I read Alastair Brown’s excellent article on the challenges of the rural physician (“The Cost of Care,” April) with both admiration for Dr. Mihu’s dedication and concern for the future of Canada’s rural doctors. General practitioners in the United Kingdom are the highest paid in Europe, taking home around $100,000 (Cdn.) after tax. The allure of financial comfort, coupled with relatively gentle working hours, makes general practice an enticing proposition for med-school graduates in the UK.
Unfortunately, increasing salaries will not be sufficient to attract Canadian med-school graduates to rural medicine. An additional solution might be to work on the image of the rural physician and family doctor in order to inspire medical students about the work of these generalists and to expose them to it. If medical students in Canada are anything like those in England, many will have a dim view of family doctors, these jacks of all trades and masters of none. Family medicine is not “sexy.” It is seen as old-fashioned and devoid of the glamour that surgery, emergency medicine, and other specialties possess. Because the majority of family physicians work in communities, hospital-based medical students have scant opportunity to be inspired by them. Their understanding of what family doctors actually do, and the role they play in the community, may be limited, or worse, false.
I work outside the field of clinical medicine but have a reasonably clear view of it, and I have often felt that family medicine is undervalued and misunderstood. It suffers from its low-tech image of treating common colds and little old grannies, and gets too little credit for its integral role. A primary vehicle for improving its deteriorating status, I suggest, should be Canada’s medical schools.
Daniel K. Sokol
Researcher in Medical Ethics
Imperial College London
London, United Kingdom
Rural physicians are truly the last “general” practitioners, and their jobs become exponentially more difficult as medical knowledge evolves and the shortage of doctors worsens. The financial pressures described by Alastair Brown have been made worse by skyrocketing medical-school tuition ($16,207 at the University of Toronto this year, set to increase this fall), which has made a $100,000 debt the norm rather than the exception. Financial assistance has barely begun to catch up. As a result, students from rural communities (i.e., those most likely to return there to practise) may be shut out.
Fortunately all is not bleak. In Ontario, new modifications and alternatives to the fee-for-service model are providing incentives for group practice, preventive care, and after-hours care, and they are doing a better job of recognizing the complex needs of elderly patients. And telemedicine, which involves two-way video technology, holds out the promise of reducing the need for travel, thus improving the access people living in remote areas have to specialists.
The pace of change has been slow, but as I prepare to begin residency training in rural family medicine at the University of Western Ontario, I am looking forward to meeting the challenges of helping preserve the “social aspect of medicine.”
Stephen Keleher
Toronto, Ontario
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