Two years is not enough

Continued growth

Fortunately, medicine is a living profession with a wealth of history, and it is perhaps in studying that history that we will resolve this debate. In 1910, most medical schools in Canada required their applicants to have only their high school diplomas. Today most students have university degrees and complete 4 years of undergraduate medical training and a minimum of 2 years of postgraduate training.

While there are definite advantages to a “better-educated” family doctor population, the possibility that Parkinson’s law will come into play is great.16 Simply stated, family medicine would need to work diligently to ensure that the same material covered in a 2-year curriculum was not allowed to balloon to cover a 3-year period. A mandatory third year would have to allow for more elective study in such areas as dermatology, sports medicine, and rheumatology. As part of that year, family medicine residents should be expected to assist with running family medicine wards and family medicine units as junior staff, supervising the more junior residents and medical students working with them. The extra training would allow residents to spend time learning traditional and nontraditional (eg, colonoscopy and colposcopy) procedural skills not well covered in today’s programs.

And what of the “unintended” consequences? Perhaps we would see a decrease in the number of consultations for investigations and procedures that should be routine, thereby decreasing the costs for governments. And what of that argument about the loss of productivity when such programs are implemented? It would only be for 1 year, and although this first class would not be out practising independently after 2 years of residency, they would still be caring for Canadians. As for patients, they might benefit from shorter times to diagnosis and faster access to other specialists. With a continued focus on the importance of a balanced professional life, we might just offset any possible decrease in medical student interest caused by adding a third year.

Lessons of the past

In some ways, today’s realities mirror those of the past, and to deny today’s family medicine graduates a longer training program is to deny them the lessons of that past. Departments of family medicine must strive to produce physicians who more closely resemble master clinicians. Two years is not enough time—as the body of medical literature continues to increase, postgraduate training will necessarily need to expand, maintaining that intensity of knowledge acquisition that simply cannot be replicated without too many years of independent practice. Longer periods of training for family physicians are inevitable; they are the natural prolongation of the hunger for elective courses, third-year programs, fellowships, and rigorous continuing education activities now coming into vogue.