Doctors across Canada will have a chance to weigh in Wednesday on lengthening family medicine training by a year, an idea that has drawn condemnation from medical students, rural doctors and health ministers who fear it will worsen a national shortage of primary care.
The College of Family Physicians of Canada, the organization that sets standards for postgraduate family medicine training, unveiled a plan last year to increase the residency period for family doctors to three years from two.
Residency is the mandatory hands-on training program for doctors after they graduate from medical school but before they earn a licence to practise independently.
At first, the CFPC proposal didn’t garner much attention outside the narrow world of medical-school accreditation. But as word of it spread, opposition began to grow, prompting Paul Dhillon, a British Columbia doctor, to put a motion calling for the plan to be paused on the agenda of the college’s annual meeting of members.
“The palpable anger and the fact that people are so upset about this speaks volumes,” said Dr. Dhillon, who practises in Sechelt, about 50 kilometres northwest of Vancouver. “I’ve had family physicians literally across the country pick up the phone to call me and say thank you for doing this.”
Dr. Dhillon’s motion isn’t binding on the CFPC’s board, so the plan could go ahead regardless of the support he receives, according to Mike Green, president-elect of the CFPC and head of the department of family medicine at Queen’s University.
The longer residency program, which would be gradually introduced beginning no earlier than 2027, is supposed to prepare residents better for the increasingly complex landscape of family medicine, Dr. Green explained.
He said the CFPC is regularly asked to add new material to the residency curriculum, such as training on new technologies including portable ultrasounds; enhanced training in long-term care, home care, virtual care and health equity; and training to treat a rising tide of patients with mental illness.
“The required skills and competencies are changing,” Dr. Green said. “We have to make changes. It’s pretty clear to me that at some point, that’s also going to mean changing length. As a standard-setting organization, we can’t ignore that.”
Canada’s two-year residency for family doctors is among the shortest in the world. Family doctors train for three years in the United States, Britain, New Zealand and Australia. Australia has a rural family medicine designation that requires four years of training. Ireland’s core family medicine residency runs four years.
Canada’s family doctors have a wider scope of practice than their counterparts in many other countries. On top of office-based comprehensive primary care, they have to be capable of providing emergency care, hospital care, home and long-term care, and maternal and newborn care, particularly in rural and remote places.
Most specialist physicians in Canada are required to complete a residency that lasts four or five years.
Critics of the CFPC’s plan fear that a longer residency will turn graduates off family practice, exacerbating the country’s primary-care crisis. Statistics Canada’s most recent survey, from 2021, found that about 4.7 million Canadians did not have regular access to a health care provider, while a more recent survey of 9,000 Canadians, conducted for a project called Our Care, put that figure at 6.5 million.
At a meeting in Prince Edward Island in October, Canada’s federal, provincial and territorial health ministers – whose governments fund medical schools and residency programs – took a unanimous stand against lengthening family medicine residency in their final communique.
Dr. Green, who will become president of the CFPC at the end of the meeting Wednesday night, said the college is greeting the health ministers’ statement as “an invitation to dialogue with them on what their issues are.”
Ontario Health Minister Sylvia Jones said in an interview that she is fine with that, “as long as the dialogue starts and ends with ‘We will not be proceeding with a three-year family residency.’”
Ms. Jones sent a letter to the CFPC last week reiterating her government’s opposition. That was followed by open letters from the Ontario Medical Association, which represents doctors in Canada’s most populous province, on Oct. 27, the Canadian Federation of Medical Students on Monday, and Resident Doctors of Canada on Tuesday. All urged the CFPC to suspend the plan, as did the Society of Rural Physicians of Canada in an earlier statement.
The society’s president, Sarah Lespérance, said that family doctors who train in rural Canada gain the skills to meet their broad scope of practice, despite the CFPC saying some have expressed concerns they’re not ready after just two years. “They’re training with people who do the work that they’re going to be doing,” she said. “They actually do feel well prepared.”
Dr. Green of the CFPC believes there are deeper reasons that fewer Canadian medical-school graduates are making family medicine their first choice of discipline now than in the recent past.
He and several other doctors interviewed for this story said primary care in Canada needs an overhaul, with more team-based care, less administrative burden, better pay and more prestige, if it hopes to attract the medical students of tomorrow. “Career choice is more complex than a one-year difference in length of training,” Dr. Green said.