As Canada moves toward 3-year training for family doctors, some worry about worsening shortages

The College of Family Physicians of Canada (CFPC) wants to increase the length of family medicine residency from two years to three as a way of preparing doctors for more complex patients. But the plan is raising concerns it will increase the shortage of family doctors at a time when six million Canadians don't have access to one.

Residency is the clinical specialty training that new physicians must do after they obtain their medical degrees; they can't practice without completing it.

The first three-year program is expected to roll out in 2027, said Dr. Nancy Fowler, a family physician from Hamilton and executive director for the CFPC's Division of Academic Family Medicine, the national body that establishes standards and accredits postgraduate family medicine training for all of Canada's 17 medical schools.

"Family doctors, in particular, as the front line of health care … are really facing a changing picture in terms of an aging population, social complexity, unprecedented levels of concern about addiction and mental health," Fowler said.

"[They] also find themselves under-supported when it comes to running their practices and the administrative supports required."

According to Fowler, the college did consultations with established family doctors, medical schools, students and residents, as well as looked at programs in other countries, to conclude two years is not enough time to learn the core skills, plus subjects such as elder care, new technologies and virtual care, mental health and addictions, and the health effects of racism and colonialism.

The first goal is to broaden the base of training and exposure so family doctors will be equipped to work anywhere in Canada — from cities to northern and rural areas, she said.

There is also a need for new and strengthened skills in specific areas of health care, learning about virtual care and artificial intelligence, and working with other health-care providers in teams, she said. Many family doctors also need to learn how to set up a practice.

"It's really not in any way an indictment of current training; it's just more we need to keep up with the times and we need to make sure that our training kind of evolves," Fowler explained.

At two years, Canada's family medicine residency is one of the shortest in the world, although new physicians have already completed a qualifying undergraduate degree and their medical degree — about a decade in school.

Most European countries select doctor trainees out of high school; medical school then lasts six or seven years, before the new physician completes a residency. 

Australia, New Zealand and Ireland offer five-year family medicine training after an MD.

Meanwhile, educators in the United States are looking at moving from three- to four-year residency programs for family physicians.

Pilot projects south of the border have found a longer training program attracts students who say that extra training gives them the confidence to practice full-scope family medicine, Fowler said. Some U.S. surveys show one-third of medical students and nearly half of family medical residents expressed interest in a fourth year.