The NGEP: Set Course for Disaster
When the New Graduate Entry Program (NGEP) was unveiled in October, it was met with disappointment1, concern 2, disgust 3, and formal statements from both the Professional Association of Residents of Ontario (PARO), and the Ontario Medical Association (OMA).4 This was because the program was, quite simply, bad. It was incredibly restrictive about where new family doctors could work and penalized them for practicing broad-based community medicine, such as providing coverage in the local emergency department or working as a hospitalist.
Fortunately, it seems that the government has picked up on the whirlwind of negative feedback; Dr. Bob Bell, the deputy minister of health, attended a brief Q & A with the Ontario College of Family Physicians (OCFP) at the recent Family Medicine Forum (FMF) in Toronto and made clear mention that the government was planning on revamping the program. Let us all hope that they consult widely and get it right, because there is more at stake than just a few empty rural jobs they are hoping to fill: it’s the trust and engagement of a whole generation of family doctors.
My experience has been that this new breed of family doctors are as open-minded as ever about practice opportunities and the challenges facing healthcare. They want to be participants in a system that is more collaborative and interdisciplinary than ever before. The vast majority of new grads have trained in a team-based clinical setting and see this as the clear way forward for primary care. They represent key stakeholders, and a potentially critical ally in any government plans for primary care reform. By floating a program for this cohort that not only ignores this reality, but dramatically limits their ability to provide the type of care they are best able to is incredibly discouraging. The result? While some of my friends and colleagues have managed to find suitable family medicine work, most are performing locums, working in walk-in clinics, and essentially working on the fringes of what the government had hoped for: comprehensive family medicine in communities of need.
Ultimately, the New Graduate Entry Program, while intending to direct new family medicine graduates to practice in underserved areas, is instead at risk of generating a very different result: alienation of an entire generation of family medicine. Combine this with an ambitious plan for further primary care reform outlined in the Baker-Price report 5 and you have a situation akin to a captain setting a direct course for a reef. If you aim for trouble, you will end up with trouble.
It is well past time to get the right alphabet soup of organizations at the table (including the OCFP, OMA, and PARO), and ensure we develop a program that makes sense.
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