If family doctors don’t define family medicine, who will?

Family medicine in Canada is being reshaped in real time.Practice models are shifting, policy debates about primary care are accelerating and many family physicians are wondering what the future of our discipline will look like. We hear politicians proclaiming “equivalency” of our differently-trained nursing and pharmacist colleagues, we manage increasingly complex patients without increased resources, and we face rising administrative burden and burnout.And yet family physicians still provide the majority of medical care in Canada. We improve health outcomes, reduce costs and adapt our skills to meet community needs. We make a meaningful difference in the lives of Canadians, and we know that the work we do matters deeply.Which brings me to a question I’ve been thinking about a lot lately, as both a practising family physician and the president of our professional home: Who gets to define what it means to be a family doctor in Canada today?For generations, medicine has been a self-regulated profession. That privilege rests on a fundamental agreement with the public: physicians are entrusted to define and uphold the standards of our work because we are committed to doing so in the public interest.But self-regulation isn’t automatic. It only works if a profession actively defines itself.What exactly does that mean? It means defining our scope, our values and the conditions required for us to thrive. Practically speaking, it means setting our own education standards, accreditation of family medicine training programs, exams and maintenance of competency through continuing professional development.If family physicians don’t define these, someone else—most likely government—will step in to fill the space, and the result could be a version of family medicine shaped more by administrative structures and political pressure than by the realities of patient care.That’s why I’ve been thinking a lot about the role of our professional home—the College of Family Physicians of Canada—and why it particularly matters right now.The complexity of what we doFamily medicine has always been difficult to capture in a single sentence.We care for people across the lifespan. We manage acute illness, chronic disease, prevention, mental health, maternity care, palliative care and everything in between. We support patients through moments that are as social and emotional as they are medical.Most importantly, we do this work over time. Continuity—the simple act of knowing a patient and their story—is one of the most powerful tools in family medicine. But continuity is not all of family medicine. Our training also enables us to be extraordinarily adaptable, meeting specific community needs in almost any area of medicine—emergency medicine, hospitalist care, addictions, palliative care and the list goes on.Yet continuity and comprehensiveness are not always easy to describe in policy discussions. Health systems often focus on measurable services or procedures, while much of family medicine’s value lies in the relationships and coordination that hold care together, as well as our ability to tailor our skills to meet specialized community needs.Professions need spaces where those aspects of their work can be articulated clearly, not only to one another but also to the broader health system.A collective voiceFamily physicians also experience the health system from a unique vantage point.Every day in practice, we see where patients struggle to navigate care, whether in under-resourced primary care, inner-city underhoused or overstretched rural emergency departments. And we see the extraordinary difference it makes when patients have access to continuous, comprehensive and highly skilled care.But individual physicians rarely have the time or the platform to translate those observations into system-level change.This is where our professional organization matters. It brings together the experiences of 47,000 family doctors and helps ensure that the realities of front-line practice are reflected in policy conversations.Right now, those conversations are happening everywhere. Governments across Canada are exploring new primary care models, digital tools, workforce strategies and payment reforms. Many of these ideas are promising, and all of them will shape how family doctors practise in the years ahead.If family physicians are not actively involved in shaping these changes, we risk ending up with solutions that look good in theory but don’t work well in practice.Supporting the next generationMedical students and residents are watching closely, and they see the pressures family physicians are facing. Their decisions about where to build their careers will shape the future of healthcare in Canada. More students choosing family medicine means a stronger profession and better care for Canadians.A profession that is visibly engaged in strengthening its practice environment sends an important signal to the next generation. It shows that family medicine is not standing still—that it is actively working to improve the conditions in which family physicians care for patients.A professional home creates the space for that work to happen: supporting education, research, innovation, and the conversations that allow a discipline to evolve.Maintaining connectionFamily medicine itself is also changing.More physicians are working in team-based models, many have focused areas of practice within family medicine to meet specific needs of a community or population and technology is reshaping how patients access care and how physicians share information.These shifts bring opportunities, but they can also make it easier for physicians to feel disconnected from the broader professional community.A professional home helps maintain the connections that allow family doctors to learn from one another and sustain a shared sense of identity, even as practice models diversify.It reminds us that whether we practise in a rural community, an urban clinic, a hospital ward, or a teaching program, we are part of the same discipline.The responsibility of self-regulationUltimately, the idea of a professional home comes back to the responsibility that comes with self-regulation.The public trusts physicians to define the standards of our work, and that trust carries an obligation to ask difficult questions about how our profession evolves. This includes considering what training best prepares physicians for the realities of modern family medicine, what supports enable family physicians to thrive, what role we can play in meeting community needs and how the relational core of family medicine can be preserved within a rapidly changing health system.These challenges cannot be addressed by any single individual or organization, they require ongoing dialogue within the profession and with the communities we serve.Without a place for that dialogue—a professional home where family physicians can come together—the conversation becomes fragmented, and fragmentation makes it harder for a profession to shape its own future.A moment for the professionFamily medicine in Canada is at an important crossroads. The pressures facing the discipline are real, but so is the opportunity to strengthen family medicine in ways that will benefit all Canadians.Doing that work requires collaboration across governments, health systems, and communities, but it also requires a profession that understands itself and speaks clearly and collectively about how family doctors can thrive in service of our patients and communities.If family physicians are not defining what it means to practise family medicine in this moment, someone else will. The future of family medicine in Canada is too important to leave that conversation to anyone else.Dr. Sarah Cook is a family physician based in Yellowknife, Northwest Territories. She is president for the 2025/26 term for the College of Physicians and College of Family Physicians of Canada.

If family doctors don’t define family medicine, who will?

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