Specialty Profile

Family Medicine GENERAL INFORMATION (Sources: Pathway Evaluation Program and the Canadian Medical Residency Guide) Family medicine is the main primary care medical specialty in Canada. It focuses care on the individual within the context of the family and the community. Family physicians deliver services across the entire spectrum of care, regardless of patient age, sex or condition. Public polls repeatedly confirm how highly the people of Canada value family doctors for their roles in caring for them. While family medicine may seem the most “general” of the specialties, it is in fact, a precise discipline, integrating a unique blend of biomedical, behavioural and social sciences, while employing a diverse range of cognitive and procedural skills. The family physician is often called upon to deal with undifferentiated clinical problems presenting at an early stage. In addition to acute disorders, which are sometimes life-threatening, there is a high frequency of chronic diseases, emotional problems and transient illnesses. Family physicians deliver care across a wide spectrum of settings, including their offices, hospital, long-term and other health care facilities and the patient’s home. The close, long-term physician-patient relationship that is established, the diversity in the work and the variety of practice opportunities offered by family medicine are some of the main factors that attract physicians to this specialty. Family physicians also play an important role in health promotion and illness prevention, coordinating care with other specialties and health professionals, and advocating on behalf of their patients with respect to the care and services they need in all parts of the health care system. Upon completion of medical school, to become certified in family medicine with the College of Family Physicians of Canada (CFPC) requires an additional 2 years of postgraduate training. This includes experiences in family practice settings; general surgery; internal medicine; pediatrics; obstetrics/gynaecology; psychiatry and emergency medicine; as well as opportunities for electives in areas selected by each resident. The training environment includes hospitals but is also very focused on experiences in community-based practices, including opportunities in small town and rural settings. While most residents are well prepared to enter practice after two years of postgraduate training, some with specific needs or interests might benefit from some additional or enhanced skills training and apply to a number of positions available for an optional third year. Examples of such third year programs include emergency medicine, palliative care, maternity care and care of elderly. The main objective of the additional training is to prepare graduates to be able to offer added services to their patients as part of their broad-based or comprehensive continuing care family practices. Following the completion of residency, there is a certification examination to evaluate competence in the specialty of family medicine. If successful, the resident will be awarded Certification in The College of Family Physicians of Canada (CCFP) that is then maintained throughout their career through participation in the College’s life-long learning (continuing professional development) program.

For more detailed training requirements for family medicine go to: http://www.cfpc.ca/English/cfpc/education/examinations/Cert/default.asp?s=1 There are currently 33,922 family physicians practicing in Canada (includes both CCFP physicians and general practitioners). Of these, 8% are under the age of 35, 37% are 35-54 and 37% are age 55 and older. The majority of practicing family physicians are male (62%) and 38% are female. (Source: 2008 CMA Masterfile). DETAILED INFORMATION The remainder of the data contained in this specialty profile has been extracted from the 2007 National Physician Survey (NPS), unless otherwise stated. All percentages are for respondents only. A total of 10,270 family physicians responded (for a response rate of 32%). Results are for both CCFP and non-certified family physicians. Complete data tables for family medicine (by certification status) from the 2007 NPS are available at: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/Results/physician2.1-e.asp For an index to all specialties, go to: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/2007results-e.asp Choosing family medicine (2004 NPS Data) Many family physicians (27%) decided on this specialty career choice during their clerkship year (i.e., the last year of medical school), while 20% decided after a period of time in practice and 18% decided during medical school but prior to clerkship. The most frequently cited reason for deciding to become a family physician was for the intellectual stimulation/challenge this specialty provides (75%). Also cited as factors were the quality of the doctor-patient relationship (71%) and for workload flexibility and/or predictability (45%). From these factors, the quality of the doctor-patient relationship was identified as the single most important career decision-making factor (31%). Practice Setting For most family physicians (67%) the main work setting is a private office/clinic, while 33% work mainly in a community hospital, 23% are in an emergency department (in a community hospital or academic health sciences centre) and 22% work in a nursing home/home for the aged. Family physicians see patients in a variety of settings, with their private office/clinic being the main patient care setting for the majority (61%). Liking the area was the major influence (59%) on family physician’ selection of their current practice location, but availability of a practice opportunity (49%), the availability of a medical support system/resources (42%), and family reasons (40%) were also cited as important influences.

