When, if not now?

When, if not now? This was the urgent call to action that Dr Nicole Stockley issued at the Atlantic Patient’s Medical Home symposium held in April 2022 in Prince Edward Island. Dr Stockley, Director of External Engagement with the Newfoundland and Labrador College of Family Physicians, described the tortuous road family physicians in Newfoundland and Labrador and their patients have been on for the past few years, with worry about lack of access to care and loss of family physicians in the province increasing. She also described how family physicians are organizing themselves regionally and working together to improve the practice environment. At the other end of the country, tremendous shortages of family physicians in British Columbia, closures of walk-in clinics in urban areas, and inadequate continuity provided by recently created urgent care centres are fueling an uprising by physicians and patients who cannot access care in a timely manner—or at all. Doctors of BC and the British Columbia College of Family Physicians are actively advocating on these fronts (https://bccfp.bc.ca/myfamilydoctorcares/).

The Quebec government has toned down its rhetoric toward family physicians and has agreed to facilitate and support family practices’ efforts to take on new patients who do not have family doctors. By the time this column is published, the provincial election in Ontario will have taken place. In the lead-up to the election, the Ontario College of Family Physicians, in collaboration with the Section on General and Family Practice of the Ontario Medical Association, launched a campaign to mobilize candidates and the public around the value of family physicians. Their public campaign, Life Without a Doctor (https://lifewithoutadoctor.ca/), supports 3 “cures”: every Ontarian deserves to have access to a family physician working alongside a team; family physicians should be supported to spend more time on direct patient care; and increased recruitment and retention are key to ensuring every Ontarian can access timely care.

Results of the Canadian Resident Matching Service’s first iteration match showed a continued decline in selection of family medicine as a career of choice by graduating medical students.¹ We share your concerns about family medicine and are advocating for better work environments. We are collaborating with the Canadian Medical Association and the Canadian Nurses Association to elevate important conversations about the difficult environment in family practice and propose solutions to politicians and decision makers.

The recommendations we propose include, in the short term, consideration of retention incentives for health care workers who are retiring or have recently retired, with the goal of improving access to health care in areas of need. Having dedicated funding is essential to relieving health care workers of the administrative burden that contributes to burnout and prevents them from allocating more time to clinical care. There are excellent examples in Canada of team-based models of care that are good for patients and for those who provide their care. We support the creation of a primary care integration fund to help scale up these models and make sure that everyone in Canada has access to a family doctor and primary care team.

In the medium term we recommend expanding virtual care to sustain and increase access to virtual primary care for everyone living in Canada. The CFPC continues to advocate for public coverage and for support for this in the context of an existing relationship with a most responsible provider, usually a family physician. We also recommend increasing the number of providers by investing in new training and education infrastructure and implementing an action plan to enable internationally trained doctors, nurses, and nurse practitioners to work here. Over the next 18 months a focus of our advocacy will be the development of a strategy to support the mental health of health care workers.

Finally, we think it is urgent that work force data collection be strengthened across provincial, territorial, and federal jurisdictions to better inform needs-based planning. The CFPC strongly advocates for the collection of data that capture scopes of practice and are aligned with the career journeys of professionals. We continue to call for national licensure to eliminate barriers to interprovincial mobility and facilitate locum coverage, particularly in rural and remote areas.

We are at a point of inflection in family medicine. We have been trying to do our best in a context of chronic neglect and chronic underfunding. It is about time that governments invest in primary care. The status quo is not an option. Please join us in our advocacy work around family physician shortages. Learn more about what the CFPC is doing and how you can participate at https://www.cfpc.ca/en/family-doctor-shortage-in-canada.

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