Family doctors vote overwhelmingly against 3rd year of training

Family doctors across Canada have overwhelmingly sent a message to put a pause on adding an extra year to their residency training, but so far, the College of Family Physicians of Canada (CFPC) will only commit to reviewing that non-binding "guidance" at its board meeting next week.

More than 91 per cent of the 2,775 physicians registered to vote at the CFPC's annual membership meeting Wednesday approved a motion to "immediately cease the implementation of the third year in family practice program," establish an independent review committee to present recommendations, then decide what to do, based on evidence.

Dr. Paul Dhillon, a family physician from Sechelt, B.C., who wrote and spoke for the motion, shared the results with CBC News.

"I still haven't found a single other organization that's supportive of the college's decision to do a third year. I think this was a resounding victory, a resounding statement to say, 'Stop.' Now, whether they listen, that becomes the next really big question," said Dhillon.

"I think it's just a very clear disconnect between the college and its membership."

Newly elected CFPC president Dr. Michael Green notes that only seven per cent of the college's total 37,000 members voted to pause the plan and that the motion isn't binding — but says he has heard the message.

"We need more dialogue and consultation on making sure there are not unintended consequences of any change to our training standards," Green said in an interview from San Francisco on Thursday.

"But we also have to recognize that we have an organization that has a responsibility for standards that can sometimes be unpopular because nobody wants to be told they have to write an exam or do an extra class or do whatever it is."

Becoming a family doctor in Canada is currently a 10-year process: Four years of undergraduate education, four years of medical school, and then two years of family medicine specialty training. Family doctors already have an option of adding a third year to focus training on a specific area of practice, and all physicians do continuing education throughout their careers.

However, the college says a mandated third year starting in 2027 would prepare physicians to deal with more complex patients, including elder care, mental health and addictions and Indigenous health. An updated and "modernized" education will also help them work in multi-disciplinary teams with new technologies. 

In a message on X (formerly Twitter) Wednesday, the college said status quo is not an option and one of the solutions to the doctor shortage is education reform.

The college also posted a document "debunking myths" about the extra year of training.

"I personally am convinced that it's not going to be possible forever to continue with a two-year program with no changes to the length of training to get all the skills that people need," Green said. "What we've heard from our academic programs is that in order to do that, they believe they need more time."

The college will respond to the motion after its board meeting in Montreal next week. It's not ruling out a "pause" to reflect on the process, timelines, and to do more research and provide more opportunities for concerns to be heard.

"Let's sit down and talk them through. Let's get all of the issues on the table, because I think we all want in the end what's right for Canadians, which is a strong primary health-care system, as our foundation with experienced and well-trained family doctors who have the skills that they need to lead those primary care teams that are providing care to Canadians into the future," Green said. 

"It's not about saying our doctors today are not good. It's about planning for the future and really for the long term."

Doctors, students want more evidence

Physicians, medical students and residents have said the college needs to provide evidence that a third year of training will provide better outcomes to patients and make their practices more sustainable.

At a time when one in five Canadians don't have a family physician, there is concern an extra year of training would make the shortage even worse.

For weeks before Wednesday's vote, groups such as the Ontario Medical Association, Resident Doctors of Canada and Doctors Manitoba asked the college to put the plan on hold and work with them to explore options.

"Family medicine is in crisis in Ontario and other parts of the country. Now is not the time to focus on implementing a third year of training, but rather the time to work with you on solutions to fix the family medicine crisis with implementation of the patient's medical home of team-based care," OMA CEO John Bozzo wrote in a letter to CFPC's then-president Dr. Christie Newton.

OMA president Dr. Andrew Park doubled down on that message following the vote, which he described as "a very strong signal."

"The OMA is calling for a pause in the implementation of a third year to family practice residency. Currently, there are over two million Ontarians without a family doctor, and that's projected to rise to over four million, or one in four Ontarians. And that's extremely concerning," he said.

"Extending a residency, even though there's a phased approach, does limit the number of incoming residents into practice."

WATCH | Will an extra year help? 

Plan to add extra year to family doctor training gets push back

1 year ago

Duration 2:03

There is growing opposition to a plan that would add one year of residency to family doctor training in Canada. Critics say it's not worth the time — particularly when family doctors are in such short supply.

Provincial health ministers also "put it in the statement unanimously that residency requirements should stay at two years," B.C. Health Minister Adrian Dix told reporters after a meeting in Charlottetown.

The college's acting CEO Dr. Nancy Fowler sent an email to medical schools describing that as "an unfortunate development."

"We are already working to reset the understanding of governments, including the evidence, potential approaches and the pace of change ... to bring a full perspective of curriculum renewal and propose a collaborative pathway for moving forward," she wrote.

Family physicians aren't opposed to tweaking the existing two-year training, Dhillon said. For example, he would like to see all physicians trained on how to use an ultrasound.

"It improves care and emergency rooms and clinics and it is the future, but it should be here now," Dhillon said.

"So, why didn't the college spend the last year and the millions they're spending on this project to make sure there's an ultrasound in the hands of every graduating family physician?" 

Family physicians also rejected a motion by the college to increase member fees by seven per cent and round it up to the nearest $5 increment as of July 1, 2024.