Dealing with the doctor shortage

Task force at work to develop strategy to recruit young MDs Mayor Anne Marie DeCicco says the city of London is a good place to live. Tourism London says the city is a good place to visit. The London Economic Development Corporation says the city is a good place to work and do business. But who has been saying London is a good place for family practitioners to establish themselves? No one. Until January, when Mayor DeCicco established the Health Care London Task Force, nobody had made it their business. In fact, London didn’t even bother to attend job fairs for graduating medical students. Now, as more than 20,000 Londoners are without family doctors and another 12,000 must leave the city to find their primary care, the task force is scrambling to put in place a strategy to recruit more medical professionals. One idea is to encourage more of the young doctors who train here to stay here. That goal was given impetus last week when the faculty of medicine at the University of Western Ontario received a donation of $26 million – the largest the university has ever gotten – which will enable more doctors to receive their education in London. The trick for the task force will be to find a way to keep these future doctors here and, at the same time, recruit more doctors from elsewhere in Canada and around the world. “I have to be really, absolutely clear about this,” Mayor DeCicco explains. “This is not an overnight issue. If people think at the end of two months or three months or six months that we are going to start making announcements that we have new doctors coming to London as a result of the work of the task force, that is not the way it works.” Tom Freeman is one of the 12 member task force. He is also chair of family medicine at Western and chief of family medicine for the London Health Sciences Centre and St. Joseph’s Health Care London. The educational system, industries, economic opportunities, affordable housing, entertainment, shopping and, among other things, restaurants will be part of the strategy the task force is now developing. Dr. Freeman says this will not be an easy task. “It is going to be difficult. There are some things that we can do easily but none of the things we are going to do have fast solutions,” he says. “A lot of these things are beyond our control.” In his position he is in touch with the medical students at the university and knows there are many reasons London is suffering a doctor shortage. Primarily, medical students find family medicine less attractive than perhaps becoming a specialist. “This is a huge concern. Family medicine is the entry point into the system for the patient,” Dr. Freeman says. “The average debt load of graduating students is $80,000 to $100,000. These are people who are in their late 20s or early 30s before they can earn $1. When you are graduating with a higher debt load, you tend to be more inclined to look for higher paying positions. The family physician’s income has gone down significantly over the past few decades compared to specialists.” And, their expenses have increased. While family doctors continue to earn a salary in the upper one per cent of income earners in Canada, they must deal with overhead expenses which consume 35 to 40 per cent of their earnings. Seymour Schulich, a Canadian entrepreneur and philanthropist is trying to ease their load. His $26 million donation to Western will provide an unprecedented level of financial support to more than 100 medical students and graduate students in medical sciences every year who will now be attending the Schulich School of Medicine. “(The donation) will give more people looking at family medicine or looking at getting into medical school the financial ability to be able to afford to do that,” Mayor DeCicco says. “That can only be positive.” Dr. Freeman says for the first time in Ontario’s history there are more specialists than there are family doctors or general practitioners. In 2001, 53 per cent of all physicians were specialists and 47 per cent were family practitioners. “The strongest health care systems are built with a strong primary care system and there has never been any infrastructure support for primary care – by this I mean bricks and mortar – the majority of health care dollars go to hospitals.” It seems medical students are also choosing to go to hospitals. Dr. Freeman calls it the hospitalist movement. Because they have the resources, hospitals can offer attractive packages to recent graduates. There is also less overhead. Negative messaging from specialists has also been partly responsible for the decrease in London’s family doctors. Dr. Freeman says medical students are not getting enough positive role models throughout their education. An increase in the number of more lucrative opportunities for students, such as emergency medicine is also drawing them away from family medicine. “What I was seeing over the last number of years was that the problem was becoming more prevalent and I, like so many others in the health care industry, held out hope that the Roy Romanow Report was going to really revise the way health care was dealt with across the province,” Mayor DeCicco says. “We had hoped there were going to be changes at the provincial level to try to better deal with the health care issues, to help places like London that were seeing these kinds of shortages and other problems. But nothing happened.” There are many things this task force will set out to do. Currently, they are looking at a survey being done with the city’s existing doctors. It will examine what their needs are, where they have space for more doctors and whether they will have fellow doctors retiring soon. Mayor DeCicco says they will also look at ways to target doctors who once practiced in London. She says it will be important to see if there is any interest in them returning to the Forest City. “One of the other things that we want to do that happens in a number of other communities that have these recruitment processes in place is we want to put together a better marketing strategy about selling London as a community,” she says. “What we need to do and what we are going to try to do is put together something that is catering exactly to the professional doctor that is looking to come to London and sell them the benefits, advantages, and opportunities that exist in London.” Source: The Londoner. April 12, 2004:"Dealing with the doctor shortage" By MARDY BACIGALUPO The Londoner