There's growing opposition to making family doctor training longer
There's growing opposition to making family doctor training longer
The College of Family Physicians of Canada is being asked to "pause, hold and maybe stop" its plans to increase the time it takes to train a family doctor from two years to three — as some medical students, family doctors and provincial health ministers express their opposition.
"Our class, the class of 2027, is going to be the first that's impacted by this change in residency length," said Yash Verma, a first-year medical student at the University of Toronto.
"It feels like that's something that's out of our control and that we have no power to change at all."
Verma said he first heard about the plan from CBC News in September. Alarmed, he asked his classmates for their thoughts.
He says he heard a recurring theme: "If this third year were to happen, they would not become family doctors."
It’s probably not the best approach. We are struggggggling to get primary care providers, at least in the US, and I suspect in Canada as well.
Family medicine is not the same as say a neurosurgery residency. It’s a lot of understanding vaccination schedules and identifying and treating things like high blood pressure or high blood sugar before they become chronic issues.
But there’s limits to what a pcp is going to manage and the complex issues are going to get punted to specialists. The problem is we don’t have enough pcps to go around and so you have this huge barrier to care because people don’t have doctors they can go see to then get referred to specialists with 3 4 and 5 year residencies that allow them to handle the complex stuff.
Honestly for the doctor that’s gone through 4 years of medical school, while it would be great if we extended their training and made them even better educated, we also need to balance that with removing barriers that might prevent docs from choosing family medicine as their speciality.
I’d rather someone have access to a doctor with 2 years of training than having access to no doctor because they can’t convince the new grad MDs to take an extended family medicine residency because it pays a fraction of what an orthopedic surgery specialty will pay.
I believe one of the reasons for the extension is because there's a trend of residents not feeling fully prepared when entering practice after just two years. Family medicine is very complex. While specialists can be experts in their scope, family physicians need to know a bit of everything from every scope.
I do agree that pay needs to increase, as access to primary care is the best preventative measure in patients needing the more expensive services less, and family doctors have considerable overhead costs compared to specialists. However, the more lucrative specialties often don't have jobs waiting at the end of them. Sure, you can take an ortho residency with dreams of the high life, but good luck actually finding a job afterwards.
Simply adding a third year of residency would probably deter a few prospective doctors, but if primary care is given the resources respective of its preventative role, it would likely become a more popular discipline. This requires changes throughout the system, though. Yes, provinces have to pay more for services, but localities need to provide the supports to enable an increase of medical students and residents, including housing, and the hiring of doctors and staff to facilitate the learning. I've never once heard a family doctor say they'd like to work more hours in a week, yet some communities turn away physicians because they're "full". Recruiters need to first exist in the first place (thanks, SaskParty), but also understand the needs of their community so adequate service is available.
Canada is way, way short on primary care providers, especially in rural and remote areas, yes. Nurse-practitioners can only fill in so many of the gaps left by the insufficient number of family physicians, and they also take time to train. We have emergency departments closing because of lack of personnel, and it's literally killing people to have to drive forty or more minutes to the nearest hospital that's open when they have a heart attack.
Forcing new physicians to practice for a year somewhere other than a major city would be much more useful than sending them back to school for an extra year.
This is the best summary I could come up with:
It wants the college to consider "the potential difficulties that a 36-month training program may pose for students, especially in the context of the current nationwide primary care crisis," according to a statement.
At a time when one in five Canadians don't have a family doctor, provincial health ministers are also opposed to mandatory longer training.
Health Minister Adrian Dix told reporters that he and his provincial counterparts "put it in the statement unanimously that residency requirements should stay at two years."
The college said it has consulted established family doctors, medical schools, students and residents, and studied programs in other countries.
One calls on the college to "immediately cease the implementation of the third year in family practice program," establish an independent review committee to present recommendations, then decide what to do, based on evidence.
"I feel like we should have a say in this as well, and it's really surprising to me that we don't get to have that vote at all, especially residents and first year medical students," Verma told him in a recent Zoom call.
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This can be fixed very easily: every new med school student gets to pick one current random doctor who is forced to retire. If the med student does not finish med school, then the retired doctor can enter med school.
This sounds fair to me. It puts decisions out of the hands of those affected by said decisions, to their detriment. Fits the spirit of the extension well.