Who wants to be a family physician?

Dr. Pimlott's editorial ("Who wants to be a family physician" CFP June 2011) articulates the challenges faced in trying to attract medical school graduates to consider a career in family medicine. He notes that in 2008 and 2009 the proportion of students choosing family medicine has risen to 31% but has failed to reach the goal of 45% set forth by the College of Family Physicians of Canada.

While there are many factors that affect a medical student's choice of specialty, there has been little research whether or not a medical student's undergraduate academic history may convey a tendency towards or away from family medicine. Currently, the vast majority of Canadian medical schools require a strong foundation in the traditional sciences from all applicants. This is manifested through pre-requisite courses including biology, biochemistry, physics, chemistry and organic chemistry. In addition, many schools still weigh an applicant's MCAT score as a significant determinant in the overall application rubric. While such criteria are certainly a logical and fair way of assessing the ability of prospective students wishing to enter a profession as academically demanding as medicine, this may serve to inadvertently influence medical students away from specialties focused around human interaction (of which family medicine is certainly that) towards more advanced specialities (academically speaking) by the nature of the advantage applicants who have undergraduate educations in the traditional areas of science possess.

As Dr. Pimlott notes, "[Family medicine] is the only discipline to define itself in terms of relationships, especially the doctor-patient relationship." The question that results from that statement is how can Canadian medical schools attract applicants who are interested in developing their career in medicine with a focus on the aspect of relationships? The ability to build, and sustain, positive inter-personal relationships is a skill as important to family physicians as the ability to interpret and diagnose EKG readings to a specialist.

Therefore, it is no surprise that this emphasis on academic ability has resulted in a majority of recent medical school graduates with strong academic interests. It stands to reason that students with advanced science degrees coupled with medical training find satisfaction from the rigourous academic challenges found in specialties. The added allure of a certain lifestyle and wage has contributed to the family physician shortage by drawing medical graduates towards advanced specialties.

If Canadian medical schools are to reach the targeted levels of 45% of medical students choosing family practice as set forth by the College of Family Physicians of Canada, Canadian medical schools must re-think the application process in order to draw a more diverse pool of applicants who can compete for admission as competitively as those applicants with a traditional academic background in the sciences.

As of this year, several institutions have changed their enrolment process that reflects this thinking and this may result in a greater number of graduates from these schools choosing family medicine. The University of Calgary and McMaster University have both increased the weighting of the personal interview and are taking only considering the verbal reasoning score from an applicant's MCAT. The advantage of this is that it allows students from non-traditional backgrounds (as defined here as having an undergraduate degree in a field other than science) to apply for to these medical schools as competitively an applicant as those from the fields of science.

The advantage of this change is that students with academic backgrounds in the field of social sciences or humanities may possess an innate academic interest in human interaction that has evolved naturally by virtue of their area of study. Will a psychology student wish to pursue a specialty such as internal medicine as quickly as a student with a background in biochemistry or is what attracts that psychology student to the field of medicine the human element and the inter-play of the doctor-patient relationship? Currently, there is no literature that supports the claim that non-traditional medical students choose human interaction dominated specialties in higher ratios than traditional medical students; however, the number of non-traditional medical students who successfully gain entrance into medical school is often so low as compared to their counterparts that any study would lack enough data to be considered fair. If the application model set forth by the University of Calgary and McMaster University yield a greater number of graduates choosing family medicine in the years to come, the medical community should take note. Such a change may serve to address Canada's need for family physicians in the future.

However, a balance must be struck between enabling non-traditional students the chance to compete competitively for medical schools while attracting the next generation of medical researchers and specialists. The development of medical schools that favour traditional students and those that favour non-traditional students runs the risk of creating a two- tiered medical community.

What remains is the idea that students from the social sciences and humanities may have as innate an interest in the human element of medicine as the biochemistry student does in proton pumps. By attracting more students from broader academic backgrounds Canada may just reach the coveted goal of 45% of medical graduates choosing family medicine.

Gregory Sawisky is a freelance journalist based in Alberta and is applying for medical school.

1 College of Family Physicians of Canada. Supporting the future family medicine workforce in Canada: Is enough being done today to prepare for tomorrow? Report Card. Mississauga, ON.: College of Family Physicians of Canada, 2008.

Conflict of Interest:

None declared