Family Medicine Residents Adopt Resolution to End Falsification of Primary Care Workforce Production by Medical Schools and Residency Programs

Change through disruption (check)

Change through creating policy (check)

Change through educating the media, legislators, and the public (pending)

All of the above are the reasons for continuing efforts to ensure that medical schools are held accountable for the primary care workforce numbers it publicizes and promotes to medical students, federal/state/local legislators, and the public. All of the aforementioned stakeholders deserve the right to know how many of its medical school and residency graduates ACTUALLY practice primary care.  

We have used this blog to call out medical schools that lie to the media and ultimately lie to themselves.  These blogs have served as references for a number of articles in the media to help explain what "the Dean's Lie" actually is. Over the past year, a number of media outlets have caught on to and have called out medical schools that, despite being shown the data, continue to publicize primary care percentages that cannot be proven until at least 3-5 years after graduation from medical school.

An article by Medical Economics ("How Medical Schools consistently cover up their primary care failures") focuses on an interview with Primary Care Progress CEO and primary care change agent, Dr. Andrew Morris-Singer. The article does an exceptional job in trying to relay this information to the media. By utilizing the media for these numbers, they may be more likely to show how many of the "primary care institutions" are actually performing at the bottom of all medical schools in the entire country.  In fact, this is already being evaluated in our internal medicine residency programs by the Graham Center and resulted in several media pieces, including the "20 worst" residency programs for contributing to the primary care workforce. 

Now that our efforts are finally starting to show promise, it is now important to continue this momentum and accumulate organizational support. Since medical schools and residencies refuse to face the truth and provide the correct data proving their inability to produce primary care physicians, we must now do the work ourselves in finding this objective data and distributing it via multiple large-scale organizations to legislators and the public. 

The opportunity to provide guidance and create policy outlining the specifics of this initiative presented itself this past weekend at the 2013 American Academy of Family Physicians (AAFP) National Conference of Family Medicine Residents and Medical Students. The Resident Congress provided a forum to present a resolution that, upon approval by the Resident Congress, a specific action and policy could be put into place to task an organization that represents over 110,000 Family Medicine physician, resident, and medical student members with advocating and collaborating with others in amplifying these efforts.

The following resolution was submitted and approved by the AAFP Resident Congress:

RESOLUTION NO. R1-407

Rebuilding Trust In and Accountability for Primary Care Workforce Production Reporting

WHEREAS, The United States (U.S.) educational system is currently doing a woefully inadequate job of producing enough primary care physicians to satisfy future demand, and

WHEREAS, medical school deans and residency programs consistently cover up their primary care failures, regularly exaggerating the number of medical school students and residents they report graduating into “primary care residencies” and practicing in “primary care fields,” also known as “The Dean’s Lie,” and  

WHEREAS, publicizing misleading data of primary care workforce production gives the taxpaying community and politicians a false sense that the primary care workforce shortage is being fixed, and

WHEREAS, after factoring in the specialization rate of pediatrics (66%), internal medicine (80-98%), and other “primary care” residencies (e.g. IM/Peds, etc.), a much lower number of medical students actually end up practicing primary care, and

WHEREAS, medical schools utilize other non-primary care specialties when reporting their primary care production numbers (e.g. obstetrics and gynecology), and

WHEREAS, the institutions touted at producing primary care physicians have recently been found to be among the worst at producing primary care workforce when looking at graduating classes from five years prior, and

WHEREAS, it costs $500,000 of taxpayer dollars to train the average resident and as part of the Affordable Care Act, provisional funding will be given to “primary care” residencies including internal medicine, pediatrics, etc., now, therefore, be it

RESOLVED, That the American Academy of Family Physicians (AAFP) advocate for accurate reporting by medical schools and residencies of primary care workforce production measuring the type of practice five years following medical school graduation, and be it further

RESOLVED, That the American Academy of Family Physicians (AAFP) explore the feasibility of working with other organizations and news outlets to collaborate in advocacy for more accurate reporting of primary care workforce production to politicians and the public.

Things are about to get very interesting....

Highlight on interesting comments:

A comment left by Sylvia Kronstadt: 

On Sunday, June 2, the dean of the University of Utah School of Medicine had a cozy sit-down with our local “spokesmodel” news anchor and made several remarks that she knew to be false.

