Survey shows nearly half of FP trainees would pick a different specialty if training is extended

As a family medicine physician, I find recent Canadian research results quite concerning. Nearly half of family medicine trainees, would opt for a different specialty if our training were extended to three years. This revelation sheds light on the complex and divisive situation surrounding the decision to prolong family medicine training. The College of Family Physicians of Canada (CFPC) has announced plans to extend residency, but this is the first time that I know of that a survey has been conducted to gauge the opinions of those who are on the verge of entering practice. When I spoke to residents across the country about this impending change, I encountered confusion and surprise. Many asked, "Why and who decided this?" I am Dr. Paul Dhillon, one of the founders of The Review Course in Family Medicine and a co-lead in the survey study, which is set for publication later this year. Read: Inside the decision to extend FP training What’s most striking is the lack of consultation. Shockingly, over 80% of respondents revealed that they were never given the chance to be part of the crucial decision to extend residency. This lack of involvement was even more pronounced in an online survey conducted within the Canadian Women Family Physicians Group. Interestingly, respondents in their second year of family medicine training overwhelmingly expressed confidence, competence and readiness to practice as family physicians. Rural residents felt this even more strongly, with 75% supporting this statement. Despite this new data and an Outcomes of Training Program report suggesting a lack of strong evidence regarding the ideal length of family medicine residency, we are left with more questions than answers regarding why this significant decision was made. Many questions persist, including when the exams will be scheduled for second- and third-year family medicine residents and the impact on Added Certificates of Competence. A motion has been presented to the CFPC for voting at the AGM, suggesting a pause in the rush to extend the residency duration without backing Canadian evidence, intent or rationale. Read: Dr. Paul Dhillon: The 3-year FM resident: How the CFPC is failing their CanMEDS competencies The poll was collected nationwide from respondents in nine provinces, with a total of 180 participants. Particularly troubling are the results from the survey in light of the most recent CaRMS match results. Forty-two per cent of survey respondents indicated they would reconsider pursuing family medicine training if it were extended to three years. It’s becoming increasingly apparent that the issue of training program length is not a pathological one. We must ask ourselves whether the current training system is genuinely “broken” and if a third year is the solution. As new family physicians graduate into a clinical work environment filled with administrative burdens, a lack of national licensure, overhead costs, and a diminishing sense of clinical independence and leadership in primary care, we must revisit the a priori logical fallacy behind this. Indeed, what are we to make of the fact that Dr. Lawrence Loh, the current executive director of the CFPC, before he had the role, argued against a third year back in 2012 in an opinion item in the Canadian Family Physician journal? To me his past words resonate strongly, suggesting that lengthening training time may deter future family physicians and burden them with arbitrary experiences rather than focusing on competence-building. Dr. Loh’s arguments in 2012 make this look like an about face and it calls for more explanation but the CFPC has refused to release minutes of board meetings, agendas, and committee meetings that led to the third-year decision. I ask: what’s there to hide? Perhaps it is time for a strategic pause, a thorough reassessment, and renewed engagement with the members who contribute fees to the college. After all, a fee-collecting college should prioritize the input and concerns of its members in shaping its actions and decisions. Dr. Paul Dhillon is a rural GP in Sechelt, B.C.

Survey shows nearly half of FP trainees would pick a different specialty if training is extended

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