Joni Mitchell had it right. “Don’t it always seem to go… That you don’t know what you’ve got ’til its gone.” I’ve officially been a family doctor now for about 26 ½ years! But I never really appreciated the value of family physicians until I had a better look at the challenges facing health systems that have not benefited from the contributions of Family Medicine.
There is currently some debate about how Canadians can best contribute to development in some of the world’s least resourced countries. I have written before about my belief that education is one of the areas where we should invest. This post expands on a specific area where I’d like to see Canadians make a contribution to post-secondary training – that is, in supporting programs to train family physicians.
I’ve worked in several countries in sub-Saharan Africa of the past 30 years and spent a lot of time thinking about how to advance health systems in those settings. Many of these countries have invested a great deal of energy and resources in primary health care. But most of the human resources in that field are low- and mid-level health workers. Few countries on the continent have focused on the training of physicians to work in the primary care sector.
In contrast, Canadians have reaped the benefits of a well-trained cadre of primary care physicians (we call them family doctors) in the context of social policies that have provided universal insurance for health care. Thanks to the work of the late Dr. Barbara Starfield, there is extensive evidence that primary care is an essential part of a health services system. A strong emphasis on primary care has been linked to lower healthcare costs, improved access to appropriate health services, better health outcomes, and reduction of inequities in the health of the population. I am fully convinced that physicians play an indispensable role in the primary care team. Multiple studies have shown better health outcomes in regions with higher ratios of primary care physicians to population.
In recent years, several countries in sub-Saharan Africa have developed enhanced postgraduate training for generalist physicians, introducing a new “specialty” in Family Medicine. Many countries in sub-Saharan Africa are currently addressing the crisis in health human resources by flooding the medical education system with increased number of physician trainees. There would be many advantages in directing the majority of these new physicians to primary care or general practice.
The following benefits could be derived from the introduction of Family Medicine training in areas where it does not currently exist:
- Recruitment and retention – Family physicians who are well-trained, supported and respected will see generalism as a lifelong, satisfying career path.
- Physicians with improved technical, surgical and emergency skills
- Better health outcomes and lower healthcare costs
- Skilled leadership of interprofessional primary care teams
- Improved equity of access to high quality primary care
- Family Medicine can be a great career option for new medical graduates averting a disproportionate supply of other specialists in the health system
Health care providers and policy makers in the world’s least resourced nations demonstrate remarkable resilience and determination to address overwhelming health issues. Yet the critical shortage of highly trained human resources in the health sector threatens to annul the most ambitious efforts. Training in Family Medicine is one of the most effective ways to build capacity. A force of highly competent and confident family physicians can lead a primary care sector and provide the best health outcomes at the lowest cost. An investment in training primary care physicians will remain long after outside resources are required because the venture builds on public infrastructure – strengthening medical education; building local leadership and solidifying primary care infrastructure.
Supporting new programs in Family Medicine is an opportunity to make a dramatic impact on health systems and improve the health of millions. Do you want to know how you can help? Let me know you are interested and I’d be happy to talk!