Dean Vivian Lee recently seduced the Utah Legislature into giving the medical school yet another $10 million (on top of the hundreds of millions it already receives) in order, she said, to train more primary care doctors. She implied that the U. is dedicated to resolving the shortage — which is rapidly becoming a crisis — especially since Utah is fourth from the bottom nationally in primary care doctors per capita. She ardently made her case for what seemed like a moral as well as a practical cause.

She referred to this victory during her interview on KUTV Channel 2 in Salt Lake City.

What she failed to disclose is that the U. is 75th nationally in recruiting students who express a desire to practice primary care.

Last year, there was NOT ONE TAKER for a scholarship that offered a $5,000 reward to any medical student willing to practice primary care medicine for just three years. That is a shocking indicator of how little interest the U. has inspired in this vital field of medicine.

Although the need for more primary care doctors has been a critical issue nationally for years, the U. has blithely ignored it.

The school glamorizes the specialties — paying professors in those disciplines hundreds of thousands of dollars more than those who teach primary care and family medicine (a professor of orthopedic surgery, for example, was paid $1.3 million in taxpayer funds last year. A professor of family medicine got $125,000).

Primary care has always been the “stepchild” of the U’s medical school, while the glamorous, high-status, high-paid, high-tech specialties are made ever more alluring.

Apparently it’s not just University of Utah officials who misrepresent their dedication to mobilizing an infusion of devoted primary care doctors into the health-care system. A shocking article, “The Dean’s Lie” (http://www.healthnewsreview.org/2013/04/the-deans-lie-about-new-docs-going-into-primary-care/), describes how medical-school deans all over the country are making the same urgent appeals to their legislatures for more money, brazenly fabricating the percentage of their graduates who are committed to serving in primary care, and then continuing to relegate primary care to the sidelines. The “dean’s lie” expression was coined by Dr. Reid Blackwelder, president-elect of the American Academy of Family Physicians.

(When I posted “The Dean’s Lie” on Lee’s University of Utah blog, it was promptly removed. Freedom of speech is so overrated, don’t you find? It just upsets people!)

Only Stanford University, according to one survey, was honest about how many of its medical school graduates actually established primary-care practices after their residencies: two percent (http://futureoffamilymedicine.blogspot.com/2011/04/deans-lie-about-medical-school-primary.html)

Primary Care, it's the Awesomest! To Be The People's Doctor, There's No Better Way to Be!

The following is a recent letter written by four soon-to-be residents who have chosen to go into various primary care fields.  The day after their graduation, they sent this letter to all medical students at their alma mater, SUNY Downstate: 

Hello, Fellow Downstaters!

Yesterday, we graduated from SUNY Downstate.  Two days ago,we were med students just like you, and now we are four soon-to-be residents who have chosen to go into various primary care fields.  We wrote this letter to you, and hope that you enjoy reading it.  Please, help spread the word!

***************************************************************

Primary Care, it's the Awesomest! To Be People's Doctor, there's No Better Way to Be!*

            There.  The title of this memo-to-all-med-students says it all.  But we’d like to elaborate!  First of all, our title might be, well, over the top, some might say--but we’re excited about where we’re headed (!), and we’ll tell you why in a second.  Plus, we felt it was that important to catch your attention, especially since in 1940, three-quarters of all doctors were general practitioners(1), but with the subsequent proliferation and dominance of specialist fields in American medicine, by 2010, less than one-third of practicing physicians were focused on providing primary care.(2) Moreover, the need for primary care physicians will continue to increase with the aging of our population and the millions more Americans who will soon be able to acquire health insurance, as a result of the Affordable Care Act.(3)  

            What does our opinion matter to you?  We don’t claim to be the end-all-be-all, or the know-it-alls, but among us, we have a good number of accumulated experiences as MS1-MS4 medical students during the years 2008-2013.  To be sure, our experiences in primary care have spanned providing care within an efficient team-based care model at a top-tier Patient-Centered Medical Home in Portland, Oregon; to staying after-clinic-hours to join in Zumba and nutrition classes with patients, led by the spirit-rich community of caregivers at Lefferts Family Health Clinic in the resource-poor community in Crown Heights; to working on public health studies of disparities in cancer screening; to experiencing successful integrative medicine practices that are helping patients to achieve better outcomes in Brooklyn Heights; to providing primary health care for uninsured patients at free clinics; to helping determine goals of care for patients and families faced with terminal cancer.  

