Shaping the future of medicine

In the first part of this Spotlight on Health podcast episode, Ontario doctors and physicians in training discuss the future of medicine and the role medical schools, technological innovation, societal demands and next-generation doctors will play in its evolution. Reflecting on professional experience, they share how a health-care system that focuses on health human resources and team-based care, values family practice and is informed by the social determinants of health can overcome its most pressing challenges.

Transcript

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association. 

Ontario’s healthcare system is facing unprecedented challenges, and the province's medical schools may be part of the solution. In part one of a two-part episode, physicians and medical students discuss Ontario medical schools’ growing pains and their role in the evolution of health care.

Dr. Cathy Mastrogiacomo is a comprehensive family physician practicing in Scarborough and the chair of the Ontario Medical Association's section on general and family practice.

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Dr. Cathy Mastrogiacomo: The shortage of family physicians right now is critical, at an all-time high rate. Personally, in my practice, we have patients calling daily looking for a family doctor. Whole families are calling me, and I just keep adding them to my waitlist because I simply don't have room in my practice to add more.

I think the workload with comprehensive family medicine is so overwhelming. It's not just your day job, it's becomes a day job and night job. I am talking to many young doctors about this, and they're literally dropping out. So, if they can't find a replacement, those patients are stranded.

It has to be attractive to stay in family medicine; right now, it isn't. So, it's not just the pay, the burnout that we're seeing is the other factor. So, we would have to improve the working conditions and the income and the support around running a practice to make it attractive for young doctors to stay or to start a practice. 

I think medical schools can help in some ways. I think entries into the residency program should be looking more for team-based care rather than going into solo practice. The patient load is huge, the complexity is huge. They need the tools for wellness, and that's where it's lacking.

It's more than just the simple thing of creating more doctors, you have to change the conditions. Unless we fix the on-the-ground issues and the system issues and improve our work-life balance, the exodus is going to just increase. Right now, doctors are closing down, they can't find locums, they are retiring earlier. The burnout is indescribable. It's heartbreaking actually. So, we need a big shake up in the system.

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Balogiannis: Dr. Jane Philpott is dean of the Faculty of Health Sciences and director of the School of Medicine at Queen's University and co-chair of the Council of Ontario Faculties of Medicine.

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Dr. Jane Philpott: Medical education is always evolving, and I think it's probably evolving faster than ever, and necessarily so given the context that we are in. We've just come through two and a half years of very challenging times in health systems. And the solutions to the crises that we are seeing in our communities, for access to care, are very much a part of the mandate of what medical schools and faculties of health sciences are really working at, in part because one of the biggest drivers of the crises that we're seeing right now is a shortage of health human resources, and we are in the business of creating health human resources, be that doctors, nurses, therapists, etc., because medical schools have a mandate around social accountability. And so, we see our role as being part of the solution on the challenges that are being faced in health systems. 

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Dr. Philpott: Many of the ways that medical students have changed over the last generation are the ways that young people in general have changed over the last generation. They're incredibly bright young people, they have come from a great diversity of backgrounds, they have, in many cases, grown up in cultures of tremendous diversity, which is a real asset, so that they are highly competent from an intercultural perspective.

I think probably one of the biggest changes is that they have grown up in a very technological society, and that has changed a lot. That actually opens up some great opportunities for us. One of the greatest innovations in education over the last generation has been the use of simulation and virtual reality and augmented reality, and it's an area of enormous potential. We already use it to a very large extent, but it will continue to be a very important part of the education that we deliver. 

One of the things that I think we do much better in medical school now than we used to do is to help our learners look at the whole breadth of what makes people sick and what makes them well. And so, when I went to medical school it was a very biomedical model. And somewhere in the 80s and 90s, we started to think about people in society, and something that we now talk about all the time — around social determinants of health, even issues like human rights, for example — are things that were not talked about in medical school before. But they are now.

