Dear CFPC Board, Provide Business Training to Family Physician Residents

Dear Board of the College of Family Physicians of Canada (CFPC),

There’s a whole lot of talk about the crisis in family medicine. Even the College of Physicians and Surgeons of Ontario felt compelled to do a cover story on this issue. I’m just a (not very) humble ordinary member of the CFPC, so I don’t need point out the ramifications to the health system to such learned members as yourselves.

I fully respect that it will take a multi-lateral approach to fix this. However, the impression one gets is that the CFPC is focusing on extending the family medicine residency to three years, from the current two.  This expansion has even been presented as a possible solution to recruitment woes.

Nancy Fowler, executive director of the CFPC, states that the current program is “way too compressed” to deal with increasing complexity of health needs in Canada, changing technologies, and greater awareness of the health impacts of racism. In the same article, she also notes that residents have told her they would like more opportunities in different kinds of practices and settings (basically that they want the extra year).

I think these arguments are weak. The most learning I ever got was in my first year of practice. There is simply no substitute for being out on your own.  Join a supportive group like I did, and you will be fine.

I do respect that the current training program may not be adequate. I’ve taught many residents myself over the past 25+ years. The amount of useless “clinic day backs” and forums, research days and “behavioural science modules” that the residents are asked to do has increased to the point where I wonder when the residents actually, you know, see a patient in real life. No wonder they may feel unprepared for having their own practice. 

University of Toronto and McMaster – I’m looking at you.

But the solution to that is, you know, fix the residency program. Not extend it with a year of the doing exactly the same nonsense that made residents feel inadequate to practice comprehensive family medicine to begin with. All that would mean is that after three years the residents will still feel unprepared.

Also, have you considered that if you do increase the residency by a year, you will have one year where NO family medicine residents graduate into practice? Would you care to explain to everyone how that will help the current shortage of family docs?

Anyway, if you do increase the CFPC residency to three years, would you at least add some practical training for our younger colleagues to the residency? I believe they would benefit from two months of their third year being dedicated to learning about the business of running a practice. How to hire people. Employment standards. Performance appraisals for staff. Negotiating leases. Finding the best prices for supplies. And yes, how to maximize your billings.

All of those above tasks (and more) are absolutely essential to running a comprehensive family practice. Yet NONE of those are taught in medical school or residency. In fact, in many universities, the feeling one gets when one brings up the idea that we should teach something as simple as billing is that you have spoken of that which shall not be spoken of, lest the appearance be created that your desire to practice medicine might even in the smallest part be less than altruistic and rather more about a hedonistic desire to generate a fair income.

The horror, the horror!

And yes, McMaster and U of T, I’m looking at you (again).

These are practical business skills all of us absolutely need to run a practice and isn’t the point of residency to, you know, make the residents comfortable running an actual practice in real life? Additionally, the reality is that we now face the existential threat of corporatization in family medicine.

This is how it works.  A corporate clinic, let’s call them  The Haleness Infirmary goes to a young family doc.  They whisper siren like inducements like “Let us do the business of medicine for you”.  “We do all the admin work so you can practice the medicine.” “We believe in high quality patient centred health care you can trust” and other alluring catch phrases.  These clinics are almost always owned by some large corporation. Let’s say in this case, a pharmaceutical chain called Buyers Pharmaceutical Bazaar. All to entice the young, business naive family doctor so sign up with their chain.

The Haleness Infirmary could care less about the doctor they hire, or the patients they serve.  What they want is the gold mine of patient data.  It allows them to create a digital profile of the patient to target you with ads to sell products, because, the patient is nothing more than a commodity to them to be exploited. 

It’s absolutely true that there are privacy laws that prevent individuals from collecting your personal information. Funnily enough, those laws don’t apply to software or AI.  Software can figure out a lot about you based on your spending habits (it’s why if you look up say mattresses on a website once, you get ads for mattress stores on your social media feeds for a week).

If you go to Haleness Infirmary, the software would identify you as someone who needs cholesterol pills, and therefore you would see targeted ads for cholesterol lowering products (all sold at a special discount at Buyers Pharmaceutical Bazaar) so you can buy more products (and get extra points if you enrol in their Choicest points program which collects even more of your personal data).  Nice ecosystem.

Don’t believe this is their goal? When I was OMA President, one of the pressing issues for OMA Legal was the fact that doctors who left (or were asked to leave) these fancy corporate owned clinics– suddenly found they no longer had any access to their notes or patients’ charts (“owned by us and only for use by our employees – and you are no longer one”).

The holier than thou types that haughtily profess that they are better than us for not teaching basic business skills of course would be the first to be horrified that patient data was being used for marketing (gasp!) and making money (double gasp!).  The irony that their own belligerent refusal to teach basic business skills drives physicians to these corporate clinics is, of course completely lost on them.  It’s hard to see irony why your head is constantly tilted upwards befitting your lofty altruistic ideals.

Extend the CFPC residency to three years if you must. But for the love of Allah/God/Yahweh/insert deity of your choice, at least give our future colleagues an appropriate education that teaches all aspects of running a comprehensive family practice.  You will be doing them, and patients, a huge service, whether you realize it or not.