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Future of Family Medicine

Across Canada, many are taking last week’s CaRMS match results as a warning sign about the future of family medicine. There were 268 family medicine residency positions that went unfilled in the first iteration of the 2023 match, about double the number that went unmatched five years ago. It’s also the highest number ever. Unfilled family medicine spots accounted for over three quarters of all unfilled residency spaces this year.

Here in Manitoba, 13 of the 62 family medicine residency spaces went unfilled, about double the number of unmatched spaces last year.

While some of this concerning number is due to an increase in the overall number of family medicine residency spaces, there’s another trend that is also concerning. Dr. José François, Department Head for Family Medicine with the Rady Faculty of Health Sciences, explains that he is ​“very concerned about the declining proportion of medical students choosing family medicine as their first choice for residency, which now sits at less than one third.“

Dr. François says this shouldn’t be a surprise when students see and hear first hand how difficult it has become to practice family medicine. ​“Students are just getting a sense that primary care is a tough job to do right now, with less prestige and increasing demands and uncertainty.” The prestige deficit is also a result of the the ​“hidden curriculum” in medical school.

Dr. Jane Philpott, Dean of the Faculty of Health Sciences at Queen’s University in Ontario, also cited the same issue. ​“Some of it is on med schools and the hidden curriculum which teaches that family medicine is a less desirable choice,” she tweeted. ​“But more importantly, it’s about the primary care system which needs a radical overhaul.”

In Alberta, with 42 unmatched positions, AMA President Dr. fred Rinaldi called the CaRMS numbers ​“alarming.” She explained that ​“years of underfunding and uncertainty have put a strain on primary care in this province and have resulted in a disincentive for learners looking to Alberta as a place to train.”

Meanwhile, in BC, only 2 spaces went unfilled. Some have speculated the new BC Longitudinal Family Practice Model, which offers a blended model of FFS and hourly remuneration, could be the reason for stronger interest. However, BC also had only two unfilled positions last year, before their new model was introduced, and zero the year before. 

Doctors Manitoba President, Dr. Candace Bradshaw, reinforced that addressing the issues in Manitoba are a priority. ​“What we do know is there are several challenges behind the primary care crisis, and thus no one solution will offer the silver bullet to fix it. We need to see some major changes to how family medicine is funded so that family physicians have the resources they need to offer the comprehensive care their patients need.”

Have Your Say on the Future of Family Medicine.

Join one of our Family Medicine Town Halls this April to help inform our work to advocate for better funding and support for family medicine practices.

Here’s the schedule and registration link:

The Town Hall will feature the following:

  • What needs fixing? Summary of the current challenges we’ve heard.
  • How can we fix it? Option to renew family medicine and primary care, including:
  • Overview of BC’s new Blended Remuneration Model and what it would mean in Manitoba.
  • Alternatives to a blended remuneration model. What’s happening in other provinces? What is the potential value of expanding or strengthening what we already have in Manitoba?
  • Feedback and discussion.

With a mix of education, discussion and feedback, Town Hall participants will learn more about how new funding and support models could help family physicians and renew primary care and have a chance to offer valuable feedback and help prioritize the wide range of policy options to modernize and renew family medicine and primary care.

The Town Halls will all be conducted virtually, on Zoom, and due to the interactive nature of the program a recording will not be available for on-demand viewing.

Rural Care Issues Continue

The availability of medical care in many rural communities continues to be very fragile.

In Western Manitoba, ER services have been partially curtailed in Glenboro and Carberry. These sites had long lost 24/7 ER coverage, but had maintained a shared call schedule to ensure 24/7 coverage between the two communities. Now, however, there are significant gaps where both communities have no ER coverage. Both communities are very concerned about the shortage of doctors and other health care workers behind the service disruptions. Meanwhile, an expanded cancer centre in Brandon won’t be able to offer some cancer treatments due to a specialist shortage. 

We also understand there continues to be significant gaps in physician coverage for ERs in the Interlake-Eastern Region.

Meanwhile, in Steinbach, the CBC reported there are no physicians accepting new patients with over 3,500 waiting for a family doctor. Doctors Manitoba President Dr. Candace Bradshaw reacted in the story with concern, and reinforced this is part of a wider problem across the province. She said Manitoba is being out-manouevered by incentives elsewhere in Canada. ​“You never know when another province is going to come up with a new attractive offer that depletes more of our physicians,” she said.

Also this week, Dr. Bradshaw recognized a move by the federal government to help recruit and retain more doctors to rural and Northern communities. As part of the federal budget, up to $30,000 in student loans for physicians will be forgiven if they practice in communities with less than 30,000 people. ​“We welcome funds that bring more resources to our rural and northern colleagues, but Manitoba is facing one of the largest doctor shortages in the nation, and an aggressive and targeted approach is required,” she said.

