“Recycling” doctors might help address family physician shortages

Shifts away from comprehensive care

Even within family medicine ranks, many physicians are moving away from traditional comprehensive community-based care—with its high overhead costs and administrative burdens—and instead tailoring their practices to focused areas, higher-income fields, or hospital work with better compensation, lower or no overhead, and team-based infrastructure. These shifts sometimes remove them entirely from the front lines of comprehensive community-based primary care.^7,8

Having fewer FPs to care for our growing and aging population, coupled with increased patient care complexity and a higher prevalence of chronic health issues, is further stressing our already overextended health care system.⁹ There is even evidence that both old and new FP practices are declining in size and that the volume of patient encounters within those practices is shrinking.¹⁰

We need more high-quality primary care health care providers.

Another resource to explore

Retired generalist physicians—adult and pediatric emergency doctors, internists, general surgeons, hospitalists, and perhaps even family doctors who retired too early—are another resource to explore. Data from the American Medical Association¹¹ indicate nearly 30% of physicians retire between the ages of 60 and 65 years, and 12% retire before age 60. These are well-trained people worth pursuing for retraining. Those who received their licences in or before 1993 benefited from a rotating internship. Others, like me, worked as general practitioners for several years before specializing.

In the United States, the Physician Retraining and Reentry (PRR) program (https://prrprogram.com), developed in collaboration with the University of California San Diego School of Medicine, helps experienced physicians from different backgrounds retrain to comfortably and competently work in modified adult outpatient primary health care practices.¹² Since its beginning in 2014, the PRR program has helped more than 150 physicians from a wide variety of backgrounds and circumstances return to primary care roles working with adult patients.¹³

This program recognizes that veteran physicians possess a wealth of knowledge and experience that can help people in need. Physicians who have had successful careers in general surgery, emergency medicine, family medicine, hospitalist practices, and other specialties possess the skill sets required to navigate the health care system and to solve problems. These physicians are already comfortable with patient care, decision making, and conversing with worried and vulnerable patients and families. They have shown commitment to learning and fluidity in maintaining currency and competency throughout their careers. They have each encountered myriad medical issues and examined thousands of patients.

The PRR program gives physicians who might be disillusioned, frustrated, or burned out in their chosen branches of medicine a chance to continue providing community assistance in a more controlled way—no ED shifts, no hospital practice, no obstetrics, and no pediatrics. Older re-entry physicians are more likely to be at stages of life beyond the stresses and demands of a young family and might be better equipped to provide time and understanding to age-associated health concerns of their adult and senior patients, especially in collaborative settings. Finding supervising physicians for these highly qualified re-entry physicians could be the responsibility of either the individual applicant or the program accepting candidates.

Yes, there are conditions and treatments that retraining physicians might not have reviewed in years, but having to read about and research these things is no different than what we all do during our careers. All these health care providers, like every family doctor, have seen patients with unfamiliar conditions and worked through new problems by reading, talking, and researching answers and options.

If such a mechanism were to be created in Canada to allow experienced non-FP doctors a route to a part-time or even a full-time defined primary care practice (with or without pediatrics) without their having to do a 2-year FP residency, its standards of knowledge and care would, of course, need to be kept high. Enrollees could be individually screened, with their careers and records scrutinized. Then, perhaps a refresher course of 3 to 6 months on the most prevalent adult (and, optionally, pediatric) health issues could be devised, to be followed by a candidate’s reintroduction to patient care under the guidance and supervision of an FP.

In the PRR program, candidates first complete an online refresher course and then begin a period of observed practice with a preceptor or a preceptor group (for 12 to 18 months), following which they take the American Board of Family Medicine certification examination. A similar program could be created in this country by the Royal College of Physicians and Surgeons of Canada in conjunction with the College of Family Physicians of Canada, perhaps with a modified licensing examination that reflects the boundaries of defined primary care practice.

Cost is a consideration, of course. Applicants should expect to pay a fee for the refresher portion of the re-entry program and for the licensing examination. Practising in the observed collaborative setting or as associates of established physicians (or groups), re-entry physicians would most likely accept modest salaried or sessional positions if Canadian Medical Protective Association and licensing fees were covered.