Solving the family medicine crisis

The polycrisis

Katz and Slade wrote previously that Canada is facing a polycrisis in primary care: people not having a family doctor; the weight of administrative tasks in family practice; family doctors feeling burnt out; and threats to the financial viability of family practices are among the issues that define the crisis.¹

Rural and remote health care systems confront even more substantial challenges, including a chronic shortage of health care providers, high rates of workforce burnout, and limited access to primary care services.^2,3 In Saskatchewan, for example, where Ramsden lives and works, one-third of the population resides in rural or remote areas, where barriers to timely and comprehensive health care are compounded by socioeconomic challenges, geographic isolation, and a scarcity of local resources.³ With over 74 First Nations already facing considerable health disparities, the primary care crisis disproportionately impacts patients in rural, remote, and Indigenous communities compared to those living in urban areas.⁴

To be relevant in the family practice context, research questions should be formulated by health care workers and patients within family practices.⁵ Participatory research requires those affected by research to be involved in it at all stages. Health care workers and patients know the circumstances of care and can skillfully formulate and test hypotheses about how to improve it. We wanted to incorporate in this issue, as best we could, scholarship and research that refected these values, too.

The process

The first step in bringing together this special research-themed issue was to invite family medicine researchers and educators from across the country to submit ideas for proposed manuscripts addressing the crisis. The second step was to internally review ideas to determine how closely they addressed the crisis before inviting full manuscripts, then sending those manuscripts for external peer review. The response from Canada’s family medicine research community was overwhelming; far more manuscripts were proposed than the journal could publish. We are both humbled and grateful.

The results

Articles published in this special issue of CFP exceeded a high bar for relevance and quality. They provide insight into the crisis in family medicine and primary health care in Canada, propose potential solutions based on original research, and offer evaluations of current family practice literature.

Family physicians have long contended that one of the biggest challenges they face is the growing administrative burden of care, which has increased substantially over the past few years. A critical review of the research literature by Storseth et al (page 417)⁶ and a qualitative study by Brown and colleagues (page e148)⁷ both address this issue. Thoughtful commentaries by Terry and colleagues (page e90)⁸ and Gilfoyle et al (page e101)⁹ address the need for family physician input in the design and implementation of tools that may reduce administrative burden, such as artificial intelligence.

The widening income gap between family physician generalists and specialists has also contributed to the crisis, making family medicine a less attractive career choice for medical students. A commentary by McCracken et al (page 377),¹⁰ along with research by Grady and colleagues (page e140)¹¹ and Jacobs and Bell (page e135),¹² explore how improved compensation models can help address the crisis.

There are also thoughtful, solution-focused commentaries by several authors that address ways in which family medicine can be made more attractive to medical students, ranging from the creation of an innovative new medical school at Simon Fraser University (page e94)¹³ to the expansion of team-based models of care (page e98).¹⁴

Patients and communities at the centre

Last, but by no means least, we sought to present crucial perspectives of the crisis from patients. To that end, we are pleased to share the most recent report of the trans-national OurCare initiative by Kiran and colleagues (page 396).¹⁵ Finally, we are grateful to Brenda Andreas, Past Co-chair of the Canadian Primary Care Research Network Patient Council, member of the Canadian Institutes of Health Research Institute Advisory Board of Health Services and Policy Research, and Canadian Patient Representative on the North American Primary Care Research Group Board of Directors, for providing readers with essential insights into how we can build a strong, equitable, and responsive primary health care system by placing patients and communities at the centre (page 375).¹⁶