Re: Beyond Kelowna

Issue: BCMJ, vol. 67, No. 10, December 2025, Page 343 Letters
By: Tahmeena Ali, MD, CCFP, FCFP

The recent editorial by Dr Kristopher Kang [BCMJ 2025;67:234] highlighting the shortage of pediatricians—particularly in rural BC—is an example of a larger challenge facing all of medicine: the death of the generalist. From general obstetrics/gynecology (which is experiencing unprecedented shortages leading to unit closures) to family medicine, physicians who choose a wide scope of practice are rewarded with punishing call schedules, poor remuneration, and diminished respect from many patients and some colleagues.

Daily, patients ask for unnecessary referrals to consultant specialists because they do not trust that their family physician has the expertise to diagnose or treat their acne or migraines or heavy periods or menopausal symptoms or whatever other malady family medicine cares for. Not only does this lead to the forever-growing referral pile that keeps our colleagues up at night—worried about what serious, time-sensitive ailment is awaiting their assessment—but it also leads to significant emotional burnout from generalists. The idea that over 2 decades of longitudinal family practice, including hospital care, maternity care, and rural experience, is meaningless to many of my patients because I’m not a “specialist” is eroding my love of family medicine. I imagine many general pediatricians experience that same pressure from worried parents who would prefer a referral to a specialist because they don’t trust that a generalist could know enough about everything. Add to that the breadth of knowledge that a rural pediatrician requires, and anyone can understand why rural pediatricians are few and far between.

In a field where no human brain can keep up with the volume of new information, we as a profession need to maintain respect and support for each other and recognize that the superpower of generalists is needed now more than ever before. This means acknowledging and countering the hidden curriculum within medical education that continues to glorify specialization and minimize the importance of generalism.
—Tahmeena Ali, MD, CCFP, FCFP
Surrey

This letter was submitted in response to “Beyond Kelowna: A wake-up call for child health in British Columbia.”

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Tahmeena Ali, MD, CCFP, FCFP. Re: Beyond Kelowna. BCMJ, Vol. 67, No. 10, December, 2025, Page(s) 343 - Letters.


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