Practice Profile Unlike the traditional image we have of family physicians where the doctor works independently in his/her own office to care for the health and well-being of their patients, today the majority of family physicians (51%) work in a group practice where on-call duties, equipment, office space and/or staff are shared amongst the physicians, but many (24%) also work in an interprofessional practice setting where physicians and other health professionals have their own caseloads and 23% still work in a solo practice setting. In their main patient care setting, family physicians share patient care with many other types of health care providers, including:

• other family physicians (81%) • pharmacists (74%) • physiotherapists (67%)

Nearly all family physicians (92%) feel that this collaboration improves the care that their patients receive and 91% feel it enhances the care that they can deliver. It also provides the family physicians involved with more opportunity to achieve a better balanced life. During a typical week, a family physician will see approximately 113 patients. More than half of family physicians (52%) serve mainly an urban/suburban population. Family physicians work an average of 50 hours per week on professional activities (excluding on-call). The majority of this time (33 hours per week) is devoted to direct patient care, with or without a teaching component. An additional 6 hours per week is spent on indirect patient care, such as making appointments with specialists, charting, meeting a patient’s family, etc. The remainder of the time is spent on CME/CPD, administration and managing their practice. The majority of family physicians (68%) make themselves available to their patients (i.e., on-call) outside of their regularly scheduled hours. More than half (54%) are on-call for hospital in-patients, while 37% are on-call for non-hospitalized patients (are available by telephone and see patients as required), 32% do nursing home/LTC facility on-call and 27% do emergency room on-call. Of those who do on-call, the majority (62%) spend up to 120 hours per month on-call, 14% put in between 121 and 180 hours per month and 18% are on-call for more than 180 hours per month. On average, a family physician is on-call 135 hours per month. During the time they are on-call each month, they spend an average of 35 hours on direct patient care and see an average of 53 patients. Income Nearly half of family physicians (48%) receive 90+% of their income from fee-for-service, while 31% receive it from a blended source (i.e., made up of a combination of 2 or more payment methods like fee-for-service, salary, capitation, sessional, contract, benefits/pensions, on-call remuneration or some other form). When asked their preferred method of remuneration, 52% of family physicians would prefer some form of blended remuneration and 21% preferred fee-for-service only.

According to the Canadian Institute for Health Information’s Average Gross Fee-for-Service Payment Report 2005-2006, the average gross fee-for-service payment per family physician in 2005-06 was $211,671. Note that this is gross billings and does not take into account deductions for overhead expenses, taxes, etc. To protect their income, physicians take out medical liability coverage in the event that a patient is harmed in a medical misadventure. According to The Canadian Medical Protective Association’s Fee Schedule for 2009, the annual cost for insurance for a family physician is:

Quebec Ontario Rest of Canada $ 1,753 $ 2,040 $ 996

Satisfaction Most family physicians (75%) report that they are very or somewhat satisfied with their current professional life. Most (85%) are very or somewhat satisfied with their relationship with their patients, their relationship with other family physicians (81%) but only 70% are very or somewhat satisfied with their relationship with specialist physicians. Family physicians are less likely to be very or somewhat satisfied with finding a balance between personal and professional commitments (56%), with their net revenue per hour compared to other family physicians (45%) and with their net revenue per hour compared to other specialties (46%). ADDITIONAL INFORMATION Additional information on family medicine can be found from: The College of Family Physicians of Canada: http://www.cfpc.ca/ The Medical Council of Canada: http://www.mcc.ca/ The Canadian Residency Matching Service: http://www.carms.ca