Vital Signs

Heading for pay dirt

Cal Gutkin, MD, CCFP(EM), FCFP, Executive Director and Chief Executive Officer

Football has always been one of my favorite sports; my aching knees constantly remind me of when I played. Although some simply see it as game where herds of helmeted behemoths beat one another to a pulp, it’s really the chesslike strategy that creates success. Crossing the goal line, scoring a touchdown, finding the end zone—or as it has been expressed by many football heroes, hitting pay dirt—creates both individual and team euphoria.

For several years, Canada’s family physicians have been involved in something akin to a classic gridiron battle. Despite a line-up of talented, committed, and well trained front-line players, the team has rarely gained the respect it deserves. Although millions of devoted fans across the country tell every public pollster that this is the best team around—the one they prefer to see before any other—the family medicine team still faces challenges to its future operations.

Why has this happened? Despite exceptional players, the family practice team is playing shorthanded. Opportunities elsewhere in the league have enticed some players to join other teams. The pressure to perform has at times stretched those remaining beyond reasonable limits, causing dissension in what used to be harmonious ranks. Management has tried to encourage players, reminding them that evidence clearly shows that they not only have the team best loved by the fans, but when given the chance to play, they actually produce results that make their followers feel better than they do with any other team in the medical league. Unfortunately, the owners and governors who control the league, who decide on how new players should be trained and what the playing conditions and pay should be for players who make it, do not seem to understand the value of the family medicine team.

Despite the joys and rewards of being a family doctor, new players have become more difficult to recruit. Trainees report that, in many centres, they are taught predominantly by veterans from specialty teams, some of whom actually discourage them from even considering joining the family practice team. Young players are concerned that, if they join the family doctors and then want to switch teams, league rules will make this difficult. They also fear joining a team that will expect them to play more minutes and more positions than they had planned. They claim that the increasing costs of their training programs make it less desirable to play for a team that pays less than the others in the league. They are also concerned that they will be respected less than their friends who sign on with other teams. They say they cannot understand the gap between the high value the public places on family doctors and the inadequate support offered by the league.

There are signs that these problems are about to end. Not only are the people, the fans of family practice, starting to speak out, but the league governors might finally be getting the message. Those responsible for training and those who determine how and where players will play and how much they will be paid are saying we must support this vital team. They are realizing they have a responsibility to society to encourage recruits to family practice and then to support them and promote them as the valuable players they are.

Most games are not won on the first play after the momentum shifts, but the momentum is definitely shifting. Serious discussions are now under way about the role of family medicine in undergraduate curriculums, about the social accountability of medical schools to produce the expected balance of family doctors and specialists (50/50), about increasing resources and prestige for family medicine teachers and researchers, and about how family doctors are supported and paid in practice.

As the game unfolds, our family practice team must stick together. While continuing to battle the opposition across the line of scrimmage, we need to ensure none of our foes are from our own ranks. We also need to remind our colleagues on specialty teams that, if family practice should ever be forced off the field, specialists could find it difficult to play without us. To ensure success of the medical league long into the future, new recruits need to see family doctors in action regularly, to practise with them early in their careers, and to know they will be well rewarded for joining the family medicine team.

We have the ball. The plays to get us down the field are being called in the huddle. Millions of fans across Canada are cheering us on. Some key players and governors in the league are ready to declare their support. We can smell pay dirt!