Posted: Oct 4, 2023

Should family physicians receive an additional year of medical training?

The College of Family Physicians of Canada recently announced plans to extend post-graduate medical education by a year, with the first three-year program expected to begin in 2027.

But will this change help a primary care system in crisis? Two experts weigh in.

by Doreen Rabi

The College of Family Physicians of Canada's expansion of training will demoralize and financially penalize early career physicians. Education will not address systemic and structural barriers to comprehensive practice.

by Douglas Courtemanche

Adding another year to the family practice residency may be controversial, but it is a good idea. All students, residents, clinicians, the system and, most importantly, patients would benefit from a more complete education of all doctors.

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  • Albert J. Kirshen, MD, FRCPC (retired) says:

    The fatal assumption, underlying this debate, remains the question of “WHAT should persons with an MD after their name actually do”? And what training requirements enable those trained to undertake those roles? Must all well baby care be done by pediatricians and family physicians? Do all immunizations require physician presence, rather than, say Emergency Medical Services? How do we enable PERSONAL RESPONSIBILITY of patients for their own control of hypertension, diabetes, etc?

    Having made a decision about this question, does everything presently done by a B.Sc. nurse require that level of training? Same question regarding Pharmacist, Social Workers, and others.

    The Canada Health Act specifies 5 pillars. Among them is “public administration” NOT public provision. As presently constituted, with the emphasis on hospital-based remuneration arising from the HIDS act of 1957, we appear to have morphed into public provision, and repeatedly argue against any other option. Others have not been as rigid as we in Canada. Does our present crisis warrant reviewing the outcome of the Act’s revision in 1980?

    I disagree with CFPC implementing this change, as the other questions, above, preclude making such a dramatic change as suggested by both authors, as it may require a different approach.

    In short, what should our system be still doing in 2024 and beyond? What resources are required to achieve those goals? And how often should this question be repeated, to ensure we are proceeding in the direction we wish?

  • Mike Franklyn says:

    Add NOSM U our family medicine R2’s are definitely practice-ready. Adding an additional year will do nothing to make them better physicians, but will deprive the public the access they would enjoy if these new physicians went directly into practice. The learning curve, the first you’re out on your own in family practice is virtually vertical and, in my opinion, cannot be simulated by adding an additional year onto their postgraduate training.

    • Rosemary Pawliuk says:

      Dear Mike: Agree. Except it is not a matter of depriving the public the access they would “enjoy”. It is a matter of having the access they need. Six million Canadians are without family doctors. More than 4000 Canadians were documented (CMA/Deloitte) to have died for the sole purpose of delay to access to care in 2021 and things aren’t getting any better. Some physicians have described that number as the tip of the iceberg as data collection does not readily provide for “delay of access to healthcare” as cause of death or address the situation where we don’t know because the patient wasn’t given the chance. Then there is the matter of prolonged suffering, increased financial stress secondary to inability to work…. and the story goes on. I cannot think of a worse time to lengthen how long it takes to license a family physician.

  • Diane McKenzie says:

    If you send docs to more school, you need to create a payment system that works better for them… but
    Maybe the family doc program should be a 4 year undergraduate degree… remove the fluff from the program.