“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.