            In primary care, the patient--and your relationship with that patient--comes first.  If this excites you, and you haven’t considered going into primary care yet, then we recommend that you start doing some considering.  Primary care is not defined by one organ system or illness category, but by whatever it is that brought that patient to you, and keeps bringing her or him back to you, in illness and/or in health.(4)  The person, their significant other, their family, their psychology, their context, their home, their community, their daily struggles, their life’s joys, their life’s tragedies, their health, illness, growth, journey to death--they all matter, and you get to be there with them, for them and their families, when they need.  The buzzword these days is “continuity” of care.  That is what primary care does and is.

            Asfuture primary care physicians, we are excited by the chance to hone and master diverse clinical, interpersonal, research, and policy skills, depending on our interests and our patients’ needs.  One of the greatest assets of being a primary care doctor is that you truly are a lifelong learner, with your patients at the center of the learning process.  Additionally, we work with other providers including specialists, psychologists, integrative medicine providers, nurses, and home health aides--not to mention teachers,not-for-profits, and policy makers--to provide care that best fits our patients’ needs, values, and life circumstances.  As “frontline providers,” we are in a unique position to work with communities--e.g. organizing community health efforts or contributing our voices to healthcare policy--as advocates for our patients.  We are incorporated into their lives and communities, and, from this unique vantage point, have initiated the development of many social initiatives and advocacy efforts; we have been pioneers of social justice and pushers of public health policy initiatives, from vaccination to improved access to care.  In all of these endeavors, primary care doctors have led the way.

            There is also an abundance of dynamic opportunities in primary care research, from improving preventive medicine to management of chronic diseases; from the hospital-to-outpatient transition to the complex needs of our aging population; and from end of life care to ending racial/ethnic health disparities.  As just one example, take the recent changes in the U.S. Preventive Task Force recommendations for mammography, prostate cancer screening, and HIV testing: primary care doctors not only help navigate their patients through these complexities, we are the ones formulating and conducting the vital research that ultimately improves our national guidelines!  As primary care becomes the centerpiece of health care reform, the opportunities to be involved in research are becoming endless.

            If there wasn’t enough respect for and investment in primary care in our country from the mid-20th century through 2010, then at least you can be sure that in the coming months, years and decades, primary care will be the main focus of healthcare investment and reform.  Who, by now, has not heard of the “chronic care model” or the more recent Patient-Centered Medical Home (PCMH)?  While there are a number of components to understand regarding these models(5), including continuity/coordination of care and patient access, at their roots, they recognize the evolutionary shift that has occurred in modern industrialized society--that people are living longer and predominance of acute morbidity has shifted now to an overwhelming burden of chronic disease in our country.  

            The 2001 national assessment by the Institute of Medicine, Crossing the Quality Chasm(6), called for transforming a “fundamentally flawed” US health care system; this report helped to propel the momentum that has led to the first serious attempt now at implementing health care reform in our country’s recent history.  With this, is a growing focus on primary care: in the words of the Institute of Medicine, “primary care is the logical basis of an effective health care system... [and] is essential to reaching the objectives that constitute value in health care.”(7)  This recognition has led to increased reimbursement rates and medical school grants for those going into primary care (contrary to popular belief, a recent study has proven that medical students with median loans are able to pay it off on a primary care physician salary(8), and there are many federal, state and private scholarships targeted to attract brilliant and compassionate future-physicians--like yourself!--to the field), which have paralleled the overall shift ingovernmental priorities to strengthen our health care workforce through support of its frontline providers.  This growing emphasis on primary care has crescendoed over recent years and is now evident in restructured health systems and practices in many parts of the country, federal and state policy, and is even beginning to take hold in medical education(9).  There has been no better time, as a medical student, to choose primary care as your match and future career.

            In fact, many are! Check out David Margolius, a resident physician at UCSF primary health track who is speaking at conventions across the country about reinventing primary care and improving access, continuity, and clinical outcomes . Take a secondto google David Katz, an internist at Yale, and his Huffington Post article titled “The Case for Caring About Primary Care” (as well as his other great food and exercise tools!).  While you’re at it, meet a few long-time primary care leaders who have, for years, inspired doctors starting their careers: go on Amazon or to the good ‘ol library and check out, Big Doctoring in America: Profiles in Primary Care.  Among the fascinating profiles turn to “Neil Calman, M.D.: Urban Warrior,” to read about the self-proclaimed “flag-waving family physician...warrior for urban health,” who founded the trailblazing Institute for Family Health in New York City.  Or, look no farther than our current U.S. Surgeon General, Dr. Regina Benjamin, who once founded a primary care clinic in a poor shrimp-fishing village on the coast of Alabama--and rebuilt it three times after two hurricanes and a fire; we are now nearing two years since the release of her unprecedented National Prevention Strategy, which has been the centerpiece of her tenure.  Its successes mirror the improved health outcomes seen across the country, in the places where there has been increased emphasis on primary care.

