Being “just a family physician” is an invaluable learning opportunity

Thank you for opening an old wound in the article “Just family doctors. Hidden curriculum against family medicine in medical schools”¹ in the January 2025 issue of Canadian Family Physician. The phrase “just a family physician” needs to be revisited.

When I graduated from medical school at the University of Toronto in Ontario (2 years of pre-med and 4 years of medicine) in 1966, my mother asked me what specialty I intended to enter. I responded I wanted to go into general practice and put to use all the clinical tools 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 year-long general internship at Toronto Western Hospital plus a month of anesthesia training in Edmonton, Alta, and started practising in Norway House, Man, with a classmate. We were both 25 years old and married.

Norway House is an Indigenous Cree community situated 452 km north of Winnipeg by plane. 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 2 greenhorn physicians with a 40-bed hospital to run and 10,000 patients scattered over 77,700 km² (approximately the size of Scotland), along with a language barrier, with more than half of our patients speaking only Cree or Saulteaux.

There were 8 fly-in nursing stations scattered over the zone we serviced that were accessed 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 winter). During freeze-up and break-up there was no air access to the hospital (2 months of the year). For backup, we each had a couple boxes of medical texts. The only specialist back-up was a visiting orthopedic surgeon from Edmonton who followed 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 cesarean sections feasible. Fortunately our patients were generally healthy. Our practice was heavily centred on obstetrics (eg, epidural anesthesia, rotations, forceps deliveries, breech extractions) and pediatrics (eg, pneumonia, meningitis, glomerulonephritis). Our salary was $11,000 per annum.

Fast-forward 55 years: My classmate became a general surgeon and I remained in family medicine. We 2 “just family physicians” looked back on our careers and agreed our first year in practice was the most rewarding year of our careers. Why was that? I think the keys are the following:

1. Our training was high school, 2 years of pre-med, 4 years of medicine, and a year-long general internship. It was short and we graduated when we were still young. This is important.

2. We had an initial introduction to general practice that employed every skill we learned, plus many 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 or suburban communities is primarily office-based. Many family physicians cannot 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 we use all our family physician skills. It is challenging and interesting.

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

4. We put trust in our fellow family physicians. Our son was born in Norway House in February 1968. It was −50°C. Out of necessity, my classmate performed both the epidural and delivery. We were in very good hands.

I went on to practice medicine in 4 provinces, 1 territory, and 4 countries—being “just a family physician.” Would I do it again? Yes, in a heartbeat!

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