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I’m about to graduate as a family physician. After 10 years of climbing that Mount Everest, eight of those years without an income, paying for two full-time degrees plus inflation and living costs, I’m $350,000 in debt. That’s living on around $31,000 a year.
The government just denied me loan repayment assistance because I get paid ~$68,500 a year as a resident. The cost to write my final exam just went from around $1,500 to $4,201. When starting a practice, a monthly bill of anywhere from $7,000 to $12,000 in overhead is waiting for most grads who take up a clinic practice, plus ~$2,000 a month in interest on debt if you supported yourself through school.
When I start practice, I can expect the Ministry of Health to take its time (at least two months) to approve my funding model. My first paycheck will come in at fee-for-service levels that won’t cover my costs.
About a year and a half ago, after working a 60-hour week, I started to quietly panic when I did the math to project my net income as an attending physician. Clinic-based family medicine is my passion, and I realized that it wasn’t going to work out based on the way most physicians work. I wouldn’t be able to even begin to pay off my debt.
After all that work, sacrificing my twenties, my health, friendships and enduring the stress of medical training, I wouldn’t be able to cover my living costs as an attending family physician.
Try imagining uprooting your entire life to go on a pilgrimage to a promised land and when you finally get there, it’s not as promised, a ghost town with worn out buildings and hardly anyone in sight. You’re 10,000 miles from home and way worse off than when you started.
The only promise this journey has fulfilled is providing the education necessary to safely and meaningfully help people who are sick and enable them to seek wellness.
A family doctor is the only professional that is trained adequately to be able to pick out disease from the general population. It is the only medical specialty educated in every body system. Family doctors are there to catch those who fall through the cracks, prevent disease and deliver medicine in a way that suits an individual.
This work will always be challenging and meaningful, requiring dedication to keep up with rapidly increasing medical knowledge and motivation to continue to seek excellence. The challenge is great, and the reward for doing it well — a healthy patient — even greater.
This is why I’m passionate about it, and sad to see it fall apart and go unappreciated. It’s hard to watch as its integrity is cheapened by being grouped into an emerging category of primary care providers with far less training and liability, and have its voice drowned out by promises of funding that seem to keep ending up in someone else’s pocket.
Because of the way things are, I have had to pivot considerably by coming up with creative ways to practice medicine and supplement my income in the future. Many of my peers have elected to do emergency medicine, hospitalist, subspecialize in family medicine or locum while they contemplate their options.
With every news release, I read about funding for health teams, funding for free schooling for nurses, funding for nurse practitioners, funding for “programs to reduce administrative burden” that I have yet to see a benefit of.
I open the news everyday, hoping to read something about increased pay for family physicians. Instead, I read about how negotiations are not going well with the government. I read that the planned increase of two or three per cent has been cut down to one per cent or even zero.
Sometimes, it’s hard not to regret going into any number of specialities I could have. I go to work, and I do my best to help the patient in front of me. They ask about where I’m going to practice with hope in their eyes.
They leave feeling better, and I try not to think about the fact that for many family physicians, the thanks for that visit is just $12 to take home.
Eventually, fueled by the same determination that got me into medical school, I started to dig deep to find a solution that wouldn’t mean I would have to abandon my dream of opening a clinic-based practice. A solution that wouldn’t mean I have to give up freedom I’ve waited years for, work unsustainable hours or in a toxic environment bred by chronic underfunding.
I scoured Ontario looking for a place that would help fund the start of my career in a meaningful way while having a sustainable business model that supports good medicine. After around a year of this search, I am lucky to have found a place in Madoc, Ontario, but I can report that it is a very hard thing to find.
I am sad to be leaving Sudbury, where I currently live and initially hoped to call home when I moved here in 2022. I hope this letter helps to raise awareness about the difficult situation many residents are in and how urgently family physicians need change.
Dr. Corli Barnes
NOSM U student, Sudbury campus