Doctors Manitoba continues to push for progress on the 20 recommendations from the Rural Health Summit we held last fall.

Physician of the Week

Dr. Oveis Adl Golchin has always wanted to be a physician. This week, he is our Physician of the Week! Dr. Adl Golchin works in The Pas, where he is most satisfied by those moments he is able to please his patients. Born in Iran, Dr. Adl Golchin has worked in Northern Manitoba for over a decade. He’s concerned about how hard it can be to achieve change in health care, as well as the alcohol and substance use among young people in his community. Read more about Dr. Adl Golchin.

For 2023, Doctors Manitoba has established a new way to recognize dedicated and hardworking physicians. Our Physician of the Week initiative has been recognizing physicians weekly. They exemplify the best of the medical profession, including a commitment to delivering exceptional patient care, to supporting the health and wellness of their colleagues, and/​or to leadership in the medical profession.

→ Suggest a colleague as Physician of the Week here.

→ Read about other Physicians of the Week so far this year here.

Federal Budget Update

This week the federal government delivered its budget, which highlights its spending and revenue plans for the next year.

Much of the budget was directed at developing an greener economy, improving health care, and assisting Canadians with affordability challenges.

In health care, much of the new spending was already previously announced in February when the federal government promised more than $198 billion in transfers to provinces over 10 years, including over $48 billion in new funding, to improve health care services for Canadians. However, there were some other developments.

Further steps will be taken to advance a national dental program. The current program provides eligible households with an amount of money intended to cover the cost of children’s basic dental care. Over time, the program will become more like Medicare, where dentists will bill a government agency for dental services provided to eligible Canadians. The additional cost of the program is estimated at over $13 billion over the next five years, and $4.4 billion each year after that, and is intended to ensure that every Canadian has access to dental care.

There were no major further steps announced to advance a national pharmacare program. The provinces will continue to determine the level of coverage, and which drugs are included.

Student debt relief for new to practice physicians, initially announced in the 2022 budget, has been expanded. Physicians practicing in any community with a population under 30,000 (including every Manitoba community outside of Winnipeg and Brandon), may be entitled to assistance with their student debt. More details will be announced in the future.

The federal government will work with Indigenous partners to provide additional support for Indigenous health priorities by providing $2 billion over ten years, which will be distributed through the Indigenous Health Equity Fund.

The federal government will provide $505 million over five years to the Canadian Institute for Health Information, Canada Health Infoway, and other federal data partners. These organizations will be tasked to work with provinces and territories to develop new health data indicators, support the creation of a Centre of Excellence on health worker data, advance digital health tools and an interoperability roadmap, and support provincial and territorial efforts to use data to improve the safety and quality of health care.

The federal government will provide a total of $359 million over five years to support a renewed Canadian Drugs and Substances Strategy, responding primarily to the opioid and methamphetamine crises (it is unclear how much of this amount is already part of the other spending in the budget).

Audit Reminder

In the event your physician billings are audited, please remember to call Doctors Manitoba first. We are here to help you through the process, every step of the way.

The Comptrollership and Compliance Unit (CCU) in the Department of Finance has had responsibility for auditing physician fee-for-service billings since December 2020.

Following extensive pushback and advocacy by Doctors Manitoba in response to signals government audits would increase, we are aware of very few audits being started in the last year. We can assist you in responding to audit letters, and guide you through the process. Your advice also helps us to determine the CCU’s priorities, and the positions they are taking.

If you receive an audit letter from the CCU, please call or email our office. You can contact our General Counsel Andrew Swan at aswan@​doctorsmanitoba.​ca.

Health System Updates

VECTRS Moving Forward

Shared Health unveiled some further details about the new Virtual Emergency Care and Transfer Resource Service, or VECTRS, earlier this week. This acts on one of the key recommendations from our Rural Health Summit last year. This responds to feedback from rural and Northern physicians about the challenges in seeking specialist advice, finding a bed in a more acute facility, and arranging the patient transportation. The new model of care being developed by Shared Health should result in less time spent determining where a patient should be transported, less time arranging the transport of patients, and more time focusing on the care of their patients.

The service is still expected to launch in May, initially with a focus on emergency consultation and coordinating patient transfer and bed access.

VECTRS will be staffed 24/7 with an Emergency Physician, an Advanced Practice Respiratory Therapist, an Advanced Care Paramedic and Communications Operators who will answer calls from Urgent Care Centres, Emergency Departments, health facilities, nursing stations and ERS
Teams province-wide.

VECTRS will offer health-care providers immediate medical advice and specialist consultation for patients in their care with a life, limb or vision threatening condition, or another acute change in their health status. This advice and consultation will help determine appropriate transport locations and, in some instances, may prevent transport altogether.

