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It is a day that represents promise for thousands of medical students across Canada. But this year Match Day, in which graduating medical students are matched with residency programs that will direct their career paths, is being seen as a sign of the worsening crisis in primary care, especially in Ontario.

Across the country, 252 family medicine positions went “unmatched,” according to the Canadian Resident Matching Service. In Ontario alone, there were 116 unfilled family medicine spots — meaning those positions were available but no one wanted them, at least in the first round of matches. There will be a second match day next month, so those numbers could change.

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But those who have been warning that dramatic change is needed to avert a growing primary care crisis say governments should be paying attention to what the numbers could mean.

Medical students, say health officials and observers, are voting with their feet against practising family medicine.

“Students don’t want that type of practice when they graduate,” said Dr. David Barber, chair of the section on general and family practice of the Ontario Medical Association.

Barber called the situation “disappointing, frustrating and alarming.”

It is clear medical students have been paying attention and are saying “no thanks” to family medicine, said Barber. He said the trend of fewer graduating students choosing family medicine is a sign of a “lack of confidence in the provincial government’s approach to supporting family doctors.”

There are currently between 2.2 million and 2.3 million Ontario residents without a family doctor, and that number is expected to more than double in the coming years.

Family doctors — and groups that represent them — have been calling for a more sustainable economic model for family medicine and a reduction in the growing administrative burden that many say is burning doctors out and driving them out of comprehensive family medicine practices.

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Dr. Andrew Park, who heads the Ontario Medical Association, said there has been a declining interest in family medicine for a while. “This kind of reinforces what we have known in terms of the perception of family medicine as a viable career is going down among medical students.”

Members of the grassroots group known as the Ontario Union of Family Physicians have even warned doctors against coming to Ontario to practice family medicine. They say the Ontario government is not responding to the crisis with the urgency it requires.

That group joined others, including former leaders of the Ontario Medical Association, in warning young doctors not to set up a comprehensive family medicine practice in Ontario, suggesting they go to other provinces that have taken steps to address the situation, such as British Columbia and Manitoba, which have offered extra money and support for administrative work to family doctors.

In a statement, the Ontario Union of Family Physicians said the match results for family medicine were “entirely predictable.

“The underwhelming outcome resulted from an unstable economic model for office-based family practice and a lack of respect and understanding for the role family physicians play in health care, by multiple levels and iterations of governments in power,” said the statement, signed by doctors Ramsey Hijazi, Vakar Khan and Alex Duong.

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Hijazi, who heads the organization, is a Carp family doctor who will leave his family practice later this spring.

“Starting up a new family practice in Ontario is not sustainable,” he said. “It is not a good place to set up a practice.”

Hijazi said the government does not seem to be listening to front-line doctors about solutions to the crisis. He founded the Ontario Union of Family Physicians, he said, out of frustration about the growing, unpaid, administrative burden on family doctors — an average of more than 19 hours per week — and the fact that the amount of money family doctors earn has been steadily declining.

The Ontario government has increased the number of interprofessional health teams — which include doctors, nurse practitioners and other health professionals, and it has also expanded the practice of pharmacists so that they can treat some minor medical complaints. Observers call the expansion of health teams a promising step, but say it does not go nearly far enough to address the size of the problem. Unlike other provinces, Ontario has not announced any significant steps to reduce doctors’ administrative burden or pay family doctors more.

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Meanwhile, many family doctors are leaving their practices, and potential openings to train new doctors are going unfilled. Amid growing desperation by patients without primary care, clinics are popping up across the province offering primary care by nurse practitioners — at a cost. A clinic in Kanata is asking patients to pay $600 a year for access.

John Gallinger, who is CEO of the Canadian Resident Matching Service, noted that there are more family medicine residency positions available this year than in the past — in part in response to the shortage of family doctors. He cautioned that observers should not come to any “strong conclusions” about medical students turning away from family medicine until the second match day, which is at the end of April.

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