According to published statistics, I am a very fortunate person. Of course there are many reasons I am privileged, but for the sake of this journal entry, I am specially privileged because I have a family physician who sees me regularly and who serves as a coordinator of all of my health care. I’ve had different family practice physicians over the years, but I have almost always had a family medicine practitioner serving me. This makes me rare. Not everyone has such a luxury. There is a shortage of Family Practice Physicians in North America. In Canada and the United States there simply are not enough family practice doctors to serve the need. The dynamics and reasons for the shortage are somewhat different in the two countries because Canada has a single payer government health care system and the United States has a for-profit health care system.

One of the reasons for the shortage in the United States is that medical education is financed by enormous amounts of debt and family medicine is not the most lucrative medical specialty. Doctors compete for residencies in specialties that pay well enough for them to pay back the debt they have incurred in their education. This dynamic is further exacerbated because in the US health care system, pay is based on procedures performed, not on the health of patients seen or treated. Insurance companies pay for procedures.

To make a lot of money, a physician has to perform a lot of procedures. The specialties that produce the most income for doctors are those in which the most procedures are performed. A single gastroenterologist can perform a lot of colonoscopies in a single day. Perhaps that is why there are more colonoscopies performed in the US than would be expected if the American Cancer Society’s guidelines were strictly followed. If you take the total population of he US between the ages to 45 and 85, when colon screening is recommended, follow the guidelines for the spacing between procedures to get the total, the number needed is far less than the number actually performed.

Other specialties where a lot of procedures are performed are also lucrative. Surgeons of all types perform procedures. Urologists perform a lot of procedures. Roughly half of the physical space of the urology practice where I am seen is devoted to outpatient surgery. I suspect that roughly half of the physicians’ time is performing procedures.

The physical shortage also has to do with the style of education, the failure of medical schools to admit enough students to meet the demand, and a host of other factors. There is no simple explanation for a very complex shortage. The result, however, is very real. There are not enough family practice physicians to serve the need.

That shortage has produced a unique program in Ontario. In a unique partnership, Queen’s University and Lakeridge Health launched a brand-new medical school a year ago with a unique curriculum, focus, clinical rotation structure, and more. The Queens-Lakeridge Health MD Family Medical Program admitted 20 students in the fall of 2023 and just admitted 20 more. Positions in the program are limited to students dedicated to pursuing Family Medicine as a specialty. Postgraduate residency positions are assured for all students, meaning that they do not need to participate in the highly competitive Canadian Resident Matching Service program. Students stay in the same cohort until they have fully completed their formal education and have graduated as Family Medicine Physicians.

Obviously a small program, graduating only 20 physicians each year will not make a significant change in the overall shortage. However, physicians in the program are guaranteed placement in southeastern Ontario following graduation. 20 new physicians per year in a small targeted area will make a significant change in that area. The proponents of the program hope that it will provide a model for many more similar programs across Canada.

The program also offers financial assistance for students for expenses related to applying to medical school including a waiver of application fees and financial assistance for the fees associated with taking the Medical College Admissions Test (MCAT) required for all schools accredited by the Association of American Medical Colleges.

The vision and innovation in this program is impressive. Simply being able to launch a new medical college is a significant undertaking. It doesn’t occur in North America very often. However, part of the solution to physical shortages is to increase the number of openings in medical schools. Because medical schools receive significant federal funding, perhaps it would be possible to make some of those funds contingent on the school making a measurable commitment to increasing enrollment. It is only one of many possible ideas about how to bring about a shift in healthcare.

From now until the election there will be plenty of rhetoric bandied about health care, but very few actual, practical policies and programs will be discussed in significant ways. It is one of the disappointments of our current political process. Candidates are far more interested in sound bytes than in substance, and unfortunately, voters seem to be swayed more buy sound bytes.

Regardless of what the candidates may or may not say, it is interesting for me to be living right on the border with a country that has a different health care system. Canada’s system is far from perfect, but there are some parts of the system that work differently and sometimes better for people. By seeing health care as a right instead of a commodity, there is more access to health care for many. Affordability isn’t the primary barrier to health care in Canada and there may be less discrimination based on class or income. However, there are shortages in the system and the shortage of family care physicians is similar to that in the United States. It will be interesting to observe the Queen’s-Lakeridge Health MD Family Medicine Program in the years to come. Perhaps it will be imitated in other regions of Canada. Vancouver would be a good place for a similar program.

In the meantime, I am fortunate to have an excellent family care physician who happened to be taking on new patients at the time I moved to this area. Were I searching for one right now, I might not be as successful. Like other health insurance programs, mine is oriented to procedures not overall health. I, on the other hand, think health is more important and wish for a system that based rewards for providers on health outcomes instead of procedures performed. In the meantime, I suppose I’ll be the subject of more procedures in the foreseeable future.