Is family medicine residency too short and too urban?

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  • M. Messier says:

    Both the University of Calgary and McMaster University UME programs are more intensive, given that students don’t get 3-4 months of summers free between each year of study. The University of Calgary’s PGME in Family Medicine is, however, too focused on urban practices. Funding models for providing procedures, as well as evolving CPSA standards, ensure that they are too cost prohibitive to provide (less than minimum wage for some procedures – really?), so no-one gets any real procedural experience unless they’re in the dedicated `rural stream’. The program won’t admit it, but the qualifications and confidence of the urban and rural residents are vastly different .because their training and experiences are not comparable. Rural community physicians will clarify this, one having said `I’m never sure if they’re medical students or urban family residents’. In addition, so much focus is now placed on `wellness initiatives’ and other `non-medical’ (I understand mental health initiatives are medically related, but learners need more clinical and physical skill development in residency) training elements that the two year program is unnecessarily diluted. The EDI initiatives take up disproportionate time in a limited time scope of training as well – UME programs have already covered most of these. Critical Care/ICU training is being substituted in some instances with on-line `Simulation Modules’. Finally, most of the preceptors are relatively new graduates with nominal practice experience in FM – again, unless you are in the rural stream. I imagine this parallels most Canadian PGME program experiences in FM. Unless something changes, an added year of urban FM residency would only increase anxieties going out into real FM practice in an overburdened public health system. Allow them some real supervised medical experiences (ie. rural exposures), and don’t allow FM preceptors to be in primary teaching roles unless they’ve also got some meaningful experiences to bring to the table. A strong program also means keeping your great teachers and experienced physicians – several of the best ones left the University of Calgary’s program in the past year or two.

  • Paul teman says:

    In Calgary, medical school is three years and then family residency is 2 years. Please, someone explain how 4 years of medical school and 3 years of family practice residency in that states is crammed into what Calgary trainees get? How can it be equivalent?

  • Franklin Warsh says:

    Even if the capacity was there to extend training by a year (and I seriously doubt there is), it would effectively remove more than 1000 family doctors from independent practice. This is what happened 25 years ago when licensure after a 1-year internship was phased out, and it created the family doctor shortage that made rural recruitment even harder. If you couple extension of training with the work patterns of the current generation of family docs (many more women taking mat leave, decrease in hours, reduced OB and hospital work), it would make a looming human resource problem – waning interest in family medicine – far worse and almost overnight.

    I learned more in my first year of independent practice than I did in most of residency. No amount of training is going to take clinical uncertainty away, and even the most experienced of us miss things and make mistakes. Residency’s purpose is to train doctors to competency, not mastery.

  • Ken C says:

    If a 3rd year of residency reduces the amount of “taking your best guess and doing it,” then I’m all for it.

    Responsibilities of northern/rural GPs are greater, this is why the learner experience is superior. It’s a balance of access to care with quality of care.

  • Hebs says:

    While I feel family medicine residency is too short, I’m astonished at how quickly a nurse practitioner can be trained (2 years of education after practicing as a registered nurse for 4 years) with relatively the same scope of practice.

    I worry about the unintended consequences of extending FamMed training. Post-education support is absolutely necessary though.

  • Nancy Fitch says:

    I am a rural physician doing ER and obs for 17 years. The CME I was funded to do by the Ontario gov’t helped me greatly for 15 years: I was supported to keep my ACLS, ALARM, ATLS, NRP, PALS all up to date. This financial support (for travel, accomodations, the course fees AND a daily stipend for being out of the office) helped me get out of Dodge, network, and keep my skills in my rural area top quality. I recommend re-instating CME funding for rural physicians.

  • Dr Mayelin Figueroa says:

    In my opinion Family Medicine Residency should be at least 3 years . I graduated from a medical school in Cuba and our program there was 3 years .

  • Wayne Weston says:

    I agree with the 4 paths for improving rural family medicine. In addition, a program of structured CME for the first few years in practice, tailored to the needs of the community and supported by mentorship might be better than a 3rd year of residency. But, one challenge that is mentioned too infrequently is the need for better training for managing patients with mental illness. And we seem to be in the middle of an epidemic of mental illness. Learning good skills in therapy & counseling requires close supervision and feedback that is hard to get in CME programs.


Karen Palmer


Karen is the Destination Development and Marketing Coordinator at The Corporation of the County of Prince Edward.

Sachin Pendharkar


Sachin Pendharkar is a respiratory and sleep doctor and an Assistant Professor of Medicine and Community Health Sciences at the University of Calgary.

Jill Konkin


Jill is a professor in the Department of Family Medicine at the University of Alberta.

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