, our faculty have been awesome for soliciting our feedback because they really want this program to work well. Likert's health history as a teaching hospital is not new. We've gone into a trajectory for many, many years. And we started with being working with some universities, but eventually we had programs which were built within Lakeridge Health system.

Today we are a Queens campus, and we also have the Learn Center, which is where we are interviewing. So we turn on the defibrillator, you will see a shockable rhythm. See? It's V5. So it's not shockable. Our commitment to education, to academia, is not new. And we are actually evolving more and more. And the way we see ourselves, actually, is that we are an academic center

within a community-based health care system. That's who we are an academic center within a community-based health care system. That's who we are. So as a family physician, what we would love to do full-time is just spend all the time we have in front of a patient taking care of them. The continuity of care, sort of like birth to grave relationship we have with our patients, it's what I absolutely love about being a family doctor. However, part of being a family doctor involves other things administratively, like running a practice, running an office, paying your staff, making sure the lights are on.

So all of those practical things take administrative and leadership skills. So our mentorship program where we assign our medical students with a family physician in the community, they start to have these conversations early on, so that people know that once they're finished medical school and they go into residency and then they're ready

for their career, they know how to manage their office. They also learn how to balance different skills that you need to be a family doctor. So we don't just work in an office practice, we do other things like palliative care, long-term care. Some of us work in the emergency room, we deliver babies. So getting that work-life balance with your family life and other things you want to do is so important. We want to decrease stress. We want everyone to work hard and take care of their patients, but if you don't take care of yourself,

you're no good to anybody. So we try to stress that balance early on and by seeing it in real time with their mentors, they can get used to it right away so it prepares them well when they start their career. I have to give them a lot of credit, those students, to have that kind of forward thinking from day one when they are such a trajectory in their life and be dedicated to become family physicians. There are lots of different reasons why I wanted to be a family doctor, but I think the first one,

and probably the most strong reason, is I really like making long-term connections with people. And I think that that's something that you definitely get in family medicine. You get to see someone from when they're born, all the way through as they go through their life. Just the ability of family doctors to form such long-term relationships with their patients

and really get to know them, I think that improves the quality of care doctors to form such like long-term relationships with their patients and really get to know them I think that improves the quality of care you can provide to people by already kind of knowing their backstory knowing what they've been through knowing What like determinants of health affect their lives? What medications are on it makes the process a lot more smooth rather than them having to go to emergency departments or like walking? clinics and like having to meet New doctors every time it and like having to meet new doctors every time it seems like inefficient to me. I was fortunate that I had a family doctor but unfortunately when I was in my early 20s she closed

her practice and I think it was really then that I realized how much that I had valued that relationship that I had built with her and I kind of felt really lost and not connected to the healthcare system. So I think that being a family doctor to me is really about making those connections and also helping connect people to the rest of the healthcare system. Being surrounded by family and friends who keep asking,

like, can I be put on your list when you're done your schooling, right? Like, I think everyone is really in need of a family doctor right now. There are so many people. And I think that just keeps motivating me. And that choosing family medicine addresses the biggest societal need, in my opinion, right now.

Well, like, three that count, because two of them are the same. What I'd like to see is our students become leaders themselves and advocate for other things that we need to solve the family medicine shortage problem like you know decreasing administrative burden for family doctors you know advocating for more team-based integrated care where you work as a team with other health care professionals in Ontario and across Canada. I look at this program almost like a triangle and the triangle you

have three three points to it. The first one is Likertal, which is an integrated healthcare system. You have a university, which is Queen's University. But those two cannot succeed without the community. I'm obviously very hopeful that some of the problems that we're experiencing family medicine will be solved over time. It's not going to be easy.

It's going to take a lot of work. It's going to take a lot of collaboration between physicians, the government, Ontario Medical Association, a lot of community stakeholders, etc. But while this sort of this crisis is going on, medical education has to continue. No one in this province should be without a family physician. It's almost unimaginable. Like, if you have a child who moves into an area with you in Ontario, can you imagine if the public school told them that they couldn't attend because there aren't enough spots? We would never stand for that. Everybody has the right to have primary care and

a family doctor, and I think the people of Ontario have to continue to advocate in order to make sure that everybody has access to care. Those students or those medical learners if you will, they will be amazing family physicians. I have no doubt about that and in my old age I hope one of them will take care of me because I believe that those are the ones that will be phenomenal in serving the communities.