            Going back to the title of this memo, “Primary Care, it's the Awesomest! To Be People's Doctor, there's No Better Way to Be!,” we aren’t really claiming that primary care is “the best” of all fields.  Obviously, the right field for you is a personal preference, and no person or memo can dictate otherwise any more than they can tell you which person to fall in love with.  But what we are saying is that, the way we see it, too few of us med students realize how awesome primary care really is, and that it is indeed the field for them.  And that really is the main and only point of this whole thing: if in a few years, we helped just one more medical student get to thisrealization, then all of our over-the-top titling and fun writing this memo together would have been worth it.  Please, come join the fun!**

Sincerely,

-Abraham Young, soon-to-be resident in Family Medicine! atEinstein/Montefiore Hospital, Bronx, New York

-Jessica Bloome, soon-to-be resident in Primary Care Internal Medicine at UCSF Medical Center/San Francisco General Hospital, San Francisco, California

-Alinea Noronha, soon-to-be resident in Family Medicine at UC Davis leadership track, Sacramento, California

-Rachael Maciasz, soon-to-be-resident in Pediatrics atBrown, Providence, Rhode Island

*Please forward this message and spread the word to all other med students you know

**If you have any questions for us, or simply would like to join a listserve of students, residents, doctors and health care professionals interested in primary care, please go to: https://groups.google.com/forum/#!forum/primaryhealthcare

---

(1) We recommend you see “Ch. 1: Primary Care Roots” inFitzhugh Mullan’s Big Doctoring in America: Profiles in Primary Care(University of California Press, 2002)

(2) See the Agency for Health Research and Quality (AHRQ) website for some more recent statistics. http://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html#

(3) Stephen M. Petterson, PhD, Winston R. Liaw, MD, MPH, Robert L. Phillips, Jr, MD, MSPH, David L. Rabin, MD, MPH, David S. Meyers, MD, Andrew W. Bazemore, MD, MPH. Projecting US Primary Care Physician Workforce Needs 2010-2025. Ann Fam Med. 2012;10(6):503-509

(4) We recommend you see “Ch. 2: Principles of FamilyMedicine” in Ian R. McWhinney and Thomas Freeman’s A Textbook of FamilyMedicine (Oxford University Press, 2009)

(5) For a helpful primer, we recommend browsing through the AHRQ's website, “Defining the PCMH”.

(6) Institute of Medicine. Committee on Quality of HealthCare in America.Crossing the Quality Chasm: A New Health System for the 21stCentury . Washington, DC: National Academy Press; 2001.

(7) Donaldson MS, Yordy KD, Lohr KN, Vanselow NA, eds.Primary Care: America’s Health in a New Era . Washington, DC: National AcademyPress; 1996;52.

(8) James A. Youngclaus, MS, Paul A. Koehler, PhD, LaurenceJ. Kotlikoff, PhD, John M. Wiecha, MD, MPH. Can Medical Students Afford to Choose Primary Care? An Economic Analysis of Physician Education debtRepayment. Academic Medicine. 2013;88(1):16-25.

(9) As examples, please see the articles, “FamilyMedicine Welcomes Mount Sinai Into the Fold,” and “Medical schools taking additional steps to highlight primary care,” published 6/20/2012 and 5/8/2013, respectively, on the AAFP’s blogs. 

Family Medicine in Canada

By: Dahlia Balaban BSc, MSc (future MD as of June 2013 and Future Family Medicine resident as of July 2013)

As a first and second year medical student, I never thought I’d go into Family Medicine-- I always saw myself as someone who loves the busy hospital environment and thrives under pressure. Further, all my mentors were internists who seemed to know everything there was to know about physiology, pathophysiology, and treatments.

