Making better picks for the doctors we need

Opinion

Hey there, time traveller!
This article was published 27/03/2024 (531 days ago), so information in it may no longer be current.

This year, the Canadian Institute for Health Care published the results of an international survey indicating that, in 2023, Canada was in last place of 10 high-income countries in access to a primary health care provider.

Currently, only 86 per cent of Canadian adults have this access. Alarmingly, this is down from 93 per cent in 2016.

Currently, four million Canadians have no family physician. Poorer Canadians who suffer from the greatest burden of illness have even lower access.

As a recently retired family doctor of 43 years, it is with this knowledge that I read with dismay a March 21 CTV News article reporting that, once again, more than 250 family practice residency positions in Canada remained unfilled after the first round of Canadian Residency Matching Service matching. In Manitoba this year, 10 family medicine positions remain unfilled.

With some justification, health care educators indicate that such factors as earning lower income compared to most medical specialists, burden of excess administrative responsibilities including unnecessary paperwork, and a high prevalence of burnout make family medicine less attractive to medical school graduates.

What is less recognized is that historically, medical schools have been admitting relatively more students whose life experiences include a privileged high school education and increased family wealth.

These characteristics are associated with reduced likelihood of choosing family medicine over most medical specialties.

During my career, I participated in and authored several studies looking at how personal characteristics of graduates of our medical school influence choice of specialty and practice location once their training is finished.

To its credit, the Max Rady School of Medicine has recently been able to increase the proportion of its student body who are female, along with those who have come from rural or Indigenous backgrounds. These student characteristics are associated with increased predilection for family medicine.

However, in Manitoba, it remains that a large proportion of medical students come from privileged backgrounds.

For instance, those who have graduated from six elite privately-funded high schools in this province are now 10 times more likely to have been accepted into medical school in Manitoba than those who have graduated from our publicly funded high schools. They now make up roughly 25 per cent of our medical school population.

Data in these studies indicate that, not only are privileged medical students less likely to choose family medicine careers, they have also been twice as likely to have left the province once they graduate.

In Manitoba, the student who is most likely to have chosen family medicine as a career has graduated from a Winnipeg high school located north of the Assiniboine River and east of the Red River.

Those graduating from rural high schools are a close second.

There are a number of features in the process of selection of medical students in Manitoba that may be permitting the persistence of this demographic imbalance.

The weighting of the admission criteria for student seeking to enroll in the Max Rady School of Medicine is 10 per cent university grade point average, 40 per cent for a personal assessment score (largely based on an interview) and 50 per cent for their score on the Medical College Admission Test (MCAT).

Studies in the United States have shown that the most sensitive predictor of success in the MCAT is the family income of the student taking the test.

There is no reason that this is not also true in Canada.

It is also safe to assume that high school students from privileged backgrounds, particularly those attending privately funded schools, probably have greater access to enhanced training for participating in interviews for entry into professional colleges.

In recent years, the Max Rady School of Medicine has made it a priority to respond to the challenge of its social responsibility.

However, I suggest more can be done to solving the problem of providing an adequate supply of primary care providers in this province, including by paying closer attention to who gets a chance to become a doctor in Manitoba.

Robin Carter is a former family physician who writes from Portage la Prairie.