Time to celebrate, not condemn

I am writing as someone who cares about the College of Family Physicians of Canada (CFPC) and cares very much about family doctors broadly across the country who are working hard every day to support their communities, their colleagues, and their patients.

I want to express my concern about how tone-deaf Dr Ladouceur’s editorial in the June issue of Canadian Family Physician is.¹ Because it appears in the “official journal of the CFPC,” the editorial reflects poorly on the CFPC itself.

Dr Ladouceur makes numerous allegations about practice patterns with no supporting data and he is highly critical without any apparent understanding that many physicians have been struggling in a system that does not support them. Many physicians started this pandemic with no access to personal protective equipment, in offices too small to safely distance from one another, and with staff who needed to excuse themselves from the workplace, leaving some physicians without usual office supports. That reality has hugely influenced the ways in which physicians have been able to see people in their office settings, particularly in the initial months of the pandemic.

I acknowledge that there are stories of practices that have failed their patients during the pandemic, but to suggest that it is all simply unethical and greedy behaviour is to completely misunderstand the reality under which many family physicians have laboured, largely unsupported by the health care system.

As many family physicians come limping out of this pandemic, this is the time to celebrate the many, many ways in which family physicians have absorbed a huge amount of emerging information, contributed to care in their communities, strengthened the health care system, and supported long-term care, assessment centres, and vaccine clinics. Now is the time to celebrate the ways in which family physicians have demonstrated accountability to their communities through adapting to emerging needs—a skill that we are abundantly capable of as generalist clinicians.

Can we also ask questions about what we can do better? Of course we can, but when we do, we should be doing so in a way that is solution-focused—which Dr Ladouceur’s editorial distinctly does not do. He slaps a metaphorical wrist and offers nothing by way of support.

Finally, the reality is that for many, the practice of family medicine does mean running a business, and those businesses have been undercut in many places—this year in Alberta in particular. There are many ways in which physicians are not trained for the businesses we must run successfully to sustain our clinics for our communities—from governance, to human resource management, to financial management, rental agreements, and supply management … the list goes on. In this past year there were so many disruptions to the business side of medicine that it would not be surprising if family doctors in many practice settings were overwhelmed. The “business management” side of family practice is a reality that we need to acknowledge. We need to equip family physicians to manage well and with accountability, not condemn them.

Perhaps it is time to review the way that the journal is governed, to find the line between “editorial independence” and ensuring that the journal, as the official journal of the CFPC, reflects the tone that the CFPC and its board want to set for Canadian family physicians.

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