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Panel on the future of family medicine

ACTION Panel MedecinsdefamilleDr. Hugo Viens, president of the QMA, recently participated in a panel on the future of family medicine organized by McGill University’s Department of Family Medicine and moderated by its director, Dr. Howard Bergman. Some one hundred students from all medical faculties across Québec and at the University of Ottawa came to hear the discussions with Dr. Julie Lalancette, director of planning and regionalization at the FMOQ, Dr. Guillaume Charbonneau, president of the College of Family Physicians of Canada (CCFP), and Dr. Frédéric Turgeon, president of the Collège québécois des médecins de famille (CQMF).

Dr. Lalancette opened the debate by remarking that there’s still a lot of work to be done on work‑life balance and the integration of professionals before we can progress from collaboration to teamwork. However, she believes that the next few years are most likely to be marked by digital health-related issues and their impact on doctor-patient relationships, but especially by the economic challenges facing the healthcare system. In a public healthcare system, doctors can’t simply ignore cost control measures, and need to keep a close eye on their practice and the appropriateness of their medical acts.

Moving in the right direction

Despite the huge black cloud hanging over the medical profession in general, and family medicine in particular in Québec, Dr. Charbonneau thinks the practice is just as strong, if not more so, than it was ten years ago, and that this will continue to be the case. While the clouds may shift according to the prevailing political winds, they’ve always been there, and we need to trust in medical organizations to guide us through the storm.

The president of the CFMC reviewed the various missions of the medical colleges and federations, pointing out that in Québec we also have the QMA which, unlike in other provinces, plays a mainly innovative role. All of these organizations exist to support family medicine, which is why the practice will have an even bigger role to play in 10 years’ time.

According to Dr. Charbonneau, Québec is headed in the right direction with doctors having abandoned solo practice in favour of family medicine groups, allowing them to work in teams with other professionals. So, really, we’ve already adopted the model of the future.

He also believes that doctors in the very near future will finally have access to information that will allow them to improve the practice and traditional professional development activities. Lastly, while more and more patients are able to see their family doctors on a daily basis, access to medical specialists will also be improved and the latter will have to start being more accountable.

The doctor as support person

Dr. Turgeon remarked that society has changed a great deal since he first started practising medicine, but that the patient relationship is still the foundation of family medicine. A family doctor actually follows a patient for their whole life, resulting in a meaningful and profound connection—a connection that Dr. Turgeon actually thinks will become even more important as time goes on.

Society is racing ahead, and while Google can be goldmine of information, it can also be a bottomless pit, he explained. People need constancy. The family doctor is uniquely positioned to convey this message and to support people through all the changes taking place in society.

He also pointed out that we’re seeing major changes on the ground. Currently, more than 7,000 of Québec’s 9,000 practising family physicians work in family medicine groups, which don’t exist anywhere else in Canada. And, while the data show that there are significant advantages to working in large teams, family medicine groups continue to expand.

And the best is yet to come, because we’re still learning and figuring out all the operational and functional possibilities that teamwork affords. Only the future will tell whether we’re witnessing an evolution or a revolution, but one thing is certain: Family medicine will have a strong coordination and communication role to play through these front-line teams.

A generation of born leaders

In introducing Dr. Viens, Dr. Howard Bergman stressed the very important role of the QMA, an outstanding Québec-based organization that stimulates debate on health policies and innovation. The president of the QMA started by explaining to the students that they have talent and knowledge that their predecessors did not, reminding them, for example, that when he was in high school, the one and only computer at his school was used to search for books in the library! He believes that the new generation are born leaders, accustomed to having an opinion, expressing their thoughts, and doing what needs to be done to make things better. He’s confident that, even though the situation seems a bit bleak at the moment, the healthcare system will evolve for the better in the coming years.

Already, most family doctors work in teams instead of alone, and there are now tools for contacting specialists and communicating between professionals—tools that the new generation have a much easier time adopting than older doctors. The family medicine of the future will therefore focus on meeting the needs of patients, rather than those of the healthcare system or organizations.

Doctors have a responsibility to make sure the public healthcare system stays viable in the long term. In terms of guaranteeing good population health, we now know that social determinants of health are more important than healthcare systems themselves, which is why it’s crucial that we improve care trajectories and make them less costly, as well as implement more integrative practices. As Dr. Viens pointed out, this is within reach for doctors, who need to step up and be leaders in overhauling the healthcare system, being best positioned as they are to implement a multidisciplinary approach, a review of compensation methods, and a reorganization of healthcare systems and, above all, the teamwork model.

 

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