It has been 50 years since the first CFPC examination and the first time the special CCFP designation was awarded. In some ways, we can consider this our golden anniversary. As I reflect on this, I begin to wonder if we are possibly entering a “golden age” of family medicine? For family physicians, what would a golden age look like?
If we could fulfil our 4 principles of family medicine1 in keeping with our core values of caring, learning, collaboration, and responsiveness, that would be golden. Tools have been developed and projects are under way that have the potential to help us realize this vision.
Our first principle of family medicine is that we are skilled clinicians. Family medicine trainees on average now receive more education than ever before. They routinely have undergraduate degrees before entering a 3- or 4-year medical school program. Currently each family medicine resident receives a minimum of 24 months of residency training, with more access to postgraduate training opportunities than ever before. However, this present situation, as positive as it is, is under reassessment from the perspective of the Family Medicine Professional Profile (FMPP). This profile “communicates the collective contributions, capabilities, and commitments of family physicians to the people of Canada.”2 It articulates our commitment to “comprehensive medical care for all people, ages, life stages, and presentations … including: Primary care, Emergency care, Home and long-term care, Hospital care, and Maternal and newborn care.”2 The FMPP also emphasizes leadership, advocacy, and scholarship.
The CFPC is embarking on an Outcomes of Training project, which aims to ensure we are achieving our goals and optimally preparing our trainees to meet the needs of their communities in keeping with the vision of the FMPP. I expect the project will develop some recommendations on the duration and structure of family medicine training in Canada, leading to even more training opportunities in the near future. With these investments that are being made today, it is possible, or even likely, that the family medicine graduates of the 2020s will be the most skilled clinicians in our history. That would certainly be part of “golden.”
Our second and third principles are about being community-based and being a resource to a defined patient population.1 One of the biggest challenges we face as a discipline is that, while we know that people with access to a personal family physician are healthier and live longer,3 for a multitude of reasons, not all Canadians have equal access to family doctors. This has always been true, but there are reasons to think that the future will be better than the past.
First, we have an articulated vision for social accountability and community adaptiveness in our refreshed Patient’s Medical Home 2019.4 A sense of direction does not get you to your destination but it helps.
Second, we are training more family medicine residents than ever before: there were 1532 family medicine residency positions in 2018 compared with 1049 in 2008 and 454 in 1998.5
Third, we are working more effectively and more often in interprofessional teams than ever before. Family medicine has become a team sport, potentially allowing us to expand our reach to larger populations.
Fourth, we have yet to unleash the power of virtual care and artificial intelligence. At the moment, these innovations are being used by some in a way that is leading to more fragmentation of care and worsening health inequities.6 However, it is not difficult to see that these same innovations could help a team of family doctors to increase access, comprehensiveness, and continuity for the populations they serve.
Finally, we are starting to see family physicians who are more actively engaged in system leadership. The development of a more effective system will require family doctors to partner with system administrators instead of the current model in which family physicians just adapt to the structures imposed by government. Kaiser Permanente has had an effective version of a physician engagement model for decades. We see innovation in jurisdictions like Saskatchewan, which is using a dyad model of leadership that engages physicians in leadership positions.7
The centrality of our relationships with our patients is perhaps our highest principle. It is in one-on-one interactions where we work our magic and experience our greatest rewards. Over the next 10 years, is it possible that more doctors, with more training, will be able to reach out to more patients—facilitated by interprofessional teammates, artificial intelligence, and advances in virtual care—to provide a higher quantity and quality of care than ever before? With all of our coordinated efforts, I think it is not only possible, but maybe even likely. And that would be golden.
Footnotes
Cet article se trouve aussi en français à la page 446.
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