More training: Canadian family medicine residency to expand to three years

A new report from the College of Family Physicians of Canada (CFPC) reveals that family medicine residency training is in for some major changes. “Over the next five to ten years, family medicine residency training will be shifting to three years in length—an increase from two years—in order to accommodate a range of educational enhancements,” said Dr. Nancy Fowler, CFPC’s executive director of academic family medicine. The report outlines the CFPC’s evidence behind the expansion of training. The college reviewed current research, interviewed recent graduates and examined family medicine training in other countries. The main driver is the changing nature of family medicine. Family physicians are now managing patients who are more complex, often with multiple comorbidities—all during a global pandemic, social upheaval, an opioid epidemic, the emergence of new technologies, healthcare system changes and growing physician burnout, the report notes. “We’re in a time of dynamic change and we want to be sure that the training of family physicians keeps pace with that and that family docs are well-poised to help respond to those societal needs,” Dr. Fowler said. The CFPC found that many early-career physicians are not practicing their full scope of practice for various reasons, from practice location to lack of support from local healthcare resources. The CFPC aims to provide training to allow physicians to provide comprehensive care in any community, the report said. Read: New website designed by FPs aims to answer common COVID-19 questions for general public More training in key areas The report recommends new residency training expectations, referred to as the Residency Training Profile (RTP). The enhanced training will include more support and instruction on: Home and long-term care Palliative care Mental health and addiction care. Indigenous health Culturally safe and anti-racist care New technologies to improve access and continuity of care (i.e.,virtual care and health informatics) “The enhancements that we want to make are still fundamentally in support of making sure that family docs can provide broad-scope comprehensive care,” Dr. Fowler said. More than a quarter of family medicine physicians already undergo enhanced training, some of whom achieve a CFPC Certificate of Added Competence. One reason people take the extra year of training is not to sub-specialize in those areas, but still gain more skills, Dr. Fowler said. “We don’t think that residents should have to do additional training to be able to provide that core set of services that include things like emergency care and obstetrical care,” she said. “We think that every family doctor coming out of residency should be able to do that full scope of care.” For example, new graduates wanted more training in emergency and acute care. “In order to practice in settings where family docs run the hospitals and staff the emergency departments, many of our grads feel that they need a little more experience and the ability to consolidate skills in those areas,” Dr. Fowler said. Coupled with healthcare reform The CFPC stresses that the educational changes will need to be linked to healthcare reform in order to improve healthcare access in Canada. Dr. Fowler said this would ideally include changes in how family physicians’ practices are structured and supported to allow for more interdisciplinary team-based care. The goal is to see more family physicians training and practicing in healthcare spaces that support the CFPC’s concept of the Patient’s Medical Home. “There’s a lot of frustration out there that not more of these practices are available to our graduates and they’re not routinely experiencing it as part of their training,” Dr. Fowler said. The idea is that if family physicians are better able to provide comprehensive care—through enhanced training and the ability to practice as part of an interdisciplinary team—there will be less fragmented care, fewer referrals, and therefore access to physicians will improve, Dr. Fowler said. “In an effective healthcare system, 90% of healthcare needs should be able to met within family practice,” she said. Read: Fee-for-service fights on Implementation The CFPC will be setting up an education task force, which will develop the new curriculum. The taskforce will work with universities and governments to make sure funding and resources are in place to manage the change. No changes to requirements for certification will be made until at least 2027. The CFPC acknowledges that the change will have “potential ripple effects.” “It requires a careful change management approach and cross- sectoral collaboration, including the mobilization of resources to support this change, sufficient notice to early-stage medical students considering a career in family medicine, and planning to maintain a stable flow of graduates into the health care system” the report states. As the process continues, more questions will be answered, such as if more family medicine preceptors will be needed and how it will affect physician supply. How much third-year residents will be paid will depend on the provinces and territories. The report, called Preparing our Future Family Physicians: An educational prescription for strengthening health care in changing times, is available on the CPFC website. It contains 11 evidence summaries that provide additional details on the review and consultation process. Read: 6 solutions from Canadian doctors to the physician shortage

More training: Canadian family medicine residency to expand to three years

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