Dalhousie prepares to add a year to family doctor training to meet new national policy

Dalhousie Medical School has started the massive job of lengthening its residency program for family physicians, and is trying to do so without interrupting delivery of new doctors to the province's strained medical system.

After earning a medical degree, new physicians must complete a residency, or clinical specialty training, before they can practice independently.

Earlier this year, the College of Family Physicians of Canada (CFPC) set new national requirements for residencies in family medicine. Starting in 2027, those residencies will take three years to complete instead of two.

While the CFPC sets the standard, it will be up to each residency program to update its curriculum to match. In Nova Scotia that falls to Dalhousie.

"It's a very big job.... We have our entire medical leadership involved in this plan and are beginning to work on expanding our curriculum," Dr. Katherine Stringer, Dalhousie Family Medicine's department head, said in a recent interview.

"We are also meeting with government and with Nova Scotia Health and just looking generally [at] expanding our residency training opportunities across the Maritimes and across the province to ensure that we have enough capacity in our clinics."

Stringer said collaborative care clinics are the ideal learning environment for residents, so she'd like to see more developed. But she anticipates that will be a challenge, as it could require building new infrastructure and hiring more staff.

Family doctor training is getting longer. Here's how Nova Scotia is preparing

1 year ago

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Dalhousie Medical School has started the massive job of lengthening its residency program for family physicians. It's trying to do so without interrupting the delivery of new doctors to the province’s strained medical system.

Additionally, Stringer said having residents for an extra year could create more work for the physicians who supervise them, in turn creating the need for more training and support.

So far, the province is expecting to pay an extra $6.8 million for the extra year, but that does not include costs associated with the university, which are still under review.

Nova Scotia opposes extended training

The change to family doctor training is proving controversial within the medical community and among policy makers.

Supporters say the additional training is needed to prepare doctors for increasingly complex patient needs — especially as the population ages — and to learn about advances in virtual care, artificial intelligence and collaboration with other health-care providers.

Opponents say the added training could hurt access to primary care at a time when access is already challenged. The concern is that another year of training might deter some medical students from entering family medicine, and as the first cohort goes through the program, there could be a year when fewer new doctors enter the workforce.

Nova Scotia Premier Tim Houston is among those opponents.

He wrote a letter to the CFPC this March, urging the regulatory body to reconsider.

This week, a spokesperson for the health department said the province still "strongly disagrees" with the change.

"Such a policy change would negatively impact access to care, particularly at a crucial time of health human resources shortages," wrote Khalehla Perrault.

"Any change that means no new physicians are entering any of our provincial health systems is completely unacceptable."

Stringer said Dalhousie is doing all it can to prevent any gaps in care.

Residents to spend more time in clinics

"We are planning for a curriculum that will involve at least six months of the residents spending time actively working in clinics and hopefully in specific resident-run clinics," said Stringer.

"Our residents are really frontline health-care workers as well as being learners," she added.

Dalhousie has yet to determine many details on its extended residency. 

Dr. Colin Audain, president of Doctors Nova Scotia, said for that reason, he's keeping an open mind on the topic, and thinks others should, too.

Many doctors, Audain said, already do an additional year of training after their residency to learn more skills or a specialty. 

"[If] components of that additional year, that many residents are already doing, is incorporated into this curriculum, then it may not be that much different and it may not change things as much as we think," said Audain.