A woman has seen the same family doctor for twenty years. He delivered her children, managed her husband's diabetes, cared for her aging parents, and now monitors her own chronic conditions. He knows her family, her work, her worries. When something seems wrong, she calls his office first. This relationship - continuous, comprehensive, personal - is family medicine at its best. A young family moves to a new city and joins a waitlist for a family doctor. Months later, they are still waiting. Walk-in clinics serve their acute needs but no one knows their history, coordinates their care, or follows up on test results. A family physician works twelve-hour days, the patient panel grown larger as colleagues retire without replacement, the administrative burden increasing, the joy of practice diminishing. A new medical graduate chooses specialty training over family medicine, the lifestyle, compensation, and prestige factors all pointing away from primary care. Family physicians, the generalists who provide first-contact comprehensive care, are the foundation of healthcare systems. How this foundation is supported, sustained, and developed shapes healthcare for everyone.
The Case for Family Medicine Investment
Advocates argue that family medicine requires priority investment. From this view, primary care is healthcare's foundation.
Family medicine is essential. Health systems with strong primary care have better outcomes at lower cost. Family physicians coordinate care, manage chronic disease, and provide continuity. Investment in family medicine yields system-wide returns.
The family physician shortage is crisis. Millions of Canadians lack family doctors. Physician retirements exceed new entries. The shortage is worsening, not improving. Urgent action is required.
Family medicine must be competitive. If family medicine is less attractive than specialty practice, medical graduates will not choose it. Compensation, working conditions, and support must make family medicine an attractive career.
From this perspective, strengthening family medicine requires: compensation that reflects value; practice support and team-based care; administrative burden reduction; and attracting new physicians to the specialty.
The Case for System Redesign
Others argue that simply adding family physicians will not solve primary care problems. From this view, models of care must change.
Team-based care extends physician capacity. Nurse practitioners, pharmacists, and other providers can do much of what family physicians do. Team models can serve more patients with fewer physicians.
Technology changes practice. Virtual care, electronic communication, and AI tools can improve efficiency. Traditional office-based practice may not be optimal. Innovation should be embraced.
Different populations need different models. Not everyone needs a traditional family doctor relationship. Young healthy people may be well-served by episodic care. Chronic disease patients need intensive management. Models should match needs.
From this perspective, primary care should be redesigned with team-based care, technology, and appropriate models for different populations.
The Shortage Crisis
Millions of Canadians lack a family doctor.
From one view, the shortage is unacceptable. Everyone deserves a family doctor. The solution is more family physicians - training more, recruiting from abroad, retaining those we have. The shortage must end.
From another view, traditional family doctor for everyone may not be achievable or necessary. Team-based care, virtual options, and other models can serve patients well. Shortage framing may limit thinking about solutions.
How the shortage is understood shapes solutions.
The Compensation Question
Family physician compensation affects recruitment and retention.
From one perspective, family physicians are underpaid relative to specialists. This deters medical students from family medicine. Closing the compensation gap would attract more physicians to primary care.
From another perspective, simply increasing fee-for-service payments may not solve the problem. Alternative payment models that reward quality and access may serve better. How physicians are paid, not just how much, matters.
How compensation is structured shapes practice patterns.
The Practice Support
Family physicians often lack support for efficient practice.
From one view, administrative burden and lack of team support drive physicians from practice. Supporting family physicians with staff, technology, and administrative help would improve retention and satisfaction.
From another view, practice support requires investment. Funding models must enable teams and support. Simply expecting improved support without changing resources is unrealistic.
How practice is supported shapes physician sustainability.
The Training Pipeline
Medical training shapes future physician supply.
From one perspective, more family medicine training positions are needed. Medical schools should produce more primary care physicians. Incentives should attract graduates to family medicine.
From another perspective, training more physicians takes years to affect supply. In the meantime, other solutions are needed. Training expansion is necessary but not sufficient.
How training is designed shapes future workforce.
The Canadian Context
Canada's family physician shortage affects millions. Each province faces recruitment and retention challenges. Walk-in clinics and emergency departments serve as substitutes for family medicine. Team-based care has expanded in some regions. Compensation models vary provincially. International medical graduates face barriers to practice. Medical school expansion has occurred but family medicine residency fill rates have declined in some years. Policy attention to primary care has increased. The problem is recognized but solutions remain elusive.
From one perspective, Canada must invest significantly in family medicine to address the shortage.
From another perspective, primary care redesign with teams and technology should accompany any expansion.
How Canada approaches family medicine shapes healthcare's foundation.
The Question
If family medicine is healthcare's foundation, if strong primary care improves outcomes, if millions lack family doctors, if the shortage is worsening - why have we allowed this crisis? When someone cannot find a family doctor and bounces between walk-in clinics, what continuity is lost? When a family physician retires and no one replaces them, what happened to workforce planning? When medical graduates choose other specialties over family medicine, what message have we sent about primary care's value? When we know that health systems work better with strong family medicine, why is ours struggling? And when we speak of healthcare reform, how central is fixing family medicine?