Primary Care Medicine in Canada

Variation in the Practice of Preoperative Medical Consultation for Major Elective Noncardiac Surgery

“…In Canada, adult primary care is almost exclusively provided by family physicians, whereas general internists and specialists principally perform a consultative role. 16,17 As opposed to the mandatory preoperative history and physical, referrals for preoperative consultations by internal medicine specialists are left to the discretion of the responsible surgeon or anesthesiologist. The responsible surgeon may also refer a patient for preoperative anesthesia consultation, which is distinct from the routine in-hospital evaluation by the responsible anesthesiologist on the day before or the morning of surgery.…”

“…First, although it characterized the predictors of preoperative consultation and its practice variation within Ontario, similar types of studies should be repeated in other settings to determine the reproducibility of our findings. Several aspects of perioperative care in Ontario, such as the average preoperative wait time, the absence of internist involvement in primary care, 16,17 and the degree of overall consensus regarding the need for preoperative medical consultation, may not be generalizable to other healthcare jurisdictions. For example, in jurisdictions where preoperative consultation is deemed "appropriate" for a higher proportion of surgical patients, there is likely to be a lower degree of interinstitutional practice variation.…”

How can medical schools create the general practice workforce? An international perspective

“…In the USA this debt eventually influences the choice of specialty, with new graduates invariably selecting higher paying specialties. Canadian medical students do not incur these high education debts in comparison to USA students due to government subsidies and they are therefore more likely to be attracted to general practice ( Whitcomb and Desgroseilliers, 1992 ). The USA and Canadian primary-care physicians pay scales are similar, but the disproportionate difference in income between primary care physicians and specialists is smaller in Canada (30%) compared to the USA (50% - 100%).…”

GERIATRIC MEDICINE IN CANADA: The History of Geriatric Medicine in Canada*

“…The medical profession in Canada views primary medical care as a distinct form of medical practice. Canadian family physicians limit their practices, for the most part, to providing primary medical care 22 . They are represented by the College of Family Physicians of Canada (CFPC).…”