The Ontario Medical Association (OMA) in Canada has reported that 2.3 million citizens lack family physicians, a figure that is projected to nearly double within the next two years.
This has opened doors for more foreign-trained physicians, as evidenced by the record number who are set to begin their residencies in family medicine at McMaster University this year.
According to OMA, there has been a consistent decline in the number of family physicians from 2019 to 2023 as well as the number of medical school graduates selecting primary care as their first choice, with many opting for other specialties instead.
Family physicians form the cornerstone of the healthcare system and serve as the crucial connection to specialist care. The shortage of family doctors is likely to result in unaddressed health concerns and subsequently poorer health outcomes.
Family medicine is less attractive to Canadians, creating opportunities for foreign doctors
The Chair of the Department of Family Medicine at McMaster, Dr. Cathy Risdon, explained that medical students are increasingly viewing family medicine as a less desirable career option.
Their concerns include the costs associated with running and staffing, the challenges of paying off educational debts on a family medicine salary, and the demands of caring for patients without the support of interprofessional teams.
As of March 2024, out of 560 family medicine training positions in Ontario, 108 remained vacant after the first round of matches by the Canadian Resident Matching Service (CaRMS). This represents a significant increase from 61 unfilled positions in 2022 and 30 in 2020.
“It is clear we need to act now to ensure there is a future for family medicine in Ontario,” OMA President Dr. Andrew Park said at a briefing to raise awareness about the issue.
“Students … don’t want to enter practice in a broken system. We must address these problems and promote family medicine as a rewarding and impactful career choice,” he said.
Until recently, family medicine residency spots at McMaster University would typically be filled by the end of the first matching round in March.
In 2020, only one of 99 positions was left vacant, and in 2018, just two of 100 spots were unfilled. The highest number of unmatched training positions before 2021 was six.
However, there was a notable shift in 2022, with 18 of the 99 family medicine training spots remaining vacant. This year, 20 of 103 spots went unfilled after the first round, despite McMaster offering a diverse range of placement opportunities in locations such as Hamilton, Halton, Niagara, Six Nations, Brampton, Collingwood, Kitchener-Waterloo, Fergus, Mount Forest, Owen Sound, and Simcoe.
“Family medicine continues to have higher unmatched spots than most other programs and Ontario schools fared more poorly than usual”, said Ridson.
“What does this all mean for patients? It means that there will be fewer family doctors practising family medicine, which means less access to care,” said Park.
McMaster University managed to fill all of its vacant family training positions after the second round of matching at the end of April by turning to more international medical graduates (IMG) than ever before.
Consequently, this year, McMaster University will welcome 33 international medical graduates into its family medicine residency program.
New medical schools to focus on training family doctors, teaching staff needed
The province has increased the number of medical school and residency positions in 2022 and 2023. Furthermore, a new medical school is set to open at Toronto Metropolitan University (TMU) in Brampton in September 2025 and at York University in 2028. These programs will focus on training family doctors.
TMU’s interim Assistant Dean of Primary Care Education, Dr. Jobin Varughese, voiced concerns about whether there will be sufficient physicians in the community prepared to handle the additional workload given the current support levels.
“An immediate investment in the teaching workforce of family medicine is one of the most urgent priorities because without that workforce, all of the efforts our schools, our policymakers … will fall short because we won’t have a place to train them,” he said.
