We are responding to the letter from Dr R. Warren Bell published in the January 2022 issue1 that offered a perspective on our commentary in the November 2021 issue.2 We agree with Dr Bell that system factors have a considerable impact on the ways in which new-to-practice family physicians are choosing to work. We welcome his call for more robust discussion about the factors that will lead to physicians embracing longitudinal family medicine, which include issues other than payment models. In our interviews with more than 90 early-career family physicians exploring the factors influencing choice of practice, prominent themes included feelings of accountability to address the needs of local communities, a motivation to provide meaningful care for patients, and a desire to work collaboratively. Payment and service delivery models were important to these physicians insofar as they supported care that was consistent with these values. We are preparing manuscripts for publication that report further on these data.
Dr Bell’s response unfortunately makes baseless and stigmatizing assertions about physicians born outside of Canada. He describes his review of the BC Medical Services Commission financial statement (“Blue Book”),3 which reports earnings from the BC Medical Services Plan. Using this review, he draws conclusions about the earnings of “Canadian-born” versus “non–Canadian-born” physicians, concluding that non-Canadian-born physicians take a more “utilitarian ... approach to the Canadian health care system”1 because they earn more. However, the Blue Book lists physician names and corresponding payments but provides no information on place of birth. We are concerned about his approach to determining place of birth, including possible assumptions being made about names that may “appear” foreign. This is clearly a methodologically flawed approach. Furthermore, making statements that tie assumed place of birth to values in family medicine fosters racism and harmful stereotypes. There should be no place for this type of analysis within Canadian Family Physician’s mission to inform current issues in family practice.
Footnotes
Competing interests
None declared
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