Risa Freeman is a family doctor and vice-chair of education and scholarship in the University of Toronto’s Department of Family and Community Medicine. Stuart Murdoch is a family doctor and postgraduate education program director in the Department of Family and Community Medicine.
Family medicine, the foundation of our health system, is in crisis. Six and a half million Canadians lack access to a family doctor, a situation that is set to worsen as existing physicians retire or leave comprehensive care.
To ensure that everyone has access to a family doctor who provides high-quality care, we need to attract more medical students into family medicine, prepare them to be highly competent, comprehensive and compassionate physicians, and support them to stay in comprehensive family practice.
But a change that will increase the time family doctors spend in training has some people, such as Nova Scotia Premier Tim Houston, worried that it will make the doctor shortage worse. And many, including health ministers Canada-wide, have reaffirmed their support for the status quo.
Currently, family medicine residents – those who have completed a medical degree and choose to specialize in family medicine – spend two years training to be family doctors. Earlier this year, the College of Family Physicians of Canada, which establishes the standards for postgraduate family medicine training in Canadian medical schools, set new national requirements. The new rules, which come into place in 2027, will make residencies in family medicine take three years to complete instead of two. The rationale is to better prepare doctors for the breadth and complexity of family medicine.
There are compelling arguments both for and against.
Adding an extra year of training could make family medicine less attractive for some medical school graduates. Our residents tell us that, after as much as a decade in postsecondary education, a shorter path to independent practice can be a deciding factor when considering residency options. The difference between a two-year and a three-year residency is not inconsequential. Being able to begin paying off debts, supporting family and shaping a career around other aspects of life is significant.
People choose to become family doctors because they are passionate about providing comprehensive care to patients, their families and their communities. Still, the length of training, finances, and job satisfaction are important considerations.
It is true Canada is one of the few countries with a two-year family medicine training program – perhaps the only one in the developed world. Family medicine is an incredibly broad and complex discipline that is only getting more challenging with the rise of chronic disease, substance use and addiction issues, and changing societal needs.
Every year at the University of Toronto, we graduate more than 160 skilled family doctors who tell us they feel ready for practice. While an extra year would help some feel better prepared and support professional well-being, many of our graduates go straight into comprehensive care with great success.
Some opt for additional training in areas such as addiction, emergency medicine, palliative care or LGBTQ health, and may not begin practicing comprehensive family medicine, in part to expand in an area of personal interest. But opportunities for new graduates within existing primary care teams are also limited, and the administrative and financial burden of setting up an individual practice can be insurmountable.
Could and should we be improving family medicine training to provide the best possible education that reflects the ever-changing reality of health in our society? Of course: whether over two or three years, that is a fundamental part of our work as educators. But changing how we train our residents will be inconsequential if we do not fix the system that we are asking them to work in.
We have to build and support interprofessional teams so there is equity and access to care, especially in underserved communities and rural settings. We have to ease the burden of administrative tasks that can take up to 25 per cent of a family doctor’s week, which is time that could be spent on patient care. We have to reform how family doctors are paid and remunerate them appropriately.
We all have the same goal: to save comprehensive family medicine and make sure that patients get the care they need, when they need it. But without broader health system change, no amount of education reform – no matter how extensive – can truly change the game.