Just family doctors

Thank you for opening an old wound. The phrase "just a family physician" needs to be revisited.

When I graduated from the University of Toronto Medical School (2 years of pre-med and 4 years of medicine) in 1966, my mother asked me what speciality I intended to enter. I responded that I wanted to go into general practice and to put into use all the clinical tools that I had learned so far. Her response was "You want to be just a family doctor?" I answered "Yes that's right".

I completed a one year general internship at the Toronto Western Hospital plus a month of anaesthesia in Edmonton and started practice in Norway House, Manitoba with a classmate. We were both 25 years old and married.

Norway House is a First Nations Cree Community situated 350 air miles north of Winnipeg. In 1967, there was no road, no airport, no air ambulance service, but we had a radio telephone service (which unfortunately, was often disrupted by the northern lights). We were two greenhorn physicians with a 40 bed hospital to run and 10,000 patients scattered over 30,000 square miles (the size of Scotland) and a language barrier with more than half of our patients speaking only Cree or Saulteaux. There were eight fly-in nursing stations scattered over the Zone that we serviced by float plane in the summer and planes on skis in the winter. Access to the hospital was by plane (landing on the water in summer and on the ice in the winter). During freeze-up and break-up there was no air access to the hospital (2 months of the year). For back-up, we each had a couple of boxes of medical texts. The only specialist back-up was a visiting orthopaedic surgeon from Edmonton, following patients with hip dysplasia (endemic due to binding children in cradle boards) and a general surgeon who joined us later in the year making local C-sections feasible. Fortunately our patients were generally healthy. Our practice was heavily centred on obstetrics (including epidural anesthesia, rotations, forceps deliveries, breech extractions etc.) and paediatrics (pneumonia, meningitis, glomerulonephritis etc.). Our salary was $11,000 per annum.

Fast forward 55 years, we two "just family physicians" looked back on our careers (Gary became a general surgeon and I remained in family medicine) and agreed that this first year in practice for both of us was the most rewarding year of our careers. Why was that? I think the keys were:

1. Our training was high school + 2 years of Pre-Med + 4 years of Med + 1 year General Internship. It was short and we graduated when we were still young. This was important.

2. An initial introduction to general practice that employed every skill that we had learned, plus many that we had to explore on our own. It was academically challenging. But, we had hospital privileges to perform comprehensive care. Current family medicine in urban/suburban communities is primarily office based. Many family physicians cannot even perform minor procedures in their offices. If society wants family doctors, it needs to provide family physicians with the ability to perform procedures in their offices and in their community hospitals. This is important. For me, isolation in an office without hospital patients and the ability to perform procedures was stifling. Rural and remote practice on the other hand demands that we use all our family physician's skills. It is challenging and interesting.

3. Feeling wanted and appreciated by the community we served. The big payoff for us was the knowledge that we were needed and appreciated by the people in our vast community.

4. Trust in your fellow family physicians. Our son was born in Norway House in February 1968. It was -50 degrees. Out of necessity, Gary performed both the epidural and the delivery. We were in very good hands.

I went on tp practice in four provinces, one territory and four countries being "just a family physician". Would I do it again? Yes, in a heartbeat!