Education key to fixing doctor shortage in N.S.

To fix the family doctor shortage in Nova Scotia, it’s often suggested, maybe Dalhousie Medical School should just train more family physicians.

If only it were that simple.

The gap is too wide. Training takes resources — including current family doctors willing and able to teach — that are already in short supply, as well as time.

Recruitment and retention remain crucial, not to mention quicker.

But Dalhousie must be a big part of the solution.

Dr. Katherine Stringer, who heads the medical school’s family medicine department, says it’s exciting to see family medicine getting the attention it deserves.

Dal’s med school has put a huge emphasis on family medicine the last few years.

“This starts right at the beginning of medical school,” Dr. Stringer told me when we spoke Friday morning, with “early and repeated exposures.”

One example would be a program called Rural Week, in which “first-year medical students spend a week with a rural physician, most of whom are family physicians,” she said.

That gives future family doctors first-hand experience — one they’ll hopefully like — in delivering primary care in smaller communities.

Overall, she said, “there’s been a concerted effort to increase the number of family physicians involved in teaching our students, especially in those crucial preclinical years.”

Sounds good. Is it working? Before the answer, let’s quickly go over how one becomes a family doctor. (Apologies to those who know).

First, there’s four years of medical school. After graduation, there’s residency in a specialty, such as family medicine, a two-year program, though there are many other choices, most taking longer to complete.

Back to Dr. Stringer. Yes, she said, their efforts are paying off.

In 2018, just a quarter of Dal’s graduating medical students chose a family medicine residency. By this year, that was up to 43 per cent.

“We are continually looking at ways to even further enhance that,” Dr. Stringer said. Their goal is to ultimately have 50 per cent of Dal’s medical graduating class choose family medicine as a residency program.

That’s great on its own. But there’s another layer.

Since most Nova Scotians who want to be physicians go to Dalhousie, if more choose family medicine, more future family doctors would have an attachment to our province and, hopefully, want to practise here.

One other thing about medical education.

Getting into a residency program is unconnected to where one goes to medical school. Every year, a national matching system pairs up Canadian education institutions with potential medical residents from across the country.

This year, for example, more than half of Dal’s 62 family medicine residency spots for Canadian graduates went to non-Dal medical school grads. Thirty (48 per cent) went to Dalhousie graduates.

(There are about 70 family medicine residencies a year; the remainder go to international medical school grads).

That might seem a negative. But Nova Scotia has proven quite enticing to family doctors-in-training from elsewhere.

Three quarters of those completing Dal’s family medicine residencies decided to stay here to practise, said Dr. Stringer.

“We ended up getting extra folks choosing to stay in local communities.”

She credits the school’s distributed medical education system. Family medicine residents train in nine centres across the Maritimes, including five in Nova Scotia — Halifax, Cape Breton, Truro, Yarmouth and the Annapolis Valley. Each site can feature a number of communities.

“Residents coming in from other universities are immersed in these communities, where they study for a full two years, they connect to the community, particularly rural communities,” she said.

“We work very closely with the communities and various community organizations in Nova Scotia and the health authority on ways to really connect them into the community.”

But the picture is not all rosy. Significant challenges remain.

The biggest choke point lies in training capacity — the people and facilities needed to teach the next generation of physicians.

“We’re very well aware of the kind of problem in that, we need more family doctors, but we need the family doctors who are there to teach more, in order to get more family doctors,” said Dr. Stringer. That’s why her department has been very focused on faculty professional development.

The last master agreement between the province and Doctors Nova Scotia did increase the extra pay physicians acting as preceptors — experienced doctors willing to supervise students in a clinical setting — receive.

So, that helped, she said.

“Yes, we do have a mountain to climb ahead of us. But we are excited to be able to address these challenges.”

To combat the doctor shortage, it strikes me that recruitment is vital, and certainly delivers quicker than the six years (by 2027, seven) it takes the educational system to produce a family doctor. At the same time, we’re competing for physicians in a fast-changing global environment, where things can change in a hurry.

“Education takes time but it is certainly the most sustainable way to increase the number of family doctors in this province,” Dr. Stringer said.