In cases where a patient transfer is required, VECTRS will help to provide seamless and timely access to air and/​or ground transport resources through Shared Health’s Medical Transportation Coordination Centre (MTCC) in Brandon and/​or the Winnipeg Fire Paramedic Service’s (WFPS) Communications Centre. In addition, staff will also provide clinical guidance and oversight throughout complex patient transfers, reducing the current requirement for facility-based health care providers to coordinate these transfers with receiving sites.

Our project team is working to implement VECTRS and the process of hiring staff has also begun. We are pleased to share that Chad Turner has been hired as VECTRS manager while Dr. John Sokal has accepted the position of Medical Director. Both individuals bring significant experience and system knowledge to the project team.

Pertussis Alert

Manitoba Health advises that a cluster of pertussis cases have been identified within the Southern Health-Santé Sud Region and is reminding health care providers of the importance of immunization, particularly in small children, to prevent further illness. Other Canadian jurisdictions, including Alberta and Ontario, have also recently reported increased pertussis activity. Current activity in Manitoba and other Canadian jurisdictions suggests pertussis circulation is returning to pre-pandemic levels.

The provincial immunization program has noted a decreasing trend in vaccination rates in the following routine infant/pre-school immunizations: MMRV, DTaP-IPV-Hib, Men‑C and Pneu-C-13 in the 2019, 2020 and 2021 birth cohorts compared to pre-pandemic levels, with the largest impact in rural regions. Parents/​guardians should be encouraged to check immunization records and ensure children are up to date with vaccines. In addition, all health care providers are reminded to review their patient/client’s immunization status to determine if any vaccines are outstanding based on Manitoba’s Immunization Schedules.

You can view the full bulletin from Public Health here.

Pharmacare Deductible

The provincial government announced today it will freeze Pharmacare deductibles for 2023/24. The deductible is calculated based on adjusted family income, and Manitobans are reminded that a family’s deductible may still change this year if their income has changed. Annual filing of taxes is recommended to ensure access to
this important program. Last year, deductibles increased by 1.8%.

Stretcher Service Launched

Three communities will see a stretcher service launched for low-acuity patients to complement and free up ambulance resources. The communities include Brandon, Selkirk and Morden/​Winkler. While new to rural Manitoba, the low-acuity inter-facility transport (IFT) service is similar to a long-standing contracted service provided in Winnipeg that transports hospital inpatients and personal care home residents to medical appointments, diagnostic tests or treatment. Brandon-area services were added in January, Selkirk launched in early February and Morden-Winkler operations began in March. Read full provincial news release.

Brandon Health Facility Expansions

The province provided an update on construction at the Brandon Regional Health Centre earlier this week, a major initiative to add 30 more medicine beds and an expanded ICU and NICU. Work should be complete in 2025. An expansion of the Western Manitoba Cancer Centre is also underway, and should be complete next year. Read the full provincial news release here.

New Model Practice Standard for MAiD

The federal government launched a new model practice standard for Medical Assistance in Dying (MAiD) this week. The Model Practice Standard and accompanying documents will help clinicians align their practice with clear guidance and will assist regulators to ensure the protection of the public in the context of complex cases, including where the person’s sole underlying medical condition is a mental illness. The Model Practice Standard is designed to ensure that MAID practice in Canada can operate in a consistent and safe manner across the country. The Model Practice Standard was developed by a task group of clinical, legal and regulatory experts in response to the first recommendation in the report of the Expert Panel on MAID and Mental Illness.

The Government of Canada is also supporting the development of an accredited Canadian MAID curriculum to support clinician education and training, which will address topics related to the assessment and provision of MAID including mental disorders and other complex chronic conditions. The Model Practice Standard, along with the MAID training curriculum, will provide valuable resources for regulators and practitioners in interpreting and applying the legislative framework safely in different clinical situations.

Access the full Model Practice Standard for MAiD here.

Health in the News

We’ve curated some of the top recent stories, to help you stay on top of what’s new in health care. This includes free access to some subscription-based content.

DRMB in the News

Other Health News

ICYMI

Here are some of our top recent posts, in case you missed them:

Upcoming Events

Upcoming events are always listed on our events calendar.

Featured Events

CBTm Facilitator Training
This course will teach the key cognitive and behavioural concepts and how to apply them with your patients. You’ll leave with the knowledge and resources to deliver the CBTm program in group or individual settings. This training happens on April 5 and April 12. Learn more and register here.

Leadership for Equity: Expanding Inclusive Medical Culture virtual speaker series
On April 20, we will be hosting Dr. Julia Chronopoulos for her session on 2SLGBTQ+ Health. Dr. Chronopoulos’ talk focuses on how to make health spaces more queer-friendly. This involves an overview of terminology in the 2SLGBTQ+ community, as well as approaches to challenging norms that are the foundation of medical teaching. Click here for more information, and to register for the session.

Upcoming Events:

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