Canada's family doctor shortage: How to get medical students to choose family medicine?

Nearly one in five Canadian adults report not having a regular health care provider, and roughly 15% of the population does not have a family doctor. The situation is increasingly alarming, given that another six million Canadians have a physician who is over 65 and nearing retirement. In a country that prides itself on universal healthcare, the shortage of family doctors has compounded consequences: longer emergency room wait times, poorer health outcomes due to a lack of preventive care, and rising health inequality in remote and rural communities. Therefore, addressing the shortage of family doctors has become an increasingly urgent priority. As health care delivery is a provincial responsibility, Canada's provinces have adopted differing strategies to address the shortage. 

This month, Ontario Premier Doug Ford announced a change to the province's residency matching system, under which only Canadian medical graduates and international graduates who attended high school in Ontario for at least 2 years will be eligible for the first round of placements. Meanwhile, in Quebec, Premier François Legault's government passed a new law, Bill 2, tying a share of doctors' compensation to the number of patients they treat and the proportion who are from vulnerable communities. British Columbia has taken a different approach, introducing a hybrid compensation model that combines a salary-style payment with remuneration based on the time physicians spend with patients and the complexity of their cases. 

Despite these varied approaches, including opening new medical schools, expanding available seats and grant programs, and implementing patient-physician matching systems, most provinces are struggling to reverse the trend. The number of doctors leaving family practice continues to rise, and fewer medical graduates are choosing it as a specialty. In 2025, only 27.9% of Canadian medical graduates selected Family Medicine as their first choice for residency, down from 31.4% in 2024. So the question becomes: how can provinces make family medicine an attractive option for medical graduates? 

In the early 20th century, doctors primarily provided comfort and reassurance, but over time, as scientific knowledge expanded, medicine became more scientific and specialized. The importance of science in medicine led to the rise of subspecialties, driven by increasing prestige and visibility. In contrast, family medicine, which is often focused on holistic care and patient relationships, has lost its status and visibility, particularly within teaching hospitals where students receive their training. 

Universities often focus on subspecialists and research, leaving family medicine to the wayside as a general program. Family medicine is perceived as an introductory topic that differs from other specialties,  which reinforces the impression that family medicine is a "lesser" path. Students' perceptions have been negatively affected, while their exposure to family medicine has been reduced simultaneously. The fact that family practice is conducted mainly in community settings, and therefore is less visible to students who primarily train in hospitals, exacerbates the problem. 

Expanding the number of family physicians in teaching and leadership roles could counter this cycle by increasing students' exposure to the field and providing visible mentors. Provincial funding should therefore not only expand medical school seats designated to those who wish to practice family medicine, but also create targeted grants to hire and retain family medicine educators within hospitals and universities. Teaching could provide an alternative path for current family physicians who want to leave the profession due to its demands, while reinforcing the notion that family medicine is a noble specialty in its own right. Students are strongly influenced by what they perceive others around them to value. Greater representation of family physicians in teaching positions could shift these norms, creating more opportunities for mentorship and reframing family medicine to incentivize more students to choose the specialty. 

Lower prestige has also coincided with lower pay; family doctors earn up to 29% less than other specialists while bearing the additional costs of running a clinic. Given behavioural tendencies towards present bias and hyperbolic discounting, overvaluing immediate costs or benefits relative to future ones, students graduating with significant debt are naturally drawn to higher-paying specialties. To offset this bias, policies should provide upfront incentives to supplement current policies that increase compensation for physicians once they work at an established practice. Health policies that provide bonuses, expand grant funding to open new medical clinics, forgive tuition, or guarantee residency, rather than the current deferred rewards, could be more powerful in driving a meaningful surge in students choosing family medicine and in providing care in underserved areas. These measures make the benefits of family medicine immediate and tangible, complementing broader reforms aimed at improving  physicians' working conditions and overall quality of life. 

Policies aimed at improving family physicians' working conditions will have the most significant impact on attracting more students, as students are unlikely to choose family medicine if current practitioners are leaving the practice. Current practice arrangements, rooted in 20th-century tradition and reinforced by Fee-For-Service payment models, favour doctor-patient care over team- or clinic-based models. Canadians have their "own" family physician, meaning that if a physician takes a sick day, patients must be rescheduled, increasing workload pressure and leaving patients without care. Transitioning from assigning patients to individual physicians to assigning them to a group of physicians could alleviate the burden on individual physicians. 

Additionally, Fee-for-service models give physicians autonomy over their work volume and incentivize them to see more patients. However, they also discourage them from providing more complex care or working in teams, while introducing extensive administrative work to track their billing. The BC Longitudinal Family Physician Payment Model, mentioned earlier, which bases payment on time with patients and complexity, has been an attempt to move away from fee-for-service models. However, physicians are still assigned to specific patients, which improves compensation equity but does little to reduce their workload. A systemic policy that incentivizes team care, complementing the move away from fee-for-service payment, could improve working conditions in family medicine. If provinces can reduce the number of physicians leaving family medicine, future students are more likely to join the specialty. 

With family doctors threatening to leave Quebec in recent weeks over Premier Legault's Bill 106, an extension of Bill 2, which would tie doctors’ pay to performance indicators, and Canadians becoming increasingly frustrated by the lack of care, it is evident that new policies must balance expanding access while improving working conditions for physicians. When doctors leave the profession, they not only reduce capacity but also signal that family medicine is an undesirable path, deterring medical students from entering the field. To alleviate the lack of family doctors in Canada, the solution is not simply to compensate for the number of patients seen and encourage students to "consider" family medicine, but to transform the structures that currently dissuade them. Only by valuing family medicine within education, overcoming the drawbacks of the practice, and improving working conditions can Canada attract more students to the field and ensure universal healthcare continues.