My career plans began to change during my third year, when I made my hospital debut and found a Family Physician mentor who inspired me to change my perspective. I quickly realized that it’s the patients and the continuity of care that appeal to me most about medicine. I started to appreciate that I’m a generalist who likes everything, and there’s nothing in medicine that I would give up in order to specialize in any one area. It also occurred to me that good Family Physicians have the potential to be the most influential health care providers for their patients, since they are involved in primary, secondary, and tertiary prevention. They have the ability to keep their patients healthy, treat them when they’re sick, and prevent them from getting re-admitted to hospital after discharge. Most importantly, they are professional advocates who help their patients digest health-related information and navigate the healthcare system.

Family Medicine has long been a popular career path for medical students in Canada. Over the last few years, 30-35% of students graduating from Canadian Medical schools chose Family Medicine as their first-choice discipline. In 2012, McGill had the smallest percentage of its graduates choosing Family Medicine (24.7%) while the Northern Ontario School of Medicine, which was originally created to help produce primary care physicians to work in under-serviced areas, had 53.7% of its graduates choosing it. There are many reasons why Canadian medical graduates are drawn to family medicine, and I will outline some of them below.

Top 10 Reasons to Pursue Family Medicine Training in Canada (in no particular order):

1) Short, 2-year Training Program:

The College of Family Physicians of Canada (CCFP) was created in 1967, and Family Medicine officially became a Canadian “specialty” in 2007. Until the early 1990s, all medical school graduates in Canada did a one-year rotating internship after which they could practice as General Practitioners (GPs) or choose to pursue further specialization. Since then, Family Medicine training in Canada has been 2 years (it is the only post-graduate medical program that is shorter in Canada than in the US). Some have argued that 2 years is not enough for residents to gain the skills they need to practice effectively as Family Physicians, but the length of the program certainly makes it attractive for people who are looking to finish their training and start practicing as soon as possible (especially those who are worried about their loans or those who went to medical school later in life). In any case, many people argue that the most important learning in your career is not when you’re a resident, but when you are starting out on your own in practice.

Although the residency is short, all the Family Physicians I have spoken to who trained in Canada have told me that they transitioned well into practice once they finished residency. However, many of them mentioned that you never really feel ready, no matter how long you’ve trained and you need just need to put yourself out there and take the plunge because you always know more than you think you do.

In contrast to Family Medicine, all other residency training programs in Canada require anywhere between 4-6 years, including Pediatrics (minimum of 4 years to become a general Pediatrician), Internal Medicine (now requiring a minimum of 5 years, even to become a General Internist), and ER (the Royal College specialty requires 5 years of training). This means that Family Medicine training is at least 2 years shorter than any other training program in the country.

2) Salary:

Family Physicians in Canada work under a variety of remuneration models, from fee-for-service to capitation to capitation with shadow billing to salary (click for an example of this model in Ontario). No matter the model, Family Physician salaries in Canada are competitive with many other medical/non-surgical specialties (especially given the flexibility of the job and the short length of the training program). For example, on average, the gross fee-for service billings of Family Physicians in Canada is similar to that of Psychiatrists (5 year program), Neurologists (5 year program), Physiatrists (5 year program) and Pediatricians (4-5 year program). Information on gross physician billings in Canada is collected by CIHI in the National Physician Database.

3) Portable:

While many specialists in Canada struggle to find work after finishing their training (some needing to pursue multiple fellowships before they are able to find employment), Family Physicians are in demand all over the country, both in urban and rural settings. Residents often choose to locum for 1-2 years after finishing their training so they can try out different work environments and locations before deciding on where they want to permanently practice.

4) Flexible:

Family Physicians have the most flexibility in terms of how much to work, when to work, and how to work. Most Family Physicians now work in group practices that have daytime hours as well as evening and weekend hours, and they can decide amongst themselves how to divide the responsibilities. Sole practitioners generally have less flexibility, but they have the advantage of being their own bosses so they can take time off as they want. Lastly, it’s common in Family Medicine to do locums after finishing residency training, and these are great when Family Physicians want to go on vacation.

5) Many ways to practice:

Family Physicians can choose to practice traditional, office-based Family Medicine, but many choose to supplement traditional practice with other types of work in order to keep things interesting (so they’re not doing outpatient clinics 5-6 days a week). There is one board-certified Family Medicine Fellowship in ER (1 extra year) in addition to many other add-ons that are offered by the various residency programs. These add-ons vary in terms of training time from 3 months to 1 year. While these options are available, many Family Physicians can practice in each area without any further training beyond the 2 years, as long as they feel comfortable/competent and are able to find work. For example, Family Medicine residents can often get jobs working in Emergency Departments without any extra training once they finish residency. They can later challenge the ER fellowship exam after working for a certain amount of time so they can get the professional designation and have more employment opportunities.