And so the young people that are going through are recognizing themselves as part of larger systems, and recognizing that we can train to deal with some of the biomedical aspects of what makes a person well, but that we need to work in partnership with social service agencies recognizing needs for housing, economic stability, employment, etc.

And so, that makes healthcare far more complex. It requires us to work in teams. We've always needed that, but I think we have now recognized it more fulsomely than we did in the past.

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Balogiannis: Dr. Sarita Verma is president, vice chancellor, dean and CEO of Northern Ontario School of Medicine, or NOSM, University.

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Dr. Sarita Verma: Our university is focused on a particular area — it is future-oriented, and it is the model of the future. We train people within the setting to become the professionals within that community.

What's the problem we're trying to solve? Trying to make sure that everybody in Ontario, certainly in northern Ontario, has access to a family doctor. Since we got here, we would say over 250,000 people now have access to a family doctor. And we've only graduated our fourteenth class of MDs and only our tenth class of graduating physicians. And we're successful because we're focused on one thing, right? Not just physicians, but health care generally, and interprofessional education.

The longitudinal pathway here is this: you bring people from within your region or your community who at least have a connection to your community. If they went to high school there or if they have roots there, they're very likely to want to go home. You train them within the community. So, the continuous clerkship that we have designed, it's a longitudinal clerkship.

We start, actually, in first year with a four-week immersion for every student at NOSM University goes to an indigenous community and lives in that community. That's also been transformative for our university.

We do look at socio-economic status. We are very interested in ensuring there's diversity. We want to be sure that our students have intellectual capacity, but they also have to have all the other aptitudes including a desire for equity, inclusion, anti-racism. We're doing very well with indigenous applicants. And in fact, so far, I think we've graduated 55 self-identified indigenous physicians into the community.

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Balogiannis: Angela Salomon is a fourth-year medical student at Queen's University and the president of the Ontario Medical Students Association.

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Angela Salomon: I really don't envy the folks whose responsibility it is to come up with med school curricula. I know it is an incredibly hard job in large part because medicine, much like science that it's based on, is constantly evolving. I know that our curricula coordinators and creators are always struggling with adding material and supplementing material and not really knowing what to take away.

In general, the knowledge base of medicine is constantly growing and the ways, the modalities in which we can treat patients is always growing and the options available to us is getting bigger and bigger. So that's great on one hand, because it means we can supply our patients with a wider range of therapies, but it also makes the job of learning all those therapies and diseases that much more difficult.

So, I guess, in saying that, one of the most important things that I've been trying to learn through med school is learning how to learn, I guess, like just becoming comfortable with the uncertainty, embracing change and knowing how to question your beliefs or how to evolve your beliefs on a particular topic, and identifying ways that we provide care to people that are inadequate and that can be improved upon.

I think, amongst med students, family medicine is often seen as a backup. It's an easy option. It's the one you can get, even if you didn't try, quote-unquote. Obviously, as somebody who's applying to family medicine, I vehemently disagree with that. I think it is perhaps one of the most difficult and stressful specialties there is and the most impactful as well, in some ways.

I think med students are used to competitive options — we got into med school because we competed with so many people to get here. So, to apply to Family Medicine in some way feels like sort of the easy route. I would say in most rotations that I've been through; I've heard from preceptors — when I tell them I want to do family medicine, most of them will try to convince me otherwise. So, it's a bit heartbreaking actually, because I think everybody knows that we need family doctors and how valuable they are.

Sometimes those warnings come from a good place because they see the stress that fam docs are under, they realize how much burnout there is, they realize how much worse and worse their lifestyle is getting. The volumes of paperwork and the relative lack of remuneration for the work there has made that job less attractive to many grads. Sometimes it can feel like thankless work.

I think that we're recognizing more as a culture, especially a culture in medicine, we're slowly recognizing that we need to take care of ourselves if we're able to take care of others. And part of that has to do with burnout and lifestyle and your interests outside of your career and your family and your friends and not just your profession. So, I still do think there is a lot of demand placed on students. I think students are learning how to advocate for themselves and protect themselves from this burnout.

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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