Medical leaders say more needed to recruit students to rural family residencies

Just over 40 per cent of spots for the Northern Ontario School of Medicine University’s family medicine program were filled during the first round of residency matching last month.

Only 18 of the medical school’s 44 positions were filled. Across the country, 268 vacancies in family medicine remained out of 1,629 spots.

Dr. Sarita Verma, the president of NOSM University said, it’s not unusual for positions to be open for the second round, which will happen at the end of the month.

She said NOSM University is one of the medical schools which does the best at producing family doctors, noting the rural generalist pathway, which they’ve put into effect.

“[Other medical schools] are all wanting to know what our secret sauce is because we are so good at it,” she said.

“We won awards 13 years in a row for having the highest proportion of students not only choose family medicine but go into rural family practice,” she said. “And so if you look at our data … 50 per cent or more of our graduating class chooses family medicine. So there’s a huge emphasis on family medicine at our institution.”

However, she said there’s a decline in interest in family medicine in the entire country, which is between 20-29 per cent of graduating classes and is still going down.

Dr. Stephen Viherjoki, the Ontario Medical Association’s chair for the Northwest district, said he wants to wait and see what the next round of matches brings.

“We know the goal for family medicine is about 40 per cent of total residency spots in the province, because that’s about the number we need on a day-to-day basis to replace things,” he said.

Viherjoki said one possibility for the unfilled spots, which might indicate a reduced preference, is the additional pressure on family doctors over the last few years.

“The last two years with the pandemic have been very hard on family physicians. We’ve seen a lot of work downloaded to family docs, a lot of extra stress and a lot of burnout, perhaps the [medical] students have seen this and then that type of practice for those who have come up in that system over the last two years didn’t seem as attractive as they would have before.”

This was also a factor which Verma mentioned, “the burnout in family doctors being on the front line of COVID and having a huge administrative burden of having to do paperwork and working seven days a week with a take home, that’s 20 per cent of what you earn. It’s not a feasible model,” she said.

Dr. Sarah Newbery, rural generalist family physician in Marathon and the associate dean of physician workforce strategy at NOSM University, said more work is needed to understand clearly what all the issues are that went into the low match rate.

“I do think it reflects some of the challenges of family medicine broadly across the country,” she said. “We know by far the majority of positions that were unfilled in Canada were family medicine positions.”

She said information collected from new graduates show they want more supports.

“What they’re saying is that practice is deeply rewarding, and they feel clinically well prepared for practice, what they don’t feel is really well supported in the transition [to practice],” she said.

“They want formal mentorship. They want to be able to start with a reasonable pace and scale up as they get used to being in practice. And we just don’t have ways to date to that we’ve been able to do that well.”

“I think we have a lot of work to do to better support that new graduate transition,” she said, adding there is a lot of work that needs to go into better supporting family physicians in practice as well.

She said in Northern Ontario the population is older, sicker and poorer and has a lower life expectancy by 2.5 years than in the rest of the province. 

“That reflects to some extent the complexity of the illness, burden that exists in Northern Ontario. We know too that there are challenges of mental health and addiction,” she said. “So there, there are significant challenges to providing care as family physicians in Northern Ontario,” she said. “And there is work that needs to be done to better support clinicians in practice.”

Newbery said there is work being done to look at what new models for ensuring that family doctors are connected to inter-professional teammates, who can support the complexity of patient care. That may help attract and retain rural family physicians.