It's time to suspend the move to third-year family practice training

In March 2022, I wrote an article about why adding a third year to the Canadian Family Medicine residency in Canada is absolutely foolhardy given that family medicine is increasingly being done by groups who have not completed formal medical training; they have nursing training plus a master's, such as nurse practitioners (NPs). If we accept that safe medical care can come from these avenues, then on what basis can we say that the current four years of medical school and two years of residency route to practice family medicine is inadequate; this represents in excess of 10,000 hours of dedicated medical study of diagnosis and treatment. I have tried several times to ask this question of the College of Family Physicians of Canada (CFPC), and a letter of mine was even published in their journal, however I have not received a direct respone. If family doctors need more training, then the corollary would be that NPs and other mid- level providers should not be able to open independent primary care practices. Read: How to stop the CFPC’s plan to increase residency to three years Since writing that article in 2022, I have also learned that evidence the CFPC used to underpin their decision to extend residency was based on a qualitative study by Aggarwal and Abdelhalim that included 75 physicians who were new to practice (less than 5 years), during a global pandemic. Yes, you read that right. Canada has almost 47,000 family doctors, and instead of polling even 10% of those dues-paying members before making a far-reaching and consequential change to how family doctors are trained, the CFPC decided that the responses of 75 study participants was reason enough to proceed. They've since doubled down on this misguided logic. This is troubling for many reasons, not the least being that as physician scientists we should know that a small qualitative study is not a bedrock upon which to draw any conclusion. Secondly, the fact that the doctors surveyed felt unprepared to practise as new grads in a pandemic—and thus ill equipped to provide safe virtual care—is not a failure. It is a perfectly reasonable response to an unprecedented situation. Approximately no one felt equipped during the pandemic. It does not mean doctors' training was deficient; I'm sure that recent grads from five-year residencies were also feeling the same uncertainty. How can our CFPC leaders use this as a reason to ram through this unpopular policy? Read: 10 questions about the three-year family medicine program Since March 2022, I have also learned that two esteemed colleagues have undertaken the work that CFPC should've done to accurately gauge how prepared family medicine residents feel, with a survey of 180 current R1 and R2 residents (at the time of their study) across Canada. Their study publication is forthcoming, and will be searchable with the following citation "Dhillon. P, Moore, S. (2023). The Uncalled for 3rd Year in Family Medicine.” They kindly shared their preliminary results with me for this article, which showed that 67% of respondents felt prepared to practise family medicine today. Given that a portion of the respondents are R1s, this result says to me that R2s are largely feeling ready. More concerning, 42% of respondents said that if family medicine was a year longer, they would've reconsidered pursuing family medicine training. So now we have data, with more than double the sample size of the Aggarwal study, which suggests that the current length of training is adequate, and that extending it by one year will affect our supply of family doctors. The CFPC should be watching this closely, and using this data to inform their next steps. In addition to the reasons above, and those offered in previous articles by other stakeholders to this issue, my other concern about a longer residency for family medicine trainees is the effect this will have on specialists. If there are fewer family doctors, that means more orphaned patients who are unable to refill their meds, which will push specialists to try to do some primary care and titrate medications possibly from outside their speciality. This scenario would spell even longer wait times to see specialists. Overall, my message here is to implore the CFPC to listen to the members' fairly universal dissent to this move, and direct the needed resources and time to study this critical topic before making any changes. The CFPC recognizes that Canadians with family doctors have better health outcomes. Canadian family doctors are already offering high-quality, life-saving care and offloading the emergency system with the current residency length. On November 1, 2023, from 19:00-20:30 pm, the CFPC is holding the annual meeting of members, a virtual event where motions can be submitted and voted upon. A motion will be put forward to suspend the move to third-year family practice training. I will be in attendance to vote in favour of this motion and I encourage all interested readers to attend as well. Dr. Teela Johnson is a hospitalist at Unity Health in Toronto, and she holds a faculty appointment at the University of Toronto in the Department of family medicine. Her views here are her own.

It's time to suspend the move to third-year family practice training

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