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.”

“One medical student was stating how because of this extra third year, he didn’t think that there was enough of a gap to justify going into family medicine versus another residency program, such as internal medicine, which is five years,” Verma said.

“What we want most is to make sure that our patients are healthy. And what concerns me about this extra year is that it may exacerbate the already present family doctor shortage.”

The College of Family Physicians of Canada (CFPC) told CBC News about the proposed change last month. Its acting CEO says it’s designed to prepare doctors for more complex cases.

But the Canadian Federation of Medical Students says it has not been consulted and does not support a longer training program.

Provincial health ministers oppose an extra year

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.

Will an extra year of training exacerbate Canada’s family doctor shortage?

The first three-year family medicine residency is slated to launch in 2027. Some are already sounding the alarm that an extra year of training could worsen Canada’s doctor shortages.

At a time when one in five Canadians don’t have a family doctor, provincial health ministers are also opposed to mandatory longer training. They would have to fund the extra year.

Becoming a family doctor in Canada is currently a 10-year process. A two-year family medicine residency currently comes after eight years of education: Four years of undergraduate schooling and four years of medical school.

In a Zoom call during their recent meeting in Charlottetown, B.C. 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.”

“So this is not the direction we’re going with respect to health, human resources,” he said.

The college said it has consulted established family doctors, medical schools, students and residents, and studied programs in other countries. It concluded two years is not enough time to learn the core skills, along with subjects such as elder care, new technologies and virtual care, mental health and addictions, and the health effects of racism and colonialism, said Dr. Nancy Fowler, the college’s acting CEO.

“Our current training in family medicine is very compressed,” she said.

Fowler, a family physician from Hamilton, Ont., doesn’t think the extra year will exacerbate family doctor shortages. Rather, she says it will prepare them to work in multidisciplinary teams.

“Our first goal is to broaden the base of training and the kinds of exposures that family docs get that will truly equip them.”

‘Stop this madness’

That argument doesn’t fly with Dr. Paul Dhillon, who has a family medicine practice in Sechelt, B.C.

“I think about my personal experience,” he said. “At the end of the day, I’ve never had someone say, ‘My doctor hasn’t had enough education or haven’t hasn’t spent enough time in school before they can start treating me.'”

Dhillon has been following the debate and has submitted motions to be discussed and voted on at the College’s annual general meeting on Nov. 1.

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.

The college is recommending members vote against the motion.

“My honest, sincere hope is that they’ll listen to the membership, listen to family doctors, both in the present and those that are coming through in the future, and just pause, hold and maybe stop this madness,” Dhillon said.

He recently spoke with Verma, a conversation he describes as “heartbreaking and devastating.”

Dhillon promised to share medical students’ concerns at the AGM.

“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.

“I have four minutes. That’s what I have to speak on. But I can definitely say that,” Dhillon replied.

The vote isn’t binding but critics hope it will raise awareness and more discussion from all of the groups it will affect.