Striving for comprehensiveness

Jennifer L. Hall

As fall begins and family physicians boost their focus on patient care, academic matters, and health care delivery at the local, provincial, and national levels, the issue of promoting and sustaining comprehensiveness in family medicine continues to be highlighted. The CFPC board certainly sees this as a high priority for the organization. Over this past year, I have become more aware of the many factors that appear to influence family physicians to start and maintain a comprehensive practice.

It all starts with education. Experiences in family medicine in the first 2 years of medical school can either plant the seed to grow or potentially destroy students’ interest in a career in family medicine. I hear it from the students when I speak with family medicine interest groups across the country. They are exposed to family doctors who teach the undergraduate curriculum at teaching centres and distributed teaching sites. They tell me that most of these physicians are engaged, innovative, and very positive about their profession, but that there are others who have been beaten down in their professional lives and are discouraged. Unfortunately, students are placed with faculty from both camps and it considerably affects their perceptions of this specialty. We need to pay attention to this and support family medicine faculty to provide a positive environment for our students. This is not to say that the reality of the hard work that occurs within our specialty should be hidden from the students, but rather effective approaches to these challenges need to be encouraged and modeled. The work of the CFPC’s Undergraduate Education Committee in continuing to enhance family medicine content in the curriculum is also a positive step. Advocacy to include a more family medicine–driven curriculum and enhance the number of family physician teachers is an ongoing project. As students enter their final years of medical school, the choice of family medicine as a career is further solidified or written off by their experiences in clerkship. When they are matched with the right preceptor or team, students can appreciate the breadth of skills the family physician possesses to care for his or her patients. For many students, this comes as a big surprise and a most pleasant one.

In residency, the complexity increases. Providing learning opportunities that model comprehensiveness can be a struggle for program directors trying to ensure that competencies are met in maternity care, emergency care, in-hospital care, and procedural skills in environments with low birth rates and preceptors with variable involvement in patient care outside the office setting. It is often difficult to try to ensure that residents receive largely family medicine–facilitated training in these areas without having them switch preceptors and even switch communities. The downside to the switching is that this might potentially destroy the continuity residents develop with patients, which is another important area that needs to be reinforced. For those residency programs in which this balance can be achieved, they try to do anything within their power to help facilitate the continued involvement of these preceptors. Within the CFPC and in universities, recognition of these individuals for the work they do is critical. Enhancing the number of family medicine preceptors being nominated for university teaching awards and CFPC awards of excellence is one way this can be achieved.

In practice, there are a number of factors that will contribute to family physicians maintaining comprehensiveness either individually or within a Patient’s Medical Home type of setting. Much has been written about appropriate remuneration, supportive regional health care authorities and licensing bodies, and appropriate practice supports, which are all factors in supporting comprehensiveness of care over the long term. As often stated by Dr Lemire, the CFPC’s Executive Director and Chief Executive Officer, practising comprehensive family medicine is not easy. It is hard work. The work is truly rewarding but also tough at times. As an organization, the CFPC continues to work with our Chapters and other stakeholders to advocate for our members in this area. Dr Lemire and the CFPC presidents including myself have recently focused on connecting with provincial governments and university deans in partnership with our Chapters to deliver this advocacy message.

The systems of education and practice are complicated. One reason that education within the Patient’s Medical Home model is critical is that more competencies can be achieved with a group of family doctors and allied health care professionals by enhancing continuity and encouraging comprehensiveness within the group while increasing family physicians’ professional satisfaction. If we continue to develop and promote strategies to support this type of practice, model it in our education system, and measure the outcomes, we can make great gains in striving for comprehensiveness.