Practice patterns of graduates of a CCFP(EM) residency program

DISCUSSION

This survey reports the practice patterns of graduates from one CCFP(EM) program. At survey completion 76.7% of graduates continued to practise EM, and most of these graduates practised in urban and suburban centres. This is the first published census reporting CCFP(EM) graduates’ job satisfaction, reasons for discontinuing EM practice, and nonclinical activities.

In Canada, EDs are staffed by family physicians, family physicians with special certification in EM (CCFP[EM]), physicians who have completed EM residency programs, and physicians with American Board Certification in EM. In recent years, EM physician training has incited considerable debate among stakeholders, and there are frequent appeals for reevaluation of the current training system in Canada.^7–9 While these discussions are ongoing, graduates of CCFP(EM) programs are seeing higher proportions of total ED visits and are increasingly an integral part of the provision of emergency care in Canada.⁵

At survey completion, most of the respondents were practising EM, and less than half of graduates were practising EM full time. Given that most of the program’s graduates continue to practise EM, these graduates fill much-needed roles in Canadian EDs. As indicated by Bhimani et al, in 25 southwestern Ontario EDs surveyed, only 30% of the physicians had formal EM training.¹⁰ Furthermore, highlighted by the 2001 Institute for Clinical Evaluative Sciences Atlas Report, as the total number of physicians practising EM in Ontario declines, physicians who work full time in EDs are needed to provide timely and efficient emergency care.⁵

Similar to previous studies, most of the CCFP(EM) respondents practise EM in urban and suburban hospitals.^3,4 Additionally, 39.4% of the practising EM graduates describe their hospitals as urban, academic tertiary care centres. Notably, however, 43.0% of the respondents had practised EM in underserviced areas at some point in their careers. It is unclear from this survey the length of time the respondents worked in underserviced areas or why these respondents did not continue in under-serviced regions. These questions warrant further study.

This study’s findings highlight that the current challenge for EM does not appear to be the number of physicians practising EM but rather their disproportionate geographic distribution. Furthermore, EM physicians’ geographic distribution compared with the distributions of other specialties is currently unknown. Previous studies evaluating factors influencing physicians to enter rural practice report trainees who have rural upbringing or exposure to rural postgraduate training are more likely to choose rural practice locations.^11,12 These influential factors should be considered when reevaluating the current EM training systems in Canada.

In this cohort, reasons cited for stopping EM practice are varied. It might be, therefore, CCFP(EM) graduates’ reasons for choosing a practice type are equally diverse. The numerous unique responses cited as reasons for stopping EM highlight the complexity of the decision making when determining an individual physician’s practice type. As reported in the UWO survey, practice type is independent of a physician’s demographic variables.⁴ Therefore, many considerations likely determine the career paths of CCFP(EM) graduates, and this complexity should be recognized in work force planning.