“If residency was going to be three years long, I would have chosen internal med.”
Ben, a 31-year-old family practice resident about to complete the second year of our program, is among the many critics of the College of Family Physicians of Canada’s (CFPC) decision to increase the residency program to three years starting in 2027. “I’ve been in school for eight years now, you know,” says Ben, who is thankful the added year will not affect him. “I want to finally start living my life.”
Despite the burnout, increasing administrative load and the lowest compensation among all medical specialties, the two-year residency was a draw for many medical students given that the average age of applicants to residency programs is 28. A short residency allows a streamlined route into the workforce, allowing graduates to finally settle down, earn a staff physician’s salary and complete their eight grueling years of competitive schooling. However, despite that advantage, family practice is an unpopular choice for medical students. More than 100 family practice positions went unfilled in the 2023 Canadian Resident Matching Service (CaRMS) for medical training, a number that has only been getting larger since 2020. And a number that surely will get worse.
The CFPC has introduced its recommendation in the context of a primary care crisis in which an estimated 6 million Canadians are without a family physician. As one doctor told the CBC, the decision creates a “foreseeable disaster.” Regional medical regulatory bodies must be perplexed by the CFPC’s move considering that in 2022, the College of Physicians and Surgeons of Ontario, in an open letter to the Ontario government, recommended decreasing the time spent in family practice residency. Both the Canadian Federation of Medical Students and Resident Doctors of Canada also have expressed opposition to the plan that will serve as yet another reason to choose a medical speciality with less administrative burden and higher compensation.
“The plan that will serve as yet another reason to choose a medical speciality with less administrative burden and higher compensation.”
The CFPC says that “graduates are not prepared for the diverse societal needs of communities, resulting in the need for future training.” In its journal, the CFPC explains that “the proposed changes … will support this approach by helping family medicine learners work in primary care teams and by providing opportunities to train to the full scope of the discipline, including acute and procedural care, palliative care, and other areas.”
This, however, is an impractical expectation for most general practitioners. The CFPC statement begs the question: Why would community GPs need to obtain competencies for an emergency department or palliative care ward if they don’t plan on working there? Is it not a more reasonable position that competency gained during residency programs should correlate with future work goals?
Alternative options exist. The Queens-Lakeridge program has begun family physician training from Day 1 of medical school. A new medical school at Simon Fraser University in British Columbia is planning to follow suit with a dedicated family practice program. These medical trainees automatically will join family practice post-graduate programs upon completion of their medical school training, bypassing the CaRMS matching system.
The goal of these programs is to select medical school applicants whose primary interest is in family practice. An extended family practice residency can only hinder these efforts by further decreasing interest in the speciality and providing competencies family physicians will never use in future practices.
A three-year family practice program will almost certainly exacerbate the current primary care crisis. For Canadians, this will result in fewer family doctors practicing community care and less access to preventative care, cancer screenings and treatment of chronic diseases.
The comments section is closed.
Being a community-based family physician is the worst job in all of medicine. Adding a third year will do nothing to change this and lead to family medicine residencies being even less attractive to medical students than they already are. There is no value proposition to the family practice resident of having an extra year of training. It adds one more year of making less money and one more year of accumulating debt.
Having family practice only residencies and family practice only medical schools (not yet happening but it’s being talked about) is not going to change the fact that, from the get-go, they will be forced to work in a business model that will see them work harder for less money every single year. Nothing will change the fact that they will have to pay business expenses that increase at market forces while their only customer, the government, dictates if and what they will be paid for what they are ‘selling’.
Physicians are human beings…whether people like it or not. Like every other human being, they will look to better the situation for themselves and their families. Who would not leave their current job for one that pays the same for less hours, pays more for the same hours or more for less hours? There has to be a value proposition to starting a family practice business and to keep it going. There is currently little to no value proposition in doing this compared to other positions in medicine and it is getting worse every year. People can believe and think that ‘family physicians make enough money’ but it really doesn’t matter what people think because that isn’t going to change what is happening on the ground…medical students are avoiding family practice residencies, family practice residents are avoiding setting up community-based family practice businesses and those currently doing community-based family practice are looking to do something…anything…else in medicine. Far too few people are talking about the money and the work-life balance.