People walk on the grounds of the University of Toronto on Sept. 9, 2020 in Toronto.CARLOS OSORIO/Reuters
Medical-school leaders are raising the alarm over their students’ declining interest in providing traditional cradle-to-grave primary care at a moment when the country is desperate for more family doctors.
Senior officials at four Ontario medical schools told a news conference on Tuesday that significant reforms, including raising pay and reducing administrative burdens, are necessary to persuade the physicians of tomorrow to choose family medicine over higher-paid specialties.
“This is urgent,” said Azadeh Moaveni, director of undergraduate medical education in the department of family and community medicine at the University of Toronto. “We need to do something now so that students will pick family medicine as their career of choice.”
Dr. Moaveni and her colleagues delivered their plea on the same day that the Canadian Medical Association warned the federal government’s proposed increases to capital-gains taxes could imperil physician recruitment and retention.
Medical associations for Nova Scotia, New Brunswick, Manitoba, Saskatchewan, Alberta and B.C. also issued statements to The Globe and Mail echoing the concerns of the national doctors’ association. The Ontario Medical Association criticized the new tax measures last week.
Prime Minister Justin Trudeau and Finance Minister Chrystia Freeland dismissed those complaints Tuesday, saying physicians are at the “very, very top” of the income scale and so can afford to pay more taxes.
“We are asking the most successful in this country to do a little bit more,” Mr. Trudeau said at a news conference in Saskatoon. “It’s fair to ask those who have succeeded extraordinarily well to be there to make sure that a lot more people have the opportunity to succeed.”
Last week Ottawa unveiled a $19.4-billion tax hike over five years through changes to the capital-gains inclusion rate – up to two-thirds from one-half – which means that more of the income generated from the sale of an asset, such as property or a stock, is taxed.
For individuals, the first $250,000 of capital gains will continue to be taxed under an inclusion rate of 50 per cent. But for corporations, the new 67-per-cent rate will kick in on the first dollar of capital gains.
This is important for physicians because most operate their practices as small businesses through medical professional corporations, which leaves them more sensitive to changes in capital-gains rules than a salaried worker might be.
The federal government’s comments mischaracterize the lives of doctors on the front lines who are not among Canada’s multimillionaires, said Canadian Medical Association president Kathleen Ross, who is also a family physician in B.C.
Dr. Ross said the proposed changes also risk exacerbating a pronounced doctor shortage that is already expected to get worse with a predicted “tsunami” in an aging profession.
As small-business owners, most physicians in Canada do not receive benefits, pensions or maternity- or paternity-leave pay. To offset that gap, Dr. Ross said that, across the country, physicians agreed to incorporate their practices in order to save for retirement, rather than be paid more up front under their provincial agreements.
After being encouraged by provinces to incorporate their practices, Dr. Ross said the federal tax changes amount to “a clear grab at our retirement savings.”
While the proposed changes to capital-gains taxes are most likely to affect doctors at the end of their careers, those just starting out look at the financial situation of their older peers when deciding what type of medicine to practise.
Later this week, the organization that matches medical-school graduates to residency positions is scheduled to release data from the final round of this year’s matching process, including whether any family medicine placements went unclaimed.
In this year’s first round, 108 of 560 family medicine residency slots in Ontario went unfilled, up from 100 last year, 61 in 2022, 52 in 2021 and 30 in 2020, according to Andrew Park, the president of the Ontario Medical Association, which held the briefing at which Dr. Moaveni and other medical educators spoke Tuesday.
Ontario has successfully filled most vacancies in the second round of matching in the past, but Dr. Park said the first-round data are the latest sign that medical students are souring on family practice.
Last year, 100 family medicine residency positions went unfilled nationwide after the final round, the most in at least a decade. The majority were in Quebec. The Canadian Resident Matching Service (CaRMS) reported that in 2023, 30.3 per cent of graduates of Canadian medical schools named family medicine as their first choice of discipline, down from a recent high of 38 per cent in 2015.
Jobin Varughese, the interim assistant dean of primary care education at Toronto Metropolitan University, said medical students are most often turned off from family medicine when they encounter burned-out doctors working in solo or small group practices without the support of a team of nurses, pharmacists, social workers and administrators to share the load.
In September of 2025, TMU will open a new medical school northwest of Toronto in Brampton, a fast-growing magnet city for new immigrants where Dr. Varughese said chronic disease rates are high and primary-care access is decreasing. “Communities that are medically underserved, like Brampton, are significantly impacted by fewer students choosing family medicine,” he said.
An estimated 14 per cent of Canadians don’t have access to a regular health care provider, according to the most recent Statistics Canada survey data from 2022. However, a separate survey of 9,000 Canadians conducted in the fall of 2022 for the U of T-led Our Care project suggested the figure was closer to 22 per cent.
Medical-school leaders in other parts of Canada acknowledged the challenge of persuading graduates to choose traditional family practice, but said their institutions are working hard to make the discipline more appealing.
Remuneration is one important challenge. The average Canadian family doctor earned $299,000 in gross payments (before overhead costs) in 2022, significantly less than $382,000, on average, for medical specialists and $507,000 for surgical specialists, according to the most recent figures from the Canadian Institute for Health Information.
Another is that some graduates bristle at the thought of spending hours every day on paperwork and running a business, rather than seeing patients, said Brenda Hemmelgarn, dean of the Faculty of Medicine and Dentistry at the University of Alberta.
”Family medicine is such an important part of our health care system. It’s foundational to everything that we do,” Dr. Hemmelgarn said. “But the way it’s administered right now, there are challenges in the profession.”
Still, Amanda Condon, head of the department of family medicine in the Max Rady College of Medicine at the University of Manitoba, said medical educators shouldn’t let their students lose sight of the joys of primary care.
“Being a family doctor is awesome,” Dr. Condon said. “I feel like we need to highlight that more because despite all of the challenges and all of the difficulties, it still is very rewarding, very powerful and super important work.”