Family Physicians can “sub-specialize” or practice in the following areas, with or without extra training (this is not an exhaustive list):

Addictions

Anesthesia

Breast Diseases

Care of the Elderly

Coroner

ER

HIV

Hospitalist

Global Health

Indigenous Health

OB (low-risk)

Palliative Care

Psychotherapy

Sports Medicine

Surgical Assist

Travel Medicine

Women’s Health

How Family Physicians practice generally depends on the needs of the community in which they work, but Family Physicians are also portable enough to move around until they find a community in need of the services they want to offer.

6) Generalist, fast paced, diverse:

Primarily, Family Physicians are generalists. They are trained to see people of all ages, including the healthy and the sick. On any given day a Family Physician can see babies and elderly patients, do well patient visits, follow up visits for chronic health problems, and assess acute illness. They may do minor procedures and they may send a patient to the ER for a full assessment. They provide primary care to patients with weird and wonderful presentations. Family Physicians typically see 4-6 patients per hour so it appeals to those who like busy, fast-paced environments. Further, some Family Physicians have a general practice in addition to a more specialized practice or hospital work. They may have multiple ways they practice within the same day, within the same week, or within the same career. No matter what, there’s no shortage of options for Family Physicians.

7) Family Physicians are integral to the medical system in Canada:

For better or for worse, Family Physicians act as “gatekeepers” to all specialists in Canada. This means that patients almost always need a referral from a Family Physician (or ER doc) before they can see a Cardiologist, a GI specialist, or a surgeon (to name a few) on an outpatient basis. This means that there is always a lot of business for Family Physicians, and Family Physicians are able to follow all aspects of their patients’ care. 

8) Quality of residency programs

In Canada, all residency programs are tied to a university that also provides undergraduate medical education. There are a total of 17 of these in Canada (of which 3 are in Quebec and are exclusively Francophone). While each of these programs may have multiple training sites, either urban or rural, all sites are overseen by the main university and are held to very high standards. This means that all Family Medicine training sites are considered to be of comparable quality and boast high pass rates for the CCFP exam. You really can’t go wrong by attending any one of the 17 Family Medicine training programs, in any one of the available sites. Most residents end up choosing a program based on location, type of program (eg. urban vs. rural, block vs. horizontal curriculum), and unique aspects of the program (eg. Francophone vs. bilingual vs. Anglophone).

9) Family Medicine = Primary Care:

Unlike in the US, Family Physicians provide almost all primary care in Canada, along with nurse practitioners (in underserviced areas), Pediatricians (who are now being encouraged to pursue subspecialties and act as “consultants” instead of providing primary care), and General Internists (who rarely provide primary care, as they’re trained to be hospitalists and subspecialists). Family Medicine residents are the only ones who are trained in all aspects of primary care (patients of all ages, preventive care, and treatment of acute medical problems of all types). For those who feel strongly about preventive medicine, patient advocacy and continuity of care, Family Medicine is a great option.

10) Rural Family Medicine

Approximately 80% of Canadians live in urban areas, while the other 20% are distributed in rural communities throughout the vast country (the second largest in the world by area, after Russia).

Family Physicians who choose to practice in rural areas can look forward to exciting opportunities, as they may be the only permanent physicians there (specialists may only be available on certain days or in a neighboring community). Rural Family physicians may do all the deliveries, work in the ER, assist in surgeries, and act as hospitalists. The Family Physician may be the first physician to assess and treat a trauma victim, and the physician leading a resuscitation in the ICU. These activities are not thought of as being part of bread-and-butter urban Family Medicine, but they are certainly not unexpected for a Family Physician practicing in rural Canada.

Rural communities in Canada are generally considered “underserviced” and physicians are often provided with great incentives to permanently move there or to locum. Some of these communities are considered “fly-in” (not accessible by land or water), and doctors will often be flown into these communities to provide care on a temporary basis. This means that even Family Physicians who primarily practice urban family medicine can participate in the exciting aspects of rural practice.

Dahlia Balaban, MSc (@CdnMDStudent) is a Fourth year medical student and future Family Medicine resident at the University of Toronto in Canada with a special interest in medical education.